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 have difficulty in understanding nonverbal communication patterns like facial expressions, gestures and intonation patterns of voice. Also, the motor coordination of articulators (mouth, lips, tongue and facial muscles) required for speaking is very complex and requires fine motor planning ability. Same is the case for using sign language and writing. Thus, it becomes difficult and challenging for children with ASD to communicate with others.

Communication Barriers Addressed with Children With ASD

With regards to communication challenges faced by ASD children, there has been a wrong notion that they can’t communicate with other individuals and that they will always be nonverbal. But there is a ray of hope for such children in the form of Alternative and Augmentative Communication (AAC) to help them communicate with other individuals in the society. It reduces their effort and helps in expanding and developing their communication skills.

There are 2 types of AAC approaches available:

- Unaided which includes sign language, use of gestures, facial expressions and body language

- Aided which includes “low tech” communication devices that are picture based as well as analog devices like communication boards (communication devices and other category includes “high tech” AAC devices that work on digital technology (electronic or computer based devices).

High tech devices are also known as Speech Generating Devices. These devices generate voiced verbal sentences.

Image Courtesy: Sign Language1

Image Courtesy: Sign Language

Unaided AAC approaches

High Tech AAC devices

Image Courtesy: Theautismhelper

Low Tech AAC devices

Image Courtesy: Isorimall

What Are Speech Generating Devices (SGDs)?

There are hundreds of voice output devices commercially available which provide an effective means of verbal communication to children and adults who are unable to speak.

There are various terms used to describe these devices i.e. "Voice Output Communication Aids" (VOCA) or Alternative Augmentative Communication devices (AAC).

Voice Output Communication Aid

Image Courtesy: Aceoldham

SGD’s contain a wide range of devices starting from simple, short single message devices (less thana minute of speech output) to highly complex computer-based systems which are capable of storingand generating unlimited messages.

SGD’s are also divided based on the form of speech output i.e. some devices use recorded humanspeech which is also known as digitized speech while others use computer-generated speech whichis a form of synthesized speech. Some devices also have text-to- speech i.e. the typed words arespoken by the device.

Also, some devices use graphic symbols, usually in the form of line drawings to representmessages, which are activated by touch that corresponds with the desired message.

For various reasons, the use of SGDs lags far behind the use of other AAC systems (e.g. PECS andsign language) as an intervention option for students with ASD.

Do AAC systems deter speech development in children with ASD?

“The child will never be able to learn to express himself/ herself verbally if he/she uses an AAC” This statement is a very big myth or a faulty assumption of parents as well as professionals who are working with the child having Autism and who uses an AAC device to communicate. It is even faulty or inappropriate to believe that using an AAC device is an easier task than speaking and the child will not attempt to speak which is a more difficult task. In fact, we can say that it is the reciprocal i.e. every child will find it much more efficient to speak/vocalize and communicate his/ her thoughts as compared to generating a message through the AAC.

To use an AAC device to communicate, the child first needs to learn all the signs and symbols of the words which are used in his/ her daily life. This way the child's receptive vocabulary which contains signs and symbols will expand, the child will then learn to formulate a sentence in which he/she has to learn to form a grammatically correct and relevant sentence which appropriately communicates his/ her thoughts. Thus, learning to use an AAC device is a very difficult task.

AAC devices do not interfere with the child’s speech development in fact they facilitate the speech development in most of the children as their non-verbal receptive and expressive vocabulary expands after using AAC. Also, their level of frustration generated due to failed attempts to communicate their thoughts verbally and non-verbally is reduced. Thus, use of AAC devices helps the child to be much happier and contented in terms of communication which in turn reduces the behavioral issues coming in their way of language learning. Various researchers also suggest that using an AAC device to communicate improves speech and language skills of the child. AAC devices should not be used as a replacement for speech but as an alternative.

When should an AAC be considered?

Most of the children with ASD are usually hyperactive and have sensitivity issues. Along with this, they suffer from other behavioural issues like frustration, anxiety, self-injurious behavior as well as injury to others. Occasionally, children with ASD have these behavioural issues because they are unable to express themselves verbally (non-verbal ASD children) and if they express themselves. the people in their surroundings are unable to understand and fulfill their wants and needs. Thus, an AAC should be considered as a supplement for verbal communication when the child’s behavioural issues become uncontrollable.

It can also be considered for use when in spite of long term therapeutic interventions, the children are unable to grasp verbal communication skills. An AAC can also be used if we want to avoid the child from developing behavioural issues due to inability to communicate verbally.

All children with ASD have the equal right to learn and use AAC communication devices so that their social, cognitive, emotional and behavioural skills are nurtured and developed well. Thus, an AAC device can be introduced to an ASD child at the age when a typically developing child starts learning language and communication skills i.e. during their first years of life.

Initially, simple low tech AAC devices can be considered. As the child’s age progresses, high tech, easy to use and effective AAC devices can be used like Speech Generating Devices. Thus, this will help in language development of the child during their early years of life and we can also expect the child to develop verbal communication skills.

AAC devices are very beneficial for the child with ASD as well as the parents because it helps them recognize the child’s cognitive potential.