This can be one of the most daunting questions parents of children with autism try to answer. As we know, each individual autistic child presents with their own particular mixture of abilities and challenges. Therefore, there is no "one-fix-suits- all" solution when it comes to helping children impacted by autism in learning language. That's why in trying to answer this question, I'm not relying solely on my Speech and Language training, but also on other approaches I believe are beneficial and appropriate to use with autistic individuals. They have all been personally employed during the last 12 years on my journey of discovery whilst investigating this field for the development of my own autistic son.
I started this journey as the parent of a non-verbal autistic child, experiencing the all-too-typical exodus of friends following diagnosis. Having my own Social Worker and being on first name terms with all the professionals in the area, I had already been implementing dietary intervention for several years and also had training in Applied Behaviour Analysis (ABA) before I went into Speech and Language therapy. Working with professionals using new behavioural and neurological approaches has helped further develop my understanding of how an autistic individual can learn and progress.
Considerations for the Non-Verbal Child
When asking yourself the question: "How do I help my autistic child learn to speak?" consider things from the child's point of view: "Why would I want to learn to speak?"
If you take a step back and observe your child impartially, you'll see a person actively employing a variety of strategies to avoid interaction with others, whilst at the same time controlling the environment to suit his needs. This often happens through use of simple but effective methods such as throwing himself down and screaming loudly until the desired item appears.
Some would say that this behaviour occurs because:
- The individual has autism
- The individual can't speak
- The individual has issues with pain
- The individual's senses are overloaded
- The individual doesn't like change
- Neurological development is not advanced enough for the individual to act in any other way
- This is a learned behaviour employed to obtain the desired outcome
The truth is, we don't know. It could be all, some, or none of the above, but it's important to consider all of the above whilst keeping in mind change is still possible.
Initially, I recommend that parents consider a behavioural approach to develop interaction with their child to help in making sense of the world around him. As people with autism often have limited interests, the approach must be based around the core needs and wishes of the individual.
We know that interacting with others can be a huge issue for the autistic individual, and therefore there must be a payoff involved if there is to be compliance. Also, we know that as with anything, the more an attempt is repeated, the easier the process becomes. So, whilst at the moment the whole interaction process may be a tremendous effort, the more frequently the action takes place, the less of an issue it will become.
So consider what really motivates your child. Some possibilities include:
- A specific toy that is particularly desired
- Bubbles
- Tickles/strong hug
- Television remote control
- Specific video or DVD
- Food
- Drink
- Musical games (e.g. "Row, row, row your boat")
Now we need to take control of whatever motivating device is selected so that the individual will have to interact with us to get it! Obviously, this will initially be a fairly stressful situation for everyone as we are changing the rules of how things normally work. Communication needs to be very specific about this process so the individual will understand as quickly as possible what is being asked of him, and what needs to be done in order to obtain the desired item or action.
Current Speech Sounds
If the child is non-verbal, does this mean no sounds are produced at all, or are there vocalizations which could be attempts at speech? Make a note of any sounds produced. Are there any speech sounds being made, and if so, which ones?
Sounds are produced by different articulators and will either be voiceless or voiced. During voiced sounds, the vocal cords vibrate during production whilst in voiceless sounds, they do not. If one sound from the pairs listed below can be produced, it's possible the other one in that pair may eventually be produced as well. It's important to note if there are any pairs of sounds that your child does not use at all so these can be targeted for production.
Visual Support
Lots of children with learning difficulties are visual learners and this is often the case with autistic children. Difficulties with the auditory processing system can make attaching meaning to sounds a complicated business. This is why a visual approach to learning can be very effective for children with autism.
It can be very beneficial to use visual mechanisms to support your child with any new process. Signing and pictures are useful supports for any child trying to make that step up to producing sounds and shouldn't be viewed as a barrier to the development of speech.
You know your child best and which approach you wish to adopt needs to be based on individual preferences, abilities, and motor skills. If you are considering signing, you'll need to access the appropriate signing materials which will usually involve the purchase of the products as copyright restrictions are very strict.
I personally prefer to use picture prompts as these allow for accuracy in assuring the images used match those of the actual items for which the child is being prompted to ask. There will be no motivation if a picture of a red car is being used when the child actually wants his well-chewed yellow one.
These pictures are easy to make using a digital camera. Be sure to remember to laminate your picture before use to extend its lifespan. You'll need to be very specific in creating the pictures. For example, if the verbal request is for "crisps," your picture needs only to include that one item, as additional items could confuse the message. Where possible, make sure the pictures are made in natural settings. For example, if the car is normally on the floor, the picture should be of the car on the floor to increase the clarity of the request.
The Behavioural Approach
If you've identified that a packet of crisps (food item) will be the best motivator for your child, then you need to set the scene by emptying the cupboard from which he would normally help himself. An empty packet or picture should be placed there for the child to bring over to you to show you what he wants. The only thing you should say when he brings the packet (picture) over is the name of the item. In this case, the process would be:
- You say the word "crisps"
- Leave a pause
- Repeat the word "crisps"
- Leave a pause
- Any vocalisation ( other than meltdown) should be rewarded with the desired item
Phonologically, "crisps" is a more difficult word as it is made up of two sets of speech combinations: c/ri/sp/s or c/ri/sps depending on how one chooses to pronounce the word. I'm using this as an example because in my experience most families tend to have a cupboard such as this with easy access to items such as crisps.
Ideally, it would be best to keep up with this approach until you receive a vocalisation. However, you may decide that you will do this for a certain length of time initially and build up the amount of time you wait for a response. You are probably going to get rewarded with a screaming fit initially as this is typical of the process. We need to work through this and show the child that a screaming fit does not get rewarded with the desired item, while a vocalisation does. The most important element of this approach is consistency. It should be built it into everything you do so that a pattern begins to emerge to guide your child and help him understand how to get the desired item quickly with a simple vocalisation.
Neurological Considerations
In children with autism, the wiring up of the neurological system tends to be atypical, often resulting in difficulty accessing or developing the skills for speech and language.1,2,3,4 Children may exhibit involuntary responses and reflexes which would normally have been settled or inhibited during the first three years of life during typical child development.5
Vocabulary and comprehension are higher-level neurological skills. The efficiency of these skills is dependent on the successful maturation of the lower centres or brain stem.6 If the development has come to a stop at the lower levels, it is blocking access to the tools further up. Neurological development in young children is dependent on the integration of involuntary reflex responses, called the primitive and postural reflexes. Integration of these responses enables more efficient access to the speech and other cognitive skills which are associated with the cortex or thinking centres of the brain.7
I have found that intervention from a Specialist Occupational Therapist using a kinaesthetic approach can been hugely beneficial for children with autism. Programmes involving 15 minutes of personalized kinaesthetic exercises on a daily basis have produced dramatic changes, even in older children. The areas of progress I've seen include:
- improved motor skills
- the ability to recall and recount memories from years previous
- increased level of problem solving skills
- greater awareness of others and their needs
- increased ability to access higher language functions.
Addressing Echolalia
Echolalia is the repetition of vocalizations made by another person. When a child repeats what has been said rather than offering a response, the appropriate response can be prompted to the child as follows:
- You say: "Do you want chips?"
- The child repeats: "Do you want chips?"
- You model: "Yes, I want chips"
If you can once again support this with visual material, it will help the autistic child attach meaning to words. Provide a choice of items using visual support of items wherein one might be selected preferentially over another. This will assist the child in learning that "Do you want chips?" actually means something more than just a collection of nice sounds.
To illustrate this practice using the example of "Do you want chips?" you could show a picture of chips and then ask, "Do you want ice cream?" whilst showing a picture of ice cream. Then reduce word content down to just choice of chips (showing picture) and ice cream (showing picture):
You need to be aware that chips/ice cream are both food items and therefore this makes it a slightly harder choice. You can reduce the level of difficulty by offering something completely unrelated such as book/chips provided you use something that will not be more motivating than the target!
General language expansion
General language expansion should be approached with an effort to consistently include things that you know are motivating for the child. If, for example, he is particularly motivated by Thomas trains, use these. You can use them for prepositions as in, "Put Thomas on the chair," or "Put Thomas under the chair." The difficulty of the task is reduced because the child already knows who Thomas is. You can make it more challenging by adding another train as in, "Put Thomas on the chair and Henry under the chair." You can also incorporate the concept of colours by referring to the trains as the red, blue or green train.
Use favorite toys to illustrate verbs in this manner: "Buzz is sleeping," or "Buzz is eating," etc.
Always use visual support, reduced language constructions and repeat information, remembering to allow your child the time needed for processing.
Question formats which can be helpful in this process are illustrated below:
1. Buzz went to the park.
2. Who went to the park?
3. Buzz went to the park.
1. It's Monday today.
2. What day is it today?
3. It's Monday.
Following these formats in developing speech can yield significant progress for your child. Remembering these simple strategies will keep things moving in the right direction: Make it visual, keep it simple and make it fun!
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