Many parents of children with autism have been told that if their child has not started speaking by the age of 5, he/she is unlikely to ever speak. However, some researchers have opposed this view. There have been cases of children who developed language during primary school or even adolescence. These are children who were diagnosed with autism and severe language delay at age 4. However, they have gone on to learn language. Researchers have also found that who go on to speak at a later age had higher IQs and lower social impairment (Wodka, Mathy, and Kalb, 2013). This shows that language rarely develops in isolation, but developing cognitive and social skills (such as joint attention, understanding and usage of gestures, eye contact) promotes language development. Therefore, early intervention programs must also target cognition and social interaction.
Each individual with autism is unique & even with tremendous effort, a strategy that works well with one child may not work with another. Therefore, though language development is a good objective, establishing communication is the broader goal. Non-verbal children with autism have plenty of alternatives to help them communicate like visual support or assistive technology.
What types of intervention help children to speak?
Interventions which use Augmentative and Alternative Communication (AAC) show optimum outcomes (Kasari, 2013). The AAC approach uses techniques like sign language, speech generating devices and PECS.
This is designed to help children communicate their wants and needs in a variety of settings and contexts (home/ school/ community). PECS does not require complex or expensive materials as it mainly uses picture symbols to communicate. The goal is to make the child initiate spontaneous and functional communication. That is, first the child is taught to approach the person they would like to communicate with, with a picture of a desired object or food item and place the picture in the person’s hand. The understanding is that the child would like this object/item and is communicating his desire for it. The next goal in the PECS system is to generalise this skill by using it in different places with different people and across distances. After this step, children are trained to select from two or more pictures to ask for their desired/preferred item. These are usually placed in a “communication booklet” – a ring binder with Velcro strips where pictures are stored for easy retrieval.
More advanced phases of this system include training to construct simple sentences on a detachable sentence strip using an “I want” picture followed by a picture of the item requested.
Children then learn to expand their sentences by using adjectives, verbs, and prepositions. Finally, children learn to answer questions using PECs, for instance, “What do you want?”; and comment in response to questions such as, “What do you see?”, “What do you hear?”, and “What is it?”.
Although you might be worried that such a system of communicating might replace speech, research has shown that there is no evidence of such an effect. On the other hand, PECS has been found to facilitate speech in some children.
Another method to facilitate communication is a speech-generating device. Studies have shown that minimally verbal children with autism do gain spoken language faster when play-based therapy included speech-generating devices (Kasari, 2013) including iPads with special apps. Such therapy encourages engagement with the therapist and the use of spoken language. Children are shown to use words more often and engage in social communication with others more spontaneously.
Other effective strategies to help children communicate include: encouraging play and social interaction. Children learn through play. Interactive play provides the opportunity for you and your child to communicate. You can try playful activities that promote social interaction like singing nursery rhymes. Imitating your child’s sounds and play behaviour has been shown to encourage more vocalizing and interaction. This in turn encourages your child to imitate you and take turns (Dawson and Elder, 2013).
Also, do pay attention to nonverbal communication. Gestures and eye contact build a foundation for further communication. Encourage your child by performing such actions, try and exaggerate your gestures. Use both your body and voice when communicating, for example extend your hand to point when you say “look”; nod your head when you say “yes”. Respond to your child’s gestures, for instance, when your child looks at or points to a toy, hand it to him/her. Similarly, point to a toy you want before picking it up (Dawson and Elder, 2013).
Simplify your language. Doing this helps your child follow what you are saying. Use single words (for instance, if you and your child are playing with a ball, say “roll ball” or “catch”). If your child is speaking using single words, progress to the next level: start speaking in short phrases (for instance, “catch the ball” or “throw it to me”) (Dawson and Elder, 2013).
To summarize, developing communication with or without language should be an important goal of all interventions.