Ontario Adult Autism Research and Support Network - OAARSN

Communication

Impairment of speech and language is a defining factor in the diagnosis of Autism in young children. Perhaps as many as one in three adults with ASD does not speak, and a significant number who can utter spoken words may not be able to use language as an effective means of communication. Many challenging behaviours of people with Autism, such as aggression, self-injury, anxiety and depression, may be expressions of frustration at their inability to communicate effectively with others.

Traditionally, someone who could not speak tended to be dismissed as nonverbal and incapable of understanding or rational thought. Advocates of disability rights have gained a hearing for arguments that:

• Communication is the means by which all other rights are realized and is, in itself, a basic human right.
• Where people lack an adequate communication system, they deserve to have others try with them to discover and secure an appropriate system.
• No person should have this right denied because he or she has been diagnosed as having a particular disability.
• Presumption of intelligence in a person who cannot speak is the least dangerous assumption.
• Access to an effective means of communication is a free speech issue.

How have professionals and caregivers tried to help overcome this profound disability? People with Autism form part of the client group for Augmentative and Alternative Communication (AAC) for which the international body is ISAAC. In Canada, we also have Communication Disabilities Access Canada (CDAC).

These are some communication systems that could help:

1. Sign Language was developed for hearing-impaired individuals but was often taught to autistic children in the 1970s. Signs and gestures were seen as a basic form of human communication and well suited to the good fine motor skills of children with classic Autism. Simultaneous use of sign and spoken language was usually taught. Signed English is the best system of sign language, if sign and speech are being learned together, as its syntax matches that of spoken language. Signed Speech, or using sign and speech together, stimulated some children, who had previously been non-verbal, to begin speaking as well. At the time, it was imagined that people with Autism might live in group homes or other congregate settings, in which sign language would be the lingua franca. However, the general inability of most ordinary people to use and understand sign language means that this medium has been less effective in community settings. Autistic adults who know sign language usually have to have other forms of communication as well.
   
2. Picture Communication Symbols have been used since the mid-1980s, supported by the insights that some people with Autism think in pictures rather than words and so might learn better with visual cues than with spoken language. The Picture Exchange Communication System (PECS) uses stylized drawings–of everyday objects, activities and even relationships and feelings–that may be used to prompt steps in a complex task or to offer options among which choices may be made. Computer software is now available to make sets of PECS symbols that are appropriate to each person, but the vocabulary is usually designed for young children rather than adults.
   
3. Facilitated Communicating (FC) is a method of Alternative and Augmentative Communication (AAC) that is also called Supported Typing (ST). Since its introduction in the early 1990s, FC techniques seemed to help particularly adults and children who had not been able to speak because of their Autism. Some have been able with FC to break out of their isolation and to show clearly that “though we cannot speak, we have things to say”. Some adults who have received help with FC or ST have been able to progress to independent typing and even speech. Some have been able to continue in literacy and further education programs, and a few have graduated from college. Even when users do not achieve independent typing, FC or ST can be a strategy to improve motor skills so they can make choices by pointing to or touching objects, pictures, letters, words or phrases.
   
   A facilitator or communication assistant provides varying degrees of physical support, as well as emotional support to encourage the user of a communication aid. Such aids range from simple boards with numbers and alphabet letters to computerized devices with voice, display and printed output and can include arrays of pictorial symbols or photographs. The most common method involves the facilitator or assistant providing physical support in the form of backward pressure as the communicator focuses on reaching forward to touch or type on the device.
   
   A survey of FC and validation tests is presented in D. Biklen and D.N. Cardinal, Contested Words, Contested Science: Unraveling the Facilitated Communication Controversy (New York: Teachers College Press, Columbia University, 1997). Seven impressive communicators express themselves in the book Autism and the Myth of the Person Alone (edited by D. Biklen, New York University Press, 2005). Ontario has the Bridges-Over-Barriers support group started by and for adults with Autism who use Supported Typing to share their successes, struggles and strategies. Some have found Clean Language questions a valuable way of showing that they are doing the thinking and choosing the words to type. See the Bridges-Over-Barriers webpage on this OAARSN site.
   
4. Social Stories are a communication-based technique developed by Carol Gray of Michigan to help autistic children to know how to interact appropriately with others in social situations. The technique allows adults with Autism as well, to read, rehearse, and write in advance what to expect in social situations. Four kinds of sentences are used in any social story:
   • descriptive, telling what people usually do in particular social situations;
   • directive, giving positive guidance to the individual as to how to act in specific situations;
   • perspective, presenting others’ reactions to a situation (something a person with Autism may finds hard to imagine);
   • control, with strategies the person can use to help remember and understand the whole social story.
     Social stories can help persons with Autism to become more independent in routines, and to know how to do an activity, how to ask for help, and how to respond appropriately to feelings of anger and frustration.
     
5. Lifelong Learning: Adults with quite severe Autism have too often been presumed to be incapable of growing and learning. When those around them have given up hope, a person may well conform to their low or negative expectations. But we have found that expressing confidence and hope and providing opportunities and interests are very worthwhile.
   
   Adults who have found they can express their thoughts with FC or ST have asked for learning material and experiences, and some have gone on to formal postsecondary education. Those whose intelligence was not realized when they were children deserve every encouragement to show that it is never too late to learn when one is supported positively.
   One aid to learning has been text-to-speech software, in which the learner may take in meaning three ways—through the eyes when reading text of a chosen topic of interest, through touch when typing from the text, and through the ears when hearing the voice output of what one has typed. One man we know, who has a good varied life, finds typing with Kurzweil text-to-speech software to be a favourite activity which he can continue for up to three hours by himself. Later, in conversations using ST, it is clear that he has taken in and thought about the subject matter and ideas. Another man was over 50 when he first used WriteOutloud text-to-speech software, a product of Don Johnston Incorporated. The experience stimulated him to speak with his voice so others could understand him at last.