Communication

Communication Problems in Autism 

The cause of speech and language problems in autism is currently unknown.  Many experts believe that the problems are caused by numerous conditions that occur either before, during, or after birth affecting brain development. This interferes with an individual's ability to interpret and interact with the world. Some scientists link the communication difficulties to a "theory of mind" or impaired ability to think about thoughts or imagine another individual's state of mind. This is combined with an impaired ability to symbolize, when trying to communicate and when playing.

The communication problems of autism vary, depending upon the intellectual and social development of the individual. Some may be unable to speak, whereas others may have rich vocabularies and are able to talk about topics of interest in great depth. Despite this variation, the majority of autistic individuals have little or no problem with pronunciation. Most have difficulty effectively using language. Many also have problems with word and sentence meaning, intonation, and rhythm.

Those who can speak often say things that have no content or information. For example, an autistic individual may repeatedly count from one to five. Others use echolalia, a repetition of something previously heard. One form, immediate echolalia, may occur when the individual repeats the question, "Do you want something to drink?" instead of replying with a "yes" or "no." In another form called delayed echolalia, an individual may say, "Do you want something to drink?" whenever he or she is asking for a drink.

Others may use stock phrases such as, "My name is Tom," to start a conversation, even when speaking with friends or family. Still others may repeat learned scripts such as those heard during television commercials. Some individuals with higher intelligence may be able to speak in depth about topics they are interested in such as music or cars but are unable to engage in an interactive conversation on those topics.

Most autistic individuals do not make eye contact and have poor attention duration. They are often unable to use gestures either as a primary means of communication, as in sign language, or to assist verbal communication, such as pointing to an object they want. Some autistic individuals speak in a high-pitched voice or use robot-like speech. They are often unresponsive to the speech of others and may not respond to their own names. As a result, some are mistakenly thought to have a hearing problem. The correct use of pronouns is also a problem for autistic individuals. For example, if asked, "Are you wearing a red shirt today?" the individual may respond with, "You are wearing a red shirt today," instead of "Yes, I am wearing a red shirt today."

For many, speech and language develop, to some degree, but not to a normal ability level. This development is usually uneven. For example, vocabulary development in areas of interest may be accelerated. Many have good memories for information just heard or seen. Some may be able to read words well before the age of five but may not be able to demonstrate understanding of what is read. Others have musical talents or advanced ability to count and perform mathematical calculations. Approximately 10 percent show "savant" skills or detailed abilities in specific areas such as calendar calculation, musical ability, or math.

The Picture Exchange System

The Picture Exchange Communication System (PECS) was developed in 1985 as a unique augmentative/ alternative training package that allows children and adults with autism and other communication deficits to initiate communication. First used at the Delaware Autistic Program, PECS has received worldwide recognition for focusing on the initiation component of communication. PECS does not require complex or expensive materials. It was created with educators, resident care providers and families in mind, and so it is readily used in a variety of settings. 

PECS begins with teaching a student to exchange a picture of a desired item with a “teacher”, who immediately honors the request. Verbal prompts are not used, thus building immediate initiation and avoiding prompt dependency. The system goes on to teach discrimination of symbols and then puts them all together in simple sentences. In the most advanced Phases, individuals are taught to comment and answer direct questions. Many preschoolers using PECS also begin developing speech.

The system has been successful with adolescents and adults who have a wide array of communicative, cognitive and physical difficulties. The foundation for the system is the PECS Training Manual, 2nd Edition, written by Lori Frost, MS, CCC/SLP and Andrew Bondy, PhD. The manual provides all of the necessary information to implement PECS effectively. It guides readers through the six phases of training and provides examples, helpful hints and templates for data and progress reporting. This training manual is recognized by professionals in the fields of communication and behavior analysis as an effective and practical guide to one of the most innovative systems available. 
PECS is especially successful if appropriately combined with elements of behavior analysis. The manual offers many suggestions on assessing reinforcers, teaching strategies, fading prompts and other issues. The authors encourage PECS users to create an environment that enhances and encourages communication through the use of the Pyramid Approach to Education. 

The Phases of PECS 

Phase I– Teaches students to initiate communication right from the start by exchanging a single picture for a highly desired item. 
Phase II– Teaches students to be persistent communicators- to actively seek out their pictures and to travel to someone to make a request. 
Phase III– Teaches students to discriminate pictures and to select the picture that represents the item they want. 
Phase IV– Teaches students to use sentence structure to make a request in the form of “I want _____.” 
Phase V– Teaches students to respond to the question “What do you want?” 
Phase VI– Teaches students to comment about things in their environment both spontaneously and in response to a question. 
Expanding Vocabulary– Teaches students to use attributes such as colors, shapes and sizes within their requests.

Natural Aided Language

Natural Aided Language is an augmentative communication strategy in which visual symbols (either icons or words) are placed on an environmentally specific language board or technology device for the purpose of facilitating interaction and participation in an activity. Communication partners touch key words on the language board while saying those words so that receptive language training is occurring naturally during the activity. Natural Aided Language is an enhancement and expansion of Goosens', Crain and Elder's (1992) Aided Language Stimulation, however in Natural Aided Language, the visual language is viewed as a legitimate and real language and every activity, environment and potential communicative need is interfaced with a visual language board with or without an AAC device. 

As a real and legitimate language, every person in the child's environment takes responsibility for using the language and implementing the language board. The child with autism is exposed to this language by his family, peers and professional helpers, thereby receiving intense receptive language stimulation with the expectation, without pressure, that expressive language (with or without AAC support) will eventually occur. The symbols most commonly utilized are the Mayer-Johnson Picture Communication Symbols. These symbols can be accessed through the Mayer-Johnson catalogs as well as a computer program, Boardmaker. 


Creating Interactive Language Boards

It is important to introduce Natural Aided Language in a child preferred and reinforcing environment. Many families and teachers choose snack or meal times. These times are generally successful for children with autism who enjoy meals and they will generally remain seated for the activity. 

A "placemat board" can be created by taking an inventory of the verbs and nouns required to interact during a meal activity. Vocabulary is chosen which drives the activity, that is, gets it started, moving and completed, as well as the objects required for the actual activity and descriptors for giving the child expressive options for commenting, acceptance or refusal. 

Pronouns Nouns Verbs Descriptors Misc. 
I cup want yummy Thanks 
You trash pour yucky Please 
plate eat more No 
straw put Yes 
napkin drink 
juice taste 
cookie finished 
chips open 
sit 

The vocabulary in above is strategically placed on the perimeter of a heavy piece of placemat sized poster board and laminated for durability. The placemat board provides a readily available language stimulation activity during the reinforcing time of snack. Caretakers interact and "chat" with the youngster naturally while touching key words. All communicative attempts on the part of the child are acknowledged as valid and shaped by parent, teacher or caretaker imitating and modeling child communication verbally and by touching the picture symbols. 

The use of VOCAs (voice output communication devices), such as the BIG MAC, Voice in a Box, and Talk Pad can enhance communication training by providing auditory feedback for the responsive student. Requesting, commenting, behavior management, as well as literacy and curricular adaptations can be addressed with Natural Aided Language Strategies on VOCAS. Strategies such as Modeling, Time Delay, environmental prompts and faded physical prompts can provide the structure for teaching AAC the student. 

Literacy Learning and Communication Skills Development

There was a time when the sequence of literacy development detailed that a child first learns to listen, speak, read, and then write. Unfortunately, this often meant that children with autism were excluded from literacy learning experiences. In light of the fact that these children have a scatter of strengths and needs, and demonstrate strong visual processing skills, it is essential to provide reading and writing/keyboarding experiences for them. In addition, current, state of the art findings are detailing hyperlexic children who, with support have been using their literacy skills in interactive communication contexts. Picture symbol adaptations of journalling programs, general curriculum and literature can make communication and participation more accessible for students with autism

Introduction to Augmentative and Alternative Communication

Augmentative and alternative communication (AAC) refers to ways (other than speech) that are used to send a message from one person to another. We all use augmentative communication techniques, such as facial expressions, gestures, and writing, as part of our daily lives. In difficult listening situations (noisy rooms, for example), we tend to augment our words with even more gestures and exaggerated facial expressions.

People with severe speech or language problems must rely quite heavily on these standard techniques as well as on special augmentative techniques that have been specifically developed for them. Some of these techniques involve the use of specialized gestures, sign language, or Morse code. Other techniques use communication aids, such as charts, bracelets and language boards. On aids such as these, objects may be represented by pictures, drawings, letters, words, sentences, special symbols, or any combination thereof.

Electronic devices are available that can speak in response to entries on a keyboard or other methods of input. Input can come from any number of different switches that are controlled with motions as simple as a push of a button, a puff of air, or the wrinkle of an eyebrow. The possibilities increase virtually every day! Augmentative communication users don't stop using speech! When speech is used with standard and special augmentative communication, not only does communication increase, but so do social interactions, school performance, feelings of self-worth, and job opportunities.

Choosing the Most Effective Communication Program

When trying to determine which communication program will have the best impact on an individual with autism, one must keep in mind that autism is a spectrum disorder. Every child is a unique collage of strengths and needs. There is no "rubber stamp" best program for every child.  Augmentative and Alternative Communication (AAC) technology is showing great promise as a vehicle for implementing a variety of methodologies more effectively. More importantly, though, providing a means to communicate immediately, that is, at first diagnosis, is essential. Functional communication training minimizes the development of aberrant behaviors and many researchers believe it provides the scaffolding for the development of more complex language and cognitive skills. Interaction, communication and discourse between people are essential parts our humanness. Individuals with autism are entitled to the tools necessary to exercise this most basic human right.