Autism is a spectrum of behaviors and characteristics, as well as of language and communication abilities. Some individuals with autism use minimal or no verbal language, and some use long chunks of verbal language taken from movies or other aspects of their environment.
Others imitate verbal language but rarely, if ever, use this language functionally for communication. In many ways, this group presents the most challenges. Although these children may be viewed as verbal, they are not using verbal language spontaneously and meaningfully for communication.
The PECS (Picture Exchange Communication System) protocol is a means of helping children learn to use verbal language in this purposeful way. The key is that it teaches facilitators to wait for initiation from the child. This means the facilitator—in our case an SLP—presents a preferred item to the student and waits for that student to initiate, perhaps by reaching for the item.
I find this protocol useful for all students with autism, whether they are verbal communicators or use a form of alternative and augmentative communication. By incorporating the concept of waiting for initiation into your treatment, students learn to “go first” and communicate spontaneously, rather than to only respond to others, regardless of their communication modality.
I find the strategies listed below most useful when I work on increasing spontaneous verbal communication in students with autism:
Follow the child’s lead
Although our students with autism can’t always tell us what they want, they almost always show us. Follow the child’s lead and give him a few minutes to explore your room. See what he gravitates toward and what interests him. Finding highly motivating items and activities makes an excellent first step in increasing meaningful, spontaneous communication. If the child doesn’t show noticeable interests, present him with a few items and assess his response. Does he laugh, reach out for the item, or try to engage with you? If so, start working with these items. Try wind-up toys, bubbles, musical toys and puzzles.
Model the language
Model the name of the item or activity the child selects. If the child gravitates toward bubbles, simply say the word “bubbles” each time before you blow them. This way the child knows what is expected of her and attaches meaning to the word “bubbles.”
After you model what you expect, simply wait a moment for the child to initiate. If you followed the child’s lead and chose something highly motivating, this usually works. For example, take a few turns blowing bubbles, put the top back on the bottle and wait for your student to initiate by reaching for the bubbles. You don’t need to ask, “What do you want?” As mentioned above, the child will likely show you what she wants.
Provide cues and then fade them
Once the child shows initiation, provide cues such as the ones listed below, or try a combination of cues to elicit the target utterance.
- Phonemic – initial sound of target word.
- Postural – mouth positioned to produce sound without actually doing so.
- Gestural – point to mouth.
For instance, after you model and wait and the child initiates by reaching for the bubbles, provide a phonemic cue, such as “buh” for “bubbles” to elicit “bubbles” from the child. You want the child to produce spontaneous language, so fade your cues by moving from your current level of cueing to another providing less information—go from phonemic to gestural, for example—until cues are no longer needed.
It might look something like this:
- Adult: Model “bubbles” and blow bubbles. Repeat this a few times making sure the child is remaining engaged.
- Adult: Place the top back on the bubbles and demonstrate that you’re waiting for the child to show initiation.
- Child: Demonstrates initiation by reaching for the bubbles.
- Adult: Provide the phonemic cue “buh” to elicit “bubbles.”
- Child: Verbalizes “bubbles.”
- Adult: Label “bubbles” and blow bubbles.
- Repeat and fade cues as appropriate.
As I mentioned at the beginning of this post, students with autism display a variety of language and communication abilities. These tips best serve students who imitate verbal language, but who use little or no spontaneous communication. Children are all different, so modify as needed, but be sure to keep in mind the key concepts of following the child’s lead and allowing him or her to initiate!
Lauren Cernaro, MS, CCC-SLP, works in a school setting in Virginia, working primarily with students with autism and those who use augmentative and alternative communication. She is an affiliate of ASHA Special Interest Group 1, Language Learning and Education. firstname.lastname@example.org