In a recent blog post on helping nonverbal children communicate, we let you know that our Autism Treatment Network (ATN) would soon publish a pamphlet on visual supports. Yesterday, we were pleased to release Visual Supports and Autism Spectrum Disorders, available for free download on our website. For perspective on its usefulness, today’s “Got Questions?” comes from the pamphlet’s authors:
Clinical Psychologist Whitney Loring, PsyD, and
Both work within the ATN at the Vanderbilt Kennedy Center’s Treatment and Research Institute for Autism Spectrum Disorders (TRIAD), in Nashville.
While working with hundreds of families of children with autism spectrum disorders (ASD), we have seen firsthand the benefits of visual supports. For some families, these tools bring immediate improvements in how their child and family function on a daily basis. Others find they need a few weeks working with these supports to see clear benefits emerge. Either way, they report significant improvements in their children’s communication and understanding, as well as increased compliance, adaptive behaviors and independence, along with decreases in challenging behaviors.
We are definitely believers in the power of visual supports!
Yet many of the families who come to us have yet to be introduced to these valuable tools. Some parents have heard that they should use visual supports. But they admit to not exactly understanding the term, where to begin, or why visual supports are important in helping their children communicate and understand others.
Often, we find ourselves explaining visual supports in the midst of answering the many other questions and concerns a family brings to us. As a result, parents may leave our clinic with “visual supports” being just one of many things they’re trying to remember and implement on their own.
Ironically, we came to realize that part of the problem was that we were attempting to explain visual supports quickly and verbally without having a visual way to communicate their importance!
Our answer is the newly released Visual Supports and Autism Spectrum Disorders, a step-by-step, easy-to-understand introduction to visual supports and the ways that parents and other caregivers can begin using them.
The pamphlet provides practical examples of how to begin integrating visual supports into a child’s daily routines. We’ve also included a variety of actual visual supports for parents to print, cut out and use, along with links to resources that provide more detailed information for those who want to go further.
So far, the response from families “test driving” this tool has been overwhelmingly positive, and the enthusiasm is not just from those new to visual supports. Some parents tell us, for example, that the guide helps them explain visual supports to other important adults in their child’s life—from grandparents to teachers and doctors.
We hope this pamphlet will help empower parents in both how they use visual supports and how they expand use among others who care for and work with their children. And we hope you find this tool useful in ways that make a positive difference for your child and your family. Of course, we continue to learn from you, as well. Please let us know more about how your family uses visual supports by leaving a comment on this blog and/or sending us an email at firstname.lastname@example.org.
Development of this tool is the product of on-going ATN activities. To learn more about the ATN or find a site in your area, please visit www.autismspeaks.org/atn. For more tools for parents, grandparents and clinicians or to find resources in your area, also visit our ATN Tool Kits page and Autism Speaks Family Services.
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.
My child is nonverbal – what are some intervention methods that might help my child communicate better?
“Got Questions?” is a new weekly feature on our blog to address the desire for scientific understanding in our community. We received over 3000 responses when we asked what science questions were on your mind. We answered a few here and will address the other themes we received in this weekly post.
Many individuals with autism do not use spoken language to communicate. It is estimated that approximately 25% of individuals with ASD are nonverbal. Despite early traditional approaches such as speech, occupational and behavioral therapy, some children still remain unable to communicate their wants and needs. A recent study found that some children with ASD do not develop spoken language until after the age 5 years. On-going speech and language intervention can promote the development of speech in nonverbal children who are of school age. In addition, there exist specific intervention approaches that can be helpful for some individuals, such as PROMPT, an intervention approach especially designed for children with motor-speech disorders.
Speech and language specialists recommend a variety of alternative and augmentative communication (AAC) devices for individuals who are nonverbal. A commonly used system is the PECS picture exchange system (PECS). PECS has been used with individuals with ASD of all ages. One advantage is that it doesn’t require expensive materials, relying on a set of picture symbols that can be used to make simple or complex requests and other statements. The symbols are typically placed in a communication book. After the child or adult learned to make spontaneous requests. The individual can then learn to construct sentences. . Other AAC methods include the following:
- Gestures and sign language
- Pencil and paper
- Communication books or boards
- Keyboards and other electronic devices
The iPhone and iPad are being used as ACC devices. These new interactive technologies have invited a wave of new applications to benefit individuals on the spectrum, especially those who are nonverbal. Many of these applications incorporate the advantages of the PECS system of offering a stock of visual images as well as the ability to personalize using one’s own images. Two of the most popular programs are Proloquo2go and iPrompts.
Although the use of these devices have not been tested in rigorous clinical trials, those trials are underway and early anecdotal reports are positive. Connie Kasari, PhD. (UCLA) leads an Autism Speaks’ funded clinical trial comparing two different interventions for young nonverbal individuals. Having previously used traditional keyboarding devices, Dr. Kasari has found that the iPad with speech generating software offers a great alternative to expensive AAC speech generating devices. However Dr. Kasari also adds, that these devices “Work best in therapy sessions with a child who has not yet figured out that they can surf the web with it, too!”
Of course, this potential distraction is also an advantage. These new applications are hosted on the multifunctional iPhone and iPad platforms. HandHoldAdaptive, the creators of iPrompts, have launched AutismTrack, a new portable journaling tool that enables caregivers to track therapies, medication and behavior. Developers continue to create new apps to address the challenges of those on the spectrum, making these new tools even more powerful for managing the everyday needs and desires for individuals on the spectrum.
ACC Institute: http://www.aacinstitute.org/
To locate a speech-language pathologist, visit http://www.asha.org/findpro/default.htm