Contents

Note: page numbers on actual pages correspond to those in the book.

The table of contents merely describes page numbers as they appear on the PDF.

Introduction 2-3
Assessment Text 4-7
Suggested Tools 8-9
Getting Results 10-11
Language Development 12-16
Reinforcer Assessment 17-18
Communication Incentives 19-21
Reinforcement Forms 22-34
AAC Assessment/Vocabulary 35-36
Symbol Use 37-40
Home/School Communication 41-42
Cue Hierarchy Grid 43
Object Symbols/Plans 44-45
Teaching Gestures, Expressions and Body Language 46-51
Recognizing Sarcasm 52-54
Voice Pitch 55-57
Sample Social Story 58
Common Responses 59-62
Asking for Help 63-67
Personal Space 68-69
Balanced Conversations 70-71
 Teaching Communication Skills to Children with Autism

I n t roduction
Communication is an essential part of everyday life. Communication
encompasses so much that defining it can be difficult, but the heart of
communication is the exchange of messages, thoughts, feelings, and
information from one person to another. It’s a process we observe hundreds
of times throughout the day, but it is far more complex than it seems.
For an exchange to occur, someone has to express an idea (expressive
communication) and at least one person has to receive and understand it
(receptive communication). While these processes function together to create
a communication exchange, and are interrelated, each requires its own set
of subskills and needs to be looked at separately. A student may understand
what is said to him but be unable to formulate a response. On the other hand,
someone may be able to express her own thoughts but lack the perspective to
understand what is said to her.

We tend to think of communication happening primarily through speech and

written language, but we also use gestures, facial expressions, body postures,
tone of voice, and behavior to convey messages. Understanding and using
nonverbal, as well as verbal, communication is a necessary part of effective
information exchange. A timely gesture or facial expression may more clearly
express what a person is thinking than the spoken word.

Although the combination of verbal and nonverbal language is the way most
individuals communicate, other methods can be used to enhance or substitute
for spoken language. Sign language is, of course, the most common. Objects,
pictures, or written words can also be used in a variety of ways to convey
messages. Since individuals on the autism spectrum vary greatly in their
communication, and what works for one may not work with the next, we need
to have a wide array of tools as we work with each child to build a bridge to
effective communication. This book will provide an overview of commonly
used methods and strategies for addressing the communication needs of
individuals on the spectrum, from the nonverbal and beginning communicator
to the highly verbal individual with high functioning autism or Asperger
Syndrome.
 ◦ Introduction 

How Does Autism

Affect Communication?
On its website, the Autism Society of America defines autism as the following:

“Autism is a complex developmental disability that typically appears during the

first three years of life and affects a person’s ability to communicate and interact
with others. Autism is defined by a certain set of behaviors and is a ‘spectrum
disorder’ that affects individuals differently and to varying degrees.”
(http://www.Autism-Society.org)

Autism Spectrum Disorders (ASD) differ greatly from one person to the next, but
by definition, ASD impacts the ability to communicate and interact with others.
How communication is affected also differs greatly. People on one end of the
spectrum have no means of communication and may appear totally disinterested in
those around them, seeming to exist in a world of their own. On the other end are
those described as having high functioning autism (HFA) or Asperger Syndrome.
Their language skills are usually on par for their age, and they may seek out others
and talk incessantly, but they lack conversation skills and appear awkward in their
attempts to socialize.

It’s often hard to determine where each person fits on the communication
continuum. However, to provide some organization, I have divided methods and
strategies into two sections: needs of nonverbal and beginning communicators are
addressed in part one, and part two focuses on verbal communicators. These are
not clear divisions. Strategies in part one may be useful for children described in
part two and vice versa. Part one looks at the characteristics, assessment, and most
common interventions for children who do not speak at all or those who use only a
few words. It also covers the use of Augmentative and Alternative Communication
(AAC).

Part two addresses the communication needs of the verbal child. Packaged
programs are not commonly used at this level since there is such a range of skills
and ability levels that it would be impossible for any single program to attempt
to meet the many needs. In part two, strategies and activities are described that
address different communication needs, including repetitive language, difficulties
in understanding verbal and nonverbal communication, language usage, and
conversation skills. It is impossible to draw a line between communication
 Part One ◦ Chapter 1 11

Challenges in Assessing Communication

• In order to provide the best, most targeted communication treatment program
for a child with autism, a comprehensive communication evaluation needs to The
be conducted by a speech-language pathologist (SLP). This assessment needs following
to evaluate pragmatic language skills (functional and social communication) as assessments
well as semantic language skills (the meaning of language­—including content in chapter
and context). Because of the unique nature of autism, the assessment requires 1 can be
a team effort, involving family, teachers, and others who know the child well, used with
and it should include more than standardized testing. A complete picture of all students
the child is needed to make treatment decisions and to provide a baseline by addressed in
which progress can be measured. part one
and part two.
Professionals face a number of challenges when trying to accurately assess
communication abilities of a child with autism. The following factors need to be
considered when planning the assessment.

• The child may have difficulties understanding directions or how to respond.

He may lack the communication skills to answer “yes” or “no.”

• A child with autism may lack motivation because she does not understand the
importance of trying to do her best in a testing situation.

• A child with autism may suffer from anxiety and will not function well in an
unfamiliar situation with an unfamiliar adult.

• Distractibility and disorganization are often associated with autism and can
make performing on cue difficult.

• The child’s ability to respond and communicate can vary a great deal from one
day to the next, making it difficult to get an accurate measure.

• There can also be significant discrepancies from one skill to the next. A child
with high functioning autism may appear to have a well-developed expressive
vocabulary, while his receptive language skills are limited.

• The testing situation is different from everyday life. How the child interacts in
the classroom or at home may not be reflected in the assessment setting, where
interactions take place in a one-on-one, organized format.
12 Teaching Communication Skills to Children with Autism

• During an assessment, the child is given more time to process language than
during typical everyday exchanges.

• In the typical assessment, the clinician directs activities and communication.

The ability to initiate communication (a common problem with autism) is
often not evaluated.

• An evaluation sometimes ignores critical nonverbal and pragmatic

language skills.

What Do You Need to Find Out?

A communication assessment for a child with autism can provide valuable
information to help parents, teachers, and specialists to understand the child’s
strengths and deficits, to set realistic goals, and to plan an effective program.
To get an accurate view of the child’s communication abilities, an assessment
should endeavor to answer the following questions.

• Are there any complicating factors such as hearing problems or

intelligibility issues?

• How has the child’s communication skills developed since birth?

• How much does the child understand? Does he . . .
• Understand individual words? Sentences? In context? Out of context?

• Follow verbal directions?

• Understand nonliteral language?

• Need extra time to process verbal language?

• How much is the child able to express? Does she . . .

• Use any verbal language?

• Use language to make requests and protests?

• Use words as labels?

• Use multiword phrases and sentences?

• Avoid speaking or speak infrequently?

28 Teaching Communication Skills to Children with Autism

Beginning Language Development

• The child begins to respond to his name or other familiar high-interest words
by looking at the speaker, by smiling, or with some other predictable response.

• The child begins to recognize the meaning of single words; usually in the
beginning these words are labels, such as “bath” or “Daddy.”

• The child will respond to commands accompanied by gestures, such as “come

here,” or “stop.”

• The child will imitate distinctive sounds, such as those that animals make or
nonsense sounds.

• The child will begin to follow simple directions, such as “give me the doll.”
• Imitation becomes more sophisticated, with the child imitating vocal sounds
and attempting to imitate words.

• Next, the child will spontaneously use sounds or word approximations with
communication intent, such as saying “baba” to indicate that he wants
his bottle.

• With practice, sounds and word approximations become recognizable words

the child uses to label items and to express wants and needs. With continued
practice, the child’s receptive and expressive vocabulary grows.

• As the child is learning to say single words, he is beginning to understand

short phrases and sentences. He begins to respond to multiple cues, like
“Give me the red truck,” responding to the words “truck” and “red.”

• The child will begin combining two words to make new phrases, such as
“Mommy come,” or “big cookie.” This is different from saying two or more
words that he has learned as a unit, such as “Teacher Robin” or “Blue’s Clues.”
The table that follows gives examples of early two-word phrases.
 Part One ◦ Chapter 2 29

Two-Word Phrases
subject – verb “Daddy run”
subject – object “Mommy coat” (for “Mommy, put my coat on.”)
action – object “kick ball”
descriptive “big doll”

words that go together “sock shoe”

location “on table”

time “want now”
number “two shoe”

more/refusal “more candy” “no juice”

possessive “Mommy car” (without the apostrophe and “s”)

• The child will begin to ask simple questions, such as “What dat?” and
“Where Grandma?”

• The child will use increasing longer utterances, adding three-word phrases and
sentences along with carrier phrases. Carrier phrases are words such as, “I want
____” that occur together in a definite order and are used frequently. These
phrases can be taught as a unit, as the child only needs to add one or two key
words to complete the message.

Three-Word and Carrier Phrases

subject – action – object “Tommy kiss baby”

subject/object – action –
“Mommy go work” “throw ball outside”
location
prepositions “car in garage”

modifying phrases “want my ball”

carrier phrases “I want ____.” “I don’t like ______.”

30 Teaching Communication Skills to Children with Autism

As children continue to use spoken language, receptive and expressive vocabularies

increase, as does the length of their utterances. They begin to use complete
sentences and gradually begin using more and more correct language structures.

Continuing Language Development

• The child uses pronouns.
• The child will frequently use complete sentences and continues to add new
words, but uses incorrect verb tense (“Yesterday we go store.”) and omits
correct word endings indicating plurals and possessives (“I see four cat.” And
“Not mine. Jade coat.”).

• Gradually, the child will begin to use correct syntax by adding “-ing” to words
and adding an “s” to make plurals.

• Past tenses are added using “-ed,” then irregular past tenses, as in “I fell down.”
• The apostrophe “s” is used to indicate possession, and articles (“the” “an” and
“a”) are added.

• The child answers “why” questions.

What Is Applied Behavior Analysis?

Applied Behavior Analysis (ABA) provides the foundation for many of the
approaches that will be described in chapter 5 and is used to some degree with all
teaching methods. ABA is an intervention model based on Skinner’s behavioral
theory of operant conditioning, which states that behaviors can be taught by using
a system of rewards and consequences. In ABA, these behavioral principles are
applied to social behaviors, such as attention and communication, and data is taken
and analyzed to measure progress and modify interventions as needed.

ABA techniques use the functional behavior analysis approach (antecedent–

behavior–consequences) to create learning opportunities. The child is given a cue,
with a prompt if necessary. After he responds, a reward or consequence follows.
Depending on the method used, the cue may be very direct (“Look at me.”) or may
be indirect (the teacher holding a desired object close to his face to elicit eye
 Part One ◦ Chapter 3 39

Observation Notes
The form on page 59 can be used when observing
the child. To gain the most information from
observations, do a number of short ones in
different environments with different people
present and on different days.

Assessments
Short informal assessments can be helpful
when reinforcers are difficult to identify. The basic idea is to present
the child with potential reinforcers and see what interests him. Multiple trials are
necessary to identify items and activities that are consistently reinforcing.

The assessment described below is an informal, simplified method, based on

assessment procedures developed by DeLeon and Iwata (1996), and Pace, Ivancic,
Edwards, Iwata, and Page (1985). For further information on these or other
assessment procedures see the references on pages 232–235.

Reinforcer Assessment
1. Choose a number of items that are
of interest to the child. Choose items
from each of the following groups:

a. Items that the child has expressed

interest in.

b. Items that share characteristics with

the items noted above. For example,
if the child has shown interest in a
toy that lights up, try other such toys or objects that light up.

c. Items that the child has not been exposed to.

2. Divide items into groups of three to seven each. Present items to the child
simultaneously, and consider how many the child can handle without
becoming overwhelmed.

3. Place the set number of items out in front of the child.

4. On the data sheet on page 60, note which items the child picks up first.
40 Teaching Communication Skills to Children with Autism

5. Allow the child to explore the item for a brief period, and then put it out
of sight.

6. Rearrange the remaining items and repeat steps 4 and 5 above. Continue until
no items remain.

7. Either repeat the steps above presenting a new group of items or end
the session.

a. A set of items could be tested again later in the day at a separate session.

b. Each group of items should be assessed five times over three

different days.

Considerations When Assessing

Kids also are motivated by interactions or activities, such as tickles or peek-a-
boo, that cannot be measured with this assessment. An alternative is to present
a potentially reinforcing activity, such as tickling the child, and note the child’s
response on the data sheet page 61. Repeat this a number of times, on different
days, to see if tickling is consistently reinforcing. When assessing this way, it’s
important not to discount an activity when the child displayed no interest after a
single trial.

Sometimes during assessments,

the child may act completely
disinterested in everything
presented. There are several
factors that should be considered
if this happens. First, look at the
reinforcers you are presenting.
Are there other items that might
be more motivating? Also,
consider whether the child
might be distracted by other
things in the environment.
The assessment may need to
take place in a smaller, more
enclosed area, with fewer
distractions. Keep assessments
brief (only a few minutes per session) and try doing
assessments at times of the day when the child is most active and engaged. Also,
98 Teaching Communication Skills to Children with Autism
Part One ◦ Chapter 6 99
100 Teaching Communication Skills to Children with Autism

Presentation of Symbols
Once you know the level of presentation, the size of symbols needed, and the
vocabulary to be introduced, determine what type of format will help the child
communicate most effectively. There are a number of factors to consider, including
the following:

• What type of symbols are being used—objects, photos, or drawings?

• What size of symbol (if using a 2-D symbol)?
• How many symbols can the child consider at one time?
• How can the child best respond—pointing, pushing a switch,
picture exchange?

• With whom will the child be communicating?

• How durable does the system need to be?
• What are the different locations where the system will be used?
• Will different vocabulary be needed for different locations and activities?
• How frequently will the system need to be updated (new vocabulary)?
There are nearly limitless possibilities for creating a system. Begin with a low- or
no-tech system, such as a communication board or picture exchange. These are
inexpensive, easily adapted, easily understood by communication partners, and
provide a trial period that allows you to evaluate how good a match the system is
for the child and his different environments. Once a child has moved on to using a
more complex device, simple communication boards should still be kept available
for times when the battery dies or there are technical problems, and to use at
locations where you would not want to take the device, like out in the rain or to
the swimming pool.

Communication systems can take many different forms and adapted to meet
various needs. Some ideas include:

• Picture or object exchange system—see PECS, pages 109–113.

• Object communication board.
• Small objects in plastic baggie; several baggies can be made into a baggie book.
 Part One ◦ Chapter 6 101

• Small objects or pictures with adhesive magnetic tape

attached, placed on fridge or metal surface.

• Communication board with realistic photos or line

drawings.

• Communication boards near site where it will be used,

like at snack table, at group time, etc.

• Communication boards kept in notebook, given to

child by adult as needed.

• Small photo album or credit card holder containing

communication symbols.

• Communication symbols on key ring, could

be attached to belt or worn around
neck.

• Communication notebook—
pictures on pages inside or displayed
on the cover with Velcro™ (with
pictures not in use stored inside the
notebook).

• Symbols in notebook using trading

card holders.

• Symbols displayed in clear library pockets.

• Symbols on choice boards.
• Symbols in small magnetic photo
holders, placed on fridge or
metal surface.

• Symbols printed on magnetic sheets

placed on metal surface.

• Simple single message switches.

• Simple voice output devices with
several messages.

• More complex electronic devices.

 Part One ◦ Chapter 6 119

Using cues and prompts effectively was discussed in chapter 4. These guidelines
hold true whether you are teaching the child to use verbal language or an AAC
system. Prompt dependency is such a major problem for both AAC users and
individuals with autism that educating parents and staff on how to effectively use
prompts needs to be a top priority. Unfortunately, it’s all-too-easy to over-prompt
without realizing you are doing it. This is an area that requires training with
constructive feedback or self-monitoring. Observing and videotaping interactions
with the child can be difficult to arrange in a busy classroom, but can make huge
differences in the child’s ability to communicate.

School and Home Communication

For AAC to provide an effective means of communication for the child, it needs
to be used in all of his environments, including home. It’s important for home
and school to support each other’s efforts and to update each other regularly on
progress and concerns. When new symbols are introduced at school, make copies
and send them home. If parents introduce new symbols or notice new types of
communication attempts, this information should be passed on to school staff.

Often parents and teachers send a daily communication notebook back and forth
that relates what kind of morning the child had, how his day at school went, and so
on. This can be a good way to share information about how he is communicating—
what new words he used, symbols he doesn’t seem to understand, sharing new
opportunities for communication. (He has a new puppy; what messages could we
add that would allow him to talk about his puppy?) One way to encourage this
home and school sharing of information is to create a simple form with different
topics where comments can be written. (See example, page 120.) Make copies of
blank forms and staple them together to make a booklet. This is a reminder to
address all areas. Otherwise comments can tend to be limited to how the child is
feeling and his behavior.
120 Teaching Communication Skills to Children with Autism
122 Teaching Communication Skills to Children with Autism

Prompting strategies differ somewhat with AAC, because you must prompt the
child to take physical actions. These are much easier to prompt and allow you to
avoid verbal prompts which are the hardest to fade. When initially teaching a child
to communicate with symbols, begin by teaching her to hand the symbol to an
adult or to point to the symbol. But do not use verbal prompts. Both methods can
be physically prompted from behind the child, fading the prompt as quickly
as possible.

The following is an example of a hierarchy of prompting as it could apply to using

a communication symbol to get pretzels.

Natural cue­—child sees pretzels, teacher asks,

“Do you want some pretzels?” Communication symbol is close by.

Teacher places symbol directly in front of child, between child and pretzels.

Teacher touches or taps symbol.

Teacher models touching the symbol and eats a pretzel.

Teacher touches the back of child’s arm and nudges toward symbol.

Teacher uses hand-over-hand prompt from behind to

help the child touch the symbol.

Another difference with AAC is that the child’s focus is on the symbol, which
makes engaging him a challenge. Pointing to a symbol, or handing it to an adult,
can become a transaction instead of an interaction, like clicking a button on the
computer. Extra effort is needed to get him to engage with the communication
partner.

As mentioned earlier, when the child is first learning to recognize a symbol, hold
it next to the object to help him make the comparison. But once he has learned to
recognize the symbol, hold it up in front of your face. If necessary, move so your
face is on the child’s level, so he can’t avoid looking at your face. Then exaggerate
your facial expressions and tone of voice while he’s looking at you, right before he
gets what he asked for. When the child has chosen the correct symbol, give a big
smile, nod your head “yes,” and say in an excited voice, “Candy! You want candy!”
 Part One ◦ Chapter 6 125

Object Symbols
Actual items: Object symbol for desired items: Sample
1. crackers 1. cassette box with crackers Symbol
2. juice carton 2. empty juice carton attached to backing
Assessment
Kit
3. play dough 3. small piece of play dough attached to backing
The following is an
4. candies 4. candies taped on card stock example of the type
5. Slinky 5. Slinky attached to backing of items that could
make up a symbol
6. inflated balloon 6. slightly inflated balloon attached to backing
assessment kit.
Realistic photos of: Line drawing symbol of: Six items in each
1. crackers 1. crackers category would
be the minimum
2. juice carton 2. juice carton number needed.
3. play dough 3. play dough Having more items
would allow for
4. candy 4. candy greater choice.
5. Slinky 5. Slinky
6. inflated balloon 6. inflated balloon

Distracter Items
Actual item: Object symbol for distracter:
1. piece of card stock 1. cassette box with piece of card stock in it
2. Styrofoam tray 2. piece of Styrofoam tray glued on backing
3. celery 3. piece of celery taped on card stock
4. sock 4. small sock in clear plastic container
5. small box 5. small box attached to backing
6. poker chip 6. cassette box with poker chip in it
Realistic photos of: Line drawing symbols of:
1. piece of card stock 1. piece of card stock
2. Styrofoam tray 2. Styrofoam tray
3. celery 3. celery
4. sock 4. sock
5. small box 5. small box
6. poker chip 6. poker chip
126 Teaching Communication Skills to Children with Autism

Communication Plan for ________________________ Date ______

Communication Mode of
Schedule/
Opportunity/ Communication/ Notes
Activity
Message AAC System
Part Two ◦ Chapter 12 191
192 Teaching Communication Skills to Children with Autism
200 Teaching Communication Skills to Children with Autism
Part Two ◦ Chapter 12 201