In the last blog post, I talked about early intervention techniques which can help young children with ASD communicate, when speech and language are delayed. Most children with autism will develop spoken language, however they may experience a delay of a number of years. This causes frustration and emotional distress for both themselves and their caregivers, during the time when they are unable to communicate their wants and needs through language. As I mentioned previously, there is significant research to show that it is helpful to use alternative means for a child to communicate which not only facilitates communication, but can also support the development of language.
Commonly known as AAC, (Alternative Augmentative Communication), these methods may include the use of pictures, voice output devices, or manual signing, such as American Sign Language and Makaton. I have used AAC systems with many children and have witnessed how incredibly empowering it is for the child to have a means of communicating their needs with others.
Today we will explore the use of these alternative methods of communication, how it positively affects the child’s behaviour, and why it is important to positively reinforce communicative attempts.
Before describing this training, it might be helpful to put to rest a common fear among many parents of children with ASD: if an alternative system such as signing is introduced, their child will rely too heavily upon it and never learn to speak. I can reassure you that this is not the case. In fact, not only will your child have a means of communicating, which will reduce any frustrations they may have, but using an AAC system has been shown to actually speed up the acquisition of spoken language.
Additionally, there is a large body of research that supports the use of AAC as a tool to help children in learning how to communicate. In fact, there is compelling evidence that preverbal children who are trained in the use of AAC systems actually have some advantage in acquiring spoken language.
The goal of AAC training is to provide children with a positive means of expressing their needs. Most young children with Autism will take the adult’s hand to guide them to what they want or they will cry. If we can provide the child with a positive means of expressing their needs, for example a few signs, they will learn that communicating using signs gives them access to more of the things that they need, like, and want, without the distress that misinterpretation and misunderstanding can cause. They are more likely therefore to use signs and, as long as spoken language is always encouraged and reinforced, research shows that they will begin to pair the signs with sounds, then with words, eventually dropping the sign altogether and using the spoken word.
This is good news indeed for parents and caregivers of young children with ASD who fear sign training may delay their child’s language development.
The concept of communicating wants and needs is a challenge for children with ASD. Yet, once they begin to grasp the relationship between a thing they want and what it takes to get it (say, a snack), they can learn how to ask for it. Often, this is displayed through the use of negative behaviours but, if you can replace that action with a more positive alternative, and reinforce it for your child, they can learn to ask for the things they want in a different way, which is where sign language training is helpful.
Signs can easily be modelled, physically prompted and shaped with help from therapists and parents and, as a result, many young children who are preverbal find it easier to communicate their wants and needs by using signs.
It is always a good idea to discuss with your therapist whether your child would benefit from a signing system or a picture system The main point of an AAC system is not what type is used, but that the system provides a more flexible but consistent and effective way for the child to express wants and needs.
In this way, AAC can build toward the ability to communicate a wider range of meanings than non-symbolic gestures or vocalizations can achieve.
When a child comes to realize that alternatives exist, they think, “So, if I say (or express in some way) something, then others do something. I don’t need to take them by the hand to what I want and hope they understand what I need them to do with it. I can use this sign (or word or picture) to get what I want and they know what I want. That’s why everybody has been wiggling their fingers and making those noises with their mouths all this time!”
Once this moment is reached, what we like to describe as the “A-HA magical!” moment, children with ASD have a far more powerful reason to learn to speak than crying and becoming frustrated.
Taking this training a step further, I have developed a system for the practical application of AAC systems, with an emphasis on using sign language as my preferred method for alternative communication training for toddlers and very young children with ASD.
I refer to this as the SET GO program for teaching signs, as in “Ready… Set… Go!”
S: Select activities and items the child enjoys.
E: Establish a positive rapport.
T: Teach the child to request.
G: Give reasons to use targeted signs by contriving situations.
O: Omit and reduce prompts as child becomes more independent.
The following is an example of the 5-step approach I’ve used to teach first signs to preverbal young children with ASD:
Step 1: Select targeted activities or items. Create a short list of targeted activities and items the child enjoys. Identify three or four activities and items for which the child will learn the signs.
Step 2: Establish positive rapport. Help the child understand that other people can make fun things happen. Engage in activities the child enjoys and find ways to share them. For example, hold the child’s hands and sing in rhythm as he or she jumps on a toy trampoline.
Step 3: Teach how to request using signs. Use consistent, simple verbal prompt phrases (“What do you want?”) as well as physical prompts, and then name the item or action with a sign. For example, provide a closed jar with a treat in it, model the sign for OPEN, physically guide the child to produce the sign OPEN, then open the jar and provide the treat.
Step 4: Give reasons to sign. Set up situations in which the child can practice the signs throughout the day; have items from each meal and snack in closed containers so the child has the opportunity to use a sign to request that the adult opens the container.
Step 5: Omit or reduce prompts. Wait before prompting, allowing the child time to produce the sign him- or herself. If s/he doesn’t produce the sign, then provide a very small prompt, such as touching the child’s hands instead of shaping them fully into the sign for OPEN.
My experience over the last 25 years using AAC systems with children with ASD has been extremely positive. Whether I am teaching American Sign Language, British Sign Language, or Makaton, all the children I have worked with, and continue to work with, move from signs to spoken language. It is always wonderful to see the development – and reward – that this brings to the child.
As the children begin to grasp that they can express themselves in a more positive way, their frustration and non-functional behaviours due to not being understood are significantly reduced.
We will continue to explore the use of AAC systems and alternative communication training for young children with ASD in future posts. We will also offer more insight as part of a future online training program for parents and early interventionists. In doing so, the intention is to further assist parents and caregivers of children with ASD to be aware of best practices and to equip them with the necessary tools.
In the meantime, if you would like to learn more about alternative communication training for toddlers with ASD, please refer to Chapter 3 of my book, Let’s Talk.
