Assistive Communication Tools and Technologies for Autistic Children

Is your child among the 25% to 35+% of autistic children who are non-speakers or minimal speakers? Can they speak but not answer questions or have a conversation?

For parents and caregivers of non-speaking children, hearing their child talk is often their top wish. As Amy says, “I desperately want to hear Sam say, ‘I love you.’ I want him to tell me what’s on his mind. And I worry whether he’ll be understood when I’m not around.”

What is Assistive Communication?

We all use multiple communication methods, whether speaking, texting, typing, gestures, touch, body language or facial expressions. Speech-language pathologist Madelaine Ingles, who has her own clinic and works with many autistic children and their families, describes Augmentative and Alternative Communication (AAC) as “any tool that supports a child’s communication needs, either in place of speech (‘alternative’) or as a supplement (‘augmentative’) to speech.” Tools range from sign language, communication boards and pictures on laminated cards to high-tech tools like screens and iPads with visual displays where a child communicates by pushing buttons or pointing.

Melanie Willis, Clinical Supervisor and Registered Behaviour Analyst at Kerry’s Place Autism Services, Canada’s largest autism services provider, notes that AAC can also benefit speaking children who cannot talk when anxious, overstimulated or dysregulated; others may have motor planning difficulties. She believes many children can benefit, whether by enlarging their exposure to vocabulary or encouraging natural, spontaneous communication.

How do I start?

The first step is to meet with a speech-language pathologist (SLP) to assess your child’s language, cognitive, motor, and sensory abilities, observe them in various settings, and determine the appropriate AAC based on their abilities and needs. If you need to find an SLP, your school board can usually recommend one.

SLPs, behaviour analysts, occupational therapists, and other qualified professionals then oversee practice and implementation, working closely with you, the school and anyone else meaningfully involved in your child’s life.

Ms. Ingles notes that many children start with low-tech tools like communication boards and binders. Sign language can help children who are most comfortable with gestures and build vocabulary and connectivity. As she says, “If a child signs the word ‘water’ and you bring them a glass of water, communication confidence builds.”

Higher-tech devices and programs can be introduced as a child becomes comfortable with these tools. Among the most common are:

• Language Acquisition through Motor Planning/LAMP Words for Life
• Proloqou2Go
• Touch Chat
• Linggo

These customizable apps have digital touch screens and speech-generating systems. Some are subscription-based, while others can be purchased outright (it’s often easier to obtain funding to purchase a device and app outright). Older children who are good verbal communicators often use voice-to-text and text-to-speech apps.

Lower-tech programs are often more affordable if you don’t have funding and cost is a factor.

Ms. Willis emphasizes that AACs should be used everywhere, in all environments, rather than sitting in backpacks. “A vocal child who keeps repeating, ‘I want to go home’ is no different than an autistic child who keeps pressing a button on their device that says the same thing. We need to allow autistic children to communicate and not take their voice away.”

What are parents’ roles in AAC?

Parents and caregivers need to be involved from the start. Research has shown that parents of non-speaking children talk to their children significantly less than other parents. Yet just because a child doesn’t speak doesn’t mean they don’t understand what you’re saying.

We are with our children far more than their therapists. Parent coaching is, therefore, a critical component, as consistent implementation at home is crucial to success.

Clinicians guide us in modelling speech and language and showing our child how to use an AAC. If they communicate, “Look, a car!”, we need to respond to reinforce the learning and build motivation. And if a child pushes the button for “cookie” at 8 a.m., we need to honour that request, at least in the early stages of learning.

What are some myths about AAC?

Research to date has not found any downsides to AAC. Some parents worry:

• Will my child become lazy and grow dependent on their AAC?
• Will they lose motivation?
• Will AAC interfere with their speech development?

The evidence demonstrates that AAC builds communication abilities with expanded vocabulary and comprehension. While it doesn’t necessarily lead to verbal speech, it can help encourage verbal production through increased language modelling provided by the speech-generating feature.

Ms. Ingles and Ms. Willis stress that it’s never too early to offer AAC, whether picture boards on the fridge with snacks, sign language, or higher-tech screens and devices.

What about Facilitated Communication?

In 1989, Facilitated Communication (FC), also known as supportive typing, came to North America from Australia. It claims to help non-speakers communicate by having a facilitator guide the child’s arm or hand and help them type on a keyboard or other device they cannot use alone.

Unfortunately, many studies have discredited FC, demonstrating that the facilitator is unwittingly the source of the messages rather than the child communicating independently.

FC is related to the Rapid Prompting Method (RPM), also known as Spelling to Communicate, in which a child is guided to communicate through pointing, typing, or writing. While the facilitator does not touch the child, as they do in FC, studies have shown that unconscious guidance makes a child highly susceptible to facilitator influence.

Organizations like the American Speech-Language-Hearing Association, American Academy of Child and Adolescent Psychiatry, American Psychology Association and Autism for Science in Autism Treatment, among others, recommend against these methods until there is evidence-based, peer-reviewed research with clear and measurable target behaviours and outcomes.

As a parent, I believe in trying anything that might work for my child. And many parents swear by these approaches. Yet I seek empirical evidence first.  Science validates and disproves claims, techniques and hypotheses, such as the “vaccines cause autism” claim. Science matters to me

AAC helps our children gain independence through improved communication skills. The communication method is not essential; we want to ensure they can get their messages across. Some children with high support needs may be limited to a few signs; others will become fluent in high-tech devices.  Both are OK!  As Ms. Willis says, “We want every child to have a voice, no matter how it looks or sounds.”

It is heartwarming to see more and more options for our children. The future is waiting.