Communication Techniques

            This is one of the areas where I made some big mistakes because I didn’t have proper guidance.  My son wasn’t learning to speak or saying his first words and I wanted to help him.  I was given patronizing advice not to worry and not to pressure him.  He was doing some babbling and I noticed that if I babbled back to him, he would stop to listen to me.  In my ignorance, I decided that I shouldn’t mimic his sounds back to him.  When we finally began working with a speech therapist, she told me that it was important to mirror back any verbal sounds that my child made because that would encourage him to verbalize and encourage him to listen to the sounds that I was making.  I made the wrong decision and it hindered my son’s progress.  It bothers and haunts me and it’s one of the reasons why I want to make sure that other parents have the knowledge that I didn’t.

            Communication is the beginning of all interaction.  It doesn’t have to be verbal, in fact, the majority of communication relies on body language rather than words.  But communication is one of the common challenges that a child with autism and their family faces.  Sometimes it’s like they’re trapped in their own world, one where you don’t exist.  That can be very frustrating and saddening for you as a parent.  You want to build a bridge to draw them out of that world and back into yours.

            Before you can do anything else with your child, you need to have them interacting with you.  Even throwing a tantrum is an interaction.  The child has noticed you and while he or she is not happy, they are aware and interacting.  When my son first began speech therapy, he was very much trapped in a world all his own.  The speech therapist practically stood on her head and turned cartwheels trying to get him to notice and interact with her.  Her persistence paid off but it took almost a year of therapy before he became reliably verbal.

Using Your Child’s Interests:

            When you’re trying to get your child to interact with you, sometimes it helps to crawl partway into their world.  There are lots of autism therapies which are based on getting down on the floor with the child and inserting the therapist into whatever activity the child is doing.  If your child is obsessively lining up cars, then you can start adding cars to the line.  Even if your child becomes upset, remember that a tantrum is an interaction.  Use the opportunity to encourage them to ask for what they want, either with a picture or words.  Generally it is best to try and teach when the child is not upset, but if a tantrum is the only opportunity you have, then use it.

            Use your child’s interests to force them to communicate with you.  If they like being on a swing, encourage them to ask for a push.  Or teach them to wait by counting to three before pushing.  It takes a certain amount of creativity in the moment, but you can combine playing with teaching.  It’s more about using a child’s natural motivation rather than sitting down and trying to motivate them in a more artificial environment.  If you’re playing with cars, you can hold out the car until the child looks at you or makes an appropriate request. 

Eye Contact:

            Looking at people and making eye contact is a very basic communication skill and one that a lot of children with autism have trouble with.  By encouraging your child to look at you during interactions, you can make it part of their natural response.  It can be a first step in teaching your child to interact.  You can use noise, bright colours, whatever you think your child might respond to.  Many children with autism respond better to objects, so holding up a desired toy in front of your face can be a good place to start.  When the child looks at the object, make a big deal and give it to him or her immediately.  Gradually, you can move the object out of the direct line of sight.

            I used to stick brightly coloured stickers or plastic poker chips to my forehead before sitting down to play with my son.  When he looked at me, he thought I looked funny.  Usually he would reach up and take off the sticker (or whatever else I was using).  I would wait a few minutes and then stick something else on.  Eventually he started looking at me more often in order to see what I had stuck to my forehead this time.  The habit persisted and his eye contact is fairly good at this point.

 

Non Verbal Techniques – PECS:

            There are ways to reach even non-verbal children.  If your child isn’t speaking then he or she is likely much more visually oriented.  Using pictures instead of words tends to work much better for these children.  In some cases, using the pictures can help prompt the child to become more verbal.  PECS (Picture Exchange Communication System) is the common method for visual communication.  Small pictures are used to communicate, often adhered to a short strip of Velcro.  The child carries a binder or container with the pictures and then pulls them out and sticks them to the conversation strip to show people what he or she wants.  Several of the tablets are now offering a version of the PECS software.

            Teaching your child to use PECS requires the help of another adult to act as a hand-over-hand guide.  Initially, you would want to pick a picture of something highly motivating to your child.  Food is the most common choice but it can be anything motivating.  You place the picture in front of the child and show them you have the reward.  The assistant then uses their hands to guide the child’s hand to touch the picture.  As soon as the child touches the picture (within 1-3 seconds), the child gets the reward.  A little while later, you repeat the process.  You don’t want to work on it too long at any one time, otherwise your child will get frustrated.  It’s usually best to set a timer and when the timer is done, the session is done, no matter how well or poorly it’s going.

            Gradually the assistant will move to prompting the child to touch the picture, then use hand-over-hand to get the child to hand the picture to the parent.  Then they can just prompt the child to give the picture to the parent.  It’s important that the parent doesn’t prompt or use hand-over-hand because the child needs to understand that this is a way to get someone else’s attention in order to get what he or she wants.  Once the child has grasped the basic concept, then you can expand the number of pictures, teaching them to choose from between more than one option.  It’s best to teach this using something you know they really like and something they really don’t.  That way the assistant can use hand-over-hand or prompting to encourage the child to pick the preferred item.  If both items are preferred, the prompter isn’t going to know which one the child actually wants and that doesn’t help the child to learn to communicate his or her actual desires.

 

Verbal Encouragement Techniques:

            If your child does use vocalizations then you can encourage them to become more verbal by imitating the sounds that they make.  If the child grunts, you grunt.  If they babble nonsense, try to repeat it exactly the way they said it.  That helps the child to clue in that people pay attention to the noises he or she makes and encourages them to pay attention to the sounds that other people are making.  Our speech therapist said that she only drew the line at repeating a farting noise that the child made. 

To help them to distinguish sounds and words, you can exaggerate your voice, using singsong or very dramatic techniques.  When you listen or watch children’s programming, the actors are very animated, bouncing around, waving their arms and exaggerating their voices.  This makes it easier for the child to pick out the individual sounds rather than having everything blur together into the background.  Watching children’s shows can give you some good ideas on how to get your child’s attention.  Low budget shows can be particularly useful because they have to rely on getting the child’s attention with the actor rather than fancy special effects.  It’s also important to use simple, clear language.  Use one or two word sentences to communicate.  Rather than ask “Do you want milk?”, just ask “Milk?” so that your child isn’t struggling to pick out the crucial word.

Another way to encourage verbal skills is to fill in the blank.  Repeat a phrase that the child knows well, from a TV show or book or nursery rhyme, but leave out the last word.  The natural inclination is to fill it in.  Eg: Jack and Jill went up the _____.  I’m willing to bet that even as you were reading it, your mind said “hill” rather than leaving it blank.  I’ve even had adults automatically fill in the blank when using this technique with my son.  I had a friend over who was sitting with my son and I at bedtime while we read “Brown Bear, Brown Bear”, one of his favourites.  I read “Brown Bear, Brown Bear, what do you-” and stopped for my son to fill in the last word.  My friend immediately chimed in “See!” and we both had to laugh.  If your child isn’t filling in the blank, you should do it and then prompt them to imitate you.  You can use this technique with videos and TV as well.  By pausing a favourite show or clip, the child can be encouraged to finish off the line or scene.

 

“Plus-One” Technique:

            If your child is more verbal, you can encourage them to expand the words they do use by using a “plus-one” technique.  That’s where you add one more word to the sentences that your child uses and encourage him or her to imitate you.  So if your child asks “Cookie?” then you encourage them to say “Want cookie.”  As soon as they do, give them what they’ve asked for (within 1-3 seconds).  If you really want to encourage their verbal skills, don’t worry about healthy eating or meal schedules.  There will be plenty of time to get those things back on track once your child’s verbal skills are more firmly established.  You can keep building on the sentence until you’ve got something that’s appropriate and grammatically correct.

            Eg:       Child says:                  Goal:

                        Cookie?                       Want cookie.
                        Want cookie.               I want cookie.
                        I want cookie.             I want a cookie.
                        I want a cookie.          I want a cookie, please.

            The goal is to get your child to ask for things clearly and appropriately so that anyone can understand him or her.  It opens up a whole new world for the child.  Realizing that you can ask for what you want makes the world into a much less frustrating and scary place.  If you’re finding yourself getting frustrated, imagine how frightening it would be to be in a world where you never understood what was happening to you or how to ask other people for things you wanted or needed.  That can be how your child is feeling if he or she can’t communicate.

 

Scripting:

            A more advanced communication technique is called scripting.  That’s where you write out what your child should say.  Obviously, the child has to have a fairly firm ability to communicate already and the ability to read, although it can be done with verbal prompts.  This is more about teaching the child appropriate language to use in various situations.

            We’ve been trying to get our son to greet people appropriately when he’s out and about in the world.  He’s very good at telling people “Good-bye”, especially if he’s eager to leave.  But he doesn’t seem to like saying “Hello” when he arrives.  Our speech therapist recommended writing out “Good Morning” on a card and showing it to him to encourage him to say it.  It’s worked very well, getting him into the habit of saying “Good Morning” to the teachers and children when he goes to school.  We’re starting to fade out the prompt, only using the card if he doesn’t automatically respond to a greeting.

            You can create scripts for any number of situations.  This may seem artificial, but we do use scripts in everyday life.  When you meet someone, unless you’re very close friends, your conversation will likely go like this:

            Person 1:  Hello.

            Person 2: Hello.  How are you?
            Person 1: I’m fine.  How are you?
            Person 2: I’m fine.

            That’s a script and it’s one we’re all familiar with.  By writing out your child’s half of the conversation, you can make it easier for him or her to concentrate on the interaction rather than the words.  Some people with autism have been known to have difficulty retrieving the appropriate words, the same way we all do sometimes when we have a word just on the tip of our tongue.  By using a script, that frees up more of the person’s concentration to focus on the actual conversation.