Speech - Language - Communication - Different forms of AAC - Part 1

1. What is communication?

Communication is a two-way process involving expression of ideas with a communication partner and  he will be able to understand what I am trying to convey. Accordingly, the partner gives a response to what I say or ask. This makes the process complete. For example, I am asking for a pen to my son. He takes it and gives it to me. This is a complete communication. Communication can be verbal or non-verbal or a combination of the two.

2. Types of Communication

There are 2 types of communication – verbal and non-verbal. In verbal communication, we use our verbal skills in the form of words and sentences. Non-verbal communication involves using gestures, eye or hand movements and other methods, instead of words. Pointing, gestures, visual clues etc are ways of communicating non-verbally.

3. Which type of communication is the most important?

Both types are equally important. In our day to day life we are using both verbal and nonverbal communication. The same message can be used as a command, instruction or a request depending on your tone. This shows that the same set of words can be used in 3 different contexts. This makes it necessary to indulge in a combination of verbal and non-verbal communication to ensure that the right message is conveyed.

4. Is it important to train your child to learn both verbal and non-verbal communication?

Let me use the example of a child I worked with. This girl is verbal, can sing songs, can use sentences, yet in some situations she struggles to use words to communicate. Repeating words, singing and talking about what they like are different from using words as a tool for effective communication. If they are able to use their words and sentences meaningfully, only then it becomes proper communication. Hence even for verbal children, it is important to introduce non-verbal methods as well. Most of the time, parents are only looking at ‘speech’ for a verbal child and non-verbal communication for a non-verbal child. We need to understand that even neurotypical people use both methods of communication, despite having no diagnosis of any sort. It thus becomes important to train our children in both verbal and non-verbal communication. Especially in the case of autism, when the child is going through high anxiety, aggressive behaviour or a difficult situation, if we are using verbal instructions, the behaviour might go out of control. In this case, you may be required to use visual clues or other methods of communication to express your ideas to the child to help him or her calm down. If you have not introduced that mode of communication to the child, he will not be able to understand what you are trying to convey to him.  This makes it very important to train both verbal and non-verbal kids in both modes of communication, in the case of autism.

5. What are the different forms of communication?

a) Motoric – The child takes your hand and instead of pointing, will push your hand onto the desired object. In a neurotypical child, pointing skills emerge before language is formed but autistic kids may not develop these skills and use the motoric mode of communication instead.

b) Gestural – Pointing, nodding, actions to express etc.

c) Vocal – Use of sounds to get attention. For example, if my child wants juice, he cannot clearly say the word but makes a sound similar to the word. For some words, he can use the first sound.

d) Pictorial – Use of pictures. PECS comes under this. For example, if the child wants to go cycling, he shows the picture of cycling. If the child wants dosa, he shows the picture of dosa.

e) Written – some children use written words or sentences to express their desire. For example, if they want to go for a walk, they may write ‘walking’ and show it to the communication partner. Writing should be in such a way that the communication partner is able to understand what the child expresses.

f) Sign Language – There are particular signs to communicate each word.

g) Verbal – use of words, phrases and sentences to communicate.

h) Non-Verbal communication – all modes of communication not involving speech come under this category.

6. Speech, Language and Communication

Language is a system that presents concepts and ideas involving the use of arbitrary symbols. There are rules to be followed and symbols to be used in a community situation where members of the community are able to follow them systematically. It is a code for expressing our ideas and concepts using symbols in a particular pattern and following rules, to make it meaningful. Typically, there are 2 forms of language – oral and written.  There are other types like sign language as well.

Components of language – phonology, morphology, syntax, semantics and pragmatics.

Phonology involves the use of sounds. Ka, ma, la etc.

Morphology involves rules for combining sounds to form words. When the child is ready to combine sounds to make sounds and phrases, it is morphology.

Syntax – Grammatical aspects of language.

When we are working with the child, we start with phonology by introducing sounds. From here, we move to morphology and then syntax. I started with sounds and then words and picture to word associations, then sentences to word association and thereafter syntax.

Semantics – includes meanings as well as rules to link meanings with the words. Semantics also is to be used along with morphology. This becomes important for picture to word associations and simple one to two-step instructions; reading instructions and following them comes under semantics.

Pragmatics refers to the use of language appropriately depending on situations. The other concepts have been taught during table-top time and therapy time. How the child uses this learning appropriately in a real-life situation comes under pragmatics. For example, if you are doing cooking with your child, you use a lot of language. Here the child is using language to do something meaningfully in his daily life. This comes under pragmatics.

These steps need to be followed sequentially for the child to come up to the pragmatic level, wherein he or she is able to understand properly. Language can be receptive as well as expressive. Receptive refers to the ability of the child to understand, respond to and follow instructions. For building receptive language, we need to start with identify pictures and common objects like fruits, vegetables, vehicles. Categorization and grouping and concepts of colours and shapes etc need to be taught. The child is taught to follow one-step instructions as well as related two-step instructions etc. To get a response from the child, you need to introduce these things and the child should be able to understand them. When the child is strong in receptive language, he automatically starts to use expressive language properly. For example, if the child is verbal and using words randomly or as echolalia, due to lack of receptive language and comprehension skills, he is unable to respond appropriately. For both verbal as well as non-verbal children, we can build proper receptive language. We use language to communicate our ideas, express our thoughts and difficulties.

Speech – Speech is a mode of expressing communication using language. It is the ability to use speech sounds in a particular language. We are using sounds in Hindi or English or any other language and combining them to form words to communicate. For sounds we need to use our tongue and lips in different ways. Oro-motor coordination using lips, tongues and jaw together to make sounds and there is more complexity in combining the sounds to form words. Some children with autism face oro-motor difficulties from the beginning, which are manifested in the form of difficulty to chew food, blow, spit etc. We work on these using oral imitations. Imitation is a very important pre-requisite for building language and speech. We will start with gross motor, followed by fine motor imitation when the child is ready to focus on this and then move into oro-motor, beginning with lip movements and using different techniques to teach them swallowing, spitting etc, with a lot of practice. If the child is flexible enough, he will start making sounds like ba, ma etc and then move to joining sounds to form words. Effective speech therapy should consist of speech, language and communication, not merely speech, in order to get proper results. You can communicate without language as well, using gestures and actions. On the flip side, you can use speech without communication as well when you are randomly using it and are not able to express ideas in a way that is understood. In the case of autism, if a child is able to produce sounds and forms words or sentences, he is called a verbal child. But he too might struggle to communicate as much as a non-verbal child. Hence it becomes important to find an alternative way of communication.

Some children with autism suffer from verbal apraxia and struggle to produce sounds and combine them to form words. Hence, they may not be able to talk but can be taught language and communication skills. They can use a different form of communication without the use of speech. Their functional academics can be handled as well. There are some kids with echolalia and repeats words without proper receptive language. If we focus only on speech with commands like ‘say bird is flying’, ‘say ball’ etc, the child only learns to repeat. This is not the right way to teach language. We need to ensure proper use of visuals,  build comprehension skills and thereby the correct understanding of language.

7. Using alternative methods of communication

In our day to day life, we use verbal and non-verbal communication. However, when it comes to our children, parents always worry about speech. But we need to use non-verbal modes as well. We need to work on language and communication skills, using any alternative method of communication. Most autistic children struggle to use their words even though they are verbal due to comprehension issues. At times they are only repeating words without attaching any meaning tothem. This makes it important to use visuals and modes of communication like PECS and Avaz for verbal children as well.

What is AAC and why it is important?

http://smrithyrajesh.blogspot.com/2018/01/what-is-aac-why-it-is-important-for.html?m=1

Q) How to start?

When the child is trying to communicate in his own way then introduce the proper way of communication to the child and help the child to communicate using AAC without asking what do you want.

Q) Important points to remember

We should prepare Visuals or objects according to kids level of understanding. We have to customise size of the pictures and should start with child's original pictures. Every one should follow the same method at home. We should practice it consistently.

PECS- PHASE 1- Physical exchange

1.To start first you have to find your child is in object level or picture level

2.prepare objects or visual cards according to kids level of understanding.

3. Introduce it when the child tries to communicate in their own way.

4. Be consistent

5. Use it in different places,use it with different family members and therapists.

Q.When you can move to phase 2?

Ans:Your child started picking the picture of desired item independently and exchanging it to the communication partner when you are providing pictures.

Phase 2: Expanding Spontaneity

You can paste the pictures (same two pictures) in a wall with velcro. It should be placed where it is easily accessible for the child.

If the child is not trying to communicate by himself just took him infront of the strip( in a distance) and help him to communicate.

Note: in this phase also we are not asking what do you want.

Consistently practice it..try to fade your prompts.

When the child started picking up the desired picture by himself,you can start adding more pictures one at a time. While adding more pictures, choose different pictures like bubbles,waterplay etc.

Q. When you can move to phase 3

Ans. When the child started moving to the velcro strip and started picking the picture of desired item independently you can move to phase 3 ( at least 8 to 10 pictures)..

PECS phase 3

In phase 3 children will pick up the picture from the communication board and will exchange it to the communication partner independently. No verbal prompt ,in this stage too..we can introduce a file for keeping this pictures and can keep the file in a place where it is easily accessible for the child. By that time if the child know the concept of categorization,you can keep food items in one page, actions in next page, places in another page etc.

PECS PHASE 4 : Sentence structure

You have to create a sentence strip with I want and should attach with the communication file. No verbal prompts in this phase too. We should train the child to find his desired item from the file and to attach with the sentence strip and after that exchanging it to the communication partner.

PECS Phase 5 , Responding to what do you want

PECS Phase 6, Responsive and spontaneous commenting
Create pictures for I see, I feel , I like etc