Developing Expressive Communication Skills for Non-verbal Children With Autism

by Susan Stokes Autism Consultant

What is Communication?

Communication is a range of purposeful behavior which is used with intent within the structure of social exchanges, to transmit information, observations, or internal states, or to bring about changes in the immediate environment. Verbal as well as nonverbal behaviors are included, as long as some intent, evidenced by anticipation of outcome can be inferred. Therefore not all vocalization, or even speech, can qualify as intentional communicative behavior (7). This definition emphasizes that communication takes place within a social context. Speech/verbalization becomes communication when there is a desire or intent, to convey a message to someone else. Because social relations are a primary area of difficulty for children with autism, it is not surprising that effective communication is significantly impaired for these children. These two areas, communication and social skills, are tightly interwoven and interdependent. Therefore the development of communication skills cannot be the sole responsibility of the speech/language pathologist. While she may provide the "guide posts" and strategies, communication must be addressed continually by everyone who comes in contact with the child.

The two-fold purpose of this article is to provide:

I	Key questions to consider in order to determine the child's current communication abilities;
II	Information regarding the development of a communication intervention program based on the child's communication needs.

1. Key questions to consider in order to determine the child's current communication abilities.

In order to develop an appropriate communication intervention program for the non-verbal child with autism, it is essential to determine the child's current communication abilities. The following are important questions to consider in order to make this determination:

• Does the child exhibit intentional communication?

It is important to determine if the child is exhibiting communicative intent. Intent to convey a message distinguishes communication from non-communicative speech, verbalizations and gestures. When the child anticipates an outcome from his communication, regardless of the form (i.e.: speech, gesture, etc.), he demonstrates intent.

Example: A parent responds to a crying child. At this point, the child has not exhibited communicative intent. However if the child continues crying, looks at the parent, and then looks at a desired object, intent to communicate has been demonstrated. Through crying, looking at the adult and looking at the object, the child is anticipating that she will obtain the wanted item.


Communicative intent is indicative of the child's desire to communicate. In turn, the desire to communicate is inextricably tied to the development of social relationships, an area of significant difficulty for children with autism. Because these children are often unaware of, or may be uninterested in, others, communicative desire or intent is often absent. They do not understand that they can use communication to get something, or to get someone to do something for them. They attempt to get their needs and wants met by themselves in any way possible, and may exhibit distress when unsuccessful. When interacting with a child with autism, it is important to be able to distinguish this distress from a desire to communicate, in order to determine if the child is exhibiting communicative intent.

• In what way does the child communicate?

A child with autism, who demonstrates intentional communication, can do so using various forms or modes. It is important to consider which of the following communication forms are used by the child:

• Motoric: Direct physical manipulation of a person or object (e.g., taking a person's hand and pushing it towards a desired item; giving a cup to a caregiver to indicate, "Want milk").
• Gestural: Pointing, showing, gaze shift (e.g., a child looks or points to a desired object and then shifts his gaze to another person, thereby requesting that object. [i.e. the communicative act of requesting).
• Vocalization: Use of sounds, including crying, to communicate (e.g., a child says "ah-ah-ah", to draw another person's attention to him).
• Sign language: Communication with a conventional sign language system.
• Using objects: The child hands an object to another person to communicate (e.g., the child hands a cup to his parent to indicate "drink").
• Using photo: Use of two-dimensional photographs to communicate (e.g., the child points to, or hands photographs of various objects, actions or events to communicate his desires).
• Pictorial: Use of two-dimensional drawings which represent objects, actions or events (e.g., a child hands a line drawing of a "swing" to his parent to indicate that he wants to swing).
• Written: Use of printed words or phrases to communicate (e.g., the child writes, "too loud" to indicate that the noise level in the environment is bothering him).

In addition it is important to determine if the form of communication used by the child varies, depending upon the context and situation or the type of communication desired. For example, the child may use a motoric mode of communication (taking a person's hand and pushing it towards a desired item) to request an object. However the same child may use a vocalization (crying) to reject an item, or to protest.

• How does the child use his language to communicate?

Research has shown that the child with autism uses his language to communicate for a narrow or restricted range of purposes or functions (7). There are three primary functions or purposes of language: behavioral regulation, social interaction and joint attention (7). It is important to note that all three communicative functions are developed by approximately age 12 months in typically developing children, and are listed in hiearchical order from least social to most social (6):

• Behavioral Regulation: This is the easiest and earliest emerging communicative function (6). The child uses communication to request / protest, or satisfy his immediate physical needs. Behavioral regulations include:
Requesting objects
Requesting actions
Requesting assistance
Protest/reject object
Protest/reject action


• Social Interaction: Types of communicative behaviors that are used to initiate, respond to, maintain, or terminate social interactions. These social communicative interactions include:
Requesting social routines (e.g., requesting to play "peek-a-boo" and "patty-cake" games);
Requesting comfort (e.g., requesting to be held when distressed);
Greetings (e.g., "Hi" /"Bye");
Calling attention: (e.g., child calls attention to self through calling others);
Showing off (e.g., child exhibits "show off" behaviors during games, such as peek-a-boo, dress up, etc.).



• Joint Attention:

This is the most difficult communicative function for children with autism spectrum disorder to develop (6). These communicative acts are used to direct another's attention to an object, event, or topic of a communicative act. Joint attention communication acts include:

• Commenting (e.g., a baby looking at his parent and pointing to the sky at an airplane overhead. The child is not requesting the airplane but commenting about it, drawing another person's attention to this object);
• Requesting information from others (e.g., the child asks another "Where did you go?").
• Giving information to others (e.g., the child gives information about something that is not obvious or known to another person: "I went to the fair last night");

• Is there a reason for the child to communicate?

It is important to determine what motivates the child before developing a language intervention plan. As in typical child language development, children with autism will generally not engage in communicative interactions unless they are motivated to do so. Therefore, if the child loves swinging, or jumping or playing with string or particular foods, then these are the actions/objects that should be part of an intervention plan. Incorporating motivating activities and objects is vital when helping children develop communicative intent / desire. Teaching a core of early developing vocabulary words is merely teaching the child with autism to label and does not constitute teaching him to communicate. By initially using motivating actions and objects, the child will truly learn the purposes or functions of communication. Once the child has learned this, vocabulary can then be expanded through a variety of teaching strategies.

• Does the child initiate and/or respond to communicative interactions?

Communication implies being both an initiator of, and a responder to information while engaged in a social situation (4). Therefore it is important to determine if the child with autism is able to understand, as well as participate in, both roles in communicative interactions.

Example: A non-verbal child might initiate a communicative interaction with his parent by vocalizing to call attention, and then pointing to request a desired item. The same child might respond by pointing to a picture of a desired food item when his parent asks, "What do you want to eat?"



Children with autism typically have difficulty initiating communicative interactions with others, and tend to be better at learning to respond (4). When determining if the child initiates or responds to any communicative interactions, it is important to ascertain the particular contexts/settings, the manner or form of communication and the communicative purpose or function.

Example: A child finds his mother in another room, takes her hand and leads her into the kitchen, where he places her hand on the refrigerator handle. The mother opens the refrigerator and begins taking items out one by one until the child indicates by facial and body expression which item he wants. In this example the child initiated communication in the kitchen (context) to request desired food (purpose), by using a motoric and gestural form of communication.



• Is the child able to use "repair" strategies when communication breakdowns occur?

Due to their significant difficulties in successfully communicating, children with autism may experience frequent occurrences of communication breakdowns as both speakers (expressively communicating) and listeners (when asked to respond). Therefore it is important to determine if the child has developed, or is able to use, any communication repair strategies for both receiving and expressing communicative messages.

• Communication breakdowns as a listener (receiving information): Because children with autism have significant language comprehension difficulties, many communication breakdowns as listeners may occur. These breakdowns transpire when the child does not understand, or responds inappropriately to verbal information. A communication repair strategy that can be used in these situations is to present the misunderstood information visually (children with autism generally process visual information more easily than verbal information. In this way one can determine if the child is not responding appropriately (communication breakdown), either because the information is given verbally, or he doesn't understand the information, whether verbally or visually presented. Many children with autism can easily be mislabeled as being non compliant when they do not respond to verbal information. Careful consideration should always be given to the child's ability to comprehend and respond to verbal information (as opposed to visual information) in determining the reason for the breakdown in the communication.
• Repair strategies for communication breakdowns as a speaker (expressing information): When breakdowns in expressive communication occur, it is important to understand whether the child exhibits any of the following repair strategies:

Repeating the same communicative attempt: Being persistent. For example the child repeatedly points to a shelf out of reach, as the adult takes each item off of the shelf and shows it to the child to see if it is the desired item.

Showing the person what they are trying to communicate: a child might take an adult to the refrigerator, for example, open the door and reach towards a shelf where the milk is located, demonstrating that he wants milk.

Use of an alternative way to communicate the same message: In the above example, if the child points to the shelf several times, but the adult still does not understand (a breakdown in communication), the child might then choose a picture from his communication book to clarify his communicative request, thus repairing the breakdown in communication.