Using Symbols to Enhance Expressive Communication

By Mary Coughlin MS, CCC-SL, Marrea Winnega Ph.D.

Introduction

Approximately half of those diagnosed with autism are nonverbal and will never develop any functional verbal language. However, just because they cannot “talk” does not mean that they cannot communicate. Recent data suggest that many nonverbal students can learn to say some words if taught appropriate ways of communicating.

With the surge in assistive technology, there are many wonderful communication devices available to provide a “voice.” Most of these “high-tech” devices are very expensive and require intense training of professionals on how to continually program the systems for an individual’s use. Most systems also require at least a certain amount of necessary prerequisite skills from the student, which many nonverbal students with autism may not exhibit. However, a very uncomplicated communication system can be set up through the use of symbol communication. It also can be viewed as “low-tech” and the predecessor of a high-tech device.

Symbols refer to photographs of actual objects, line drawings, or written words. We refer to photographs and line drawings as “pictures.” When students do not understand that pictures represent objects, real objects are used instead. For example, a plate represents wanting food or a cup represents wanting a drink. The method used to teach object exchange is the same as the method to teach basic picture communication. Picture communication or object exchange can be used with any nonverbal or minimally verbal student.

What is Picture Communication & Why Use It?

Picture communication involves the student giving another person a picture to request something. This may be a desired object, food, or activity. It also may be used to express feelings or wants and make comments or respond to others. Picture communication encourages spontaneous communication. It teaches that by giving a picture, the child will obtain the desired item or action.

Picture communication is different from other augmentative communication systems, such as communication boards, in that it requires the student to actually give the other person the picture, whereas communication boards and devices may only require pointing to or touching a picture, depending on how they are used. When only pointing is required initially, this decreases spontaneous initiation and requires the student to wait until the other person comes to him for communication. However, at higher levels, as in using interactive boards, pointing is appropriate and can be spontaneous.

Once a child understands what to do and can discriminate between pictures, then the number of choices can be increased, and expressing actions, feelings, and other functions, including, “I don’t know” and “help,” can be taught. Also, adults should use pictures to communicate with the student so that they are modeling how the system works.

Teaching Picture Communication

One adult assists the child from behind, using hand-over-hand assistance, to give a picture of a highly preferred item to another adult. As the child understands what to do, the adult assisting then fades out of the picture. The adult being communicated with ups the ante, that is, he waits for the child to spontaneously give the picture. Then he has the student find his hand. After a while, the adult moves his hand toward his eyes to get the child to make eye contact briefly before getting her request fulfilled. Some students are slow to respond and can give the picture when they see the item. The process takes time, but is well worth the outcome.

Once the students understand picture communication, entire classrooms or homes can be set up to elicit spontaneous communication by using choice boards. By placing various choice boards of pictures where they are easily accessible, such as on desks, walls, refrigerators and cabinets, students are visually encouraged to use them. However, desired items need to be placed out of reach, locked up, or put in difficult-to-open containers so that the students cannot readily access them. Remember, when favorite items can be easily accessed, the child has no need to communicate.

Choice Boards are menus of information that let the student know what is available at a particular time. They also can give information to the student as to “what” is not available as well. They can be used for anything in which the student has a choice of what he can do. Choice Boards can be used for leisure activities, places to visit, what activity to work for, which song to sing, which toy to play with, what foods and drinks are available, etc. The list is endless. They can be as simple as having only two choices or as complicated as having many choices.

Examples of Choice Boards--this one contains photographs of toys:

Choice Board

This one shows the student's sensory choices:

Sensory Choice Board

For example, at snack time a few Choice Boards are put on the table with pictures of food and drinks available; at the play area, boards are on the walls displaying the toys available; and by the shelf of videos are pictures of the videos. Initially setting up a classroom or home requires time and effort; however, the end result will be a more efficient “communication-based” setting.

Choice Boards can be helpful for those with word retrieval problems. One student looked at the board with toy choices and spontaneously said, “I want trucks.” Trucks were not pictured on the board, but he was given them because he was able to ask for them.

Interactive Boards

Interactive Boards are described by Quill (2000). They are used along with an activity or setting to promote the student’s use of spontaneous requesting and commenting. A single board has multiple messages. These boards are formatted in columns with each column providing several choices. For example, a board can be arranged in the following columns: persons/pronouns, verbs, descriptive statements, nouns. Typically the verb choices correspond to the nouns; for example, for blocks the verb is “build.” Other pairs of verb-nouns include: play game; watch television; go outside. If the child points to blocks, an adult would point to each symbol and say, “Build blocks.” Imitating and expanding the child’s communication is important. The ultimate goal is to have the child point to symbols from several columns, and thus, make a sentence. When speaking to the child, the adult should use the board and model how to use it through pointing. If a child does not point or attend to the board, use hand over hand to assist the child in following your pointing. Accept a child’s using your finger to point.

Teaching Expressive Communication Through Picture Exchange

There are many books and manuals out on the market to assist one in getting started. Lori Frost and Andrew Bondy have developed and published ECSP-- The Picture Exchange Communication System. This is a very good training manual. They use a very systematic process that incorporates various behavioral teaching techniques that guide the communication training for picture exchange. They state that the first step is to observe and determine what items are highly motivating to the student and then use symbols of these for picture exchange. The student is taught to give a picture of the item to the teacher in order to obtain it. The teacher can show the item to the child to entice him but is not to ask, “What do you want?” According to the authors, it is important that the child initiate the act of requesting. The authors state that initially a second person should be a part of the process, sitting behind the student and facilitating the exchange. The use of the second person is usually faded very quickly, especially if a highly motivating item is used. Students move from single pictures to a sentence strip such as, “I want.” As part of the PECS system, each student eventually has his own PECS book where the pictures of items/activities are stored. It is the student’s responsibility to go to his book and get the picture of the desired item, and then exchange the picture for the item. According to the authors, it is the responsibility of the teachers or the other person involved in the exchange to ensure the picture is returned to the book.

One nonverbal student with autism, Joey, had a PECS book at his home. His mother reported that he was having difficulty using it spontaneously. Then one day she was very tired and lying on the couch. Joey kept tugging at her to get off the couch and get him something to eat. She was so tired she could not be moved. Finally, Joey went to his PECS book, grabbed a picture of something he wanted to eat and dropped it on his mother. She immediately got up and got him what he wanted! Eventually, students will learn that we don’t respond this fast, but since he was having difficulty using his book, this mom knew she had to respond quickly.

For More Information:

Autism Resource Network, Inc. 
904 Main Street #100
Hopkins, MN 55343 
Phone: (952) 988-0088 
E-mail: info@autismshop.com

Autism Speaks 
2 Park Avenue, 11th Floor
New York, NY 10016
Phone: (212) 252-8584 
Fax: (212) 252-8676

Visual Strategies for Improving Communication Volume 1 
Linda Hodgdon, M. ED., CCC-SLP 
Quirk Roberts Publishing 
This book contains many practical strategies in using pictures for communication.

PECS-- The Picture Exchange for Communication System 
Lori A. Frost, M.S. CCC-SLP and Andrew Bondy, Ph.D. 
Pyramid Educational Consultants 
A training package that includes a manual and video to assist in implementing PECS 

Do-Watch-Listen-Say: Social & Communication Intervention for Children with Autism. 
Kathleen Quill 
Paul H. Brookes Publishing Co., 2000 
This book contains several methods including interactive boards for communication and discusses teaching a variety of functions of communication before length of sentences.

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