communication - autism ni

Booklet 3

Communication

00293 PAPA Book 3 14/5/07 8:52 am

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The KEYHOLE® EarlyIntervention Programme

in Autism SpectrumDisorder

1

THE KEYHOLE EARLY INTERVENTION PROGRAMME IN AUTISM SPECTRUM DISORDER

Communication

For most children learning to communicate is exciting. It starts right from birth andshould be fun for the child, his family and friends.

Yet it is not easy, as the complex process of communication involves: -Listening, looking, understanding, thinking, wanting to communicate andneeding to communicate.

Children learn to communicate at different stages and children with Autism are nodifferent.

Communication involves being able to: –- Establish attention- Cope with interruptions- Take in information and understand it- Remember what you have heard- Reply meaningfully

If you can communicate with your child in a way that is meaningful to him you will beable to help him understand. - Where to go- What to do- What comes next- How to do it- When to move- What are my choices- What can I do- What can't I do

Developing a way for your child to understand the answers to these questions will helpreduce your child’s frustration levels and will help him to cooperate better with dailyroutines.

The ability to understand speech is one of the biggest challenges for your child toovercome. Understanding spoken words is difficult for a number of reasons; - Your child may have difficulty paying attention to words because he may not be able

to pick out the words as being the most important things he hears. You mayexperience times when you feel your child does not even appear to hear words at all,and you may have thought he was deaf.

- Sometimes your child may be able to pay attention to what you say but your speechis much too fast for him. So slow down,- Use fewer words maybe only one at a time- Give him time to respond- Only repeat exactly what you have said, if necessary- Make sure you have his attention when you repeat words

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2

Tantrums

For some children with Autism a tantrum is the only way they have to communicate thatthey want something or that there is something they don’t like or don’t want.

We do not want to encourage this so it is very important we give them another way tocommunicate their needs.

Where Do You Start?

Communication is like all the other things he has to learn and you need to start withwhat will be easiest for your child, what he will understand best. We suggest startingwith objects and move onto pictures when you know your child understands themeaning of picture cards.

Objects The most concrete symbols for your child to understand and use forcommunication.

*'TOBI’s' (True Object Based Icons) are made by cutting around the outline of aphotograph of the object. This should be large enough for the child to recognise theshape of the object.

Photographs Try not to include unnecessary details in the background of thephotograph.

Line Drawings You can draw your own simple line drawings or use symbols fromcomputer programmes e.g. Boardmaker for Windows (Mayer-Johnson Co) to representobjects, food or activities etc.

Your child needs to learn the power of communication and a way for him let youknow when he wants something. Some children who use objects for communication maybring an object e.g. a cup to you. Don't waste this opportunity. Even if he has just hada drink, show him you understand what he is telling you and give him a drink. This demonstrates to him that this form of communication is as powerful as a tantrum.

* Based on the work of B.C. Bloomfield (www.icontalk.com)

Booklet 3 - Communication

00293 PAPA Book 3 14/5/07 8:52 am

1


Communication

For most children learning to communicate is exciting. It starts right from birth andshould be fun for the child, his family and friends.

Yet it is not easy, as the complex process of communication involves: -Listening, looking, understanding, thinking, wanting to communicate andneeding to communicate.

Children learn to communicate at different stages and children with Autism are nodifferent.

Communication involves being able to: –- Establish attention- Cope with interruptions- Take in information and understand it- Remember what you have heard- Reply meaningfully

If you can communicate with your child in a way that is meaningful to him you will beable to help him understand. - Where to go- What to do- What comes next- How to do it- When to move- What are my choices- What can I do- What can't I do

Developing a way for your child to understand the answers to these questions will helpreduce your child’s frustration levels and will help him to cooperate better with dailyroutines.

The ability to understand speech is one of the biggest challenges for your child toovercome. Understanding spoken words is difficult for a number of reasons; - Your child may have difficulty paying attention to words because he may not be able

to pick out the words as being the most important things he hears. You mayexperience times when you feel your child does not even appear to hear words at all,and you may have thought he was deaf.

- Sometimes your child may be able to pay attention to what you say but your speechis much too fast for him. So slow down,- Use fewer words maybe only one at a time- Give him time to respond- Only repeat exactly what you have said, if necessary- Make sure you have his attention when you repeat words

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2

Tantrums

For some children with Autism a tantrum is the only way they have to communicate thatthey want something or that there is something they don’t like or don’t want.

We do not want to encourage this so it is very important we give them another way tocommunicate their needs.

Where Do You Start?

Communication is like all the other things he has to learn and you need to start withwhat will be easiest for your child, what he will understand best. We suggest startingwith objects and move onto pictures when you know your child understands themeaning of picture cards.

Objects The most concrete symbols for your child to understand and use forcommunication.

*'TOBI’s' (True Object Based Icons) are made by cutting around the outline of aphotograph of the object. This should be large enough for the child to recognise theshape of the object.

Photographs Try not to include unnecessary details in the background of thephotograph.

Line Drawings You can draw your own simple line drawings or use symbols fromcomputer programmes e.g. Boardmaker for Windows (Mayer-Johnson Co) to representobjects, food or activities etc.

Your child needs to learn the power of communication and a way for him let youknow when he wants something. Some children who use objects for communication maybring an object e.g. a cup to you. Don't waste this opportunity. Even if he has just hada drink, show him you understand what he is telling you and give him a drink. This demonstrates to him that this form of communication is as powerful as a tantrum.

* Based on the work of B.C. Bloomfield (www.icontalk.com)


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Visual Communication

Those things we can see that help us to understand what is happening. Using visualcommunication will help your child understand what you are asking him to do.

Objects

You can use an object to help your child understand what is going to happen next in hisdaily routine. For example, when you give your child his coat, this is his object whichtells him he is going outside. It is helpful to have a box of different objects that you only use for communication e.g.

Cup means drink Plate means food Toilet roll means toilet/bathroom Keys means out in the car Ball means outside play Sponge means bath time

You should use the objects you think your child will find most meaningful to start with.If you want to teach your child that objects have meaning, always use the same objectand only use them for communication.

Example:-Ryan is a little boy with Autism who uses objects to communicate. First he gets up, getshis nappy changed and gets dressed, watches television, has breakfast, goes to thepark, comes back home and plays.

Ryan's mum hands him his nappy and says 'nappy changed' and he has learned (after alot of practices!) to take it to the bathroom where his mum puts him on the changingmat to change him. She shows him his clothes and helps him to dress. Then she giveshim a video box and says 'video'. He takes it downstairs and puts it on top of thetelevision. Mum puts on 'The Tweenies' which he loves. After the Tweenies, mum giveshim a breakfast bowl and says 'breakfast'. Ryan brings it to the kitchen table and sitsdown to have his cereal. After breakfast mum gives Ryan his coat and says 'outside',and they go to the park. After Ryan has had a good run about and has enjoyed theslide. Mum gives him his Teddy Bear Links (his object which means home for Ryan) andsays 'Home'. He doesn't like leaving the park but he understands the message andcomes with a little protest. When he gets home, mum hands him his red block and says'play'. He takes it and puts it on top of the matching red block on his table. He does 10minutes of structured play.

Ryan is a much happier and more contented little boy since he learned to understandmore about the world around him. Teaching him to use objects has made it easier forhim to understand what comes next. His mum says his protests are a lot shorter nowand she feels that he seems to be able to understand more.

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Picture Schedules

Picture schedules are an extension of the 'first/then' routine to help your childunderstand what is going to happen next. You will remember this routine was explainedin Booklet 2.

A picture schedule is a sequence of pictures that will show the child what the day holds.

Following a schedule at home will make your child's day more predictable. He will beable to see when things will happen and as a result may be a more content child.

A word of warning! If you are going to use a picture schedule at home you are helping your child to follow adaily timetable.You may not want to use a picture schedule all day every day. You might only use aschedule when you want to communicate to your child when something is going tohappen and you need your child to follow a certain routine e.g. a bedtime routine, goingout.To use a schedule properly, your child needs to follow the sequence in the way you haveput it in place. He should not be allowed to choose what he wants to do, he needs tofollow the sequence of events on the schedule. It is very important that dailyschedules do not become choice boards. If this is difficult for you or your child then askfor help.

You can put your schedule up on the kitchen door and point to each activity as it occursthen remove each picture or allow your child to post it into an 'all done' box when eachactivity is finished.

Example of a part day schedule

Jack's dad is showing him what'sgoing to happen next.

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3


Visual Communication

Those things we can see that help us to understand what is happening. Using visualcommunication will help your child understand what you are asking him to do.

Objects

You can use an object to help your child understand what is going to happen next in hisdaily routine. For example, when you give your child his coat, this is his object whichtells him he is going outside. It is helpful to have a box of different objects that you only use for communication e.g.

Cup means drink Plate means food Toilet roll means toilet/bathroom Keys means out in the car Ball means outside play Sponge means bath time

You should use the objects you think your child will find most meaningful to start with.If you want to teach your child that objects have meaning, always use the same objectand only use them for communication.

Example:-Ryan is a little boy with Autism who uses objects to communicate. First he gets up, getshis nappy changed and gets dressed, watches television, has breakfast, goes to thepark, comes back home and plays.

Ryan's mum hands him his nappy and says 'nappy changed' and he has learned (after alot of practices!) to take it to the bathroom where his mum puts him on the changingmat to change him. She shows him his clothes and helps him to dress. Then she giveshim a video box and says 'video'. He takes it downstairs and puts it on top of thetelevision. Mum puts on 'The Tweenies' which he loves. After the Tweenies, mum giveshim a breakfast bowl and says 'breakfast'. Ryan brings it to the kitchen table and sitsdown to have his cereal. After breakfast mum gives Ryan his coat and says 'outside',and they go to the park. After Ryan has had a good run about and has enjoyed theslide. Mum gives him his Teddy Bear Links (his object which means home for Ryan) andsays 'Home'. He doesn't like leaving the park but he understands the message andcomes with a little protest. When he gets home, mum hands him his red block and says'play'. He takes it and puts it on top of the matching red block on his table. He does 10minutes of structured play.

Ryan is a much happier and more contented little boy since he learned to understandmore about the world around him. Teaching him to use objects has made it easier forhim to understand what comes next. His mum says his protests are a lot shorter nowand she feels that he seems to be able to understand more.

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4


Picture Schedules

Picture schedules are an extension of the 'first/then' routine to help your childunderstand what is going to happen next. You will remember this routine was explainedin Booklet 2.

A picture schedule is a sequence of pictures that will show the child what the day holds.

Following a schedule at home will make your child's day more predictable. He will beable to see when things will happen and as a result may be a more content child.

A word of warning! If you are going to use a picture schedule at home you are helping your child to follow adaily timetable.You may not want to use a picture schedule all day every day. You might only use aschedule when you want to communicate to your child when something is going tohappen and you need your child to follow a certain routine e.g. a bedtime routine, goingout.To use a schedule properly, your child needs to follow the sequence in the way you haveput it in place. He should not be allowed to choose what he wants to do, he needs tofollow the sequence of events on the schedule. It is very important that dailyschedules do not become choice boards. If this is difficult for you or your child then askfor help.

You can put your schedule up on the kitchen door and point to each activity as it occursthen remove each picture or allow your child to post it into an 'all done' box when eachactivity is finished.

Example of a part day schedule

Jack's dad is showing him what'sgoing to happen next.

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5


Travel Schedule

A travel schedule is a small schedule you can use when going out to show your childwhere you are going to, what you are going to do and what happens next. You may not need to use a “travel schedule” but if your child experiences difficulty goingto the shops or other outings a travel schedule may help as he is familiar with thisroutine it will make things more predictable for him.

Show your child the schedule before you go out and talk him through what will happenusing simple language e.g. 'first bus, then hair-cut, then shop, then bank and thenMcDonalds'! As you leave each place remove the corresponding picture and remind yourchild what is next. Remember to always include something he likes within the travelschedule you need to make it worth his while to use it.

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Help your child to communicate with you and others

Your child's ability to communicate is affected by a number of factors:

� If he is under pressure e.g. with strangers or in an unfamiliar place. Often your childwill have a tantrum because he can't communicate in a more appropriate way howhe is feeling or what he needs

� He may not know that he has to do anything at all to get you to understand what heneeds and often gets upset and frustrated when you don't give him what he wants

� He may not realise that he needs to get your attention first

� He may not be able to find the right words and uses his own language

Give your child a reason to communicate

Example:-Harry was 2.4 years old when he started in the KEYHOLE® Project. He had no speech and was a very passive little boy who spent prolonged periods of time throwing objects over his shoulder or flicking his fingers in front of his eyes. He did not pay attention to anyone and his parents found it very hard to engage with him. His parents were frustrated and helpless because they didn't know how to help him or where to start. Harry only ever communicated by crying or throwing a tantrum. Otherwise his parents just tried to guess what he needed. They began by providing him with opportunities to communicate; they gave him a way to communicate by using objects. They stopped guessing what he meant and responded to his use of objects for communication. This encouraged him to use the objects and he learned that he had to do something to let them know what he wanted.

00293 PAPA Book 3 14/5/07 8:52 am

5


Travel Schedule

A travel schedule is a small schedule you can use when going out to show your childwhere you are going to, what you are going to do and what happens next. You may not need to use a “travel schedule” but if your child experiences difficulty goingto the shops or other outings a travel schedule may help as he is familiar with thisroutine it will make things more predictable for him.

Show your child the schedule before you go out and talk him through what will happenusing simple language e.g. 'first bus, then hair-cut, then shop, then bank and thenMcDonalds'! As you leave each place remove the corresponding picture and remind yourchild what is next. Remember to always include something he likes within the travelschedule you need to make it worth his while to use it.

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6


Help your child to communicate with you and others

Your child's ability to communicate is affected by a number of factors:

� If he is under pressure e.g. with strangers or in an unfamiliar place. Often your childwill have a tantrum because he can't communicate in a more appropriate way howhe is feeling or what he needs

� He may not know that he has to do anything at all to get you to understand what heneeds and often gets upset and frustrated when you don't give him what he wants

� He may not realise that he needs to get your attention first

� He may not be able to find the right words and uses his own language

Give your child a reason to communicate

Example:-Harry was 2.4 years old when he started in the KEYHOLE® Project. He had no speech and was a very passive little boy who spent prolonged periods of time throwing objects over his shoulder or flicking his fingers in front of his eyes. He did not pay attention to anyone and his parents found it very hard to engage with him. His parents were frustrated and helpless because they didn't know how to help him or where to start. Harry only ever communicated by crying or throwing a tantrum. Otherwise his parents just tried to guess what he needed. They began by providing him with opportunities to communicate; they gave him a way to communicate by using objects. They stopped guessing what he meant and responded to his use of objects for communication. This encouraged him to use the objects and he learned that he had to do something to let them know what he wanted.

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Give your child a reason to communicate by using: :

Positive Routines

Your child will have a preference for routines and will expect things to happen in acertain way. Make a list of the routines that are important to your child. Select theroutines that can be disrupted in a way that will encourage your child to communicate toget you to complete the routine. For example: - Give him his cup but with no juice in it- Give him his yoghurt but no spoon- Give him his crisps but unopened- Turn on the TV but 'forget' to put on his favourite video- When changing his nappy or pants, don't pull up his trousers

Your child may get very frustrated when you do these things and he may not have away to tell you what he wants except through negative behaviour or tantrums or he maynot bother to communicate in any way at all. If so, continue to provide him with theseopportunities to communicate now and again but you will need someone to help youshow your child what to do in this situation.

For Example:-When you give him his unopened sweets or crisps� Wait and look expectant� Hold your hand out to your child as a prompt to him to give you the packet to ask

for it to be opened, � At the same time your partner or helper should be behind your child and hand over

hand help him give you the packet� As your child gives you the packet say 'open'

Your child needs lots of practice in this physical act of exchanging objects in order to getyou to do something for him.

This is the start of a positive communication routine.

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Powerful Motivators

Your child will be more motivated to communicate for things he really enjoys. Youngchildren with Autism may be motivated by noisy/musical toys, toys with flashing lights,bubbles, rough and tumble play, sweets/crisps, dinosaurs, cars and trains. You willknow what your child likes best.

Make a list below of the things you think your child enjoys and assess which items arethe most motivating. You will be able to list these by noting if: - He gets upset when the item or activity is taken away- He gets excited when he sees the item - He looks for the item or activity - He spends a long time playing with the item

List of Powerful Motivators

Food

Toys

Games

Others

Use these motivators regularly throughout the day to encourage your child tocommunicate. If he is not interested at the time that you are trying to work on hiscommunication, then try something else, leave it to later or follow what he is interestedin at that moment.

00293 PAPA Book 3 14/5/07 8:52 am

7


Give your child a reason to communicate by using: :

Positive Routines

Your child will have a preference for routines and will expect things to happen in acertain way. Make a list of the routines that are important to your child. Select theroutines that can be disrupted in a way that will encourage your child to communicate toget you to complete the routine. For example: - Give him his cup but with no juice in it- Give him his yoghurt but no spoon- Give him his crisps but unopened- Turn on the TV but 'forget' to put on his favourite video- When changing his nappy or pants, don't pull up his trousers

Your child may get very frustrated when you do these things and he may not have away to tell you what he wants except through negative behaviour or tantrums or he maynot bother to communicate in any way at all. If so, continue to provide him with theseopportunities to communicate now and again but you will need someone to help youshow your child what to do in this situation.

For Example:-When you give him his unopened sweets or crisps� Wait and look expectant� Hold your hand out to your child as a prompt to him to give you the packet to ask

for it to be opened, � At the same time your partner or helper should be behind your child and hand over

hand help him give you the packet� As your child gives you the packet say 'open'

Your child needs lots of practice in this physical act of exchanging objects in order to getyou to do something for him.

This is the start of a positive communication routine.

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8


Powerful Motivators

Your child will be more motivated to communicate for things he really enjoys. Youngchildren with Autism may be motivated by noisy/musical toys, toys with flashing lights,bubbles, rough and tumble play, sweets/crisps, dinosaurs, cars and trains. You willknow what your child likes best.

Make a list below of the things you think your child enjoys and assess which items arethe most motivating. You will be able to list these by noting if: - He gets upset when the item or activity is taken away- He gets excited when he sees the item - He looks for the item or activity - He spends a long time playing with the item

List of Powerful Motivators

Food

Toys

Games

Others

Use these motivators regularly throughout the day to encourage your child tocommunicate. If he is not interested at the time that you are trying to work on hiscommunication, then try something else, leave it to later or follow what he is interestedin at that moment.

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Using Objects to Encourage Communication

Your child may be motivated by objects such as balloons, bubbles, wind-up toys, orconstruction activities such as building a train track. He will usually need your help tomake the toys work and the motivation to communicate will be strong.

Example:-� Blow up a balloon and let it go� If your child wants it again, he will go and pick up the balloon � Be physically close to him and hold out your hand to prompt him to communicate� He may need someone to physically prompt him from behind, hand over hand to give

you the balloon� This is his way of asking you to repeat the activity.

Example:-Blowing bubbles. First you blow the bubbles then place the bubble wand on the floor ortable where your child can see it. You keep hold of the jar. If he is interested he will joinin by taking the wand in his hand, and as he does this, hold your hand out to him offerhim more bubbles. Another adult may need to use physical hand-over-hand promptingfrom behind if your child has difficulty knowing how to ask for more. As he gives you thewand, say an appropriate phrase, such as 'bubbles', 'more'

Don’t be afraid to ask for help if you can’t think of any other ideas.

Visual Communication Systems

As already explained teaching your child to communicate by exchanging an object orpicture is one of the most powerful tools for communcation and interaction that you cangive your child. Visual communication represents the next level of communication, it is astep on from tantrum behaviour or motor communication such as leading you by the hand.Visual communication is a step towards spoken communication. Children with autism find iteasier to understand messages they can see because of the difficulties they have inunderstanding the meaning of words. Your child may understand it is time to go out whenhe sees you with your coat on, holding the car keys but if you were to say 'we are goingout' while you are both sitting watching TV he may not respond. He needs a visual cue tohelp him understand what it is you have said to him. There are a number of visual cuesyou can use to help him understand what you want him to do next. You will need tochoose the most meaningful visual cues for your child. What does he respond to best?

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Objects - The most concrete symbols for your child to understand and use forcommunication

TOBI - TOBI's (True Object Based Icons) are made by cutting out around the outline ofthe object. This should be large enough for the child to recognise the shape ofthe object

Photographs - Try not to include unnecessary detail in the background of the photograph

Line Drawings - As previously mentioned you can draw your own or use symbols fromcomputer programmes

Written Words - Even some pre-school children with autism can understand written wordsbefore they understand speech It is often easier for very young children to start withobjects and TOBI's. Assess your child's understanding of symbols so that you can use themost appropriate one.

How will you know what he responds to best

You need to know if your child recognises objects.

- Can he match a picture to an object? - Can he match pictures on a colour lotto board? - Does your child look at photographs of items and show recognition of the item? - Can he match the photograph to the real object when given three or four pairs of

photographs/objects?

Yes? Use Photograph Level, he is ready to use photographs on his picture schedule.

No? Use Objects, your child will understand what you are trying to communicate to himif you use objects to help.

- Can he match black and white line drawings with a photograph or an object? - Does he show any recognition of a black and white line drawing?

Yes? Use Line Drawings on his picture schedule.

No? Stick with photographs for the time being.

If you are unsure and can't get advice from a professional, start at the simplest level asyour child should not have difficulty understanding objects.

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9


Using Objects to Encourage Communication

Your child may be motivated by objects such as balloons, bubbles, wind-up toys, orconstruction activities such as building a train track. He will usually need your help tomake the toys work and the motivation to communicate will be strong.

Example:-� Blow up a balloon and let it go� If your child wants it again, he will go and pick up the balloon � Be physically close to him and hold out your hand to prompt him to communicate� He may need someone to physically prompt him from behind, hand over hand to give

you the balloon� This is his way of asking you to repeat the activity.

Example:-Blowing bubbles. First you blow the bubbles then place the bubble wand on the floor ortable where your child can see it. You keep hold of the jar. If he is interested he will joinin by taking the wand in his hand, and as he does this, hold your hand out to him offerhim more bubbles. Another adult may need to use physical hand-over-hand promptingfrom behind if your child has difficulty knowing how to ask for more. As he gives you thewand, say an appropriate phrase, such as 'bubbles', 'more'

Don’t be afraid to ask for help if you can’t think of any other ideas.

Visual Communication Systems

As already explained teaching your child to communicate by exchanging an object orpicture is one of the most powerful tools for communcation and interaction that you cangive your child. Visual communication represents the next level of communication, it is astep on from tantrum behaviour or motor communication such as leading you by the hand.Visual communication is a step towards spoken communication. Children with autism find iteasier to understand messages they can see because of the difficulties they have inunderstanding the meaning of words. Your child may understand it is time to go out whenhe sees you with your coat on, holding the car keys but if you were to say 'we are goingout' while you are both sitting watching TV he may not respond. He needs a visual cue tohelp him understand what it is you have said to him. There are a number of visual cuesyou can use to help him understand what you want him to do next. You will need tochoose the most meaningful visual cues for your child. What does he respond to best?

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10


Objects - The most concrete symbols for your child to understand and use forcommunication

TOBI - TOBI's (True Object Based Icons) are made by cutting out around the outline ofthe object. This should be large enough for the child to recognise the shape ofthe object

Photographs - Try not to include unnecessary detail in the background of the photograph

Line Drawings - As previously mentioned you can draw your own or use symbols fromcomputer programmes

Written Words - Even some pre-school children with autism can understand written wordsbefore they understand speech It is often easier for very young children to start withobjects and TOBI's. Assess your child's understanding of symbols so that you can use themost appropriate one.

How will you know what he responds to best

You need to know if your child recognises objects.

- Can he match a picture to an object? - Can he match pictures on a colour lotto board? - Does your child look at photographs of items and show recognition of the item? - Can he match the photograph to the real object when given three or four pairs of

photographs/objects?

Yes? Use Photograph Level, he is ready to use photographs on his picture schedule.

No? Use Objects, your child will understand what you are trying to communicate to himif you use objects to help.

- Can he match black and white line drawings with a photograph or an object? - Does he show any recognition of a black and white line drawing?

Yes? Use Line Drawings on his picture schedule.

No? Stick with photographs for the time being.

If you are unsure and can't get advice from a professional, start at the simplest level asyour child should not have difficulty understanding objects.

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Choice Boards

A choice board is a board which shows objects, TOBIs or pictures of the choices that areavailable for your child at that time. To teach him to choose between milk or juice,show him a choice board with pictures of both these options. Your child can see whathis choices are and should let you know what he wants.

To teach choice, start with two symbols stuck with Velcro to a strong piece of colouredcard or place two object symbols on a Choice Tray.

One of the items will be a strongly desired item and the other not so important to thechild. In this way, if your child makes the wrong choice and gets something he doesn'tlike he will learn to pay more attention to his symbols and select more carefully. Youcan also do this for play, toys, video, food etc.

Example:-Ryan's mother made him a choice board for different places in the house. He had achoice board with three food TOBI's at the dinner table and he had another choiceboard for his four favourite toys in the playroom. She encouraged Ryan to make his choices by showing him the Choice Board. He had tochoose a TOBI before he was allowed to either take the food or toys.

Example of a Choice Board

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The Two Way Flow of Communication

Your child needs a reason to communicate. Use something that you know he likes andwill want to ask for. Let him see it, but make sure he can’t reach it to begin with. Weneed to teach him that he needs to do something to you to get what he wants.You will need to have decided what you are going to use with your child – objects,TOBIS or pictures.

These need to represent those things that you have already identified as being yourchild’s powerful motivators.

Prompt your child to look at the card or object. You may need another adult to helpattract your childs attention to the object or the card and encourage him to touch it, tolet you know he wants another treat. You need to reward him and help him understandthe power of what he has just done. He has asked for a treat. You can teach him thisnew skill in other situations when he understands that he will not get things until heasks for them.

- Once your child has grasped the concept of exchanging to get something, you canintroduce a Choice Board.

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Choice Boards

A choice board is a board which shows objects, TOBIs or pictures of the choices that areavailable for your child at that time. To teach him to choose between milk or juice,show him a choice board with pictures of both these options. Your child can see whathis choices are and should let you know what he wants.

To teach choice, start with two symbols stuck with Velcro to a strong piece of colouredcard or place two object symbols on a Choice Tray.

One of the items will be a strongly desired item and the other not so important to thechild. In this way, if your child makes the wrong choice and gets something he doesn'tlike he will learn to pay more attention to his symbols and select more carefully. Youcan also do this for play, toys, video, food etc.

Example:-Ryan's mother made him a choice board for different places in the house. He had achoice board with three food TOBI's at the dinner table and he had another choiceboard for his four favourite toys in the playroom. She encouraged Ryan to make his choices by showing him the Choice Board. He had tochoose a TOBI before he was allowed to either take the food or toys.

Example of a Choice Board

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The Two Way Flow of Communication

Your child needs a reason to communicate. Use something that you know he likes andwill want to ask for. Let him see it, but make sure he can’t reach it to begin with. Weneed to teach him that he needs to do something to you to get what he wants.You will need to have decided what you are going to use with your child – objects,TOBIS or pictures.

These need to represent those things that you have already identified as being yourchild’s powerful motivators.

Prompt your child to look at the card or object. You may need another adult to helpattract your childs attention to the object or the card and encourage him to touch it, tolet you know he wants another treat. You need to reward him and help him understandthe power of what he has just done. He has asked for a treat. You can teach him thisnew skill in other situations when he understands that he will not get things until heasks for them.

- Once your child has grasped the concept of exchanging to get something, you canintroduce a Choice Board.

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Top Tips for Communication

- Give your child a reason to communicate

- Use your child's interests and motivations to encourage him to communicate more

- Disrupt familiar routines to encourage your child to communicate

- Develop an Exchange Communication System for your child

- Use Choice Boards to help him see what his choices are and to teach him how to ask

- Use simple language for your child to copy when he is ready

- Unless your child is very upset, work through the tears to help your child learn abetter way to communicate. The tears will soon disappear.

You might like to make a record here of how your child communicates:

What is he/she doing?Why is he/she doing this?

What do you think he/sheis trying to communicate?

Where is he/she whenhe/she is communicating?

Who is he/she most likelyto communicate with?

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Do Children Who Have Speech Need to use VisualCommunication Strategies ?

Even children who use speech will benefit from visual communication strategies. Usingvisual supports will help them say what they mean more appropriately and reduces theirstress levels.

Example:-Jack had quite good speech. He wanted to ask his Mummy for a biscuit and he couldn’tfind the right word, the more he tried the harder it became for him to use the word.Jack was shown a drawing of a biscuit, he immediately looked at the picture and said “Iwant a biscuit”. The visual prompt helped him to use speech appropriately.

Provide Good Models of Speech for your Child to Copy

It is best to keep your language short and simple to help your child understand and togive him any chance of attempting to copy what he hears.

Use simple comments

'I see a dog' 'Train broken''Daddy's away'

Label things your child looks at or has

'Dinosaurs''“Juice”''Red train”''Big lorry”'

Provide speech for your child to copy at other times

� To Greet - 'Hello Nanny', 'bye daddy’� To Protest - 'No want', 'no like' � To Refuse - 'Don't wanna go' � To Request - 'Mummy do it?' � To Express an emotion - 'Ryan's cross'

Generally use only one and two word utterances to begin with. Remember to use an animated tone of voice and use repetitive phrases, whilstemphasising the key words in your sentence. Your child will learn to say the words whenhe is ready. Continue to provide him with the opportunity to hear simple language usedas part of his fun times and daily routines such as dressing and meal times.Visual communication strategies will not prevent speech development, it willhelp your child to learn more words, use them meaningfully and reduce stress.

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Top Tips for Communication

- Give your child a reason to communicate

- Use your child's interests and motivations to encourage him to communicate more

- Disrupt familiar routines to encourage your child to communicate

- Develop an Exchange Communication System for your child

- Use Choice Boards to help him see what his choices are and to teach him how to ask

- Use simple language for your child to copy when he is ready

- Unless your child is very upset, work through the tears to help your child learn abetter way to communicate. The tears will soon disappear.

You might like to make a record here of how your child communicates:

What is he/she doing?Why is he/she doing this?

What do you think he/sheis trying to communicate?

Where is he/she whenhe/she is communicating?

Who is he/she most likelyto communicate with?

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13


Do Children Who Have Speech Need to use VisualCommunication Strategies ?

Even children who use speech will benefit from visual communication strategies. Usingvisual supports will help them say what they mean more appropriately and reduces theirstress levels.

Example:-Jack had quite good speech. He wanted to ask his Mummy for a biscuit and he couldn’tfind the right word, the more he tried the harder it became for him to use the word.Jack was shown a drawing of a biscuit, he immediately looked at the picture and said “Iwant a biscuit”. The visual prompt helped him to use speech appropriately.

Provide Good Models of Speech for your Child to Copy

It is best to keep your language short and simple to help your child understand and togive him any chance of attempting to copy what he hears.

Use simple comments

'I see a dog' 'Train broken''Daddy's away'

Label things your child looks at or has

'Dinosaurs''“Juice”''Red train”''Big lorry”'

Provide speech for your child to copy at other times

� To Greet - 'Hello Nanny', 'bye daddy’� To Protest - 'No want', 'no like' � To Refuse - 'Don't wanna go' � To Request - 'Mummy do it?' � To Express an emotion - 'Ryan's cross'

Generally use only one and two word utterances to begin with. Remember to use an animated tone of voice and use repetitive phrases, whilstemphasising the key words in your sentence. Your child will learn to say the words whenhe is ready. Continue to provide him with the opportunity to hear simple language usedas part of his fun times and daily routines such as dressing and meal times.Visual communication strategies will not prevent speech development, it willhelp your child to learn more words, use them meaningfully and reduce stress.

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DedicationThe KEYHOLE® Booklets are dedicated to the children and their families who participated in the KEYHOLE® Early Intervention Project.

Their openness, cooperation and commitment are at the core of the booklets. They gave heart to this work.

Their opinion, experiences and insights gave the booklets their direction. They gave hope.

Funded By:

Booklets written by Heather Crawford MBE (Speech & Language Therapist Manager) andKate Doherty (Senior Teacher Autism Spectrum Disorder)

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communication - autism ni

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