ConnectABILITY

Autism Spectrum Disorder: Supporting Children and Youth – Module 5

Developing Communication Skills

Introduction

Communication is one of the core areas of difficulty for individuals with Autism Spectrum Disorder (ASD). We often think of speech as the main form of communication. Communication, however, involves much more than simply talking. A child may use words but they may not be intentional, in context, or understood by the child. A child may also be able to communicate non-verbally but not use speech.

Communication consists of verbal as well as nonverbal behaviours that take place in a social context. It includes a child’s ability to understand (receptive language) as well as to convey ideas (expressive language). A behaviour becomes communication 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.

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.

The Development of Intentional Communication

Children 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 to convey a message to its mother that s/he is hungry, but cries out of distress. A mother, however, 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 communication with their infants – they play both parts in the conversation. In typically-developing children, pre-intentional communication soon becomes intentional and by the second year most children are able to intentionally communicate.

During the first year, typically-developing infants acquire behaviours they can use to communicate their needs to others. They learn, for example, that by crying an adult will attend to him/her, that smiling and making noises gets 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. When a message is sent with a purpose, and with an expected outcome, the communication is intentional. 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 are not intentional include:

  • Practising a skill
  • Reacting to an enjoyable or unpleasant experience
  • Obtaining desired objects
  • Soothing 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

Reasons to Communicate

There are three main functions of communication:

  • Behaviour Regulation
    This is the earliest emerging function of communication. It involves requesting and protesting to satisfy immediate physical needs.
    Examples:

    • Asking to be fed
    • Trying to acquire a toy that is out of reach
    • Objecting to having one’s nose wiped
  • Social Interaction
    Communicative behaviours that involve initiating, responding to, maintaining or ending social interactions.
    Examples:

    • Greetings/farewells (“Hi”/”Bye”)
    • Showing off
    • Requesting to play games such as peek-a-boo
  • Joint Attention
    Communicative 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 and pointing (“Look”)
    • Requesting information while pointing (saying “What’s that?”)
    • Providing information to someone while looking at the same item (“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. S/he bites the container, throws it, begins to cry, and eventually walks away from it. His/her mother is sitting next to him/her.
A mother offers her child a glass of juice and the child shakes his/her head “No”.
A mother is talking on the phone and her child is behind her reaching for his/her 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 his/her favourite 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

How Can Communication Occur?

There are a variety of means by which messages can be delivered. The following are some communication modes:

  • Motoric
    Motoric means physically moving a person/object (e.g., the child takes your hand and puts it on a toy that s/he wants you to activate.)
  • Gesturing
    Gesturing involves moving a body part to convey a message such as 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., the child cries to draw the adult’s attention).
  • Signing
    Signing encompasses using either a formal or informal system of hand signs.
  • Using Objects
    Using objects refers to passing/moving an object to communicate (e.g., passing a cup to another person to request a drink)
  • Pictures/Line Drawings
    Picture communication includes using photos / line drawings that represent real objects (e.g., child passes a picture of a cracker to indicate that s/he would like a cracker to eat).

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

Communication Characteristics and Skills in ASD

There are a number of communication characteristics common to children with ASD. It is important to recognize the large range of communication skill levels among this population of children.

Communication Characteristics of Children with ASD

Communication Characteristic Example
Understanding / Comprehension
  • Inconsistent responses
  • 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
  • Some children may not acquire verbal language
  • Limited intentional communication
  • Limited use of eye contact
  • Lack of joint attention
  • Limited gestures
Verbal
  • Reversal of pronouns (“You want a drink” instead of “I want a drink”)
  • Echolalia *
  • 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 (personal-space boundaries) and orientation relative to a communicative partner (being face to face)
  • Limited ability to initiate, maintain and/or end conversations and social interactions
  • Limited ability to shift topics of conversation
  • Tendency to interrupt others
  • Difficulty providing clarifications when a person does not understand
Emotional
  • Limited display and understanding 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 which includes sounds, words, and phrases. Echolalia may be immediate. This refers to when the child repeats words/phrases immediately after hearing 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?”

** Hyperlexia

Hyperlexia refers to an unusually well-developed early ability to decode written words, significant difficulty in understanding and using verbal language, and challenges in social interactions. This usually becomes apparent without the child having been taught explicitly to read.

Hyperlexia is a characteristic that is observed in some children with ASD, and occasionally in other conditions. This ability to remember letter patterns seems to be related to the visual learning style of children with ASD.

Variability in Communication Skills in ASD

Children with ASD vary greatly in their communication skills. Some children with ASD are non-verbal, some have limited vocabulary, and some are verbal with extensive vocabularies. Echolalia may be used by children with ASD to communicate or without purpose. 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.

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)

  • Screaming
  • Throwing
  • Gestures
  • Facial expressions
  • Looking at things
  • Taking your hand and leading you
  • Pointing
  • Through pictures
  • Making sounds
  • Using words/sentences
  • li>Echolalia

Why is the child communicating? (Function)

  • To protest
  • To refuse
  • To respond
  • To greet
  • To get someone’s attention
  • To comment
  • To ask questions
  • To express feelings
  • To pretend

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 are early communicators need help in understanding that their behaviour can affect another person. A 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/her to say the word within an appropriate context. If the child is non-verbal the goal might be for him/her 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 to develop intent. They demonstrate to the child that doing one thing causes another thing to happen. Examples of cause-effect toys are those activated by pushing a button or a switch and pop-up/wind-up toys.
  • Use Highly Motivating Actions and Objects
    In order for a child to communicate, s/he must be motivated to do so. If a child really likes an activity such as swinging, you can start by teaching him/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 the child well. If, however, you attend to his/her need before a request, this removes the need to communicate. If you briefly delay meeting the child’s needs. s/he has a reason to communicate in order to get what s/he wants. Communicative temptations encourage a child to ask for “more”, “help”, or an activity/item by name such as “book.” For example, placing favourite items or food out of the child’s reach can encourage him/her to ask for them using whatever means that s/he can – e.g., pointing, sounds, single words, or a phrase. Reward the child by providing the item when s/he attempts to make a request or uses the means you are teaching. Always give the child time to request the activity (wait up to 10 seconds). Accept word approximations at first from non-verbal children. Reward any form of intentional communication to encourage and motivate for continued use.

Communication Skills for the Non-Verbal Child with ASD

Children with ASD may require a variety of methods both to express their thoughts and to understand what others are communicating. The term “augmentative and alternative communication” (AAC) is used to refer to alternative communication methods that can support a child’s efforts to communicate. Augmentative and alternative communication methods can be unaided or aided, using objects or devices. Examples of unaided methods of communication include gestures, facial expressions, vocalizations, and sign language (such as American Sign Language). Examples of aided forms of communication include the following: handing to an adult a cup to signal being thirsty, pointing to pictures on a communication board or in a book, and activating a device that provides auditory output.

Please note: The type of augmentative and/or alternative communication system used by a child is identified and the implementation is monitored by a registered Speech and Language Pathologist.

After determining how the child communicates (gestural, 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 unaided 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.”
  • Facial Expression
    Expressions can include requesting, protesting, declaration of feelings (e.g., happy, sad, upset, etc.)
  • Vocalizations
    Vocalizations can include requesting for attention, refusing, affirming, greeting
  • Sign Language
    Early signing can include requesting, protesting, refusing, greeting, etc.

The following are some of the aided ways that a nonverbal child with ASD might communicate:

  • Object Manipulation
    Can include reaching for items, grabbing items, handing items to adult to request, throwing items to indicate protest/refusal/dislike
  • Pointing to Pictures
    Pointing to pictures requires the child to point to or tap the picture to communicate. The pictures may be photos, drawings, or symbols.
  • Picture Exchange Communication System (PECS)
    PECS is a program developed by Bondy and Frost specifically to teach a child to initiate 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

Expanding the Functions of Communication

The child may be nonverbal or verbal but as long as s/he means to send messages to others, s/he is showing intentional communication. As stated above, communication takes place for a variety of reasons. Observing the child provides you with ideas as to why s/he is communicating. Your goal can then be to expand the purposes for which the child communicates. The functions of communication are as follows:

  • Behaviour Regulation
    Communication can be used to regulate a child’s immediate physical needs. To develop communicative behavioural regulation, you have to provide opportunities to request or protest during the daily routine.
  • Social Interaction
    These are behaviours that initiate, respond to, maintain, or end social interactions.
  • Joint Attention
    This communicative behaviour involves the child being able to direct the attention of another person to an object or event.

Expanding Reasons to Communicate

Expand a child’s reasons for communicating:

  • Identify the best setting or time to implement the strategies (e.g., snack time, circle time, one-on-one time). This may vary depending upon the functions on which you are working. For example, greetings will be practised most naturally on arrival at the centre, or when returning to a particular room. Snack time provides many chances to practise requesting food or drink.
  • Identify what you want the child to say, taking into account what is developmentally appropriate for the child and for the language used by his peers. For example, when a 4-year-old child wants a peer to join in a game, s/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 will have learned and may say, “I’m okay”.

Strategies to Improve Understanding

Working on the child’s receptive communication is as important as working on expressive communication. Children with ASD have difficulty processing auditory/verbal information, as well as making sense of their environment.

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 is going to happen next. This helps the child to understand what s/he is supposed to do in different situations. It also provides repeated opportunities to engage the child with language that describes what will happen in a context s/he will understand.
  • Using Visual Supports
    Most children with ASD are primarily visual learners. The use of visual aids, therefore, enhances their understanding. Visual schedules can reduce anxiety, provide concrete reminders, and/or describe the steps in a task.
  • Combine Words and Gestures
    Use gestures/actions when speaking to children. For example, point to a chair while asking the child to sit down, or show a picture of snack food while saying “Time for snack”. Instead of pictures, real objects can also be shown to children who need a more basic representation of the item. Written words can be shown to children who can read.
  • Structure the Environment
    Remove or decrease distractions such as materials that are not related to your teaching/learning goals. This allows the child to better focus and to understand what is expected of him/her. Arrange the seating so that the child can better attend to the topic or task. Refer 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. Try to be consistent and concise when speaking.

      When helping your child get dressed for outside, allow the child time for processing between each direction. For example, say:
      “Shoes off”
      “Boots on”

      “Coat on”
      “Hat on”
      “Mitts on”

When you emphasize key words in a phrase, you are developing the child’s ability to understand the meaning of the request/demand/comment. Key words can be emphasized by saying them more loudly, using a different tone, pausing slightly, or making your voice more animated. To support the child’s ability to generalize the use of the word in multiple environments, use the same word for every applicable.

For example,
Doing simple imitation exercises such as waving, touching nose or ears, clapping will prompt the child to look at you and copy responses. This will also encourage the child to look at his/her communicative partner and to try different imitations such as vocalizations and gestures.

Developing Functional Play and Adaptive Behaviour