AAC and autism spectrum disorders

Autism spectrum disorder is a term used to identify a range of people with varying skills and abilities.  People identified with an autism spectrum disorder usually have difficulties with social interaction and communication.  They may also have unusual repetitive patterns of behaviour.  A number of people on the autism spectrum have an intellectual disability while others, such as people with Asperger’s syndrome, have normal or above average intelligence.  

Some people with autism spectrum disorders have little or no speech.  People with autism who cannot speak or are difficult to understand may use a range of communication strategies. These people often have difficulty recognising and using facial expression and gesture.  However, they may learn to use aided and unaided strategies such as Picture Exchange Communication Systems (PECS) and key word sign (Makaton).  For most people, speech and language is their main method of communication, but AAC is often used to support memory problems, reduce anxiety and develop social skills.

AAC and autism spectrum disorders in early intervention

For children who have autism spectrum disorders, early intervention has a positive impact on their communication later in life.  Early intervention may refer to informal therapy activities carried out by the family member at home, or a more formal program run by trained professionals.  Early intervention programs generally see children up to the age of six years.  They may be based at a school, a centre, or therapists may see individual children in their homes.  People involved in early intervention programs might include teachers, speech pathologists, occupational therapists, psychologists, physiotherapists and other professionals.

A common early intervention goal for children who have autism spectrum disorders is the ability to use shared attention with other people to get their needs met.  Shared attention may be gained using eye contact, speech, speech attempts, body language, touch, key word sign (Makaton) and other aided communication options. One aided communication strategy is the use of PECS.  PECS may be suggested as a way for the child to learn to request desired items.  Items are represented by pictures or photographs. The child is taught to request an item or activity by handing a picture/photograph of the item or activity to their communication partner. In exchange, the communication partner provides the child with the requested item/activity. Children often learn to recognise and use a large vocabulary of pictures stored in their own communication folder. They may also be taught how to link pictures together to form simple sentences for communication.  Photographs and line drawings may also be used to help the child understand the sequence of activities in a day and to develop self-help and social skills.

AAC and autism spectrum disorders at school

Children who are on the autism spectrum may use a range of communication strategies at school.  The communication strategies used depend on the child’s intellectual ability, literacy skills, and social interaction skills.  Communication strategies used may include speech, speech attempts, body language, touch, PECS, communication displays, and voice output communication aids.   

Communication displays (eg. communication board, wallet, folder) and voice output communication aids can be used when a child has intentional communication and is able to make a choice between vocabulary items. Aided and unaided AAC strategies are also useful to help the child understand others.

When communication partners use key word sign (Makaton) and gesture to accompany their speech, the child sees and hears what is wanted. When communication partners point to objects, pictures, photos or line drawings, the child is able to learn more quickly. This is called modelling and it is the way we all learn new skills.

People who have autism spectrum disorders often have difficulty understanding abstract ideas. AAC may be used to help visualise abstract concepts.  For example, some people may find it hard remember the order of activities that are planned for each day and get anxious if there are changes to their routine.  Visual timetables may be used to represent the activities that the child will be doing.  Each activity is represented by a picture, and/or word, and displayed in the order that they will happen. Pictures are used to indicate when an activity is finished and/or when something unexpected is going to occur.

Some people with autism spectrum disorders have sensory problems. They may be over-sensitive or under-sensitive to touch, sound and visual information. This can lead to some behaviour problems when the child and others do not understand what is happening.  There may also be problems developing social skills.  Social stories (“What to do stories”) and behaviour scripts may be used to help develop appropriate behaviour. The stories can be used to let the child know how long an activity may last, what is involved in the activity and what is expected of them.

If possible, the child will learn literacy and numeracy skills at school. Sometimes an academic curriculum is too hard for a child on the autism spectrum. Instead the child may be taught more practical skills based around the activities of daily living such as cooking, shopping and personal care. If a child does not develop literacy skills, other strategies may be used to support learning. These may include photo or picture-based books and activities.

Children on the autism spectrum will often develop good literacy skills. It is important to teach children with autism speech and language skills to help with the development of spelling and literacy. 

AAC and autism spectrum disorders beyond school

Most adults who have autism live in the family home or live independently.  Others live in shared housing or supported accommodation.  Supported accommodation facilities, such as community residential units can also provide respite care for people who normally live at home.  Some people who have autism spectrum disorders and live at home spend time in day centres. Day centres provide care and recreational options for people with disabilities. More able people with autism or Asperger’s syndrome may be in the paid work-force.

In supported accommodation, employment and day centres, visual supports (eg. objects, photographs, line drawings) can be used to help people on the autism spectrum to make choices and to remember and predict activities and events. When selecting AAC strategies, it is important to consider the individual’s ability to recognise and understand speech, photos, line drawings and/or text.  For example some people may understand that photographs represent an item, but may not understand that the printed word represents the same item.  This is because words are more abstract than photographs or objects. For someone who does not understand print alone, objects, photographs or line drawings can be used instead.

In general, AAC use for people on the autism spectrum is likely to be less formal within the home or in supported accommodation. Speech that is difficult to understand may be better understood by friends, family members and other regular communication partners.  People who are most familiar to the person with autism learn to recognise and understand their unique communication behaviours. It is only when communication breakdowns occur that the person with autism may use a more formal means of communication.