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Communication-Based Intervention for Nonverbal Children with Autism
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In the last section, we discussed Questions Concerning Autism. These included What is autism? Should an autistic child run wild? Is it genetic? Environmental factors; Is it something I did? and Is there a cure?
In this section, we will discuss Compensating for Lack of Language. This will include finding something worth trying for, modeling the words, getting them to talk on their own, keeping things social and interactive, turning requests into conversation and encouraging initiations.
Bridget, age 37, was the mother of Kyle, age 15, who had an autistic spectrum disorder. Bridget explained to me, "I’ve been trying to get Kyle to talk for a few years now. It’s not working. If he wants to play a game or to drink some orange juice, he doesn’t ask for it, he’ll take my hand and lead me to it. Kyle is toilet-trained, but sometimes, when we go to a public place, like a movie theater, and Kyle can’t locate the restroom, he’ll just go in his pants. Other times, he’ll throw a temper tantrum because he can’t lead me to what he wants."
I stated to Bridget, "Kyle leading you to what he wants sounds to me like autistic leading. If Kyle can get something accomplished by simply showing you what he wants, he probably doesn’t have a motivation for talking. All his needs are taken care of already."
I found it helpful to continue to Bridget, "A child with autism may not initially understand why it’s so important to talk—it’s hard work and a lot easier to just take someone’s hand and march him over to the orange juice when you want orange juice. You may start to think why bother? Here are six steps you might try to encourage Kyle to talk."
6 Steps to Encourage Talking in the Child with Autism
♦ Step 1 - Finding Something Worth Trying For
I stated to Bridget, "The first and most critical task is to identify the objects or activities that are so important to Kyle that they are worth talking for. If you just can’t find an item he likes, an activity he enjoys can also serve as a useful, concrete reward. Once you’ve found something that works, don’t worry about spoiling him with it. Talking has to be worth his while. Kyle will need to make the connection, ‘Hey, I ask for something, I get it!’ Communication leads to attainment, and for a special needs person, that connection needs to be clarified and emphasized. You show Kyle an item, he attempts to say its name, you hand it to him. A connection is made, and he gets the idea. Talking pays off."
♦ Step 2 - Modeling the Words
Bridget stated, "If only it were that simple. I’ve tried to show Kyle an object, say what it is and get him to say it back to me, but he doesn’t understand what I want him to do. He’ll just throw a tantrum until he gets what he wants. And, of course, I give him what he wants because I want him to stop crying."
I stated to Bridget, "Often, the most difficult part of the learning process is the second step—modeling the words. Continue to show Kyle an object, say the word and try to get him to repeat it. Try to make sure that Kyle knows what he’s saying and isn’t just repeating what you say. In the beginning, he will probably revert back to behaviors that have worked for him in the past, like tantrums. It will be difficult, but try not to give in. Kyle needs to learn to replace crying with words. Calmly wait until Kyle says something. It can be anything—a sound, a noise, part of the word, anything. Just something that sounds like he’s trying to communicate. Then give him the item immediately. Keep repeating this until it’s clear to Kyle that a verbalization is the one and only thing that will get him what he wants. This is going to be hard work, so it may be helpful to reward for good trying instead of perfection. There might be more incentive to keep trying for Kyle this way. Also, sounds can be words too."
Do you have the parent of an autistic child who is not speaking? Would he or she benefit from listening to this section during one of your sessions regarding modeling words?
♦ Step 3 - Getting Them to Talk on Their Own
About a month and a half later, Bridget stated, "I have found that music is something I can use to get Kyle to want to talk. He loves to listen to music, so the radio is his reward! However, he is still just repeating things when I say them. How do I get him to talk on his own?"
I stated to Bridget, "This is the third step. If Kyle has gotten to the point where he can be shown an object and he starts to say the word, don’t model the word for him. If Kyle doesn’t make an attempt to say the word, then go ahead and model it, so he won’t get frustrated. But each time, wait a little while, looking anticipatory, to give Kyle an opportunity to say the word alone."
♦ Step 4 - Keeping Things Social and Interactive
I stated to Bridget, "The fourth step is to keep things social and interactive. Words need to be developed in the context of meaningful and functional interactions. Using real objects, taking turns with things and using those objects functionally will help Kyle develop a sense of sharing and what it takes to work well with others."
♦ Step 5 - Turning Requests into Conversation
Several months later, Bridget said, "Kyle is starting to develop a vocabulary, but how am I going to get him to learn how to talk with other people?" I stated to Bridget, "This is the fifth step, and you will want to make sure that Kyle has a pretty big vocabulary of 50 words or more, that he can say by himself before you help him combine them. It’s easiest to teach Kyle to string together two words that he already knows and uses.
For example, if Kyle were to just say the word ‘open,’ you might ask, ‘Open door?’ and wait until he has repeated ‘open door’ before taking him outside. Just like teaching him single words, make sure Kyle isn’t just repeating what you say and that he can repeat the words spontaneously. When he starts learning present and past tense, I’ve found with autistic children that pop-up books tend to be very effective. Pull the tabs in the book to make something happen and ask, ‘What’s happening?’ Make the action stop and ask, ‘What happened?’"
♦ Step 6 - Encouraging Initiations
I stated to Bridget, "The sixth step is to teach initiation. You might try getting a bag and filling it with some of Kyle’s favorite things. Let him know they’re in there. Once you have his attention, you’re going to model the question you want. Say, ‘What’s that?’ then pull out one of the desired items. Put the item back in the bag and tell Kyle it’s his turn to try. Gradually put some new items in the bag. Try something neutral, like a tissue or a pencil, something that’s neither desirable nor undesirable. Now, he’ll genuinely be asking, ‘What’s that?’"
Do you have any clients who may benefit from hearing the six steps regarding Compensating for Lack of Language in this section?
In this section, we covered, finding something worth trying for, modeling the words, getting them to talk on their own, keeping things social and interactive, turning requests into conversation and encouraging initiations.
In the next section, we will discuss Echolalia. This will include why autistic children echo, teaching "I don’t understand," rewording the question, adding questions, giving choices, and repetition for its own sake.
Peer-Reviewed Journal Article References:
Bowler, D. M., Poirier, M., Martin, J. S., & Gaigg, S. B. (2016). Nonverbal short-term serial order memory in autism spectrum disorder. Journal of Abnormal Psychology, 125(7), 886–893.
Gordon, K., Pasco, G., McElduff, F., Wade, A., Howlin, P., & Charman, T. (2011). A communication-based intervention for nonverbal children with autism: What changes? Who benefits? Journal of Consulting and Clinical Psychology, 79(4), 447–457.
Kane, M., Connell, J. E., & Pellecchia, M. (2010). A quantitative analysis of language interventions for children with autism. The Behavior Analyst Today, 11(2), 128–144.
What are six steps for encouraging a child to talk?
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