A common early sign of autism is that a child doesn’t start to speak at the usual age. For parents, feeling that you can’t ‘reach’ your child can be one of the most painful experiences in the world, and for children, being unable to say what they want and need can be very frustrating.
There’s no magic pill, but there are systems that can make things easier. Sometimes parents have to develop some extra communication skills in order to meet their child where they’re at. It’s a challenge, but it’s do-able – and if your child really struggles, even the most basic exchanges can make a world of difference to both your and their quality of life.
Collectively, these systems are known as AAC – alternative augmentative communication. (‘Alternative’ means a system that replaces speech, while ‘augmentative’ means one that goes alongside it. For children with autism, this can be a bit of a mix-and-match rather than an either-or).
Spoken language can be a difficult thing for children with autism. Many are far more visual than verbal, and find it a lot easier to understand something they can look at than something they have to hear or say.
The use of symbols, when it comes to children with autism, generally means using pictures. People with autism tend to be concrete thinkers so a word which is supposed to represent something they see in the real world may pose some difficulty for them e.g. the word ‘cup’ doesn’t look, sound or feel anything like a cup; it’s just a noise that we’ve used to label it. It can be helpful for a child with autism to start with something a bit more tangible.
Common steps are:
An object: If your child is hungry, for example, encourage them to bring you a plate. (If explaining it to them doesn’t work, you might put the plate in their hand and then ‘pass’ it back to yourself.) That’s a pretty clear association. You might also designate one plate as the ‘symbol’ plate and use other plates for food to make it clear that the plate represents food rather than being just there to be filled.
A photograph: Use an image (preferably laminated, as it’ll get a lot of wear) that’s completely realistic and shows a plate. It’s a step away from the concrete and towards the abstract, but the connection is still fairly clear.
A more abstract, stylized picture, accompanied by text: A picture of a plate that stands in for the generic concept, with the word ‘food’ printed underneath it. The more your child uses it, the more they’ll associate the written word with the image, and the image with getting some food.
A card with just the word printed on it: If your child wants something to eat, they hand you the card labeled ‘food’.
Each time your child gives you the appropriate symbol, you reward them, both with praise (‘Good showing! Well done!’) and by getting them what they ask for so they know that the system works. In this way, they come to see that communication is actually the most efficient way of getting what they want, and start seeing the point of using it.
This, of course, may be more support than your child needs: some children with autism may already be able to use some language, or might be able to use an abstract symbol right away. Where best to start with symbols will be, as with so many things, something best decided by those who know the child best – i.e. you.
There are a variety of formal systems – PECS (Picture Exchange Communication System) is a popular one – and it’s a good idea to check out which, if any, your local health workers and school systems use. Getting formal systems set up can take time, though, so the home-based system above can be a good thing to try while you’re waiting for the support to come through.
As with symbols, sign language is visible and thus a lot easier for some children with autism to understand. For a child who’s struggling to speak, or who can speak but has trouble articulating their words clearly, a bit of signing can be a great support.
Before you tremble at the idea of learning a whole new language, don’t worry: there are a lot of different kinds of signing. If you’ve watched a TV show with a sign language translator, for instance, it’ll look pretty complicated – and it is, because BSL (British Sign Language) is a complete language just like English or Spanish, and to learn that you’ll need support from a fluent or native speaker. However, there are simplified languages specifically designed to help out people with disabilities, and those are a lot easier to master.
Some examples include:
This is a system designed to help all sorts of people who have problems speaking, from children with autism or Down syndrome to stroke patients; the Makaton Charity was established in 2007. It has a core vocabulary of about 450 words – which is a very solid foundation in basic communication – and a supplementary ‘Resource Vocabulary’ of over 7,000 concepts.
If you want a quick guide to what Makaton looks like, an easy way to check it out is to switch on CBeebies or get onto YouTube and type in ‘Mr Tumble’ or ‘Justin Fletcher’. (For those not in the UK, Justin Fletcher is a popular TV presenter and clown; Mr Tumble is the character he plays most often.) Many of his shows, particularly Something Special, use Makaton. You can teach yourself a lot of basic signs just by watching his shows, and schools often use a bit of Makaton to supplement their teaching.
Signalong is based on BSL (British Sign Language), and uses its symbols unaltered as far as possible. Signalong places a high value on consistency in its presentation. Their reasoning is that if you don’t always use the same hand and the same angle of the hand, a person with concentration difficulties can get confused and communication can break down. Signalong aims to be flexible in how you choose to sign – you can, for instance, choose which is your lead hand when signing – but precise once you’ve decided how you do it.
Signalong is a system with a broad range of vocabulary and can be used by both children and adults. It’s what’s described as a ‘total communication system’, which means that body language, facial expression and voice tone are always used to reinforce the word being signed.
Signed English isn’t the same as British Sign Language: it’s a specific dialogue which has a sign for each word in spoken English. Their website includes a dictionary covering over 3,000 words, which can be a useful place to get started.
You might have gone to a class, or known someone who went to a class, which taught ‘baby sign’, often using the signs as actions accompanying songs. The exact signs vary from country to country; British classes tend to use a simplified version of Makaton/BSL or Signalong. In general, the idea of baby sign is that it helps children communicate at an age where they haven’t quite got the mouth-skills to form words and all systems use big, clear gestures. If you’re already using these signs with your son or daughter, you may find it helpful to continue; a quick call to the teacher should let you know which system they based their baby sign on.
If you’re choosing between symbols and sign language, each has its pros and cons. The main advantage of symbols over signs is that they’re easy for outsiders to understand: a picture of a toilet will suggest ‘I need the toilet’ to pretty much anyone. The main advantage of signs over symbols is that you don’t need to carry a file or pocketful of cards everywhere; if everyone in the family and the school has a basic vocabulary, it’s as portable as spoken language. You could also use a bit of both if that doesn’t confuse your son or daughter.
Exactly which form of signing you use is likely to be a judgment call: whatever gets your kid communicating has to be a good thing, and as with symbols, which one you choose is likely to be more a question of access than anything else. Talk to nursery or school staff, local professionals like occupational therapists, and anyone else who’s likely to be a major player in your child’s care, and see which signing systems, if any, are already in place. All of them have their merits: for you and your child, the best choice is almost certainly the one you can get everybody to cooperate with.
Mobile devices such as smartphones and iPads fascinate a lot of kids with autism, and there are, as a result, quite a lot out there specifically designed for them – either games to help learning concepts or AAC apps that allow them to pick out words. The latter can be quite expensive (though probably still cheaper than many AAC programs), but do sometimes make a big difference to a non-verbal child.
Whether or not these apps are helpful for you is going to depend very much on your child’s age, maturity, personality and skills. It’s likely you’ll already have a gut feeling about whether tablet communication might be a help or a hindrance. If your child seems to have the potential to benefit from these apps, it’s useful to know that they’re out there: searching ‘AAC apps’ or ‘assistive communication apps’ in Google will turn up a lot of options.
An important reminder
It’s important to remember that a child who needs AAC now is not necessarily a child who’ll grow up to be non-verbal. Some people with autism never do get the hang of speech: for those people, AAC can be enormously important, making all the difference between frustration and a manageable life. On the other hand, many people with autism do master language as they grow up – there are performers, advocates, even rap artists who are on the spectrum – and AAC can be a way of laying the foundations. If you can give your child a way to grasp the concept of communication, that’s the base from which you’ll be building. When it comes to autism – and to families in general, really – any communication is good communication.