Anne S. Holmes, M.S.,C.C.C.,B.C.B.A.
Looking back over the past 40 years, it is amazing to see how far we have come in regard to supporting individuals with ASD. In the 70’s, a nonspeaking child with ASD had little chance to communicate and because of that a poor prognosis. In 2018, it is well acknowledged that every person with ASD can communicate verbally, through sign language, with picture systems or with a voice output system.
In 1973, Margaret Creedon kicked the “communication door” open with her study demonstrating that teaching sign language to a nonverbal child with ASD positively impacted their verbal skills development. Then in 1985, Andy Bondy and Lori Frost introduced PECS (Picture Exchange Communication system) which captured the need to include a communication partner within a picture system. With the development of the PC (personal computer) in 1975, to the introduction of the iPad in 2010, the ability to provide a “voice” for the individual with ASD became a reasonable option. Technology (iPad, iPhone etc.) is reasonably priced, extremely portable, socially current and new communication applications are being created continuously. With these systems as the primary AAC (augmentative alternative communication) systems, the challenge becomes how systems are selected.
Autism is a spectrum disorder, and as such, it should be obvious that no singular AAC system can be introduced to every nonspeaking individual with ASD. To that end, assessment is necessary to determine what AAC system is the best match for each nonspeaking individual. The assessment model that best suits individuals with ASD is based on a feature-matching process (Swengel & Varga, 1993). This process focuses on matching the skills of the nonspeaking individual to the features of the AAC system. While attempting to match features of the individual to the AAC system, it is important that the individual’s needs at the time of the assessment are the focus, not future use. Communication options should develop with the individual.
Taking into account the uniqueness of ASD, there are some specific features that need to be attended to when selecting an AAC system. When a child is first diagnosed with ASD, the focus of early intervention services is on establishing verbal language. While developing verbal language remains the priority, the most natural system of communication to support the emerging language is a gesture system. Eliciting a point for requesting, a “push away” or head shake for “no” and a “pull” for help should be prioritized.
When considering sign language as a potential AAC system, it is important to acknowledge that in order to effectively use sign language as a communication system, the user must be able to retrieve the desired sign from memory and use it. Scrolling (producing all known signs) is an indication that the user is not able to retrieve the sign from memory and as such may not be a good match for that individual. However, sign language is a viable option for an individual who can’t manage materials. Whether the difficulty is stereotypy with the materials or destruction of materials, sign language eliminates that challenge until the behaviors are appropriately replaced.
Picture systems and voice output systems have a unique feature that can remediate the challenge of retrieval. These systems are “menus”; instead of needing retrieval from memory, the individual can “look” and find the desired icon/picture. Static picture boards (pictures placed in permanent locations) add the feature of having a “built in” positional prompt. The individual can rely on knowing that the desired icon/picture is always in the same location.
The social exchange feature of PECs is what distinguishes it from all other picture systems. It builds in the need to have a communication partner from the beginning of implementation. For individuals who have limited motivation to communicate, PECs may not be a good match as the response effort it takes for the individual to find the icon/picture, remove it from the book, place it on the strip and then bring the strip to a person is too high and they opt not to communicate. An individual with limited motivation to communicate may respond better to a voice output system as the voice output serves as the exchange with a communication partner.
Currently, the most widely used voice output systems are technology based as these systems are reasonably priced, easy to access and socially acceptable. For many nonspeaking individuals with ASD, technology will be the AAC system that becomes their permanent system. When attempting to determine the appropriateness of an iPad for example, there are two features that should stand out. First, does the individual have a positive reaction to hearing the voice output. Do they acknowledge it by a change in facial expression or the desire to activate the icon again. Secondly, if the individual activates an incorrect icon, do they immediately self-correct after hearing the voice output. These two responses indicate a good match.
Once an AAC system has been identified, vocabulary selection and initial implementation are paramount for success. The vocabulary selected has to be what the individual wants to communicate, what is important to them, not what others want them to communicate. Initially, only wants and needs should be targeted. Once the individual begins to demonstrate that they understand the power of communication, then functional vocabulary can be introduced. In addition to selecting vocabulary with importance to the individual, it is essential that the appropriate use of the system by the individual is honored consistently. The benefit of using an AAC system will be proven to the individual by the reliable response from adults.
In 2018, every individual with ASD, verbal and nonspeaking, can reach their communication potential. An AAC system allows the nonspeaking individual to communicate effectively while focus is being placed on establishing verbal skills, particularly for young nonspeaking children with ASD. Understanding the unique characteristics of individuals with ASD and the features of AAC systems will result in a good match and successful communication for the individual with ASD.
Anne S. Holmes is a licensed Speech Pathologist and Board Certified Behavior Analyst with over 40 years experience working in the field of autism. She is the past Vice Chair of the Board of Directors and past Chair of the Panel of Professional Advisors for the Autism Society of America. Ms. Holmes is the Vice President of Autism Consulting Services for KDH Enterprises located in Hightstown New Jersey.