This section considers the ways in which practitioners can support children's understanding and communication by using every day routines, objects and visual prompts.
Also included are ideas to motivate children to communicate, along with achievements in developing understanding and communication.
How everyday routines can help
Routines are important for all children and especially children with autism. If a child has problems understanding spoken language, routines can be used to help with understanding because they are repetitive and predictable.
Many children with autism develop their own routines and rituals. There are several possible reasons for this. Sometimes they develop because the child is trying to predict or control what is going to happen. They may also be a way for the child to occupy themselves.
A preference for routines can be used to an advantage when trying to teach a child everyday self-help skills. At first, a fixed routine will need to be used so that the child will begin to understand what is happening and what will happen next.
Simple reduced language (key words) can be used to show the child what is going to happen along with gestures, objects or pictures to support understanding. The routine gives lots of opportunity to repeat and emphasise words, which gives the child lots of experience of associating the words with the event.
When the routine is familiar, small choices and changes can be introduced. For example, when the child has learned to sit at the table for his favourite snack, a choice between two foods can be offered.
Using visual prompts
Children with autism often need extra help to understand spoken language. Speech should always be simplified and repetitive, with an emphasis on key words. Visual clues such as gesture, objects, signs and pictures should also be used.
As the child progresses it may be helpful to use a hand signing system such as Makaton. The advantage of using signs is that they are both available and transportable. Signs are very useful for teaching verbs. For example, the sign for running can be more obvious than a picture of someone running. Signs are also useful when the child is ready to start putting words together and understand short sentences.
Using objects of reference
At an early age, babies learn to associate objects and sounds with events, eg the sight of a bottle means that milk is coming. Objects can be used with a child with autism to help prediction, eg a cup to indicate snack time. An accessible box with key objects can also be used to encourage the child to fetch objects to show you what he wants.
It is advisable to start with one or two objects. Teach the child to give one when he wants the associated event and always deliver what is asked so that the connection is learned. This exchange with objects or pictures is a good way show a child the purpose of communication.
Using pictures or photographs
As well as using objects to show what will happen next, it can also be helpful to use pictures or photographs to show the sequence of an activity. For example, lay out pictures of clothes in a sequence so that the child can learn to get dressed in the right order.
Completing tasks can be difficult for children with autism. They often lose the thread of what they are doing and can stop or repeat an action over and over again. Using a visual sequence helps to cue them into what they are doing now and what will happen next.
Using pictures and symbols to communicate has been developed in a number of programmes for children with autism and can be very successful in developing the early stages of communication. Picture Exchange Communication System (PECS) is one programme which uses symbols to communicate. It has been found that in the early stages this helps to develop rather than delay the child's ability to understand and use spoken language.
Helping a child to understand words
Practitioners should observe, wait and listen to the child; becoming a responsive partner with many opportunities to talk.
Ways to do this include:
- Simplifying language so that the child can understand
- Making points that are direct and simple
- Concentrating on what the child is doing
Getting close to the child and talking face to face. Patience is needed here, as some children with autism will resist physical closeness with others
When the child shows some understanding of a few key words and can imitate a familiar action, it may be appropriate to start some direct teaching to develop understanding of words and concepts.
Achievements in developing understanding:
- Demonstrates understanding of gestures, such as hand out to be lifted up
- Co-operates when being physically guided through familiar routines such as going to the toilet
- Understands that gestures or objects can communicate familiar events, for example, come here can be shown by the gesture of a hand held out, dinner time can be shown by giving the child a spoon
- Responds to own name by stopping and turning
- Stops an activity when gestured or told 'no' or 'stop'
- Understands a few key words, signs or pictures in context, for example, drink, car
- Follows simple instructions accompanied by gesture, such as 'come here', 'give it to me' and 'wave bye bye.' Objects and pictures can also be used to support understanding.
- Identifies some familiar people and objects when named, for example; drink, car and ball. Gestures and visual cues will still be used to support understanding
- Follows requests verbally and supported by visual cues that involve five objects for example; throw the ball, give me the cup
- Understands ten or more requests involving everyday items for example, cup, coat, chair
- When asked can touch own body parts
- Understands twenty or more requests involving everyday items for example; plate cup, coat, chair , names of food and drink, names of clothing
- Understands the words and signs for simple actions such as; sit, jump, clap and can perform the action
- Follows instructions involving two key words for example, put cup on table, put car in box
Visual support should only be phased out when the child can attend more to the words that are being said. When new words and phrases are introduced it is helpful to go back to using visual supports, even if the child can understand some words without them.
Children will only begin to use language meaningfully when they have heard and understood it. All children need to hear words over and over again before they want to say them. Children with autism often have very little motivation to speak because they find it hard to understand the purpose of communication.
To communicate successfully the child will need:
- A reason to communicate
- The opportunity
- The means to communicate
To feel that the effort to communicate is worthwhile, the child will need to get results. He needs to know that someone understands him and is responding in the way he wants.
Some common reasons why young children communicate include:
- Requesting an object
- Asking an adult to do something
- Wanting more or wanting something again
- Wanting some attention
- Commenting on something of interest
- Asking for something to be named
Opportunities can be created for a child to communicate:
- When he wants something but is not able to get it without help
- When a choice is offered - story or outdoors?
- When something unusual happens, either a change in routine or a familiar object being used differently
- When the child wants to get or keep your attention
Means of communication that young children commonly use include:
- Smiling and laughing
- Using their bodies, throwing, banging
- Using objects, for example throwing a spoon on the floor to show he has had enough to eat
- Using speech
Babies do not do things to communicate on purpose, but gradually learn that what they do gets a response. A child with autism may have difficulty noticing the connection between what he does and what happens as a result. They need structured teaching to begin to make this important connection and to make progress in communication.
Developing a child's ways of communicating
If the child is not using words it will be helpful to teach him to copy sounds, which may encourage further vocalisation.
Set up opportunities where the child can see something he likes but needs to signal to you that he wants it.
If the child repeats words/phrases heard but not in a communicative way, (echolalia), add meaning to this by assuming he means to communicate, eg repeating the phrase or pointing to the object. When the child is responded to in this way, it encourages him to make further attempts to communicate.
Offer choices to encourage communication; this could initially be reaching out or making a noise. If he finds it difficult to make a choice, offer one thing you know he likes and one he doesn't. In the beginning, limit the choice to two things and slowly increase this as his understanding develops.
Achievements in a child's communication
- Observe the child to analyse how he communicates how he feels and what he wants
- Assume he is trying to communicate his needs and respond positively, naming what he is doing; this will encourage him to communicate more
- Help the child to realise that adults are useful in getting what he wants
- He may approach and touch another person to get something. He may also reach towards an object when someone is close by
- He may push another person's hand away or may push yours away if you get close This is his way of communicating 'no' or 'go away'
- Gradually the child will learn to take adults hand or pull her to something he wants
- Next, he may use his voice along with some gestures to request objects and actions
- He may make sounds and say some words, not necessarily to communicate
- The child may say several words, phrases and rhymes but not in an appropriate context
- He may repeat words he has heard to get what he wants
- The number of words used will increase. Adults need to respond as if he meant to communicate eg by giving him the things he has named
- He may use some learned phrases to communicate, for example, 'what you want' to mean he wants a drink
- He may be able to make choices that are important to him. He will have his own way of communicating 'yes' or 'no' from shakes of the head for 'no' to putting his hand out for 'yes'