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How Can Speech Improve in Nonverbal Children with Autism?

Autism spectrum disorder is just that–on a spectrum; therefore, there are numerous ways in which ASD-type behaviors can present themselves as well as a spectrum of behavioral and emotional deficits. It is not uncommon for individuals with autism to have some form of speech and communication deficit and about 40 percent of those with autism are considered nonverbal. Those with nonverbal autism should have a more in-depth set of treatment options than those who are higher on the spectrum, which may include various speech and language interventions such as intensive speech therapy, learning and using sign language, and being trained on and utilizing a voice output system and a picture exchange communication system. 

Not only do those with autism tend to have delays in verbal communication, but it is also more likely that they have difficulties communicating nonverbally, such as making eye contact or understanding others’ gestures or facial expressions. Sometimes these deficits can be quite severe and treatment must begin immediately after the first signs of a delay are observed. 

“There are many different approaches, but the best treatment program begins early, during the preschool years, and is tailored to the child’s age and interests. It should address both the child’s behavior and communication skills and offer regular reinforcement of positive actions. Most children with ASD respond well to highly structured, specialized programs. Parents or primary caregivers, as well as other family members, should be involved in the treatment program so that it becomes part of the child’s daily life” (NIDCD). 

The Value of Speech Therapy

Speech therapy can assist individuals with or without autism with verbal and nonverbal goals such as accurately reading facial expressions, communicating basic needs to others, appropriately engaging in social activities with peers, making clearer speech sounds, understanding body language, practicing social skills, understanding idioms and figurative language, working on feeding, appropriately respond to questions, and so much more. 

Individuals who have nonverbal autism may go to speech therapy in a private, clinical setting or may get services in school through their Individualized Education Program (IEP), out on community skills, or even may be serviced at home. Whoever is working with the individual must be a licensed Speech and Language Pathologist (SLP) (Autism Speaks). 

“The fact that early language and cognition predict later language for children with ASD may seem obvious, yet these findings reinforce the importance of starting interventions with children with ASD as early as possible” (Watson, 2008). 

Sign Language for Those with Nonverbal Autism

Children who have autism and do not communicate verbally can begin to learn sign language as a primary form of communication, although they may need to supplement with other means, which will be discussed later on. 

Even though small babies are not diagnosed with autism, between six months to one year parents and caregivers should begin to pay close attention to developmental milestones and red flags. If a parent notices that speech is delayed or their child is completely nonverbal, getting their child seen by a physician and SLP immediately are recommended.

Once it is determined that a child has autism, speech services should begin as soon as possible, which should include teaching the child sign language if he or she is nonverbal. This can be done through a variety of methods, such as using flip charts, flashcards/picture cards, videos, and explicit instruction with the tell-show-do method. 

In a study by Pearson Assessments, it was found that “On average, participants (children with autism) demonstrated a moderate degree of communication improvement regardless of the communication intervention strategy, although the largest effect (based on the PND) occurred for sign only. Only three of the seven studies presented generalization or follow-up data, and two of the three found that the participants were able to transfer the treatment condition learning to new environments” (Schwartz, 2006). 

This shows that using sign language with children with autism is successful in increasing their overall communication and what they are taught in a clinical setting is generalizable to other settings. 

Augmentative and Alternative Communication

Augmentative and Alternative Communication (AAC) is “any form of communication that people use if they are unable or unwilling to use standard forms of communication such as speech” (Research Autism). 

Two examples of these include using a voice output system and using a picture exchange communication system (PECS). Both are highly effective in allowing those with developmental delays and speech deficits to communicate their needs. 

Using Voice Output Communication Aids

Voice Output Communication Aids (VOCA) is a type of electronic aids that can support or replace language and writing by indicating images or sounds. The users can press the buttons on the SGD (Speech Generating Device) interfaces to facilitate communication with others (Beukelman). 

VOCAs are mainly used in clinical or educational settings for an individual to express themselves. To use the device, a clinician or educator will want to choose a variety of desirable and undesirable pictures or symbols (e.g., symbols that represent snack time, bathroom, break, etc.). Next, the child will be trained to use the device and will either point to or push the intended button on the device to communicate. The device will say the word or phrase aloud (which would have been pre-recorded by the adult). 

There have been no large-scale studies on voice output communication aids and more research is needed to prove the effectiveness of using them with children with autism. 

Using a Picture Exchange Communication System 

The Picture Exchange Communication System, or PECS, allows people with little or no communication abilities to communicate using pictures. People using PECS are taught to approach another person and give them a picture of the desired item in exchange for that item. By doing so, the person can initiate communication. A child or adult with autism can use PECS to communicate a request, a thought, or anything that can reasonably be displayed or symbolized on a picture card.”

A study entitled, Effectiveness of the Picture Exchange Communication System (PECS) on communication and speech for children with autism spectrum disorders: a meta-analysis, synthesized gains in communication and relative lack of gains made in speech across the PECS literature for children with ASD (Flippin, 2010). This says that children with autism who used a PECS showed an increase in overall functional communication, but not in speech output (talking). Without PECS, they would not have been able to communicate their needs otherwise while participating in the studies. 

While certain speech interventions may not increase functional communication in children with nonverbal autism, early treatment with a licensed speech therapist is highly recommended to see positive gains in skills. 

Brittany Wilson

Master of Education (M.Ed.) | Northeastern State University

Behavior and Learning Disorders | Georgia State University

February 2020

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