Post #48 Supporting communication at home: youngsters who do not speak

Communication is powerful. Communication is a social process through which we send and receive messages to and from other people. There are many forms of communication, but often there is an emphasis upon speech, which may not be possible, nor effective, for some autistic youngsters. In this post I reflect upon ways to support your child's communication at home if they do not speak, or if speech is not their most effective means of communication. I do not provide training but suggest two key aspects to think about, developing: 1) early social communication & 2) functional communication.

Communication is an exchange of information between communication partners. Communication is essential in all aspects of everyday life. We communicate throughout the day for a variety of reasons. For example, we ask for instructions at work, we communicate with a partner to arrange who is picking up our children from school, we chat with friends etc etc. We communicate for functional and formal reasons, but importantly we also communicate to be social and many of us enjoy social chit-chat.

Just as we communicate for a variety of reasons, so we also communicate in a variety of ways. Typically when we think of how we communicate the focus is upon talking, but it is important also to be aware of other ways we communicate. For example, we exchange emails, communicate via social media, use gestures, send flowers or cards - these ways of communicating can be equally, and sometimes more, effective than the spoken word.

Many autistic youngsters who also have severe learning difficulties do not speak. Some speak, but their spoken words may not result in successful communication. 

However this does not mean they are not able to communicate, rather they may communicate in different ways. Some are able to use and understand communication methods which we all use, and which are not speech, such as gestures. Some may use other ways to send messages, for example handing you an empty cup to request a drink. Some are able to use Makaton signs. Many use structured alternative and augmentative communication systems (AAC) at school, such as the Picture Exchange Communication System (PECS). At home your son or daughter may communicate differently compared with their communication at school. This is not wrong! It is important to be open to your child's 

communication, to value their efforts and to support them to enjoy communicating with others. Communication exchange between people is rich and diverse, including for autistic youngsters. However, if we are to be effective communication partners with our autistic children, we may need to be more vigilant in recognising and celebrating their communication efforts and find ways to respond which are meaningful to them. 

If your son or daughter does not speak, firstly communicate with your child's school. If you do not know how your child communicates at school, ask questions - for example, how do they make requests? How do they give information? How do they communicate about how they are feeling and their emotions. If your child uses an alternative/augmentative communication system at school, such as PECS or Makaton signing, ask for a list of vocabulary which your child understands and uses. If they use pictures or symbols, ask if you may have a copy as there may be some which you can introduce at home. Discussion about how your child communicates at school is important to help you to support their communication at home during home learning and also for everyday family life.

1) Early Social communication

Be open to, and value, your child's communication efforts. Your child may not be using a formal communication system yet, but nevertheless they will be communicating in some way. You may be very familiar with their unique ways of communicating at home. For example they may stand next to you, silently, when they need something. They may communicate through body movements and/or sounds - their stimming may communicate how they are feeling, for example repetitive jumping when excited. You may intuitively know what your child is trying to communicate, for example you might know how your child feels when they hum a specific tune. Tuning in to your child's communication attempts will help you to reinforce their communication and to build up communication interaction. 

Whilst some children are not yet using any formal way of communicating, as their communication partner you may be able to find ways to begin the process of communication in ways which are enjoyable and which form a communication connection with your child. For example, Intensive Interaction is an approach used to develop interaction and pre-speech skills. Dr Dave Hewett OBE describes the approach as the 'Fundamentals of Communication':

https://www.intensiveinteraction.org/find-out-more/history/

Watch this film to learn how Intensive Interaction develops the 'Fundamentals of Communication'. The principles of the approach are illustrated and the film may give you ideas for ways you can interact and communicate with your child and which you both find enjoyable.

If you feel this may be a good starting point for your child, ask school if/how they use the approach. For further information see Intensive Interaction Institute where you will find more videos which demonstrate the approach. Also, revisit post #16; watch the film 'Reaching Ricky' for an example of using the approach at home. Notice what Phoebe does to support Ricky's communication and how the interaction is mutually enjoyable.

 

Many children will use other ways to communicate. They may take you by the hand or wrist and lead you to something they want.  They may jig up and down on your lap to ask for "more" bouncing games. They may use body movements to communicate how they feel. These are valid ways of communicating that are meaningful for your child. They are not less worthy because they do not involve speech nor a formal alternative system. So join your child in their preferred activities, follow their lead and copy their sounds or actions. Use repetition to build up anticipation and enjoyment. If your child engages with you and you find that both of you are enjoying the 'conversation', do not under-estimate the value of learning which is taking place. What looks like fun may also be a powerful communicative exchange from which your child can learn and develop.

2) Functional communication

Alternative and augmentative communication (AAC) systems. There are many ways to communicate as an alternative to, or as a means of augmenting, speech. The use of signs, pictures, symbols, text and technology such as switches or talking mats are commonly used in special schools. A key benefit of AAC is that strategies can be personalised according to individual needs and strengths. Your child may be using AAC at home and/or school, or you may feel they would benefit from introducing AAC to enhance their communication at home. If your child uses AAC at school, but not home, then discuss what, and how, strategies are used and how these might be helpful at home. 

Visual communication strategies can be particularly powerful for autistic 

youngsters. The use of photos, pictures and symbols can be highly effective in enabling individuals to communicate and to enhance the effectiveness of their communication partners. Elsewhere in this blog I have written at length about the use of visual schedules (see posts #2, 3, 4). These tools provide us, as communication partners, with a method of giving information in meaningful ways to our autistic children and young people. Likewise, visual communication strategies can empower autistic individuals to communicate with us more effectively as part of the communication partnership. Note, visual communication strategies will not prevent your child from speaking, in fact some children who learn to use visual communication go on to develop speech. Visual communication can teach your child about the power of communication.

One commonly used AAC is the Picture Exchange Communication System, PECS, which is a way of teaching functional communication. There are a number of reasons why PECS may be helpful as an AAC if your child does not speak, or if their speech is not yet effective for them to communicate meaningfully, for example:

• PECS makes use of the visual processing strengths of many autistic youngsters
• PECS makes the exchange between communication partners concrete and explicit. In this example the child is giving a picture of a cup to request a drink during snack-time:
  
  
  
  
  The usual 'to and fro' of conversation is quite abstract and transient and may be difficult to process, whereas the use of visual cards which are exchanged between conversation partners can add meaning and clarity for autistic individuals
  

See What is PECS? for more details of the principles of the approach.

If your child is using PECS at school, ask how you could introduce this at home and what visual pictures or symbols your child understands and uses at school. If your child has never used PECS at home, it may be that school suggests trying the approach at an earlier phase at home - my advice is keep it simple! Note: PECS is not the only way of using visual communication, so do not be deterred if school is not using PECS with your child. You can still try out visual communication at home if you feel your child would benefit. If you are unsure whether your child understands pictures (i.e., that a picture represents an object), you can test this out by presenting them with a picture upside-down:

If they turn the card so the picture is the correct way round, this suggests they are aware of the picture as a representation of the object.

If you decide to try using pictures, try to find ways to make picture exchange motivating and powerful for your child. 

Some tips on getting started:

• Start by introducing 1 or 2 pictures of objects or activities that your child loves - these may be favourite toys, games, food items and so on. Teach your child to give you the picture of their chosen favourite item, in exchange you provide them with the requested item.
• Lots of repetition will reinforce the exchange between you and will help your child to learn how to request using their pictures. This skill is empowering and can become your child's voice.
• When you have a few pictures of activities which your child can request, try putting items away and provide picture labels which your child can use to make requests. For example, play box - place 2 or 3 favourite toys in a container. Velcro corresponding pictures to the lid of the play box. Teach your child to select and request the toy they want to play with by removing the corresponding picture and handing it to you. In exchange, you remove the lid of the play box and then give the requested toy to your child - NB do not let your child lean over and grab the toy. 
• When your child is making requests using pictures, introduce the strategy in different contexts. For example, Velcro pictures to kitchen cupboards doors so your child can request food items or kitchen utensils.
• If you feel your child is confident with using pictures, you might consider introducing corresponding symbols - attach a symbol to the picture and gradually remove the pictures. Add words as some youngsters quickly build up a sight vocabulary and begin to use written words to communicate.
  

Use of PECS and other visual communication strategies differs for individual children. Many move on to using multiple pictures/symbols and to using PECS communication books, for example:

Some children start to make sentences using PECS.

Communication boards like this can be made for different types of requests, e.g., snacks, stories, DVDs, interaction games. 

   

Some youngsters are able to use a communication book - ask your child's teacher if they use one at school and how you might adapt for home.

These can be developed to enable more sophisticated communication for a variety of reasons, e.g., making comments, communicating about emotions.

Some children use communication keyrings or lanyards:

PECS is not the only AAC which autistic youngsters may find powerful as a communication tool. Many special schools use a 'total communication' approach, defined by icommunicate as: a holistic view of communication, often using a range of modalities or even thinking “outside the box” to create a system of communication that works for an individual. For example, schools may use objects of reference, signing, a range of hi-tech and low-tech assistive technology as well as PECS and other visual communication strategies. Just as we use a variety of ways to communicate, so your child may also use more than one way to communicate at school and/or with you. So find out how your child communicates at school - ask about social communication, such as intensive interaction or music interaction, and about AAC.

Use ways of communicating that work for your child, rather than trying to impose a system that may be popular but that is not meaningful for your child. 

Further information & resources:

TEACCH Susan Boswell Communication incentives

National Autistic Society Communication tools - visual supports

TWINKL Alternative augmentative communication systems (explanation and some free resources)

Autism East Midlands/Sutherland House Musical interaction

Intensive Interaction Institute Fundamentals of Communication

Pyramid Educational Consultants What is PECS?

Pyramid Educational Consultants PECS research