Guidance on communicating and interacting with your autistic child or family member, including a breakdown of the stages of communication, advice and strategies for how to help them to develop their communication skills, and what sort of support systems are available.
Communication happens when one person sends a message to another person either verbally or non-verbally. Interaction happens when two people respond to one another – a two-way communication.
Most people on the autism spectrum have difficulty interacting with others. This may be a difficulty with responding to others when they are approached by them, with initiating interactions, or with using interaction to show people things or to be sociable.
Many autistic children are delayed in their use of language and some autistic adults don't use speech. Therefore, other methods of communication need to be established.
Understanding the communication of someone who's autistic
The person may appear not to hear what you say to them, not respond to their name, or appear indifferent to any attempts you make to communicate.
Observe the way they communicate. If they don't use any sound or speech, try using gestures rather than talking to them. The person may use some of the following to communicate with you:
- taking your hand to the object they want
- looking at the object they want
- using pictures
- echolalia (the repetition of other people's words).
At first, when a child uses echolalia it's likely that they are repeating words that they don't understand and aren't trying and communicate.
However, echolalia is a good sign as it shows that the child's communication is developing. In time, they will begin to use the repeated words and phrases to communicate something significant. For example, they may memorise the words that were said to them when they were asked if they would like a drink, and use them later, in a different situation, to ask a question of their own.
A child or adult might use phrases that they frequently hear in their favourite TV programme. Watch the programme with them to try to understand what they might be trying to communicate to you when they use these phrases.
Stages of communication
The stage of communication that a person has reached depends on three things:
- the person's ability to interact with another person
- how and why they communicate
- their understanding.
Communication may be:
- pre-intentional: saying or doing things without intending to affect those around them. This type of communication can be used by someone to calm themselves, focus themselves or as a reaction to an upsetting/fun experience.
- intentional: saying or doing things with the purpose of sending a message to another person. This type of communication can be used to protest about something or to make requests.
Intentional communication is easier for a child once they have learned that their actions have an effect on other people. The move from pre-intentional communication to intentional communication is a big step for a child on the autism spectrum.
The four different stages of communication, as defined by The Hanen Programme, are as follows.
1. The own agenda stage
The person appears uninterested in others and tends to play or do activities alone. Their communication will be mainly pre-intentional. The majority of children are at this stage when first diagnosed as autistic.
2. The requester stage
The person has begun to realise that their actions have an effect on others. They are likely to communicate their wants and what they enjoy by pulling you towards objects, areas or games.
3. The early communicator stage
Interactions will begin to increase in length and become more intentional. The person may begin to echo some of the things that they hear to communicate their needs. Gradually, they will begin to point to things that they want to show you and begin to shift their gaze, beginning to engage in a two-way interaction.
4. The partner stage
The person has become a more effective communicator. They will be using speech and will be able to carry out a simple conversation.
While they may appear confident and capable when using communication in familiar settings (eg at home), they may struggle when they enter an unfamiliar environment (eg a new school). In these places, they may use memorised phrases and appear to be ignoring their communication partner, speaking over them and ignoring the rules of turn-taking.
Ways that you can support communication development
Be a helper and teacher
When someone is unable to communicate their needs, it's tempting to help by constantly doing things for them. For example, fetching their shoes and tying their shoelaces. However, this reduces opportunities for the person to show that they can do such things for themselves. When at the "own agenda" stage, it is particularly difficult to decide how much to do for the person. Ask if they need help, wait and then ask a second time before giving the help.
Slow down the pace
Caring for someone who's autistic can be hard work and time-consuming. It can be tempting to rush the person when they are performing daily tasks such as eating breakfast and getting dressed. Spare an extra few minutes for these tasks to help them understand what's happening around them and to think about what they can say during these activities.
Follow their lead
Follow the person's lead, rather than directing them. They will be more likely to pay attention to the activity, more likely to focus on the same thing as you, and will learn how to make choices for themselves.
Be face-to-face with the person so that you can more easily observe what they are interested in. Being level with them will allow them to see the variety of facial expressions that are used in communication. An autistic person will often fail to pick up on these non-verbal communicative behaviours during conversation, so draw attention to them where possible.
The person may eventually become used to you playing or interacting with them and will begin to anticipate your presence, fetching you if you are not there.
Imitate the person's actions and words. If they bang the spoon on the table, and you do the same, it is likely that they will pay attention to you. You could also imitate sensory behaviours such as hand-flapping and spinning.
Once the person has established that you are imitating their actions, they may begin to imitate back. This creates the opportunity for you to add something new to the exchange for the person to duplicate.
Reward attempts to understand and communicate. By doing this you can increase the likelihood that they will try and do it again. By using praise and commenting on what has been achieved, the person can make a connection between their own actions and your specific words.
Help the person understand what is said to them
Processing information can be difficult for an autistic person. Even if they understand a situation, they may not have processed the words that go with that situation. It might sometimes seem that the person understands what you have said to them because they appear to follow instructions.
However, the person may know what to do when instructions are given in certain contexts because they have done it numerous times previously. There are several ways in which to make what you say easier for them to understand.
Say less and say it slowly
- Limit the amount of words you use to communicate the relevant information.
- Use key words that are specific to the context of the situation, repeat and stress them, and use gesture such as pointing, to accompany the words.
- If the person has only recently begun to use speech as a means of communication, use single words, eg naming favourite toys and food at the moment when you present them. If the person's attention has shifted onto something else, the word will lose its meaning.
- Pause in between spoken words and phrases to give the person time to process what has been said, and to give them an opportunity to think of a response.
The following rhyme can remind you of these ideas: "Say less and stress, go slow and show!" (Sussman, 1999).
Use gestures and visual supports
- When offering a drink, gesture the action of drinking by pretending to hold a glass in one hand and bringing it your mouth.
- Nod/shake your head for "yes" and "no".
- Wave your hand for "hello" and "goodbye".
- When talking about people, eg "grandma is staying", show a photo of who is being spoken about.
Other visual methods that can be used to increase understanding include picture timetables, line drawings, cue cards and object/picture schedules.
Giving a reason to communicate
If the person has no difficulty getting what they want, they will have no reason to communicate and interact. You can engineer situations to create an opportunity for communication and interaction.
- Encourage requests
Place a favourite toy/food/DVD in a place where the person can see it but is unable to reach it, eg on a high shelf. Alternatively, place the favourite object in a container which is difficult to open, eg an old ice-cream tub or an old jam jar. This will encourage the person to ask for help and result in an interaction.
- Offer a toy or game that is difficult to operate
Some toys and games will be difficult for some children and adults to operate alone, eg jack-in-the-boxes, spinning tops and music boxes. Once given the toy/game, allow them some time to work out how to use it. When they become frustrated, step in and help them.
- Give them a 'high-interest' object
Balloons and bubbles are high-interest items and can be easily adapted to involve two people. Blow up a balloon and then let it go so that it flies up in the air. Then blow up a balloon part-way and wait for a response before blowing it up to its full capacity. This could enhance interaction. A similar thing can be achieved with bubbles. Blow a few bubbles towards the person. Once their attention has been captured, close the container and wait for a response from them before you blow any more.
- Give them things gradually
If you give everything that the person wants, they will have no reason to ask you for anything else. Staggering how much food/how many toys are given creates opportunities for them to express their wants and needs. For example, if the person wants a biscuit, you could break it into small pieces, initially give them one piece and then gradually give them more once they have communicated a request for it.
- Let the person decide when to end an activity
Once engaged in an activity, carry on until the person indicates that they have had enough. Look out for facial grimaces or the person pushing away the activity. If they do not use language to indicate they have finished, accompany their form of communication with words such as "had enough" and "stop" to encourage their language development.
Find opportunities to interact
When the person isn't interested in doing any of the activities presented, you might still be able to find opportunities for communication and interaction.
For example, if a child is lining up their cars in a row, you can join in the activity by handing them the cars one by one. This way, you play a part in the game and the child includes you in what they are doing. If they are only interested in throwing the toys on the floor, you could use a basket to collect them before giving them back, establishing a pattern of interaction and communication with the child.
They may begin to learn that interaction with another person can be fun.
Using Augmentative and Alternative Communication (AAC) supports
AAC describes any form of language other than speech that can help a person in social-communicative interactions.
Autistic people who have no spoken language sometimes resort to challenging behaviours to meet their needs and express their feelings. The use of an AAC device can give them a primary means of social communicative interactions with others.
There is a large range of AAC devices. It is essential that a team of appropriate professionals evaluates different AAC options with the person before making a decision about what to use. Criteria that need to be discussed include cognitive and motor abilities, learning style, communication needs and literacy ability.
Examples of AAC devices
- Picture Exchange Communication System (PECS), where the person hands over a picture to request or express something.
- Sign language, eg British Sign Language (BSL), Makaton, Sign Supported English, or as part of a total communication approach (where a combination of methods is used, eg a person might receive information via speech and signs but express themselves using signs and symbols).
- Communication boards and communication books, where the person can point to words, photos and/or symbols.
- Communication cue cards, used primarily with people who are verbal, can be a reminder of what to say and provide an alternative means to communication in stressful situations.
- Conversation books, which can use text, pictures or photographs to support conversation.
- Voice output communication aids, eg BIGmack, generate digitised speech when the person presses a symbol or button. The person will need an understanding of cause and effect to use these devices.
The combined use of AAC, social supports, organisational supports and visually cued instruction can strengthen communication and interaction.