A Practical Review of Communication-Assistance Technologies

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.

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