As you may know, I’m an autism mom and Board Certified Behavior Analyst. I am also the author of The Verbal Behavior Approach: How to Teach Children with Autism and Related Disorders which was published over a decade ago and is now available in 9 languages. As a Behavior Analyst, I know that any behavior (including vocal language and speech sounds) can be increased using proven ABA strategies. In this week’s video blog, I’m going to discuss techniques I use when working with a child who is non-vocal or minimally vocal.
As you may know if you’ve watched my other video blogs or have read my book, the first step to changing any behavior is to complete an assessment. Before working on getting a child to talk, we must first assess not just his language but we need to assess the whole child and the supports and services that are currently in place. We can’t just zone right in on the child’s language and only focus on assessing what sounds a child is currently saying.
We need to take a step back, take a look at their whole situation including things like feeding. I have found that most children with autism who are not speaking by the age of 2 or 3 usually also have feeding issues. They might still be using a bottle or a pacifier or they might refuse mushy foods on utensils or be extremely picky. We need to do a full assessment on these feeding issues and, so for example, if the child is still taking a bottle or drinking out of a spill proof sippy cup, it may be reasonable to put in a plan to teach open cup and straw drinking as this may help with vocal speech.
We also have the problem where there’s a limited availability of Speech and Language Pathologists or SLPs especially SLPs with ABA knowledge or expertise. In my almost 2 decades in the autism world, I believe children with autism, especially those without any vocal speech really need a team of professionals, including an SLP who all familiar with ABA to have the child make the most progress possible.
I’m fortunate to have worked with several speech pathologists along the way and they have taught me a ton about how to get initial speech sounds and first words. I’ve also developed some interventions to help parents improve articulation and get their children with “pop out” words talking a lot more. When I say kids with pop out words, I’m referring to those kids who only say a word here or there on their own terms.
The first place to start is to assess the whole situation and then specifically the speech sounds or words the child can say. If your child or client is non-vocal or minimally vocal, it’s probably because you do not have echoic control. This is when I say “say ball” and if I had echoic control, the child would say “ball” with no ball present. We are going to assume that your child or client cannot echo sounds or words on command at this point.
The next step is to assess whether the child is making any sounds, word approximations or saying any words spontaneously. A lot of infants babble. They start babbling “ba ba ba ba” and “da da da da.” They might be babbling all these different sounds, when the baby’s dad hears da da da da, the dad is going to get excited and start reinforcing that da da da da. “You said da da da da,” providing reinforcement. When the baby babbles “Ba ba” for bottle, the child then may get the bottle. The same thing happens with “Ma ma ma ma”. This is the way language gets shaped up.
With our non-vocal children with autism, we have to ask the question, “Are they babbling at all?” Next assess if they have any word approximations, or “pop out” words. They may not say much, but they have been heard to say different words throughout the day or maybe a couple of times a week you might hear a pop out word. You need to be a little bit of a detective here. If the mom says, “My child does say some things here and there.” Okay, what are those things? Is it mama? Does he say hi? bye bye? Is it da da? Is it movie?
Another strategy I came up with many years ago is to formulate a list of words that you have heard your child or client say.
You might need to sit and watch a child and record spontaneous babbling and word approximations. Take 15 minutes of data when they are engaged in playing Legos or something alone. Then take 15 minutes of data when you are swinging them or bouncing on a ball then another 15 minutes of where you are giving them little bits of reinforcement while saying words.
Once we have our baseline assessment done, we want to use stimulus-stimulus pairing throughout our days to try to get the babbling up and to try to get word approximations and sounds up.
Now the term stimulus-stimulus pairing sounds really complicated but it’s not. It is basically saying a word 3x before delivering reinforcement. You want to sit with the child. I usually like to sit catty-corner. We want to hold the reinforcers to our mouth. Make the sound or word loudly and elongate if possible, so if we are having the child build a simple inset puzzle and we are holding a puzzle piece of a pig up, we say “pig, pig, pig” as we hand the child the puzzle piece.
Each pairing, we want to get the reinforcer a little closer and we don’t want to hold out. We want to deliver the reinforcer after a successful sound or after the third try, which ever comes first.
You also want to be pairing words away from the table. So, if you’re going up the stairs instead of saying, “Johnny, let’s go up the stairs. Johnny is a good boy,” all this language, you just want to say, “Up, up, up,” and then take a couple of steps up, then “up, up, up.” You see, my voice is a little bit more exaggerated, a little bit more playful, emphasizing just one word
In conclusion, we want to always assess the situation, assess the whole picture, and specifically focus on feeding and spontaneous babbling, speech sounds and words. We then want to pair sounds and words with reinforcement throughout the day, both at table teaching sessions and within the natural environment.
I hope you found this video blog on developing first sounds and words helpful. If you’d like this information in one handy place, download your cheatsheet here. Please join me next week where I’ll discuss teaching kids who have some ability to speak to talk in longer utterances. See you next time!