Autism Q&A: Introduction to Teaching Young Children with Autism Spectrum Disorder to Communicate Using Spoken Language

by Heather Fleming, M.Ed. and Dawn Hendricks, Ph.D.

Many young children with Autism Spectrum Disorder (ASD) have difficulty learning to use spoken language. Some children may be able to use only single words while others may be able to make sounds. Still others might not speak at all. Communication is an essential life skill that leads to enhanced interactions and improved quality of life. For all young children who have communication impairments, building skills is critical. There are many different modes or ways we can teach a child with ASD to communicate. For example, a child can learn to use sign language, communicate by exchanging objects or pictures, or can use an electronic device with voice output. While all of these are effective and valuable modes to communicate, we will also want to focus on teaching the child to communicate using spoken language.

In this Q&A, we will explore how to teach spoken communication to children with ASD. Each child is different and possesses various strengths and skills. Spoken communication may be easier to learn for some children than it is for others. Because of this, spoken communication may be the primary way to communicate for some children, while others might use it to supplement other modes. Regardless, the steps to teaching spoken communication are similar for all young children and can be applied to those on the spectrum who are learning to communicate.

Question: How do caregivers and educators begin teaching verbal communication?

Answer

When teaching spoken communication the most important factor will be motivation! Before you start any communication intervention, you must know the child and find things that motivate him or her. What are the child’s favorite things to do? What are his or her favorite games, places, people? What makes the child laugh? As you determine the items that motivate the child, consider the following areas: physical activities (running, jumping), toys (trains, dolls), edibles (food), liquids (drinks), activities (computer games), social interactions (playing with a sibling, tickle games, peek-a-boo). It will also be helpful to identify items that are considered to be repetitive or restricted patterns of behavior in which the child engages and enjoys. For example, a child might like watching items spin, enjoy flicking a string up and down, or like driving a car on a track over and over.

Question: When should caregivers and educators teach verbal communication?

Answer

Adults should teach when the child is motivated to communicate! This will likely be when the child is engaged in his or her favorite activities. Caregivers and educators can embed strategies into the child's favorite activities and use the child's favorite toys and foods to elicit communication. For example, if the child loves gross motor activities, like running, jumping on the bed, being spun and thrown in the air, then these times can be used to teach him or her to communicate.

When teaching spoken communication, begin by teaching the child to request an item. Requesting is a basic function of communication and is the best starting point, as it helps the child to get needs and desires met. Using motivational moments will allow the caregiver or educator to capitalize on the child's desires. If the child is whining to get something or reaching for a desired item, this is the perfect opportunity to get the child to request. Do not automatically give the item to him/her. Instead, use this as a teachable moment!

We can begin teaching communication by taking advantage of "naturally occurring opportunities." Naturally occurring opportunities are activities and events that happen naturally throughout the day.

Because learning to communicate orally may be difficult for the child we will want to be sure there are plenty of teaching opportunities. Therefore, in addition to the naturally occurring opportunities, we also want to provide "planned opportunities" for teaching communication. By planning opportunities to work on communication we can expand the times to teach communication!

Question: What are naturally occurring opportunities and how are they used to teach communication?

Answer

Naturally occurring opportunities are natural, everyday situations that we can use as the context for learning. Naturally occurring opportunities can be determined by just sitting back and watching! Observe the child's play and see what the child is playing with and what interests him or her. Learning to communicate is a very social process and children learn to communicate best with their caregivers during everyday interactions that are fun and motivating! When children learn to communicate during these activities they are naturally rewarded by engaging in their favorite type of play, eating their favorite food, and enjoying their favorite drink. For example, taking a bike or car ride, a bath, eating dinner, having an afternoon snack, meeting dad at the door – these are all natural, everyday situations when communication opportunities are present.

Question: What are planned opportunities and how are they used to teach communication?

Answer

Additional opportunities must be planned by caregivers or educators. Teaching spoken communication skills is not something that will come easily. The child must receive many learning opportunities. While it is essential to take advantage of the natural opportunities that arise, often, these are not enough. Planned opportunities are those times the caregiver or educator sets aside to work on communication. The adult can use the same motivational items and activities, but will create the opportunities for the child to communicate. For example, perhaps after lunch and again after dinner there is a 20 minute period designated to work one-on-one with the child and target communication. These 20 minutes should be planned opportunities but still be a part of the regular routine. After lunch the caregiver could get out the child's favorite train track and building blocks and engage him or her in play which leads to many communication opportunities. After dinner, they may go outside and play on the swing and slide, providing additional opportunities.

Question: How can caregivers and educators set up opportunities for communication?

Answer

There are numerous ways we can elicit spoken communication. The following strategies can be used to create learning opportunities while simultaneously keeping the child motivated to communicate!

Arrange the environment to keep the child's favorite toys out of reach or in containers that are hard to open. This will require the child to communicate to indicate he would like to play with the toy.
Give the child small amounts of the item requested. For example, Sarah's favorite food is cereal. To elicit communication at breakfast time only give Sarah a tiny bit of cereal and when she is done, wait for her to communicate in some way before giving her more.
Set up problem solving situations. For example, have a piece of puzzle missing or give the child a juice box without a straw.
Give the child the wrong item requested. When Sarah says cereal, elicit more communication by giving her the wrong item--fruit. This way she will have to communicate to say, "NO! Cereal!"
Build on the child's own motives and interests. During the activity, use the motivational item to provide many, many opportunities to communicate. For example, when working on communication during bath time, splash the water and prompt the child to say, "splash." Do this many times in a row. Later, show the rubber ducky and then work on the child saying, "duck." Later, move to pouring water, and so on.

Question: What are the steps to teach communication?

Answer

Interact with the child during the activity. Play with the child and make the activity fun and engaging.
Elaborate on the child's communication by providing a model. Label or say the word the child is to learn. If he or she is playing with a ball label it by saying, "ball." As the word is modeled, start by saying the word multiple times, pausing in between and saying the word calmly.
Expand the child's language. Eventually pair words together and increase what the child is to say. Here is an example of expanding: "Yellow ball!" "What do you want?" "Throw yellow ball!"
Be patient and pause to allow the child to communicate. Provide a model and then wait several seconds. It may be necessary to wait 15 or more seconds to allow the child to process. After multiple language models, begin adding in a pause to allow the child to interact. The goal is to give the child an opportunity to respond and to speak. For example, you can say "What are you playing with? (pause) It’s a (pause) ball!"

Question: How do caregivers and parents prompt communication?

Answer

When teaching spoken communication, a prompt can be provided. The prompt can provide the entire word or phrase the child is to say. For example, when showing the child a duck the prompt simply would be, "duck." A prompt also can provide only part of the word or phrase. For example, as the child is learning to say the word duck, the prompt may be, "du." This type of prompt provides just enough of a cue to remind the child what he is to say.

When using prompts be sure to fade the prompts or increase the expectation for communication. The ultimate goal should be for the child to communicate independently; however, if the child is constantly being prompted he will not get the opportunity to be an independent communicator.

Question: What are the steps to teach communication?

Answer

Shaping is the process in which a caregiver or educator gradually shapes the child's response by slowly accepting closer and closer approximations to the word the child is to say. Below is an example of how communication can be shaped. Here, the caregiver or educator is reinforcing the child in building and shaping the word "bubble."

A: "Look.--Bubble." (then blow bubbles)
C: "Aaaah"
A: "bubble" (then blow bubbles)
C: "ah ah"
A: "Yes, bubble" (then blow bubbles)
C: "bu"
A: "bubble!" (blow bubbles)
C: "bu-bu"
A: "bubbles!" (blow bubbles)

Question: What are the most important tips to remember when teaching a child to verbally communicate?

Answer

Teach words that are meaningful and that are of interest to the child. Some early words are: all done, up, want, drink, or a favorite food item. Many caregivers teach the words 'please' or 'more' first, which are great words to use for requesting; however their meaning can vary depending on the context. For example, if the child is eating dinner and asks for 'more' it is not clear if they are referring to 'more food' or 'more drink.' By teaching the child the word 'milk' it is obvious what the child wants. Gross motor skills are often a strength for children with ASD, thus teaching verbs first is also very motivating and practical for children.
Identify the activities of the day when you are going to teach communication. These are the 'additional opportunities' or planned opportunities discussed earlier in this fact sheet. It is best to identify the specific activities so they are remembered and the child is provided ample opportunities to communicate each day.
Be prepared for multiple trials. Children with ASD may require many learning trials to learn to speak. Every child with ASD is different. Some will learn to imitate and respond to your vocalizations quickly and some will take longer to respond.
Incorporate high intensity reactions! High intensity reactions motivate children to speak by getting their attention and getting them excited about the activity. If the caregiver is excited about the activity, the child will be too. Have fun during play!
Talk! Even if the child is unresponsive. Talk to the child about their play using short sentences. Narrate what they are doing and then pause to let them speak. Caregivers often state they stop speaking with their child because their child is not responding. Even if the child is unresponsive, never stop talking! Talking with children helps them process and attend to language, and understand that it is meaningful.
Praise and reinforce the approximations. Reinforcement for spoken communication should be easy. The child gets the item he or she wants! Keep in mind that we have to start somewhere, so praise and reinforce the approximations and the attempts to communicate. Reinforce the child for trying. Do not just reinforce if the word is spoken perfectly.
Pause to give the child a chance to respond. For example, when a child is pointing to a ball, say "Do you want your ball?" then wait for the child to respond. Children with ASD might take many seconds to process information and respond, so be patient.
Imitate and elaborate the child’s vocalizations. Imitate and elaborate the vocalizations so they know what they said is meaningful! When the child points at a cookie and says "ookie" you can say, "Oh,you want a COOKIE?" When elaborating and expanding on the vocalizations, it helps them learn to expand their own language.

Summary

Many young children with ASD have difficulty learning to use spoken language. Communication is a critical life skill and many children with ASD can learn to speak. Teaching children with ASD takes time and lots of repetition, but it should be a fun process for the child and the adults. Communication should build on the child's motivators and be incorporated into daily routines. Prompting can be used to shape the child's use of words so he or she is able to move from making sounds or approximations to saying words and even phrases.

References

Autism Speaks. Symptoms. Retrieved from http:// www.autismspeaks.org/what-autism/symptoms on 2011, September 19.
Koegel, L. (2000). Interventions to facilitate communication in autism. Journal of Autism and Developmental Disorders, 30 (5), 383-391.
Landa, R. (2007). Early communication development and intervention for children with autism. Mental Retardation and Developmental Disabilities Research Reviews, 13, 16-25.
Levy, S., Kim, A., & Olive, M. (2006). Interventions for young children with autism: A synthesis of the literature. Focus on Autism and Other Developmental Disabilities, 21 (1), 55-62.
Paparella, T., Goods, K., Freeman, S., & Kasari, C. (2011). The emergence of nonverbal joint attention and requesting skills in young children with autism. Journal of Communication Disorders, 44, 569-583.
Siller, M. and Sigman, M. (2002). The behaviors of parents of children with autism predict the subsequent development of their children’s communication. Journal of Autism and Developmental Disorders, 32 (2), 77-89.
Whalen, C., Schreibman, L., & Ingersoll, B. (2006) The collateral effects of joint attention training on social initiations, positive affect, imitation, and spontaneous speech for young children with autism. Journal of Autism Developmental Disorder, 36, 655-664.

Additional Resource

Additional Q&A Fact Sheets will provide information on how to support individuals with ASD in the classroom amd the community. Please visit the ACE website for more resources -- http://www.vcuautismcenter.org

For additional information on ACE please go to our website: www.vcuautismcenter.org

Contributors for this issue
Heather Fleming, M.Ed. and Dawn Hendricks, Ph.D.
Editors: Becky Boswell, M.B.A. and Linda Oggel, M.A., CCC-SLP

Information for this Frequently Asked Questions (FAQ) is from Virginia Commonwealth University's Autism Center for Excellence (VCU-ACE), which is funded by the Virginia State Department of Education (Grant # 881-61172-H027A100107). Virginia Commonwealth University is an equal opportunity/affirmative action institution providing access to education and employment without regard to age, race, color, national origin, gender, religion, sexual orientation, veteran’s status, political affiliation, or disability. If special accommodations or language translation are needed contact Voice (804) 828-1851 | TTY (804) 828-2494.