Non-Speaking Autism | How to Improve Communication Skills in Children with ASD
It can be stressful not knowing what to do to help your child learn to speak and communicate more effectively with others. If you are a parent who has a child with autism who isn’t able to use words to express their thoughts, feelings, needs, and wants, you might be looking for strategies to help improve your child’s communication skills. We’ll explore some strategies that are likely to help.
Nonvocal or Nonverbal?
First, let’s clarify the difference between some terminology. What does “nonvocal” mean? What does “nonverbal” mean?
Many children with autism are described as being “nonverbal”; however, that is often not the case. If a child with autism does not use many words or if they don’t speak to communicate, they can be described as “nonvocal” but this does not mean they are “nonverbal”.
“Nonvocal” could also be described as “nonspeaking”. People communicate with nonverbal behavior in a variety of ways, including gestures, body language, and visuals.
Those who are nonvocal can communicate using sign language or the Picture Exchange Communication System (PECS) and still be considered verbal, even if they communicate without using spoken language.
How Parents Can Help Their Nonvocal Child
There are many strategies that parents can use to support their nonvocal children with autism in learning how to communicate. Consultation with a behavior analyst, speech therapist, and/or occupational therapist is recommended for the best results. This article will discuss options for communication for nonvocal children with autism, evidence-based interventions that can be used to address expressive language skills, and parent friendly strategies to use to encourage communication.
Using a Technology-Based Communication Device
For children who are not yet speaking, using a communication device such as an iPad or Speech Generating Device (SGD) can provide a voice output device for them to use with spoken language. Apps can be put on the iPad like TouchChat and Proloqou2go.
Communication devices, especially apps on a phone or tablet, are not as obvious because most people carry these devices in public. Touchscreens can be easier for children to navigate, and the apps can have language added or removed from them quite easily. Speech or behavior therapists can evaluate children for a communication device and determine what is best for their skill set and needs.
There is not a one-size-fits-all solution, so it is important to try different communication methods for an appropriate length of time to see if each app or device is a good fit for the child. It’s also highly recommended to consult with a professional who is experienced with helping in this area to develop an effective communication system for your child.
An important note for communication devices is that children may not understand their purpose, how to navigate them, or what to do with them without proper education and training on them. Parents, school staff, and other therapists should incorporate and teach using the communication device throughout all aspects of the child’s day to promote generalization.
Using a Non-Technology-Based Communication System
Communication methods that do not involve technology include the Picture Exchange Communication System (PECS) and sign language.
PECS involves using verbal behavior and applied behavior analysis to teach communication. Reinforcement and specific prompting methods are used to teach functional communication.
There are six phases of the PECS protocol:
- How to communicate
- Distance and persistence
- Picture discrimination
- Sentence structure
- Attributes and language expansion
- Responsive requesting
First, the individual learns to request by exchanging a picture with a communication partner for an item or action. Then, the individual goes on to learn how to discriminate between pictures, how to put the pictures into sentences, and then how to use modifiers, answer questions, and comment.
The Picture Exchange Communication System has been used with learners of all ages with various challenges. A speech therapist or behavior analyst could assist you in getting the picture exchange communication system set up for your child.
A GoTalk device is similar to PECS and could be used as well. Like a communication device, PECS is a visual system that can be easily understood by those around the child. The child will have to learn and be taught to exchange PECS icons with people in the community with faded adult support. PECS can work well for children with autism because they respond well to visual stimuli.
Another non-technological method of teaching communication is sign language. Many parents teach their toddlers sign language as early as six months of age. Using sign language in toddlers for communication is a great example of functional communication because toddlers are taught to communicate via sign rather than cry or tantrum to get their needs met. This also keeps parents from guessing a toddler’s needs when the toddler instead can express their wants and needs through sign language.
Two cons for sign language are that the learner needs to have the fine motor skills to do so and that the communication partner needs to understand sign language for the communication to be effective. Even with those cons, starting off a nonvocal toddler with sign language can begin to increase their communication and language skills to then transition them to a more easily understood communication method like PECS or a communication device if needed.
Supporting Communication Skills in Your Child’s Everyday Life
In addition to the communication modalities that we’ve discussed, there are some easy-to-implement strategies that parents can keep in mind to encourage communication in their children during play and their natural environment.
A great first start for working on communication is through play. Parents can make an effort to play interactively with their child in an activity they know the child enjoys or by giving the child the choice of what activity to do.
Paying attention to the child’s body language, facial expressions, eye gaze, and vocalizations can help you know when the child is or isn’t interested, wants an item, wants your attention, etc. If a child is looking at you, at the activity or item they are engaging in, smiling, or babbling the child is most likely interested in the activity. If a child is looking away, turning their body away from the item or activity, trying to leave the area, avoiding eye contact, or pointing or reaching for other items, the child is probably losing interest or has already lost interest in the activity at hand.
- When a child shows interest, this is a good time to share enjoyment in the activity, describe the item or activity, play interactively, and engage in other joint play activities.
- When a child shows disinterest, this is a great time for a parent to model language to ask to be all done, request something else, ask for a break, among other things.
The child’s nonverbal communication can lead the play interaction while the parent supports the child to play and learn communication in a natural way.
Pretend play is a fun activity in which to teach children language skills.
Singing can also encourage social interaction. Being at the child’s level, facing the child, and speaking or singing clearly can increase the child’s attention and engagement.
Support Communication with Imitation Skills
Another way parents can help their nonvocal children to communicate is by teaching their child imitation skills through modeling. Many children with autism do not pay attention to the behaviors of those around them and do not imitate peers or adults in the way that typically developing children do.
Teaching Pointing Skills
Especially with early learners, teaching a child how to point can help increase their ability to communicate their wants and needs. Parents should find a highly preferred item and then model pointing at it. Help your child point by using your hands to shape the child’s hands into a point if needed. Once the child is pointing at the item, give it to them! This is especially useful if the item is edible so that once they have finished eating it, they will hopefully want to point at it again to get more!
Continue to help the child point at the item and give less and less help as they start to point their finger on their own. Try to physically help them point or show them how to point with your hands rather than tell them “point.” We want them to learn how to point by imitating someone’s body rather than following someone’s direction to point when learning to request.
Imitation Skills Support Communication Skills
Modeling and imitation can also help a child learn sign language. Using physical prompting and modeling of the signs (after you learn them of course) can help children learn how to say yes, no, ask for preferred items, etc.
Can Your Child Answer Yes/No Questions?
Having a child know how to answer simple yes or no questions and request their favorite things can make communication so much easier for them.
Especially in the beginning learning stages, make sure to reinforce their sign language attempts or imitation attempts. This means that when they sign or gesture, give them what they are asking for. This will help encourage the behavior to occur more often in the future. If they were to try to sign or gesture without any reward, they may be less likely to attempt to communicate that way in the future.
Receptive Language Skills
Teaching children receptive language skills, such as following simple directions, identifying objects, and identifying objects in pictures can help to increase a child’s communication and language skills. Especially for children to learn to use PECS or a communication device, it is helpful to teach children to match pictures to objects and objects to pictures so that they understand that their PECS pictures mean the same thing as the object they are requesting. These receptive language skills can be transferred to expressive language skills once a child has a communication method that works best for them to be able to label objects and pictures as well as answer questions in the future.
Have Pictures Around Your Home
Another way that parents can help their children communicate is by having pictures around the house. For example, having a board on the fridge or cabinet with snack or food choices so that the child can point to what they want, or take off the picture and hand it to the parent. This is a good start to using PECS to communicate as well.
Another example would be having a visual choice board of the child’s favorite TV shows near the TV or remote. The child could then point to what they would like to watch rather than screaming or being upset until mom or dad finds the right show for them.
If the child likes to eat fast-food, fast-food restaurant choices could be on a choice board in the car. Outing locations such as the library, pool, and park could also be on a choice board in the car for when the child gets to pick a location to go for playtime.
There are many ways that pictures can help a child communicate what they want or need without having to vocalize. This can also take some of the guesswork out of figuring out what the child wants or deciding for them, and the child is unhappy. Giving children control and choice when possible is beneficial to a child’s development.
Functional communication training is a learning technique to replace less clear communication forms (such as reaching or leading an adult to something) with more easily understood and more functional communication forms (such as pointing, using the picture exchange communication system, signing, using a device, or verbalizations).
Children will often use what they can to get what they want. Nonvocal children can often lead parents, reach for items, or display behaviors like crying or tantrums to get their needs met. Functional communication training can give children a more appropriate way to ask for what they want and need in a way that others can understand. FCT also helps a child develop more advanced communication skills.
With functional communication training, it is important that the child has a communication method to use as a replacement behavior for the behaviors we do not want to see, like crying or having a tantrum. For example, a child may lead a parent to the fridge when they want milk. Instead, a child could use their PECS book to take out a milk icon and hand it to the parent indicating they want milk. The child could also use a communication device to ask for milk, sign milk in sign language, point to a picture of milk on the fridge, or verbalize “milk” if they are able. Asking for milk with a more understandable communication method can help all involved in the child’s life know what the child wants, rather than adults having to “guess” what the child is asking for when they are led to the fridge.
An important caveat for functional communication training is that a child will most likely have to gain the attention of the adult they are trying to interact with when using sign language, a gesture, or a picture exchange. The child should be taught to first get the adult’s attention, then make the request using their communication method. Children who use a voice output device like an iPad may not need to gain attention before asking but should be near enough to the person that they can be heard.
All communicative partners (parents, siblings, teachers, therapists, etc.) should be taught how the child communicates and to reinforce the child for communicating quickly and consistently, especially in the beginning stages of teaching.
Generalizing and Maintaining Skills
With all of the above-mentioned strategies and ideas, it is important to continue to practice these communication skills and generalize them. Generalizing skills means that the child practices the skill in different places, with different people, and with different materials. This will help the child be able to communicate in their natural environment without needing specific materials or people to get their needs met.
Parents are an integral part of a child’s development, especially communication development. Consulting with a behavior analyst or speech therapist is preferred but encouraging and reinforcing a child for communicating in appropriate ways will go a long way in helping the child successfully navigate their daily lives by using effective communication skills.
Griffin, W., & AFIRM Team. (2017). Functional communication training. Chapel Hill, NC: National Professional Development Center on Autism Spectrum Disorder, FPG Child Development Center, University of North Carolina. Retrieved from http://afirm.fpg.unc.edu/functional-communication-training
Sam, A., & AFIRM Team. (2016). Picture Exchange Communication System(R). Chapel Hill, NC: National Professional Development Center on Autism Spectrum Disorder, FPG Child Development Center, University of North Carolina. Retrieved from http://afirm.fpg.unc.edu/picture-exchange-communication-system
Suhrheinrich, J., Chan, J., Melgarejo, M. Reith, S., Stahmer, A., & AFIRM Team. (2018). Pivotal response training. Chapel Hill, NC: National Professional Development Center on Autism Spectrum Disorder, FPG Child Development Center, University of North Carolina. Retrieved from http://afirm.fpg.unc.edu/Pivotal-response-training
Credits: Content Contributions by Lisa Freed; Content Contributions/Editing by Heather Gilmore