ConnectABILITY

Autism Spectrum Disorder: Supporting Children and Youth – Module 5

Developing Communication Skills

Introduction

You will recall that communication is one of the core areas of difficulty in Autism Spectrum Disorder (ASD). Many of us think only of a child’s speech when considering their communication skills. Communication, however, involves much more than what a child can say. For instance, a child may talk a great deal yet not be a good communicator, or be able to communicate non-verbally but not speak.

Communication consists of verbal as well as nonverbal behaviours that take place in a social context. It includes a child’s ability to understand as well as to express ideas appropriately. A behaviour becomes communication only when there is a desire to send a message to another person. The message may be sent by using words, gestures, facial expressions, tone of voice, body language, or through other means such as pictures or sign language.

Children with ASD struggle to be good communicators. This module will help you to identify a child’s current communication abilities, and to develop strategies for developing effective communication skills in children with Autism Spectrum Disorder.

Objectives

After completing this module, you should be able to:

  • Distinguish intentional communication from early (pre-intentional) communication.
  • Identify characteristic communication patterns in children with ASD.
  • Indicate the range of communication skills of children with ASD.
  • Identify how and why a child is communicating.
  • Set goals for developing communication skills.
  • Implement strategies to attain these goals.

Section 1: Communication

Communication refers to the verbal and nonverbal behaviours that a person uses in order to convey a message to another person.

Some keys points about communication:

  • It can be verbal (e.g., speaking) or nonverbal (e.g., pointing).
  • It is intentional in that the person must “intend” to send the message.
  • Communication is person-to-person, occurring in a social context.

1. The Development of Intentional Communication

Typically-developing infants or children with ASD who have not yet learned the power of communication are unaware that what they do or say has an effect on those around them. For example, a newborn baby who cries does not intend for her mother to think that she is hungry. She cries because she is in distress. However, a mother often interprets the crying as communicating hunger despite the infant’s lack of intent. It is the mother’s response to the behaviour (crying) as intentional that sets up the interaction, which is the context for the development of intentional communication. Mothers have intentional communications with their infants – they play both parts in the conversation. In normally developing children pre-intentional communication soon becomes intentional and by the second year most infants are able intentional communicators.

During this first year, typically-developing babies acquire behaviours they can use to regulate what other people do. They learn, for example, that crying brings mother running, that smiling and making noises get adult attention or that an adult will say a word when they pick up an object. Regardless of the form of communication used (reaching, pointing, vocalizing), intent is demonstrated when you understand that what you say or do has an effect on someone. That is, when a message is sent with a purpose, and with an expected outcome, the communication is intentional. As well, intentional communication involves the ability to persist with that behaviour until the desired effect has been reached.

Children with ASD do not develop intentional communication as quickly. Pre- and non-intentional communication may be predominant for some time even after a child has developed some speech.

Some purposes of early communication that is not intentional include to:

  • Practice something
  • React to an enjoyable or unpleasant experience
  • Obtain desired objects
  • Sooths one’s self

Examples:

  • Repeating words when no one is around.
  • Reaching toward a desired toy on a shelf when no one is present or looking.

2. Reasons to Communicate

There are three main reasons to communicate:

  • Behaviour Regulation
    This is the earliest emerging function of communication. It involves requesting and protesting to satisfy immediate physical needs.
    Example:
    Requesting or protesting (e.g., asking to be fed, trying to acquire a toy that is out of reach, objecting to having one’s nose wiped)
  • Social Interaction
    These communicative behaviours involve initiating, responding to, maintaining or ending social interactions.
    Examples:

    • Greetings/farewells (“Hi”/”Bye”)
    • Showing off
    • Requesting to play games such as pat-a-cake or chase.
  • Joint Attention
    These communication behaviours direct someone else’s attention to something that you are already attending to (an object, event or topic). Joint attention is critical to word learning, when labels are provided while both adult and child are focused on the same object.
    Examples:

    • Commenting (“Look”)
    • Requesting information (directing a puzzled look or saying, “What’s that?”)
    • Providing information to someone (“That’s a red truck”)
Exercise: Early versus Intentional Communication

Indicate which of the following behaviours are examples of early communication (EC) and which are intentional communication (IC).

Behaviour EC IC
A child has difficulty opening a container of candy. He bites the container, throws it, begins to cry and eventually walks away from it (his mother is sitting next to him).
A mother offers her child a glass of juice and the child shakes her head “no”.
A mother is talking on the phone and her child is behind her reaching for his train on a top shelf.
A father tries to participate with his son who is building a tower of blocks. When the father attempts to place a block on top, the child looks at him and then pushes the block away.
A child is reciting phrases from her favorite movie while sitting at the table.
A child walks into the kitchen and says, “Do you want a cookie?” (No one is nearby).
A child who is thirsty takes her brother by the hand and leads him to the refrigerator.

Click here to see a sample answer

3. How Can Communication Occur?

As already indicated, there are a variety of means by which messages can be sent. The following are some communication modes:

  • Motoric
    Motoric means include physically moving a person/object (e.g., child takes your hand and pushes it on a toy that they want you to activate.)
  • Gesturing
    Gesturing involves pointing and/or eye gazing (e.g., pointing to milk and then looking at the adult and waiting).
  • Vocalizing
    Vocalizing entails using sounds to communicate (e.g., child cries to draw adult’s attention).
  • Signing
    Signing encompasses using either a formal or informal system of hand signs.
  • Using Objects
    Using objects refers to passing an object to communicate (e.g., passing a cup to request a drink)
  • Photos/Pictures
    Photos and picture communication includes using photos or drawings that represent real objects (e.g., child passes a picture of a cracker to indicate that they would like a cracker to eat).

(Adapted from Autism: Interventions and Strategies for Success, 2001)

Section 2: Communication Characteristics and Skills in ASD

There are a number of communication characteristics common to children with ASD. However, it is important to recognize the large range of communication skill levels among children with ASD.

1. Communication Characteristics of Children with ASD

Communication Characteristic Example
Understanding / Comprehension
  • Inconsistent responses when hear things
  • Over-reaction or under-reaction to environmental stimulation
  • Literal interpretation (e.g., if told to “hop out of the car”, literally tries to hop when getting out of the car)
Non-verbal
  • Many children will not acquire verbal language
  • Limited intentional communication
  • Limited use of eye contact or shared attention for communication purposes
  • Limited gestures
Verbal
  • Reversal of pronouns (“You want a drink?” instead of “I want a drink”)
  • Echolalia *
  • Limited focus on the content of a conversation
  • Focus of a conversation is based on own interests and fact-based
Written
  • May display hyperlexia* (precocious reading)
Using Language in Appropriate Contexts(Pragmatics)
  • Conversations and interactions lack typical “give and take”
  • Unaware of others’ nonverbal cues (e.g., unable to judge a listener’s understanding by the expression on their face)
  • Limited ability to take another person’s perspective
  • Limited ability to interact or communicate with others around their interests
  • Difficulty with understanding the appropriate distance and orientation (i.e., face-to-face) relative to a communicative partner
  • Limited ability to initiate, maintain and/or end conversation and social interactions
  • Limited ability to shift topics of conversation
  • Tendency to interrupt others
  • Difficulty providing clarifications when a person doesn’t understand
Emotional
  • Limited display of facial expressions
  • Mismatch between emotional expression and situation (e.g., may laugh when a person is hurt)
  • Difficulty understanding the emotions of others

(Adapted from The Denver Model Treatment Manual, 2001)

Echolalia
Echolalia refers to the repetition of what another person says. Echolalia can entail repetition of part of a phrase or sentence or the entire utterance. Echolalia may be immediate in that the child repeats words/phrases immediately after he hears them.
Example:
Adult: “Jane, do you want a drink?”
Child: “Jane, do you want a drink?”

Echolalia may also be delayed. This refers to when a child hears words/phrases but may not repeat them until days/weeks/months later.
Example:
A child falls down and says, “Are you alright?”

This child is repeating exactly what he heard his mother say to him in the past, whenever he fell down. The child was unable to come up with anything to say on his own but was able to use an echolalic sentence that he had heard numerous times in the same situation.

Hyperlexia
Hyperlexia refers to an unusually well-developed early ability to decode written words. This usually becomes apparent without the child having been taught explicitly to read.

Hyperlexia is a symptom that is observed quite often in children with ASD, and occasionally in other conditions. Most often, the child’s ability to understand the words that he can read is much less well-developed than the decoding ability.

This ability to remember letter patterns seems to be related to the visual learning style of children with ASD

2. Variability in Communication Skills in ASD

Children with ASD vary greatly in their communication skills. Some children with ASD may never develop speech, whereas others have limited vocabularies, and yet others are very talkative with extensive vocabularies. The children who use echolalia may do so to communicate, while others echo phrases without any such intention. As well, children may communicate for a very limited number of purposes (e.g., to request or protest), or they may communicate with many intentions (e.g., to greet, to show, to comment). Regardless of their level of communication ability, what children with ASD have in common is difficulty in communicating effectively.

Section 3: How and Why a Child Communicates

In order to help a child to communicate more effectively, you must be aware of his current communication abilities.

How is the child communicating? (Mode) Why is the child communicating? (Function)
  • Screaming
  • Throwing
  • Gestures
  • Facial expressions
  • Looking at things
  • Taking your hand and leading you
  • Pointing
  • Through pictures
  • Making sounds
  • Using words/sentences
  • Echolalia
  • To protest
  • To refuse
  • To respond
  • To greet
  • To get someone’s attention
  • To comment
  • To ask questions
  • To express feelings
  • To pretend

Once you know how and why the child communicates, you should be able to answer these questions:
a) Is the child communicating non-verbally and/or verbally?

b) Is the child’s communication intentional?

Section 4: Strategies to Help a Child Communicate

After observing a child with ASD and gathering information, goals can be developed and strategies selected to increase communication skills.

The following goals and strategies are categorized based on whether the child’s communication is intentional/non-intentional or verbal/non-verbal.

1. Working on Early Communication Skills with a Child with ASD

Children with ASD who have not yet begun to communicate intentionally need help in understanding that they have the ability to affect another person’s actions. An appropriate goal for a child at this level might be that the child will communicate a desire for something (e.g., a toy, a drink, to go outside). If the child has some verbal language the goal might be for him to say the word in appropriate contexts. If the child is non-verbal the goal might be for him to point to a picture that indicates the desired outcome or object.

Strategies to Help a Child Develop Intent

  • Cause and Effect Activities
    Activities that demonstrate cause and effect relationships help develop intent, because they demonstrate to the child that doing one thing causes another to happen. Toys that are activated by pushing a button or a switch and pop-up/wind-up toys are examples of cause-effect toys. Bowling, in which the child rolls a ball to knock the pins over, is another example of a cause-effect activity.
  • Use Highly Motivating Actions and Objects
    In order for a child to communicate, she must be motivated to do so. If you have an object that the child really likes, she will be more motivated to communicate to get that object. Similarly, if a child really likes an activity such as swinging, you can start by teaching her to request or make choices involving the desired activity. See Module 3 for a way to survey object and activity preferences/rewards.
  • Give the Child a Reason to Communicate
    You can often anticipate what a child wants, especially when you know him well. However, this may remove his need to communicate. If you delay meeting the child’s needs, he has a reason to communicate in order to get what he wants. Placing favorite items or food out of the child’s reach can also encourage him to ask for them using whatever means that he can – pointing, sounds, single words or phrase. Reward him by providing the item when he uses the means you are teaching.

Communication Skills for the Non-Verbal Child with ASD

The most important first step for the child who is nonverbal is to provide some way for him to communicate effectively. Remember, the nonverbal child may demonstrate pre-intentional or intentional communication. If a child is not yet demonstrating intentional communication, implement the strategies mentioned above. If he is communicating intentionally but without words, use the strategies outlined in the following section.

After determining how the child communicates (gestures, motoric, etc.), it is important to decide whether a more consistent and efficient form of communication can be used. For example, if the child often communicates by screaming or leading you by the hand, another system of communication would be more appropriate. As well, if the child does not yet speak, he needs to use another communication system, either in addition to or instead of his current means.

Below are some of the possible ways that a nonverbal child with ASD might communicate:

  • Gestures
    Gestures can include pointing or looking, as well as shaking or nodding your head, pushing items away or waving “Hi/Bye”.
  • Pointing to Pictures
    Pointing to pictures requires the child to point with an index finger to communicate. The pictures may be photos, drawings, or symbols.
  • Picture Exchange Communication System (PECS)
    The PECS is a program developed by Bondy and Frost specifically to teach communication using visual symbols. It involves systematically teaching the child to give a visual/picture to someone to communicate, when words are not yet reliably used for this purpose. The use of PECS requires training for those who are working with the child; consultation with a Speech-Language Pathologist is recommended.
  • Voice Output Aids
    These devices have a button that the child can activate to play a pre-recorded message. This message communicates what the child wants, or allows him to participate in an activity. For example, the child presses the button and the device says, “I want tickle”, or plays a line of a song to enable the child to “sing along”.

2. Working with a Child with ASD Who Shows Intentional Communication

If the child with ASD communicates intentionally she will benefit from strategies to expand the purposes of her communication and to improve her understanding.

Expanding the Functions of Communication
The child may be nonverbal or verbal but as long as she means to send messages to others, she is showing intentional communication. As Section 3 (How and Why a Child Communicates) described, communication takes place for a variety of reasons. Your observations of the child give you ideas as to why she is communicating. Your goal can then be to expand the purposes for which the child communicates.

  • Behaviour Regulation
    Recall that a child may use communication to regulate her immediate physical needs. To develop communicative behavioural regulation, you have to provide opportunities to request or protest during the daily routine. This may include requesting food/drink or objects, making a choice among items, requesting the start or end of an action, requesting assistance or protesting an action or object.
  • Social Interaction
    These behaviours initiate, respond to, maintain, or end social interactions. To develop this purpose of communication, provide opportunities to practice greeting someone or saying good-bye, provide opportunities to request social games or routines, or to request “more” of a game.
  • Joint Attention
    This communication behaviour involves the child being able to direct the attention of another person to an object or event. Strategies for expanding communication purposes in this area include providing opportunities to use gestures or vocalizations to bring attention to objects or events, opportunities to comment on new things, or opportunities to request information or clarification if something was not understood.

Expanding Reasons to Communicate
In order to help expand a child’s reasons for communicating you need to:

  • Identify the best setting or time to implement the strategies – snack time, circle time, one-on-one time. This may vary depending on the functions on which you are working. For example, greetings will be practiced most naturally on arrival at the centre, or when returning to a particular room, while snack time provides many chances to practice requests for food or drink.
  • Identify what you want the child to say, taking into account what is appropriate for the child’s age and for the language used by his peers. For example, when a 4-year-old child wants a peer to join in a game, he may say, “Come on!” instead of “Do you want to play?”
  • Encourage generalization by providing a lot of opportunities, with different people, in a variety of contexts, during the child’s daily routine.

Working with a Child who Uses Echolalia
One strategy for managing echolalia in children is to model phrases from the child’s perspective. For example, instead of saying, “Are you okay?” when the child falls down, say “I’m okay” or “I hurt my knee”. The child will then repeat an appropriate phrase from his own perspective. If you are consistent with this, the next time the child falls down, he may say, “I’m okay”.

Section 5: Strategies to Improve Understanding

Our discussion of communication has referred primarily, until now, to what the child communicates. However, working on the child’s comprehension is also very important. As you have learned in previous modules, children with ASD have difficulty processing auditory/verbal information, as well as making sense out of what is around them.

The following strategies can help a child’s understanding (also see Module 2):

  • Predictability/Routine
    Being predictable with your actions and creating predictable routines helps a child to understand what’s going to happen next and helps him understand what he is supposed to do in different situations. It provides predictable and repeated opportunities to provide the child with language that describes what will happen in a context he will understand.
  • Using Visual Supports
    As you know by now, most children with ASD learn best by looking rather than hearing. Therefore, the use of visual aids enhances their understanding. Visual schedules provide concrete reminders of a routine, or what the steps are in a task.
  • Show as well as Say
    Use gestures/actions when speaking to the child with ASD. For example, point to the chair while asking him to sit down, or show a picture while speaking to the child. For example, show a picture of a specific snack food while saying “Time for snack”. Instead of pictures, real objects can also be shown for children who need a more basic representation of the item, as can written words for higher functioning children who can read.
  • Structure the Environment
    This involves such things as removing materials that are not related to what you are working on, allowing the child to focus and understand what is expected of him. Seating can be arranged so the child can better attend to the appropriate things or people. This makes it clearer to the child what you are talking about and aids understanding. Refer back to Module 2 for other suggestions.
  • Simplify What You Say, Emphasize Key Words and Repeat!
    Simplifying what you say means talking at the child’s level of understanding. If the child is only able to understand short sentences, adjust what you say to match this.
    Example:
    When helping your child get dressed for outside, say:
    “Shoes off”
    “Boots on”
    “Coat on”
    “Hat on”
    “Mitts on”

    Emphasizing key words also helps the child to understand by making the important information stand out. Important words can be emphasized by: saying them more loudly, using a different tone, pausing slightly, or making your voice more animated.
    Repeating words and information many times in different situations gives the child multiple chances to hear these words. It results in him understanding these words used in a variety of different ways and situations. For example, if the word “down” is repeated when the child wants to get down or when something/someone falls down or in the song “London Bridge is Falling Down”, it allows the child opportunities to understand this word’s use in many situations.
Exercise: Developing a Plan

Select a child with ASD in your centre and choose one appropriate communication goal that you’d like to work on. Identify specific times in your daily routine that provide good opportunities to work on this goal. Identify specific strategies that would be appropriate.

Child’s Communication Modes and Purposes:

Communication Goal: ________________________

Specific Time Daily: ________________________

Specific Strategies:  ________________________

Click here to see a sample answer

Review

Remember the following key points:

  • The child’s communication develops from pre-intentional to intentional as he gains an understanding of the effect of his behaviour on others.
  • Observe both HOW (e.g., screaming, pointing, picture) and WHY (e.g., request, protest, comment) the child communicates.
  • Wait to provide things the child wants, or put things out of reach to encourage him to let you know what he wants.
  • Help or prompt the child to follow through with what you want him to do.
  • Teach all skills in a wide variety of contexts.
  • Provide many opportunities to practice all skills.

Developing Functional Play and Adaptive Behaviour