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A Practical Review of Communication-Assistance Technologies

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In my last article on GoodTherapy.org, we reviewed the importance of communication training for children who have limited or no verbal ability. Communication is so important that it should be a treatment priority. Successfully addressing communication needs frequently results in reduction of challenging behavior, improvements in mood and affect, and increases in skill acquisition. It truly is a fundamental quality-of-life issue.

This article will focus on five basic strategies/technologies for enhancing communication. Pros and cons for each technology will be reviewed. Good communication strategies are easy to teach and implement, are cost effective, and are applicable in all settings.

This is not an exhaustive review of all the potential strategies available to consumers, but it is based on personal experience with former and current clients.

1. Idiosyncratic gestures and sounds
This is not so much an intervention or technology as it is a strategy of doing nothing. Here, the individual develops a repertoire of gestures and sounds to express their wants and needs. Caregivers learn what various gestures and sounds mean and can then figure out what the individual wants.

  • Pros: There is very little reason to recommend this strategy.
  • Cons: This often happens on its own without any specific interventions (which might be considered a pro). However, this requires that people know the individual to understand what he or she is trying to communicate. This limits the universality of the approach. Furthermore, there is no guarantee that an individual will develop such strategies on his or her own.

2. Sign language
In this system, the individual is taught a structured form of nonverbal language, usually based on American sign language.

  • Pros: The nonverbal individual has the potential to learn a full range of expressive language. This strategy has perhaps the longest documented track record of any of those mentioned in this article. Potentially cost effective, depending on the availability of education. An OK option, but limited in scope.
  • Cons: Limited generalizability. Relatively few people know how to sign, so the chances of an individual being able to use this language to, say, order a meal at a restaurant without an interpreter are less than with other strategies. Some (but not all) nonverbal individuals have impaired fine motor skills that make learning intricate gestures more challenging. A great deal of education is required to train an individual in the use of sign.

3. Picture-exchange communication
Also known as PECS, this system was developed by Pyramid Educational Consultants. It involves teaching an individual to exchange pictures to communicate wants and needs.

  • Pros: Cost effective … all it takes is some basic supplies that you can get at the office store to set up. Easily expandable … as the child’s vocabulary expands, just add icons to match. Portable … the child simply carries a binder with icons. Great generalizability … most anyone can understand what the individual wants based on the pictures. Icons can be put on a sentence strip to easily create sentences for more complex communication. All in all, this is a great system, and it should be explored by most anybody looking to enhance his or her child’s communication.
  • Cons: It takes a great deal of specialized training to learn to implement the system as well as to teach it. You need at least two people to do the initial communication training. It takes a great deal of initial prep as well as ongoing work (reprinting and recovering lost icons, printing new icons, replacing damaged books, etc.). The communication process is a little more “clunky” than with other systems.

4. Talking devices
This strategy involves using a device: You record words, and the individual can then play back those words by pressing a button.

  • Pros: There are myriad devices that can meet the needs of almost any communicator (from simple recording of a few words to something as complex as what Stephen Hawking uses). Devices better replicate verbal speech so that the person can be easily understood by just about anybody. A good option for some individuals, but not necessarily a universal option.
  • Cons: Devices tend to be very expensive—several hundred dollars for a simple, four-button device, to thousands of dollars for more complex devices. Devices need programming and can be complicated to use. Devices can be broken if not handled gently, or run out of power and then leave the individual unable to communicate. Some autistic individuals may use the electronic device to simply “stim,” pressing buttons to make sound but not actually using the device to communicate.

5. iPad or other tablet device
This is really just an extension of the last strategy. In this case, the individual has a tablet and uses applications that mimic PECS icons or do something like text-to-speech. Many innovative apps have been developed in recent years that offer great options to enhance communication.

  • Pros: Apps are pretty inexpensive. A variety of great communication apps exist already, with more being developed every day. The tablet can be more than just a communication device, as it allows for entertainment, education, etc. For many people, this may be a more cost effective and successful option than other electronic communication options.
  • Cons: Tablets can be expensive, are prone to damage if not handled gently, are harder to use than simpler technologies, and may not be suitable for all individuals. When a tablet runs out of power, the individual’s communication is limited unless other technologies are available. As with talking devices, autistic individuals may use the tablet to “stim” rather than communicate.

I hope you find this review helpful. Please share your experience using these or other communication-assistance technologies in the comments section below.

© Copyright 2013 by Erik Young, MEd, LPC, therapist in West Chester, PA. All Rights Reserved.

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Comments
  • Megan March 6th, 2013 at 3:29 PM #1

    I think that the biggest challenge that many parents will find is having the ability to think outside of the box. It is hard when every other child communicates one way and you have to do something different for your kid. It’s not that you don’t want to, but there is still this big push to make these children fit into that traditional mold of what kids are “supposed” to be like instead of meeting them in a way that addresses their own unique and special needs. I don’t necessarily care if someone looks at me like I am crazy, but I know there will be many parents who will find this difficult to deal with and might shun many of these techniques for fear of how they will look to others.

  • Moises.K March 6th, 2013 at 11:28 PM #2

    Its amazing where we are in terms of technology to help special needs individuals compared to even just ten years ago. Everyday there are newer apps and devices that can do more and more for them. And as with everybody else, technology will become an important part of special needs people and this needs to be encouraged. We have so many new pros coming out each day, we should be focusing on reducing the cons in such devices.

  • jake March 7th, 2013 at 3:47 AM #3

    when it comes to your kids and having the ability to carry on any kind of conversation with them is awesome- if a tablet did the trick then I couldn’t let the money stop me

  • simone March 8th, 2013 at 12:00 AM #4

    know people who have difficulty in having an actual conversation for an elongated time but do just fine with the aid of technology. I think it’s far more rewarding and feels better to be able to use tech to help you than to have to depend on other people. gives someone a sense of independence in the long run.

  • Warner March 9th, 2013 at 5:19 AM #5

    And where are the families getting the resources to have these things? many of them are already so stretched financially with medical bills that they couldn’t afford to have anything additional. They are all fantastic, and if your family has the means then I am sure that you could benefit. But what about those who need the same and don’t have any way to get it? Shouldn’t there be some way to help those families too?

  • Erik Young, M.Ed., LPC March 10th, 2013 at 9:18 AM #6

    @Megan — You are correct. I have worked with famiies who are concerned about the stigma associated with their autistic child’s behaviors or needs. In these cases, highlighting the benefits of particular interventions (versus the potential stigma) as well as helping the family become comfortable with each other becomes a treatment priority. In every case where I have been able to successfully address communication needs, I have seen significant reductions in problematic behaviors on the part of the child.

  • Erik Young, M.Ed., LPC March 10th, 2013 at 9:19 AM #7

    @moises — This is so true.

  • Erik Young, M.Ed., LPC March 10th, 2013 at 9:20 AM #8

    @jake — it goes beyond just having conversations. Giving a person the ability to communicate their wants and needs increases their independence and allows them to better care for themselves. The importance of this cannot be understated.

  • Erik Young, M.Ed., LPC March 10th, 2013 at 9:21 AM #9

    @simone — Very True!

  • Erik Young, M.Ed., LPC March 10th, 2013 at 9:23 AM #10

    @warner — This is definitely a concern, particularly for the high-tech devices. There are grant available, and sometimes social assistance can be used to purchase devices. However using something like the PECS system can be very inexpensive (just print out some pictures using your cellphone camera and a printer).

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