Autism Spectrum Disorder (ASD) and Communication
Development of communication skills among children with autism does not follow so-called typical patterns. Children with ASD appear to learn differently than other children and frequently have difficulty with spoken and written language expression. Children with ASD may not speak at all, they may speak just a few words, or they may speak but what they say doesn’t make sense in the situation. Children with ASD may have difficulty understanding spoken language – even if their hearing is “fine”. They may also not be able to understand gestures, body language, and tone of voice that convey subtle differences in meaning. Children with ASD often demonstrate difficulties with overall motor planning. The motor planning involved in speaking – coordinating the mouth, lips, tongue and facial muscles – is extremely complex and requires sophisticated motor planning ability. Similarly, the motor planning involved in writing or using sign language is complex and can prove challenging for children with ASD. These factors complicate communication for children with ASD.
Communication Barriers Addressed with Children With ASD
Despite the communication challenges ASD can present, an assumption should never be made that nonspeaking children with autism don’t or can’t communicate, or that they will never “speak”. An array of Alternative and Augmentative Communication (AAC) approaches can be used to enhance, expand and develop communication skills. The three primary forms of AAC used with individuals with autism include unaided approaches (signs; gestures), “low tech” picturebased systems (for example, Picture Exchange Communication System -- PECS), communication books and boards and speech generating devices (SGDs). In addition, a variety of other assistive technology, such as portable word processers, can support effective written expression. What Are Speech Generating Devices (SGDs)? Speech Generating Device (SGD) is the term given to the hundreds of voice output devices commercially available that are designed to provide an effective means of verbal communication for individuals whose “natural speech” is not functional for them. Other terms sometimes used to describe these items are “voice output communication aids” (VOCA) or augmentative communication devices. SGDs range from simple, single message devices with less than a minute of speech output to highly complex, computer-based systems capable of storing or generating virtually unlimited numbers of messages. Some SGDs use recorded human speech (digitized). Others use computer-generated speech (synthesized) and some of those have textto-speech capacity (as words are typed into the system, they are “spoken” by the device). Graphic symbols, most commonly in the form of line drawings, are used to represent messages, which are activated by finger, headstick or other method touching an area on the device that corresponds with the desired message. SGDs have either a static display where input for stored messages is fixed (like buttons or keys) or a dynamic display (like a touch computer screen) where the input can be changed quickly and often. For reasons unrelated to their effectiveness, utilization of SGDs lags far behind the use of other AAC systems (e.g. PECS and sign language) as an intervention option for students with ASD.
Do AAC systems deter speech development in children with ASD
NO – It is erroneous to believe that if a child is given a communication device, in particular a SGD, it will hinder speech development. This seems to be based on the faulty assumption that using the AAC system is “easier” and the child will “give up” on the more difficult task of developing speech. Research and clinical experience indicate this is not true. Humans tend to use the most effective means of communication available to them to interact with others. It is usually much more efficient for a child to use speech and/or vocalizations if possible to communicate than to formulate a message using an augmentative communication system. AAC will NOT interfere with speech development. AAC systems in general have been shown to not interfere with speech development for those individuals who have the capacity to develop natural speech, and there is evidence that AAC can facilitate speech development for some children. Research suggests that once an AAC system is introduced and an effective means of communication is available some children improve their language skills as well. In any case, appropriate AAC interventions will almost ALWAYS improve communication. Because of fears that AAC will impede speech development, there is a mistaken belief that AAC should be introduced only after giving up all hope on development of natural speech. This should not happen! By exposing a child to years of failed communication attempts, we increase the likelihood that other effective but unacceptable means of communicating will be used (e.g. excess “behavior” like throwing a chair to mean “I’m bored with sitting at this table”) or communication will decrease altogether. For children with ASD, AAC should not be viewed as a wholesale replacement for natural speech, but rather as a supplement or alternative means to provide functional communication access as natural speech development is pursued. The choice is NOT BETWEEN AAC or “natural” speech, but how to use AAC – including SGDs, unaided, and low tech approaches - to maximally support development of natural speech and effective communication.
SGDs- Speech generating devices
Although sign language and low –tech picture-based systems (including PECS) have established records of success with students with ASD, there are a variety of features that make SGDs compelling options as part of an AAC intervention for children with ASD. SGDs provide speech output, which is more readily understood and accepted by other communication partners (e.g. family members, community members, professionals, peers, etc.). Because the output is spoken, communication partners don’t need to learn special skills like how to interpret pictures or gestural messages. SGDs also provide the child with an auditory model of what the message sounds like when it is “spoken”. Speech output can transcend distance, e.g. can be used for telephone communication, or when the listener cannot make eye contact with the child (e.g. when mom is driving and the child is in the back seat). High end, dynamic screen devices come pre-loaded with extensive symbol arrays that can be organized with little effort and in many instances new page sets can be developed on the fly. Low tech, static devices generally use overlays that can easily be changed and, increasingly, more and more companies are utilizing bar code technology that improves the ease of use. Many SGDs are designed to be portable and durable. Implementation and observation by speech language pathologists, special educators and other professionals has uncovered additional positives in support of SGDs including: The “techie” nature of SGDs is appealing and motivating to children with ASD. Use of SGDs may be less stigmatizing than PECS and other AAC systems. Children with ASD frequently prefer visual stimuli. SGDs use a visual medium, frequently a dynamic visual interface, making them effective for children with ASD. Most SGDs require only simple motor movements to operate, bypassing the motor planning difficulties that some children with ASD evidence. SGDs often can serve to preempt difficult behaviors since they provide a quick, consistent means to express needs and wants.
When Should AAC Be Considered For Use With A Child With ASD?
As soon as readily possible! All children with ASD deserve access to an effective and efficient communication system including a full range of AAC options that can be used to support positive cognitive, social, emotional and behavioral development. That includes consideration of SGDs. Simple SGDs such as the single message BIGmacks can be used at roughly the same time that non-disabled children begin to speak. More advanced devices can be introduced as appropriate based on the child’s development. The first years of a child’s life are critical to language and speech development and children with ASD need the same opportunities available to non-disabled children -- language rich environments and encouragement to express their thoughts and needs. Are There Any Cognitive Prerequisites A Child Must Have To Use SGDs? There are no cognitive prerequisites for using an SGD. It is extremely difficult to assess the cognitive ability of some children with ASD. Thus, it is important to assume cognitive and communication potential. An SGD provides a framework for the development of language and as a result, regardless of the current cognitive/language level at which a child with ASD functions, an SGD can support and expand that existing language. When a child with ASD is able to communicate, his or her cognitive abilities can become more evident. This can change the perception of parents, peers, teachers and the child himself.
Specific SGDs for Use with Children With ASD
Any SGD can serve as a first step in exploring communication with children who have ASD. Evaluation usually proceeds through the identification of device features that will “match” the needs of the child. Features include the number of messages that can be stored, the system for retrieving messages, the approach to combining units of meaning (e.g. to generate new messages), the system used to represent vocabulary, the potential of the device to “grow” as the child’s language develops, the flexibility of the device (e.g. to run other software programs), etc.
What other assistive technology (AT) can be used to support children with ASD?
Children with ASD can benefit from a variety of assistive technologies in addition to AAC such as:
- Assistive Technology
- Portable Word Processor
- Talking Word Processor
- Text To Speech Software
- Visual Assistants Electronic/NonElectronic
- Assistive Listening Systems
- Keyboard with small LED screen
- Writing software programs that provide speech feedback
- Program used to convert text from print to audio formats
- Graphic symbols sequentially laying out events/activities (may also have auditory cues)
- Earphones that cancel extraneous environmental noise
- Speaker worn transmitter and listener worn receiver or near placed speakers
- Used To Address
- Poor fine motor or motor planning skills for writing
- Poor fine motor, motor planning, cognitive, or combination
- Poor reading comprehension, decoding, fluency, etc.
- Behavior issues and develop task completion/focus and language/communication skills
- Auditory overstimulation issues
- Deficits in attention and listening comprehension and auditory
There are three levels of technology that are helpful for you to understand as you read further.
"Low" Technology: Visual support strategies which do not involve any type of electronic or battery operated device - typically low cost, and easy to use equipment. Example: dry erase boards, clipboards, 3-ring binders, manila file folders, photo albums, laminated PCS/photographs, highlight tape, etc.
"Mid" Technology: Battery operated devices or "simple" electronic devices requiring limited advancements in technology. Example: tape recorder, Language Master, overhead projector, timers, calculators, and simple voice output devices.
"High"Technology: Complex technological support strategies - typically "high" cost equipment. Example: video cameras, computers and adaptive hardware, complex voice output devices.
Low tech options: For AAC, low tech options include: communication books, Picture Exchange Communication Systems, topic boards, picture communication symbols, Pragmatic Organization Dynamic Display (PODD) communication books.
Mid tech options:
- Yes/No Buttons
- Talking Brix
High tech options: High tech options include, but are not limited to:
- Prentke Romich Company (Accent)
- Prentke Romich Company (ECO2)
- Tobii (the C series)
- Toby Churchill (Lightwriter)
- Saltillo (NovaChat series; Alt Chat)
- Dynavox (Maestro; Tango)
Apps for Communication/AAC
Apps that are going to be used for AAC on the iPad need to be adapted and customized for each child. Therefore, as stated above, it is essential that a skilled professional determine whether an iPad app will meet a child’s communication needs and then provide ongoing programming and training. Here are just a few of the apps available for AAC/Communication needs:
- LAMP Words for Life (By Prenke Romich Company (PRC)
- TouchChat (By Saltillo)
- TouchChat with WordPower (By Saltillo, Word Power by Nancy Inman)
- SonoFlex (By Tobii)
- Tap to Talk
The Mayer-Johnson software program, Boardmaker, is a user-friendly program for both adults and children (18). The program offers a 3,000 Picture Communication Symbol (PCS) library in either black/white or color, and can be accompanied by any written word/message. The symbols can be made in any size, and tend to be universally understood. They present a relatively clear, 'uncluttered' representation and remove any ambiguity, which can sometimes arise when using photographs, especially personally-made photographs, as in the following example.
If the child has difficulty understanding the Picture Communication Symbol (PCS) line drawings and needs a more concrete representation, a good software program to use is Picture This (20). This program allows for the presentation of real photos, without risking ambiguous background clutter, which can be a part of personal photographs. Picture This contains over 2,700 photos from numerous categories which are ideal for:
- Creating schedules;
- Augmentative communication systems;
- Reading activities;
- Sequence activities for following directions;
- Various academic activities.
For children who have difficulty understanding two dimensional visual representation systems (e.g., photo, drawings, line drawings), and require objects as their visual representation systems, the use of True Object Based Icons (TOBIs) is suggested (3). These TOBIs can be any line drawing, picture, etc., which are cut out in the actual shape or outline of the item they represents. The child can both see and feel the symbol and shape, thus assisting him to more readily understand the two-dimensional representation system. TOBIs tend to be somewhat larger than the typical two-dimensional visual representation system. When first introduced, they may be 3 inches in size or larger (3). The printed word label should always accompany the picture, and should be placed strategically so as not to alter the symbol shape.
A web catalog to help find the most suitable apps for every person with autism!
The Bluebee Pals
The Bluebee Pals are an Assistive Technology tool used to engage students in learning and socialization. Many Speech-Language Pathologists and Special Educators have observed increases in communication, following directions and turn-taking when the Bluebee Pals are used in conjunction with an appropriate Android or Apple device. For students using an Augmentative and Alternative Communication application, the Bluebee Pal can be paired with their bluetooth enabled app or device.
The Center for AAC and Autism
The Center for AAC and Autism is dedicated to building awareness of the power of augmentative and alternative communication to change the lives of children with autism and other developmental disabilities who are challenged by limited spontaneous communication skills
DynaVox Mayer-Johnson: Augmentative and Alternative Communication (AAC) Devices and Services
As the world's leading provider of AAC products and services, DynaVox offers complete solutions for individuals with speech and learning challenges. Our speech generative devices, often funded by Medicare, Medicaid or insurance, help those with conditions such as autism make meaningful connections with the world around them.
Enabling Devices is a company dedicated to developing affordable learning and assistive devices to help people of all ages with disabling conditions.
The GoTalk Pocket is lightweight, contoured, and so small it fits nicely in your hand or your pocket! Six message keys with five levels give the user plenty to talk about. Overlays slide in easily and are stored in a removable compartment on the back. The Pocket is rugged, attractive, easy to use, and has great sound quality.
LAMP: Language Acquisition through Motor Planning
LAMP is a therapeutic approach based on neurological and motor learning principles. The goal is to give individuals who are nonverbal or have limited verbal abilities a method of independently and spontaneously expressing themselves in any setting.
MyVoice is an alternative and augmentative communications aide (AAC) designed to help non-verbal, low cognitive people communicate their needs and desires. It's the digital big brother of a “picture board”, a communication method that has been shown to work extremely well many non-verbal children.
Parelerai is the world's first Augmentative Collaboration (TM) service, using state-of-the-art Internet tools to enhance collaboration, bringing together the people and information needed to meet the challenges of everyday life for a child with special needs.
Pass It On Center
The Pass It On Center is creating national and state resources to foster the appropriate reuse of AT so that people with disabilities can get the affordable AT they need in order to live, learn, work and play more independently.
Proloquo2Go: AAC In Your Pocket
Proloquo2Go is a new product from AssistiveWare that provides a full-featured communication solution for people who have difficulty speaking. It brings natural sounding text-to-speech voices, up-to-date symbols, powerful automatic conjugations, a default vocabulary of over 7000 items, full expandability and extreme ease of use to the iPhone and iPod touch.
ProxTalker is a LoganTech brand of products that offers two unique communication solutions for individuals who are non verbal. The ProxTalker and ProxPAD use picture and tangible object tags to give a voice output. These picture tags are movable, and can be easily customized and recorded. They uniquely use RFID (Radio Frequency Identification) technology to enable independent verbal picture communication. Simply place any photo, symbols or object on a sound tag card and receive a voice output.
SmartEdPad: A Dedicated Therapy and Intervention Tool
A dedicated therapy tablet for Special Education bundled with over 100s of Therapy apps approved by experienced Therapists! SmartEdPad is one-stop solution for Children with Special Needs, Special Education professionals, Therapists, SLPs who are in Special Education Space. SmartEdPad leverages the power of a mobile device and transforms special education by taking it to a whole new level! SmartEdPad can be customized to each child or group and it can be used at school, in clinics, or at home.
A wearable device that lets you send messages with swipe, tap, or shake gestures. Smartstones Touch is the first wearable that lets you send messages with simple gestures. We're building a platform for nonverbal communication, designed for use by anyone and everyone.
Switchamajig products enable an iPad to control things in the physical world. They sell the Switchamajig Controller as well as unique adapted toys such as remote controlled cars and boats.
TalkingTablet Communication Aids
TalkingTablets help people with speech or learning difficulties to communicate. There are different TalkingTablets to meet different user needs offering text, symbols or photos as well as a choice of voices. For children and adults alike, TalkingTablets support people with a range of disabilities such as autism.
Portable, customizable, affordable, socially acceptable AAC for Nintendo, iPad, iPod Touch, iPhone, Android devices and the web. Give your child a voice!
A revolutionary computer station that enables people of all ages and abilities to effectively use the computer independently.
A revolutionary computer station that enables people of all ages and abilities to effectively use the computer independently.