Enhancing communication: what can we do?

Dr Glenys JonesAutism Cymru

May 2006

Carol Gray (2000) ‘We hold more than half the solution’

• It’s unfair and misleading to state that those with ASD have a communication impairment

• Alter our communication, so that they can understand us

• Teach the person how to communicate and give them a means and incentive to communicate

Differences in communication in ASD

• Difficulties in taking part in early carer-infant dialogue (Hobson, 2002)

• May not develop speech, or this may be delayed

• Limited use of non-verbal means• Functional, rather than social• Often INITIATE far less contact • Limited range of communicative functions• Sensory issues (Bogdashina, 2003)

Our communication

• Our behaviour can be very difficult to interpret and understand

• Our social signals and intent via our facial expressions; gesture; intonation; body language may not be noticed or understood

Our communication

• Our words may be taken literally (Welton, 2003)

• Different intonation can make the same words have different meanings

• Our rate of speaking might be too fast• There are often competing sounds and other

stimuli

Adults’ language(advice from Potter and Whitaker, 2000)

• Reduce speech to single words or two word phrases supported by pictures or objects (eg tidy; story;snack)

• Map single words onto the most meaningful aspect of the situation/activity

• Use long pauses (10 seconds or more) to allow time to process and respond

• Use physical prompts for new task– delay use of speech

• Engage in interactive games, leaving pauses

Developing communication: prerequisites

• Must have a reason • Must have the opportunity • Must have a system

• Must feel enabled

Three main elements to consider:

• Means: eg language – spoken , written or signed; gesture, eye contact; facial expression; touch; behaviour; drawings, volume, tone, intonation, email, poetry

• Reasons: request; negate; affirm; tease; inform; share comment; greet; chat; express choice

• Opportunities: where:classroom; canteen; home; leisure areas / when: time, duration, frequency/with whom – adults, peers, other staff, parents

Communication in ASDs

• Some (33-50%) do not develop spoken language and so will need to be taught other forms with which to communicate (eg signs;photos; objects)

• Some with ASDs develop very good spoken language skills, in terms of vocabulary and grammatical structure BUT they need support to communicate effectively

Comments made:

• ‘He never communicates with me.’• ‘He can’t communicate.’• This is highly UNLIKELY as we communicate

in many different ways • These comments usually mean that the

person does not communicate in the ways expected or in ways we notice or can understand

Challenging behaviour as communication

• treat CB as a form of communication• Zarkowska has suggested we see CB as a

‘gift’– it prompts us to try to identify what the person is feeling or ‘saying’

• Teach an acceptable alternative behaviour to get the same result

• Communicate with the person in a way which is likely to avoid challenging behaviour

Assessment – person and setting

• Observe when and how s/he communicates and why?

• Pragmatics profile useful (Dewart and Summers, 1988)

• Factors which promote communication (eg setting/ activity/ sensory/people)

• Learn their ‘language’ (Caldwell)

Alternative forms to speech

Choice of system - need to consider:

• intelligibility to general public• portability and convenience• compatibility with cognitive, linguistic, sensory

and physical level of functioning• usability within present and future

environments

Types of intervention to enhance communication

• Interactive work (intensive interaction; musical interaction; Option approach)

• Developing play and role play (Sherratt and Peter, 2001)

• Changing parent/staff style (eg Child’s talk, Aldred, 2001)

• Object,picture, symbol or photo exchange• Computers (email; written work)• Social stories and Circles of friends

Interactive approaches

• Mimic early infant-carer dialogue• Work on social timing• Person-centred and enjoyable• Shows benefits of human company – basis of

friendships• Negotiation and turn-taking

Create opportunities: Circle of friends/buddies

• To promote the inclusion of the person in work and play activities

• To facilitate discussion and negotiation with others

• Allows adults to gain insights into their understanding

Communicate through a Passport

• My name is Adam.• I am happy when…..• I don’t like it when teachers….• If I am upset, it helps to…..

Email opportunities

• This avoids face to face contact• Can be done when the person feels ready• Provides a permanent record• Can create a wide network of contacts, with

no travel involved

Sharing the diagnosis with the child/adult (Jones, 2001): why?

• Can better understand themselves• Can develop their own strategies• Can avoid or invite interaction (eg Autscape

strategy)• Can meet others with ASD

Extract from Gunilla Gerland’s book

• Eye contact• Some of us with AS think it is easier to listen

if we don’t have to look in the eyes of the person we are listening to.

• When you don’t look in the eyes of the person you are listening to, they may think you are not listening.

• It may help if you explain that you are listening even though you are not looking at them

Gain the individual’s views: why?

• A reason to communicate• Guides interventions (Bullock, 2005)• Can gauge their self esteem (Moran,

2001)• Enhances their emotional awareness

and vocabulary• An indication of how well something is

working or not

Build self esteem to prevent

withdrawal/depression • Often can not think of anything they are

good at• Told many times they are wrong• Use applauding stories • Put positive statements within Social

Stories• Create permanent records of success

and refer to these

Wendy Lawson’s poem: an extract

The future

‘My future may not depend on my stock

So much as it does upon sources

Sources of warmth, sources of care

I depend on the nurture to be for me there.’