Teaching Pre-Communication Skills to Children with Autism

Teaching Pre-Communication Skills to Children with Autism
How does your child currently communicate? How does he let you know what he wants and what he doesn’t want? How does he get your attention and comment on the world around him?

Just because your child isn’t communicating verbally doesn’t mean he isn’t communicating. Beginning communicators with autism often express themselves by: leading you by the hand to what they want, handing you items or placing your hand on items (i.e., placing your hand on a windup toy to activate it), pointing to what they want, smiling, crying or exhibiting challenging behaviors.

We use communication for a variety of reasons; the reasons we communicate serve different functions or purposes. Eight basic functions of communication include: seeking attention, greeting, requesting, protesting, choice making, commenting, recurrence (wanting more of something) and rejection (rejecting an item or wanting to cease an activity). The functions of communication that are exhibited most often by children with autism include requesting, protesting, recurrence and rejection. Social functions of communication (i.e., seeking attention, greeting, and commenting) are often more difficult for children with autism to learn.

In the past educators commonly believed that children must exhibit certain cognitive prerequisite skills prior to teaching functional or symbolic communication skills. Functional communication means being able to effectively express wants, needs, thoughts and ideas to a variety of communication partners (both familiar and unfamiliar) throughout the day as effortlessly as possible.

Today, we know that while these prerequisite skills are important and should be addressed in intervention programs, we also know that there is no reason to wait to teach children functional communication skills.

To be a functional communicator typically requires the ability to use some form of symbolic communication (i.e., using a symbol to represent an idea). Symbolic communication may take many different forms: verbal speech, sign language, gestures, pictures, photographs, written word, alphabet boards , voice output systems, object and tactile symbols, etc. Non-verbal forms of symbolic communication are called augmentative-alternative communication (AAC) .

In this article, we will focus on teaching important cognitive skills that are considered the prerequisites to using symbolic communication. These skills should be taught in conjunction with a program designed to teach symbolic communication skills.

While we shouldn’t delay teaching children functional or symbolic communication skills, we also shouldn’t ignore the importance of cognitive development and the impact it has on language development. To help you better understand how cognitive development leads to language development I will highlight three key cognitive skills that you can work on with your child to improve his communication skills.

I. Teaching Joint Attention Skills to Children with Autism



Joint attention is achieved when a child looks at an object of interest and then to the parent to see if she is sharing the experience. Joint attention is of critical importance to developing communication skills.

Begin by positioning yourself so you are face-to-face with your child at his eye level. Bring an object of interest into your child’s line of vision. You may want to try a favorite toy or a new toy to get your child’s attention. I have the greatest success with new toys that the child has never seen before. I have had the most success with wind up toys that the child doesn’t know how to operate, bubbles and puppets.

Your child’s immediate reaction will be to try and grab the toy. If he needs your help to activate it then you have to play an active role. Try activating a wind up toy, let it play out on a table and then hold it up next to your eyes, shake it, smile, say your child’s name or phrases such as “Oh, look!” with excitement. If he looks at the toy and then at you reinforce him by activating the toy the again and praise him verbally by saying, “nice looking!”

You are encouraging your child to share the moment with you. You may want to try blowing a bubble, catching it on the wand and bringing it next to your eyes or hold a talking puppet close to your face and pretend it is speaking to you and your child. Try to make this fun and playful exchanging eye contact, smiles, facial expressions, and joint attention to the object (i.e., your child looking at the object and then back at you to see if you shared the experience).

Incorporate working on joint attention on a daily basis even if you only have a few minutes it is so important to build this skill. Joint attention is the foundation upon which we build communication skills.

II. Teaching Pointing Skills to Children with Autism



Many children with autism do not learn to point by simply watching others do it. They require additional help. We will want to teach children with autism to use more sophisticated means of communicating but learning to point is an invaluable skill to learn and should be taught. Learning to point to items to make requests is a skill that typical children acquire early in their second year of life and is an important prerequisite to learning to use symbolic communication (Potter, C. & Whittaker, C., 2001, 98).

When your child takes you by the hand and pulls you over to the refrigerator to ask for some juice, open the refrigerator, take his hand and shape it into a clear point with his index finger and actually touch the juice container with his finger. Help your child in this manner, with hand-over-hand assistance, to point at all items he is requesting. You will want to slowly increase the distance between your child’s finger and the object over time so he learns to point from a few feet away from the object. With enough repetition (have patients this skill is not easy for some children, it may take months!) your child will have learned a critical communication skill that is reliable and goes everywhere with him.

It is important to fade out prompts as soon as possible so your child does not become dependent on your teaching prompts. Children with autism tend to anticipate prompts as part of the routine and may not perform until they are prompted this is called being prompt dependant. You want to avoid your child becoming prompt dependant by fading out (i.e., gradually removing) your prompts as quickly as possible.

Now you have learned some strategies to teach your child to make requests by pointing; but what about pointing to show things or comment? This is a far more difficult task because children with autism are not generally interested in “sharing the moment” or telling/commenting about things. I recommend engaging your child in activities such as painting or block building (anything your child enjoys where he is creating or finding things) and encourage him to show the final product or treasure to a non-threatening person. A non-threatening is someone who the child is not afraid will take the item away or destroy it (some sibling may be seen as threatening). Encourage the person your child is showing the item to, to provide lots of positive feedback. Again, hand-over-hand assistance will be needed and lots of repetition!

III. Teaching Imitation Skills to Children with Autism



“In general, imitation is important because of the developing ability to construct internal representations of the behavior of others and to duplicate them. To imitate physically, the child must be able to perform at least three tasks: turn-taking, attending to the action, and replicating the action’s salient features” (Owens, 1996, 145).

Hierarchy of Imitation skills:
If your child has difficulty imitating, this hierarchy will help you understand where your child’s skills fall on the continuum of imitation skills that precede speech development. First, determine where your child falls on the hierarchy and then follow the steps from where he has difficulty to help improve his imitation skills. Imitation of speech sounds and simple words can be worked on at the same time as you teach other imitation skills.

  1. Gross motor imitation without an object (i.e., large muscle movements) such as: jumping, running, walking, hopping, skipping, etc.


  2. Gross motor imitation with an object (i.e., rolling a car or bouncing a ball).


  3. Fine motor imitation (i.e., small muscle movements) such as: clapping hands, touching your nose, stomping your feet, etc. Songs such as ‘Wheels on the Bus’ are great for teaching imitation skills in a natural context and is often motivating and reinforcing to the child. Check with your child’s teacher to learn what is expected of him at circle time and then practice circle time songs at home. You may initially need to provide physical assistance to help your child perform these fine motor movements. It is also important to provide lots of practice!


  4. Oral motor imitation (i.e., small muscles of the face and mouth) such as: blowing a kiss, open/close your mouth, sticking out your tongue, raspberries, puffing up your cheeks with air, flapping your lips like a horse. Try these in front of a mirror so your child can see himself and use props such as lollipops and liquorish to get your child to stick out his tongue to lick the candy!


  5. Even if oral motor imitation is difficult for your child go ahead and try this. Encourage him to imitate sounds such as: clicking your tongue, coughing and sneezing. An exaggerated sneeze is lots of fun. Remember to be playful!


  6. Imitation of animal noises while you play with animal toys or read a favorite book about animals (try the books, “Brown Bear” and “Polar Bear” by Eric Carle).


  7. Imitation of speech sounds and simple words can be worked on at the same time as you teach these other imitation skills. You don’t have to wait for your child to correctly imitate all oral motor movements, fine motor movements, etc. However, it is important to continue to work on all types of imitation skills because they teach different skills such as movement concepts, body parts and oral motor awareness.



  8. In summary, children with autism learn cognitive and pre-communication skills differently from neuro-typically developing children and will require active teaching of skills such as joint attention, understanding and using gestures and imitation skills. While it is important for children with autism to learn these cognitive skills it is not required that they demonstrate competency of these skills prior to beginning teaching symbolic communication. The teaching of cognitive and pre-communication skills may be taught concurrently with the teaching of symbolic communication strategies such as picture exchange communication system (PECS), sign language and verbal speech, respectively.


    References:



    1. Owens, R. (1996). Language development: an Introduction. Needham Heights, MA: Allyn & Bacon.


    2. Potter, C. & Whittaker, C. (2001). Enabling Communication in Children with Autism. Philadelphia, PA: Jessica Kingsley Publishers.


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