Our 4-part series on communication development in children with Autism Spectrum Disorder (ASD) continues with a focus on verbal communicators
Expected Verbal Skills in Typical Development
According to the CDC (Center for Disease Control and Prevention), typically developing children begin to say and imitate their first words around 1 year of age. At 1½ years, they begin to say more words and start to say “no” to protest and begin to point to request. At 2 years of age, children start to combine words into phrases and increasingly attempt to imitate adults’ conversation. By 3 years, children can label most familiar objects, and can use pronouns like “I,” and “you.” They can answer basic social questions about themselves, such as their name, age and gender, and can participate in basic conversations. At 4 years of age, children start to tell stories, relate events to themselves and start to talk about their likes and interests. At 5 years of age and beyond, children can tell stories using complete sentences and can use a variety of verb tenses, like past, present and future.
Challenges Children with Autism have when using Verbal Communication
When children with autism start to use verbal communication, they are often slower to develop expressive language skills than their typically developing peers and they can get stuck at earlier language levels. Often, their primary purpose to communicate is to meet their wants and needs and they may have difficulty expanding their language and communicating for social purposes, such as commenting, telling stories and participating in conversation.
Some children have difficulty gaining another person’s attention before talking to them, which might lead to repetition of language and frustration if the person does not respond. If a child doesn’t know how to respond to a question or comment from an adult, they may repeat what the person said instead of saying “I don’t know” or “tell me again.”
Other children may repeat words or phrases rather than saying “yes” or following instructions. This is called echolalia. Some children have difficulty using a variety of words, phrases and sentences while communicating and playing, and may rely on scripted language from favorite TV shows or movies. Children with autism also frequently have difficulty using appropriate pronouns, often mixing up “I” and “you,” and they may have difficulty using gender pronouns accurately (e.g., he/she).
Some children have difficulty asking/answering questions to gain information and being able to relate personal events in simple ways. In addition to verbal deficits, children with ASD may present with difficulties with nonverbal communication. Decreased coordination of eye gaze and difficulty with use and interpretation of facial expressions and gestures can add to overall difficulties with social communication with others.
Goals and Strategies to use in Speech Language Therapy
Providers frequently refer children with autism for speech language therapy, which can be provided through a child’s school and can also be provided through a private provider in the community, such as a clinic or a hospital. At school, a speech therapist can provide one to one therapy to increase expressive language skills, such as increasing vocabulary, using appropriate verbs and pronouns and using phrases and sentences for a variety of purposes (e.g., labeling, protesting, commenting, requesting, etc.).
Speech language therapy may also be recommended at school to increase a child’s ability to understand and use language appropriately in the classroom and to facilitate play and social interactions with a child’s peers.
Speech therapy can focus on social communication (gaining attention and commenting) and increasing early conversational skills (asking/answering questions, relating personal events, retelling stories, and having simple and reciprocal conversations). It is important for the clinician to use motivating activities to increase the child’s participation and motivation to communicate. The therapist should also use visuals as needed to help increase understanding and promote independent speech production.
Tips for Parents to Use at Home
At home, parents can encourage communication development by providing appropriate language models. It is recommended that parents follow their child’s lead when they are playing and communicating. The adult comments on what the child has initiated and elaborates on the child’s speech and actions. The adult can also use gestures to prompt the child’s speech rather than ask direct questions or tell them what to say. This can be done throughout the day across many different activities and experiences.
Some helpful strategies to use while talking to your child include:
1) Parallel-Talk: Talk about what your child is doing (e.g., “You are drinking”)
2) Self-Talk: Talk about what you are doing (e.g., “I’m pouring the juice”)
3) Expansion: Repeat what the child says in a grammatical, complete and simple form (e.g., child says “bubbles,” adult says, “I am blowing bubbles”)
4) Expatiation: Follow the child’s lead in conversation (e.g., Child says “open,” adult says “open crackers.” Child says, “crackers.” Adult says, “I’m eating crackers, mmm!”)
In addition, it is important to provide relevant language for your child. If they are going to imitate or echo speech, provide language that is relevant to the immediate context and use pronouns that will allow them to comment or ask questions in the first person. For example, if your child needs help, they may repeat you if you say, “do you need help?” Instead, prompt them with language that they can use, such as, “I need help.”
Part 1 in Series: Pre-intentional/Pre-verbal
Part 2 in Series: Emerging Verbal
Part 4 in Series: Verbal
The following resources may be helpful for increasing verbal communication in the school, therapy and home environments and are available online:
1) Visual Strategies for Improving Communication, Vol. 1: Practical Supports for School and Home by Linda Hodgdon, available through Amazon online.
2) Mayer Johnson’s Boardmaker Software program can be used to create visuals.
3) My Favorite Things Book, created by Pyramid Educational assessment is a great visual tool to use to increase conversation skills about favorites.
4) For more information about developmental milestones, please visit the CDC’s website