Home > Got Questions?, Science, Uncategorized > My child is nonverbal. Anything new that might help him communicate better?

My child is nonverbal. Anything new that might help him communicate better?

Today’s “Got Questions?” answer comes from speech-language pathologists Cynthia Green, Kameron Beaulieu, and Jill Dolata (left to right in photo) of the Autism Speaks Autism Treatment Network (ATN). Their ATN work at the Oregon Health & Science University’s Child Development and Rehabilitation Center involves individualized parent training using a 24-week program that improves children’s social communication skills.

Today, parents and therapists have many new applications and devices that support a child’s nonverbal communication. First and foremost, however, we strongly recommend an insightful look at how your nonverbal child communicates—in other words, how he sends messages to others.

As you and other parents of children with autism know well, non-verbal does not mean non-communicative. So we always want to start with a good understanding of children’s current communication level before attempting to help them move to the next level.

We regularly use the Communication Matrix, a skills assessment designed to evaluate children’s communication abilities. This tool is unique in measuring all possible communicative behaviors, including: pre-intentional (involuntary actions, including crying when wet or hungry); intentional (actions such as fussing and turning away that are not primarily intended for communication);  unconventional (tugging, crowding to get attention);  conventional communication (head nodding, pointing, etc.); concrete symbols (pantomime, “buzzzzz” to mean “bee”); abstract symbols (single words, manual signs); and language (oral and written word combinations, American Sign Language).

To be successful communicators, children need to see that their actions influence those around them, and they must want to communicate. Sometimes, it’s difficult to determine when nonverbal children are sending intentional messages—particularly when they prefer to play by themselves, engage in self-stimulating behaviors or have difficulty sustaining interactions.

There are several programs designed to initiate positive interactions and increase communication in children with autism, including First Things First, Indirect Language Stimulation, DIR/Floortime, the Hanen program, the Early Start Denver Model, and the Autism Parent Training Program. These programs have many similar components including putting yourself at your child’s eye level, allowing your child to direct activities (following his lead), and imitating your child’s behavior. These strategies help forge a connection of interests between you and your child and can support your child’s desire to communicate.

Once children communicate using concrete or abstract symbols, they may benefit from having access to additional communication tools. It helps to remember that we all use a variety of communication methods, including eye contact, facial expressions, body language, tone of voice and gestures. So you might want to start with a system of gestures or sign.

Other low-tech tools include picture symbols and PECS . Some children seem to respond to tangible symbols such as an actual key for “let’s go outside” or a cup for “I’d like a drink.” From the use of tangibles, families can move to photographs of familiar items and eventually to more abstract symbols. Children at this stage may benefit from Tangible Symbol Systems.

Finally, parents and therapists now have access to a number of technological devices and options, from a tape player with simple buttons for playing prerecorded messages and keyboards for typing messages to sophisticated voice output devices and specialized iPhone/iPad applications.

We hope you’ll have fun exploring these options with your child, ideally under the guidance of a therapist well versed in the best evidence-based practices. And please stay tuned for the fall release of the new Autism Speaks ATN brochure on Visual Supports and ASD. We’ll be posting it for free download on the ATN’s Tools You Can Use webpage.

Readers are urged to use independent judgment and request references when considering any resource associated with diagnosis or treatment of autism or the provision of services related to autism. Autism Speaks does not endorse or claim to have personal knowledge of the abilities of references listed. The resources listed in these pages are not intended as a referral, or endorsement of any resource or as a tool for verifying the credentials, qualifications, or abilities of any organization, product or professional. The contents of this blog are solely the responsibility of the authors and do not necessarily represent the official views of Autism Speaks, the Autism Treatment Network and/or the Autism Intervention Research Network on Physical Health.

  1. Tonya Myers
    October 14, 2011 at 9:21 am

    I am also the parent of a non-verbal child. My son is six years old now and is picking up a few words here and there. Working with the ipad and other devices has been a big help for him. Sign language also helped a lot. But I think the biggest thing you have to do is be your childs best friend and advocate. Get to know your child well. He’ll let you know what he wants and needs. They have their ways of getting the message across.

  2. taffimak
    October 14, 2011 at 9:39 am

    Please do not give up hope. My son did not or could not speak until he was 9 or 10 years old and was not allowed to attend school until then. Doctors said he was a ‘write-off’ and to ‘put him in an institution and forget him’. Mind you this was years ago and things have changed thank goodness. Anyway, eventually my son was able to go to University and graduated in Computer Science – some write-off!! He is a kind, affectionate son with a great sense of humour. People comment about his good manners and likeable personality so miracles do happen. By the way he spoke suddenly out of the blue just as though a switch had been turned on.

    • PostiveThinker
      October 14, 2011 at 10:35 am

      I love hearing stories like yours. My son is 6 and just starting to imitate sounds. I know he is smart and I long to hear his voice and his thoughts. He is in on going therapy to work on all his needs. Thanks for sharing your story it gives me alot of hope :)

    • October 14, 2011 at 10:49 am

      Thank you for your insight. I have will not give up.

    • Patricia O'Brien
      October 14, 2011 at 12:48 pm

      My nephew also did not use many words and had great difficulty with expressive language. At the age of 9 he began with an OT getting a lot of good sensory integration therapy and at 11, began Tomatis training at Spectrum Communication Center in New York. We saw a big difference in his speech and in his ability to take exams and focus. He is now in college and verbal, albeit with difficulties, but he thrives in math and science. Don’t ever give up looking for ways to address your child’s needs, and don’t believe everything your doctor says.

    • Sarita
      October 25, 2011 at 11:22 am

      Reading your note gives me hope. My son is non-verbal and has many delays. However my fear is never hearing him speak. Weeks go by and I never hear him say Mom. He is getting older now and it is difficult for me as a mother, people notice that he is delayed and non-verbal and that is even more difficult. However reading your post made me feel some hope for my son. Thank you for writing it.

  3. Katie Wright
    October 14, 2011 at 10:29 am

    My son lost every word of his vocabulary at the age of 2- just poof- totally gone.
    I have found that it is EXCEEDINGLY hard for children who had severe regressions to regain meaningful speech. We used to be able to have conversations!

    We tried everything imaginable. Every single intervention listed above, nothing worked. It was so devastating. Meanwhile I would see friends whose autistic kids really took off w/ speech therapy. The difference was that they had more classic, less environmentally induced autism. Their kids never spoke as toddlers and missed other milestones but really seemed to respond well to therapy and started gaining words and steadily improving.

    My speech therapists tried so hard but it was so frustrating for all of us. If your child is like mine look into biomedical resources, chances are your child has underlying biological problems preventing him from progressing. Finally I attended an Autism Research Institute conference and met parents w/ kids like mine. Once I addressed the GI issues things got better. PECS and sign language still did not work but the IPAD is great.

    Don’t give up but don’t feel trapped either, if something isn’t working don’t be afraid to try something new and talk to other parents who have autistic kids like yours.

  4. NANCY
    October 14, 2011 at 10:29 am

    PECS is an excellent tool for my daughter.

  5. Debbie Obney
    October 14, 2011 at 10:31 am

    we use sign lanaguage with my son when he was young, just basic stuff then he cuaght on language skills.

  6. October 14, 2011 at 10:33 am

    I have a friend who’s her child is also a non-verbal. I deeply felt pity on her before since she find it hard to understand what her child is expressing. She always come to us her friends and ask for an advice on how she could help her daughter. So we keep on comforting her and help her to become a stronger mom despite of everything. Today, her daughter is already 8 years old and was enrolled in school of non-verbal disability. I really appreciate my friend because she never gave up helping her daughter to cope up with anxiety and sensory difficulties.

  7. heather
    October 14, 2011 at 10:36 am

    I PRAY ONE DAY THE SWITCH HAPPENS 4 MY 11YR OLD SON …HE IS ALSO NON-VERBAL………..

  8. Tami
    October 14, 2011 at 10:42 am

    Has anyone here ever been told not to use sign language because if you did your child would never learn to speak? Do you think at age 10 it might still help to try signing?

    • October 14, 2011 at 11:41 am

      My nephew learned to talk by using sign language as he said a word. “Please” with the appropriate sign was first. This started at about 6 years old. For a few years, every new word he learned was with sign. Then he started not needing the sign and just learning the words. Today, at age 13, when he has trouble saying something he will make the sign almost involuntarily. When he started elementary school, the school’s speech therapist said that she would not use sign language because most of society does not use sign and it would do him no good. We quickly educated her on the fact that the sign language wasn’t the end goal, that it was a tool for him to learn to speak. Not sure if she got it, but he progressed fine without help from her. Today, my nephew is somewhat verbal. Learning some full sentences and even expresive intonations. Spontaneous speech is not common. Bottom line however, sign language helped him become verbal, so yes, I would defintely recommend it.

  9. Carol
    October 14, 2011 at 10:52 am

    I work with different levels of students with austim, We can communicate we just have observe there actions and looin to there heart thru the eyes.
    Don’t give up when your child is trying to tell you something Watch for body language and such

  10. Belle
    October 14, 2011 at 11:03 am

    I was a Behavior Tech/Tutor at an Autism school. One small tip I’d add is to make sure that you give a positive response to whatever attempt your child makes to communicate. The ideal,of course, is to quickly give them what they request (within reason of course). Or if you cannot understand, at least encourage heartily their attempts. This may help them to understand that you want them to communicate and that they will get a positive result when they do.
    There is hope! I saw so many children go from non-verbal to verbal and the fact that you are a good parent looking for help will go a long way for you child.

  11. Kynyatta
    October 14, 2011 at 11:06 am

    My son is 11 and has never been verbal. He also receives speech therapy and has since he was 2. Just recently he has started imitating sounds and phrases (to the best of his ability), but nonetheless, he is trying! Yes it gets frustrating and sometimes even heartbreaking when you just want to HEAR your child call you “Mom” or say “I Love You”. He never caught on to PECS and he trys with simple sign so we keep pushing forward! I will NEVER give up on one day him having a verbal conversation with me. I can’t because it would mean giving up on him!!

    • marisa
      October 14, 2011 at 1:18 pm

      My son is 2 & also nonverbal. Your post made me cry because I think about this everyday. I hope I have done right by him & his life experience has been favorable thus far. I hope he understands what I mean when I convey love for him.

  12. Julie
    October 14, 2011 at 11:10 am

    Our son has limited verbal ability and also has difficulty with writing so our O.T. suggested teaching him to type. We began at age 10. I had thought perhaps he could begin typing in middle school but isn’t it funny that I didn’t think of it as something we could try in elementary school! Why not? He is now 14 and will type a one-paragraph e-mail using simple sentences. We use an iPod with Proloquo2Go software. It has a nice option to go back and forth from PECS symbols to a keyboard quickly and easily. He can choose whether to type his words or use PECS.

  13. rhea
    October 14, 2011 at 11:24 am

    my son is 11 years old, and he dont speak till now..he use conventional for his needs..he grab my hand when ever he wants something..

  14. October 14, 2011 at 12:10 pm

    Political Correctness and the SLP

    What is the role of a Speech and Language Pathologist (SLP) in the treatment of autism? It makes sense that when a child doesn’t speak or understand, this would be the first place to go for help. Correct? Not so fast… MSN Health and Fitness attempted to give the parent of a child with autism 10 questions to ask the SLP to ensure that the parent understands what the SLP has to offer. Then the Health writers slip under their politically correct blanket when they say, “interventions also vary widely… That’s why it’s essential to get individualized answers to your questions…” Wow!!! That sure was helpful, wasn’t it?

    It is worth noting that a good SLP is priceless, and a bad SLP will steal your child’s precious time, and empty your bank account. So, caveat emptor! In addition, many parents are not informed that when a very young child enters a high quality, Intensive Behavioral Treatment (IBT) program, the speech and language aspects of the program have already been incorporated into the treatment protocol. Once the child has progressed to the point where the IBT program has not adequately remediated the speech and/or language difficulties, then it is time to search for a competent SLP. A good behavioral consultant will often recommend an effective SLP who becomes an important part of the team. If that happens, chances are the parent will be in good hands; however, if this does not occur, it’s time to be a savvy consumer:

    Here are my 10 questions to ask a prospective SLP, and the answers you should be looking for (I’m putting on my Beekeeper’s suit since I’m shaking an SLP hornet’s nest here):

    1. What techniques do you use for autism spectrum disorder in your practice today?
    Answer: Although I’ve learned a variety of philosophies, for autism I rely on a highly behavioral approach since that works best.

    2. Do you use a child-lead philosophy or is your approach more adult-lead?
    Answer: For autism, my approach is much more adult-lead than most SLPs because the learning is more efficient that way.

    3. What is your opinion on the Hanen method?
    Answer: I’m very familiar with the Hanen Method, but I do NOT use it for children with autism (and I don’t think that there is enough data supporting that method to use it with this population of children).

    4. Are you going to send me to a course to teach me to use the “It Takes Two to Talk” manual?
    Answer: The burden of therapy with your child will not be placed on you, particularly since this manual has insufficient science behind it to justify its use.

    5. What do you think of the SCERTS method?
    Answer: I’m also familiar with the SCERTS Model, and I am unimpressed with the data to this point.

    6. What about “The Learning to Speak” program?
    Answer: “The Learning to Speak” program with the twelve minutes a day “parent as therapist” model has insufficient science behind it to justify using it with your child.

    7. Do you create speech and language exercises for others in my child’s life to do outside of one-on-one therapy with you?
    Answer: I am committed to provide exercises the therapists can do with your child in their treatment sessions (as long as they take data to make sure that they are adequately executing my written instructions). I would also like to do training with them as the need arises.

    8. How do you generalize the activities my child has done in your sessions to his/her world outside of the therapy room?
    Answer: Generalization of skills is my ultimate goal! I will be instructing you on how to incorporate language when you are with your child (and the therapists have gone home). I am not suggesting that you have therapy sessions with your child; however, every skill your child masters must be generalized to you as well. In other words, I want mastered linguistic skills incorporated into your child’s life; otherwise, what is this entire exercise for?

    9. How much of my child’s time should be spent concentrating on speech and language outside of sessions with you?
    Answer: I would like to see skills introduced by me, practiced every day with your child by your treatment team, and then generalized through every communicative interaction in your child’s life.

    10. Do you use behavioral techniques in your work?
    Answer: I use behavioral techniques heavily, relying on highly motivating rewards in my sessions with your child. In addition, I will set up rewards for your child to earn when with others at home, at school and in the community.

    If the SLP is enamored by the Hanen Method, the SCERTS Model, or any child-lead model or philosophy when it comes to autism, run the other way… You will save your child’s precious time, and as a side benefit, you will not have to undergo excruciating pain of watching high-price inefficiency at work.*

    *Despite the number of SLPs with Ph.D.’s behind their names and the number of university clinics offering this method, peer-reviewed data studying children with autism on the Hanen Method, SCERTS model and the “Learning to Speak” program are either weak or non-existent.

    • October 15, 2011 at 4:45 pm

      Dr. Freeman,
      I would like to suggest that a review of the adequacy of the child’s diet for proper brain development will provide a great assist in seeing progress. I recommend the nutritional equivalent of two to three regular eggs or egg yolks daily to ensure the proper nutrients are available. One parents comments regarding his non-verbal son were as follows:

      “Hi Dr. Harold Rongey,

      Leon is doing great improvement. We are more than happy as he is capable
      of understanding everything. This being in our opinion the most important concept.
      Since the introduction of your diet, followed six months afterwards by the help of a
      facilitator from the Education Department, provided to my son, he is doing extremely
      well. Regarding speech he is slowly increasing his vocabulary. Besides, he is capable
      of repeating some words. Although having problems with some phonetic, still is understood,
      and being helped by a speech therapist regarding the the phonetics problem. I must
      admit that he started to understand and utter some words since the introduction of your
      diet. — Before, my sons vocabulary consisted of only ten words and often there was no eye to eye contact, hence having great difficulties in understanding us. Adapting to your natural diet improvement was seen after the first two months and by the sixth month was understanding us and obeying our commands. In school before he always ran round the classroom without sitting on a chair for a second throughout the course of the day. Nowadays Leon is capable of sitting down and listening to the teacher and facilitator. Last year at San Raffaele Hospital in Milano he was diagnosed with medium autism, and Dr. Natalie Sora was aware with the problem Leon had, I wonder what she would say if this specialist had to see him now?
      I would like to thank you, as your diet was the most important factor that started improving
      my son’s mental condition.

      Regard
      Philip Mamo”
      Milano, Italy

      Note: When first talking with Philip he advised that stem cell research was contemplated but would take six months for the treatment to start and six more months to see if it was successful. My advice was to try the simple diet change and that he would likely not need the stem cell treatment. He later advised that due to the success of the dietary change, he had postponed the stem cell treatment for a year.

      Nutrition makes it possible to speak while therapy will show them how.

      • October 17, 2011 at 12:28 pm

        Children with autism may have other medical issues that need to be resolved (e.g., allergies, headaches). Unfortunately, it is often very difficult to separate the medical condition from the behavior because the child may be non-verbal or have limited verbal ability. If a child is suffering from an underlying medical condition, it will often manifest itself in difficult behavior. My comments always assume that the parent has taken care of the other medical issues that may be bothering the child. That said, feeling better doesn’t teach skills; technique does. That is why it is crucial to have the child work with SLPs who use scientifically validated techniques.

  15. Bradley
    October 14, 2011 at 8:14 pm

    My child has been able to “communicate” by using his Ipad, and proloque2go program.
    Manyu thanks to the Hollyroad foundation for supply the Ipad for my son for free.

  16. Julie DePaola
    October 14, 2011 at 9:56 pm

    My son was also nonverbal until we tried the gluten-free and casein-free diet. His became more communicative and began to have spontaneous speech for the first time. Prior to the diet he was an ‘echo’ of what we said or what he heard on tv. lLso, eye contact and stimming were greatly improved.

  17. Marjory
    October 15, 2011 at 3:49 pm

    SOLUTIONS: RE Early Speach Development

    Practice- practice-Consistancy- dicipline-

    Regarding delay speach, I am a mother with a Son diagnosed early on with Autism, or PDD-NOS, later Aspbergers,Logans learning was retarded due to bowel issues. Today Logan functions just like any other boy. What worked for my son was early on we had help through Early On school intervention. We also took the iniciative to turn our gerage into a sensory room. We had sorting sations. rolling areas, presented all sorts of exercises to do daily. We also used picture word association. I labled basic things in our home I.e When my son would want a drink of milk he would attomaticly go to the fridge, some time out of frustration bang his head on the floor. We put a pillow under him until there we would have him point to the picture of the mild on the firidge. We practiced showing till he was ready to go beyond his frustration and get the mild card. We did this daily, and consistantly He could not get the milk until he gave it to us, tanrums or not. consistancy was the key, early on,waiting out the tantrums was also the key. Logan had many sensory issues, When kids are 2 or 3 they can not tell you “Hey I have gas pain” however watch phicical ques, We made great gains with him much was deminished due to agressive sensory exposure, we tried the Mio- Munchie- ( that did not work for us) but also brushing and conpressions on joints. His picky appetite was another challenge Logan was highly lacking in fruits and veggies at age 2- often would spit them at us. In hind sitgt we should have waited Logans hunger out and returned just to that veggie or fruit. We did try to supliment with juices and drings however that doses not supply fiber that helps carry toxins out of the body, the lack of these foods caused, bowel issues and that caused hemeroids, that causes also an in ability to sit still and learn.. Many years went by we tried every mineral oil, and natural remedy first we did not want to medicate, however we did finnaly use Polyethylene Glycol ( it is just like mirilax, It got Logan regular and in Using this helped deminish many behavior issues as well, The key is not to give in ,and to present those vegies and fruit, or pictures and words come with work you do the work and try to pronounce the word and you get the milk , or cookie. at every meal to encourage good foods. Time frames with meals too helped.. 20mn to eat and take food away next meal that comes around if not eating rounded meal they get to see that fruit and veggie once again.

  18. November 16, 2011 at 12:20 pm

    Hi All,

    I really Thanks the authors of this blog.This is really a fantastic one.This helps a ton for the children using non verbal communication.

    I am bookmarking this blog and will be waiting for updates.

    Thanks,
    Josh.

    • November 17, 2011 at 1:33 pm

      One of the first questions that parents of newly diagnosed children often ask is: will my child ever speak? No professional really wants to touch that question with a ten foot pole because the answer is: it depends. I like to share what I’ve learn over 20 years of reading about this topic in the academic literature, speaking to thousands of parents of children with autism, and personally observing several dozen children with autism in behavioral treatment programs. I need to preface my opinions in this post by saying that I’m talking about children with autism, not Asperger’s syndrome (children with Asperger’s syndrome need to work on language as well; however, they have a much easier time improving their language abilities than children with autism).

      Echolalia (including Delayed Echolalia)

      If your child cannot use language to communicate but is able to repeat things people say, or can sing songs and actually pronounce words or the lyrics of a song, you should be very happy! With much hard work, and a qualified Behavioral Consultant and/a Behavioral Speech and Language Pathologist (SLP) your child will likely gain the ability to use language functionally. The child’s ability to use language will be highly dependent on the amount of time devoted to communication (and a once a week, one hour treatment session is generally not sufficient). Speech and language must be incorporated into an intensive program designed by a qualified Behavioral Treatment Consultant. If you have only recently established an intensive program for your child, at this point the full potential of your child is impossible to predict. After a few years of treatment, it will become much clearer to you, and the professionals in your orbit, regarding how fluent your child may become in future. So, my advice is not to inherit the future prematurely. Concentrate on maintaining a great treatment program with a heavy emphasis on speech and language!

      Apraxia

      There is a small subset of children with autism who also suffer from Apraxia, which is a difficulty in actually creating the verbal utterances required to speak. Apraxia occurs in children with and without autism. If a child with autism is Apraxic, the child will need a behavioral Speech and Language Pathologist to work with the child to teach how to create the individual sounds that comprise letters and words. This work should be part of an intensive program, where the SLP is a consultant to a team of behavioral therapists who practice the exercises designed and introduced by the SLP. There is controversy in the literature regarding the rare incidence of Apraxia amongst children afflicted with autism; however, if it is your child suffering from both, the prevalence of Apraxia in autism is irrelevant to you.

      Aphasia

      There is a subset of children with autism who also suffer from Aphasia: they cannot remember words, even after they are taught. A good behavioral SLP will be able to diagnose whether the child with autism also suffers from this syndrome. Although not common in children with autism, it is important to know whether the child suffers from Aphasia because the SLP, Behavioral Consultant and parent are going to have to agree on a strategy to attack the child’s communication difficulties. The challenge to create meaningful language is greater when Aphasia is added to the mix; however, working intensively on language is still crucially important for the child.

      One very promising piece of research that was published by Smith et al. 1997, demonstrates that even the most severely affected children with autism can gain enough language to speak in words, label objects and express needs orally. Whether the children in this study suffered from Apraxia or Aphasia is less clear; however, these were children who had NO speech whatsoever at intake.

      • November 17, 2011 at 4:09 pm

        Dr. Freeman,
        I believe it should be pointed out that a nutritionally adequate diet that meets the needs of the brain will dramatically improve the speed with which the child responds to therapy. It is the proper diet, one that includes an adequate amount of choline, cholesterol, plus the other vitamins, minerals, fatty acids, and amino acids that will actually make speech possible, whereas, therapy can then show them how to speak. This can shorten the program from years to a few months as reported by parents in my recent study..

  19. December 18, 2011 at 4:35 pm

    Really great info!

  20. December 28, 2011 at 3:27 pm

    Having children enrolled in child care is something I have no choice but to do. Luckily, I know they are in good hands, learning new materials everyday!

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