Positive language empowers. When writing or speaking about people with disabilities, it is important to put the person first. The group designations such as “the blind,” “the retarded” or “the disabled” are inappropriate because they do not reflect the individuality, equality or dignity of people with disabilities. My paper focusses on the problems and challenges in communication faced by Autism Spectrum Disorder children. Autism is a disorder of neural development characterized by impaired social interaction and communication, and by restricted and repetitive behaviour. Typically, there is a particular difficulty in acquiring expressive communication skills.
According to the American Psychiatric Association, autism is diagnosed on the basis of three primary areas of impairment: social functioning, language and communication, and repetitive and stereotyped patterns of behavior, interests or activities (1994). The research on autism and other neurodevelopmental disorders suggests that the social and communication impairments are unique and specific deficits, which define the autism phenotype.
Social skills represent the ability to accommodate or adapt to the ongoing situations and social interactions. The symptoms defining social impairments in autism include “a marked impairment in the use of multiple nonverbal behaviors, such as eye gaze, facial expression, and gestures to regulate social interaction”; “a lack of spontaneous seeking to share enjoyment, interests or achievements with other people”; and “a lack of social and emotional reciprocity” (American Psychiatric Association, 1994, p.70). These symptoms characterize the nonverbal social-communicative behaviors of children with autism, and they, along with imitation deficits and atypical play behaviors, are the most important diagnostic indices of autism (Baron-Cohen, Allen, & Gillberg, 1992; Osterling & Dawson, 1994).
Social interaction, Communication, and Play are the three major areas in which individuals with autism demonstrate deficit and unique patterns of behavior. Being successful in communication with the child with an autism disorder does not only involve an understanding of how they communicate but also requires an understanding of why they communicate. In understanding the purpose of the child’s communication you can help the child find more ways and more reasons to communicate.
Most children with ASD (Autistic Spectrum Disorder) will have difficulty interacting with others. This is because, in order to be successful at interaction, the child needs to respond to others when they are approached by them or be able to initiate interactions. Although many children with an ASD are able to do this when they want something, they tend not to use interaction to show people things or to be sociable. It is important to remember that communication and interaction do not have to involve the use of language and speech. Many children with an ASD are delayed in their use of language and shy away from using speech. Therefore, other methods of communication need to be established before speech and language will follow.
Often, the parents of children with ASD feel that they are unable to communicate and interact with their children and are unsure of how to do so. The children may appear not to hear what is said to them, fail to respond to their name and/or be indifferent to any attempts of communication that are made. The use of everyday opportunities and play can encourage communication and interaction in a child with ASD.
The way in which the child communicates needs to be observed in order to develop their communicative strengths and needs. For example, if the child is not using any sound or speech, rather than communicating with him/her through words, try using gestures. The child with ASD may use some of the following to communicate with others: crying, taking the adult’s hand to the object they desire, looking at the object they desire, reaching, using pictures and echolalia.
Echolalia is the repetition of other people’s words and is a common feature of the child with ASD. Initially, when the child uses echolalia, it is likely that he is repeating words that he does not understand and is doing so with no communicative intent. However, echolalia is a good sign as it shows that the child’s communication is developing - in time, the child will begin to use the repeated words and phrases to communicate something significant. For example, the child may memorize the words that were said to him when he was asked if he would like a drink, and use them later, in a different situation, to ask a question. The stage of communication, that the child has reached, depends on three things:
a) Their ability to interact with another person
b) How and why they communicate
c) Their understanding
A child with ASD will find processing information a difficult thing to do. This is because he may find it difficult to understand the world around him. Even when the child with ASD does understand a situation, he may not understand the words that go with that situation. Sometimes, it is easy to assume that the child understands what is being said to him because he appears to follow instructions. However, the likelihood is that the child will know what to do when instructions are given in certain contexts because they have done it numerous times previously.
There are several ways in which to enhance a child’s comprehension of what people are saying to him. The adult can limit the amount of words that he uses to communicate with the child, but still communicate the relevant information. He should use key words that are specific to the context of the situation, repeat and stress them and use gesture such as pointing, to accompany them.
If the child has only recently begun to use speech as a means of communication, the adult should use single words to communicate with him, for example, labeling favourite toys and food. When using this method of communication, it is important to label things when they are immediately given to the child. If the child’s attention has shifted onto something else, the word will lose its meaning. Pausing in between spoken words and phrases can also help the child with ASD to understand what is said to him. The adult should use pauses to give the child time to process what has been said to him and to give him an opportunity to think of a response.
Using gestures to accompany language can also encourage the child to understand what is being said to him. For example, when offering the child a drink, the adult should gesture the action of drinking by pretending to hold a glass in one hand and bringing it to his mouth as if he were taking a sip. A similar thing can be used for eating. Over exaggerated facial expressions can also be used along with the shaking of the head for “yes” and “no”, and a waving of the hand for “hello” and “goodbye”. When talking to the child about people, for example “grandma is staying”, it helps to present the child with a photo of who is being spoken about.
The other visual methods that can be used to increase understanding include picture timetables, line drawings, cue cards and object/picture schedules.
Using Augmentative and Alternative Communication (AAC) supports
AAC describes any form of language other than speech that assists a child in social-communicative interactions. There is a large range of AAC devices available for children who have no speech, and these children themselves are very diverse. Therefore, it is essential that a team of appropriate individuals evaluates different AAC options with the parents of a child with ASD, before a decision about their use is made. The criteria that need to be discussed before an AAC device is implemented include, cognitive and motor abilities, learning style, communication needs and literacy ability.
The use of AAC devices for children with ASD can be particularly helpful. Those children with ASD, who have no spoken language, often resort to challenging behaviours to meet their needs and feelings. The use of an AAC device can give them a primary means of social communicative interactions with others. If it is decided that an AAC device is appropriate for the child, it is the responsibility of those around him to model the system.
Different types of AAC devices, that are suitable for the child with ASD, include:
- Picture Exchange Communication System (PECS, Frost and Bondy, 1994)
- Sign Language
- Interactive Communication Boards
- Communication Cue Cards
- Conversation Books
- Voice Output Communication Aids.
There are several different sign language systems, and when using sign language with a child with ASD, it can be beneficial to use a total communication approach. Total Communication is the use of combined speech and sign so that the same language structure is modelled for the child in two modalities. The use of total communication helps to highlight key word meanings and language comprehension.
Interactive communication boards
Interactive Communication Boards contain visual symbols organized according to the topic. They can be created in different sizes and formats depending on the activity and environment that they are needed for. They can be both portable and stationary - one board is designed to stay in one location. The selection and organisation of the symbols, that are used, need to be motivating and chosen to enhance functional communication for the child.
Cue cards are primarily used with verbal children. They are used to remind the child what to say and to provide him with an alternative means to communicate. They can contain one or more messages in pictorial or written form and can replace verbal prompts. They are therefore, particularly useful for children who are reliant on verbal prompts. Cue cards can work well in situations where the child with ASD needs to express a message in a stressful situation.
Voice output communication aids
Speech output devices give non-verbal children a ‘voice’. A team of relevant professionals should determine the most appropriate technology option. Once this has been established the team, then, needs to decide on an appropriate vocabulary selection, the layout of the device, the size of the symbols and the principal situations to encourage the child to use the device. There are a wide range of devices available including simpler ones for people who do not understand visual symbols. In order to use these devices, the child will need an understanding of cause and effect. The combined use of AAC, social supports, organisational supports and visually cued instruction can enhance the social communicative interactions in children with autism.
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Archana Parashar, PhD, is an Assistant Professor (Business Communication), Indian Institute of Management, Raipur. (Chattisgarh)