Will communication device hamper real speech in child with autism?

Today’s response is from speech-language pathologist Barbara Braddock. Dr. Braddock practices at the SSM Cardinal Glennon Medical Center of the Saint Louis University School of Medicine. The center is one of 14 sites in the Autism Speaks Autism Treatment Network (ATN).

My son has autism and speaks a few words. The school has recommended using a speech-generating device. Are the teachers and therapists giving up on my son's speech?

You ask an important question. I’ve heard many parents express fear that a speech-generating device will prevent a speech-delayed child from developing natural spoken language. They worry that their child will default to pushing a button rather than learning to speak. And like you, many parents worry that even the suggestion of using such a device means that teachers and therapists are giving up on the possibility that their child will ever speak independently.

The good news is that we have clear evidence that these devices actually help children learn to speak.

Study on nonverbal communication devices

Several years ago, Autism Speaks funded a pilot study, enrolling 60 children with autism, ages 5 to 8 years, who were nonverbal or minimally verbal (fewer than 20 words).

All the children participated in a play-based intervention that encouraged the use of spoken language. To measure the added benefit of a speech-generating device, the researchers used it with half the children from the very start of therapy.

At the 3-month mark, the researchers measured the children’s progress. Those who were gaining language skills continued on course. The researchers added the communication device to the therapy of children who were responding slowly without it. At the end of six months, all participants gained spoken language. However, the children made earlier and more rapid progress when they were allowed to also use the speech device.

Most encouraging of all perhaps, this study helped dispel the belief that children who use speech-generating devices will stop making gains in spoken language. It showed just the opposite.

Why did the speech-generating devices help?

We don’t know for sure. But it may be that the speech sounds produced by the device provide the child with a model for imitation. Many of these devices pair pictures with sounds. (See example iPad above.) This may help reinforce the sound of the word with the child’s mental representation of the object or activity.

Bottom line, I believe that a speech-generating device will provide your son with a "voice." And that “voice” can both encourage him to communicate with others and provide him with a model of the sounds he needs to imitate to develop spoken language.

I don’t know what type of speech-generating device his therapists are recommending. Some provide simple one-message buttons. Others are more complex. For example, some allow the user to use combinations of graphic symbols to produce phrases.

There are speech apps for smart phones. Others work on touch tablets. And they range in price from free to hundreds of dollars.

I’m guessing that the speech-generating device your son’s therapist has in mind has graphic symbols organized in a way that can be gradually expanded with his growing vocabulary.

Given that your son is already speaking a few words, I would encourage him to use what we call “multi-modal communication.” This means encouraging him to use the speech-generating device along with his natural speech and gesture. For example, you would continue to respond to all his communication attempts – including gestures and attempts at speech. You should also continue to use clear spoken language with your son so he can model it. But it’s also helpful for you to show him how to use the speech-generating device when he seems unable to respond verbally. Remember, the word sounds produced by the device – like your spoken language – provide models for him to imitate.

It may help to understand that a speech-generating device is just one of many helpful types of alternative and augmentative communication. Pointing and other gestures are the most familiar examples. Sign language is another.

Other forms of alternative and augmentative communication involve using a “device.” At its simplest this can be a picture card or illustrated notebook.

The good news is that research consistently shows that none of these augmentative and alternative communication approaches hamper the development of spoken language. Just the opposite: They encourage communication and speech.

Editor’s note: The above information is not meant to diagnose or treat and should not take the place of personal consultation, as appropriate, with a qualified healthcare professional and/or behavioral therapist.