Find an alternative communication method.
We used PECS (Picture Exchange Communication System) with R. We were fortunate that our ABA provider made all the icons and set up the binders. We used a combination of the standard icons and actual photographs. We started hand over hand and offered preferred items. In the beginning the therapists would put her trampoline against the wall and she would have to hand over the icon for the trampoline to get them to put it down so she could play with it. We keep two PECS books around the house, one for food and the other for activities. R. does not use them as much as she used to, I think she really understands it is easier to be prompted to say the word than retrieve the icon, but she will occasionally go back to them and bring us one of the cards.
Sign language is another option. R. did not have the imitation skills when we began, so this really was not a good fit for us. I have met other children with ASD who are as adept with signing as R. is with PECS. One advantage to signing is that you don’t have to bring your PECS book everywhere and keep track of all of those icons.
Our former program director would talk about PECS enabling R. to learn the power of communication. It really is not possible to physically prompt a child to speak, but both of these methods can be physically prompted. The advantage of being able to physically prompt the correct response, in ABA speak is errorless learning. The prompt level will be gradually decreased. When R. started using PECS the prompt was to hand over hand help her remove the icon and hand it over. After a while the only prompt she needed was for us to show her the PECS book.
Several family members asked me if R.’s using PECS was going to delay her ability to speak. They were concerned that it appeared easy for her, and she would become reliant upon the method. I think PECS is what enabled R. to get to the point she is now with speaking. She was not at the developmental point to be able to access language, but she was able to be taught how to communicate. NT infants and toddlers in the pre-verbal stage are becoming experts at non-verbal communication, R. needed to develop these skills before she could speak. PECS enabled her to have the benefit of being able to communicate at her developmental level.
The ipad and other devices will be opening up new worlds in alternative communication for children on the spectrum.
Don’t reward crying/tantrums
Crying and tantrums are a form of communication. They were R.’s main method when we started on this journey. ABA was very helpful in teaching me that I should not give her what she wants when she cries, I should prompt her to communicate her wants. I wrote about this a few months ago. I’ve read discussions on different ASD boards that describe this method as not acknowledging or ignoring crying/tantrums, and I think this is an incorrect interpretation. Crying should be acknowledged for what it is, a complaint. The message I want to send R. is that, I hear you, you are upset, but if you want whatever it is you have to say a word or give me an icon. Crying may get my attention, but only communication is going to get you what you want.
At this point I can usually prompt R. to say a word if she is crying for something she wants. This actually happens rarely, because most of the time she will start with a gestural communication (hand leading) and then will either say or be prompted to say what she wants. But sometimes she can’t have what she wants, or she has to wait and then she will cry. This is probably more accurately described as a complaint, she usually has no tears and there is babble and sometimes words among the yells. I also try to explain why she can’t have what she wants and offer an alternative. So if she’s crying because she’s impatient for the popcorn to finish in the microwave, I can show her the bag that is popping, the countdown timer and say we have to wait. It’s always harder if it is something she can’t have, but it is getting so much better. So if she is crying because she wants to go outside, I can tell her it is too late to go out and offer something else to do. I’m still in awe every time this works.
Consider that communication is more than just words.
Shortly after we started ABA, R. began hand leading. I realize now this is quite common among children with ASD. At the time it seemed quite amazing, and now it is so much a part of how she communicates. Prior to any gestural communication it seemed her only method of communicating was by crying or with a look or expression . The first programs that ABA started with were what they called anticipation games. They would do something she liked – tickles, spins, bubbles… and then wait for her to look at them to repeat it. It wasn’t long before she would gesture by grabbing their hand to continue the activity. These play activities taught R. that people could do fun things if she communicated.
In the book The Special Needs Child by Dr. Stanley Greenspan, he writes about closing circles of communication. If I tickle her and she looked at me to continue, that would be one circle of communication. I really liked this concept because it gave me a sense of actually doing something using skills she already had. It still feels like a game to see if I can get her to close just another circle or two. Floortime lite Mama writes about Floortime as a lifestyle, and that is how we do things around here.