Jennifer Howe, SLP started with RehabVisions in 2011 and for nearly five years has been treating patients in a hospital setting in eastern Iowa. Part of her caseload includes autistic children who come to her for supplemental treatment, beyond what is provided at school. Her pediatric patients refine their communication and learn additional skills that are transferable as they progress through the education system and into adulthood.

“Most of my patients have some sort of functional deficit or behavioral problem,” says Jennifer. “Sometimes it’s as simple as behavioral management and assisting in being more ‘socially appropriate,’ or to better communicate their emotions. One individual I’ve been working with is nonverbal. We’re using an Augmentative and Alternative Communication (AAC) device to work on expressing wants and needs and to facilitate more verbalizations.”

AAC is a valuable treatment tool–AAC can be as simple as a picture system that is presented for the client to point to, to a complex computerized device. Studies have found that when nonverbal or minimally verbal children use AAC, it encourages speech, and use of AAC strategies advances verbal communication. Socially, autistic patients have to be able to answer questions—at school, at home and out in the community. Jennifer suggests creating a variety of situations where they can practice verbal responses. Some of her progression tactics include:

• Basic yes or no questions
• Sentence closure tasks
  • Ex: Practice moving the patient away from emotional and behavioral outburst when expressing something is wrong, to identifying the “what,” so parents can identify the issue (like a broken toy).
  • You can prompt, “Oh, something is wrong! The problem is_____.” The patient can respond with, “Wrong piece” and provide the closed statement.
• Total communication
  • Provide your patient with pictures that represent a request and establish that in order for the listener (parent, teacher, etc.) to understand the request; the listener must be presented with both the picture and a verbal response.

When you work with a patient who is used to a specific AAC device, don’t let it limit your choice of activities. “Instead of spending 10 minutes finding a spot to program a new button, just print or draw a picture and use it instead of the AAC device,” recommends Jennifer. “I feel it’s good for kids with autism to learn and practice all types of flexibility—and it’s okay to have flexibility with AAC.”

Flexibility becomes increasingly important when you consider critical moments when a child would need to communicate outside of the home. “My strategy is always centered on how I can support this child at home and out in the community,” says Jennifer. “I had a parent who expressed concern that her child understood she was ‘Mom’, but couldn’t say her name.” Safety is also critical to consider. Can a patient verbalize their address or state their mom or dad’s first name? Can a patient state their phone number? If a parent calls for them, do they answer with a verbal response? Or do they have a device programmed with this information?

“The rational and functional impact of practicing these scenarios is to achieve appropriate responses for safety,” says Jennifer. Two examples to consider:

• Practice basic location responses
  • Prompt, “[Name], where are you?” The patient should respond, “Here I am!”
• Don’t let the form of the question limit the response
  • Practice potential variations of a question with your patient.
  • Ex: What is Daddy’s name? Can you tell me your parent’s name? What is your father’s name?

“Having therapy at school, additional therapy with a therapist and then carryover practice at home reinforces with the patient that he/she needs to communicate with all types of different people. There is justification for getting more therapy outside of school. It’s helpful with family and friend relationships. It creates flexibility across environments. And it’s really important for kids with autism to learn to transfer skills.”

Read about treatment strategies for Autism Spectrum Disorders on the ASHA website.