Nicole DeRosa, Psy.D., BCBA-D, LBA The Family Behavior Analysis Program Department of Pediatrics Upstate Medical University email@example.com (315)-464-3950
Jamie R. Bishop, MS, BCBA, LBA Proud Moments (315) 452-0427
Social communication deficits is one of the diagnostic symptoms of Autism Spectrum Disorder (ASD). Thus, it is not surprising that many individuals with ASD have difficulties communicating with others around them. Communication difficulties can range from having limited or no functional communication system, for those who are nonverbal, to having problems with social reciprocal interactions. Limited communication skills can lead to challenging behavior or difficulties with establishing and maintaining social relationships. When a child doesn’t readily learn an effective way to communicate with others and to obtain his/her wants and needs then more intensive intervention is often necessary. However, when the appropriate conditions are arranged along with effective techniques your child can be successful with developing functional, independent communication skills.
What to know before you start
A child’s communication abilities, like many other skills, should first be assessed before deciding upon a starting point for establishing or improving upon communication. It’s important to know how the child currently communicates. This can be completed by direct observations of the child during naturally occurring situations in addition to more structured language-based assessments.
Goals for communication should be identified following completion of the assessment by the BCBA in conjunction with the caregivers.
Communication goals will likely focus on both expressive skills (how the child communicates to others) and receptive, or listener, skills (how the child responds to communication from others).
It’s important to remember to start at the skill level of the child, rather than basing goals on other factors such as the child’s chronological age.
Once goals are established, specific teaching techniques should be identified and implemented. Caregivers and other individuals who may be involved in the child’s journey toward improved communication should be trained on the teaching or prompting procedures that will best assist the child in being successful with communicating.
Questions for the BCBA
What will direct observations of my child look like and how will this help with improving my child’s communication skills?
It can be helpful to observe how a child naturally interacts in his/her environment to get a full understanding of the “tools” that currently work for a child. Some individuals with autism, especially non-verbal individuals, may use various behaviors to communicate their wants/needs. For example, some individuals point, pull adults to things, or engage in challenging behavior such as aggression.
What is involved in structured language-based assessments?
Language-based assessments, such as the Verbal Behavior Milestones Assessment and Placement Program (VB-MAPP; Sundberg, 2008)) or the Assessment of Basic Language and Learning Skills (ABLLS-R; Partington, 2006), will involve arranging specific situations or engaging with your child in specific activities to test their skills to get a more detailed understanding of the child’s communication abilities that may not be apparent in everyday interactions. Teaching Language to Children with Autism or Other Developmental Disabilities (Sundberg & Partington, 1998) is another effective resource the BCBA may use to help assess the child’s skills, as well as develop an effective teaching program.
The assessments should take into account varying degrees of a skill for the child. More specifically, while the BCBA should be identifying what skills your child can complete independently, knowing how your child responds with additional instructions or prompts is also valuable information.
What are the teaching conditions going to look like? How are you going to teach my child to communicate more effectively?
The teaching conditions should be individualized to the child’s needs. For some individuals with limited communication skills, some structured teaching time (e.g., sitting at a table) may be necessary to teach pre-requisite skills. However, this structure teaching time should be supplemented with teaching under naturalistic conditions.
There are numerous natural opportunities each day to assist a child with communicating and these opportunities should be captured and utilized. For example, desired items can be placed out of reach such that the child will need to gain an adults attention and request the item, rather than just having it readily available where he can grab it himself. While reading books one can use pointing, gestures, and labels to help the child attend while also delivering instructions (e.g., turn the page) to strengthen listener responding.
Particularly in the beginning much more prompting and hand-over-hand assistance should be used to assist the child with following through with expectations. The BCBA should be collecting data on the child’s progress (e.g., daily probes of independent opportunities).
My child has some vocalizations, why are we not solely focusing on increasing his vocal communication?
If a child engages in vocalizations, whether it be sound or words, it will be important to focus on those skills. This can be completed through vocal play (engaging in back-and-forth vocalizations) and vocal imitation (you imitate sounds he makes and vice versa), for example.
Improving communication involves learning on the child’s part and this can be challenging and at times frustrating. Therefore, while you’re working on strengthening the occurrence of vocalizations it may be necessary to arrange a more functional communication-based system in the meantime with another modality (e.g., sign language, vocal output device). This can also be helpful at the early stages of communication development as you want your child’s communication responses to contact the relevant consequences (i.e., your child’s wants and needs). If you focus solely on vocalizations you cannot ensure that your child will engage in the appropriate communication as you cannot assist your child in making vocalizations; however, you can assist your child in engaging with an appropriate sign response by using hand-over-hand guidance to help form the sign.
Materials you may want to have
If using a picture-exchange system you will need the relevant pictures, board, or binder that the pictures will be stored in. Another possibility is using a vocal output device (e.g., iPad with communication app).
Any items that your child may find to be reinforcing, or that your child frequently wants access to. For example, your child’s iPad or a preferred snack. This will allow the BCBA to set up conditions in which the motivation to communicate for the item is higher.
The BCBA should collect data to appropriately track your child’s progress. The type of data collection may vary based on the type of teaching program that is in place. Some BCBA’s may opt to collect data on each opportunity your child has throughout the teaching program, whether they are prompted or independent opportunities. While others, may only collect data on arranged independent probes to assess your child’s progress with obtaining the skill.
Data collection can also help with making modification to teaching programs if your child is making progress with a particular teaching technique.
What to expect
You’ll likely need to consider how you prefer your child to communicate to others (e.g., vocalizations, sign language, picture exchange, vocal output device), while keeping in mind programming will need to begin at a level where your child can be successful. Both the caregivers and BCBA should have input on the selection of the most appropriate communication modality, and at times consultation with a speech-language pathologist may be appropriate.
Increasing communication skills involves learning for your child; thus, the use of positive reinforcers will likely be an inherent part of the programming.
Given that developing communication skills involves learning, this can result in situations where your child may appear frustrated. Thus, it is important to start with small expectations and goals so that your child can contact success.
Every child learns at different rates. If your child is not readily obtaining the skills you want don’t get discouraged. Communicate with your BCBA to ensure the programming is on the right track before making any changes in the teaching approach.
Books and resources
Barbera, M. (2007). The verbal behavior approach: How to teach children with autism and related disorders. Philadelphia: Jessica Kingsley Publishers.
Rogers, S. J., Dawson, G. & Vismara, L. A. (2012). An early start for your child with autism: Using everyday activities to help kids connect, communicate, and learn. The Guilford Press.