Delayed Speech Development: Talking in Sentences Children with Autism

You’re listening to the Turn Autism Around podcast, episode number 26. Today I’m going to be talking about the seven big mistakes parents and professionals make when teaching kids with autism to talk in sentences, which is usually a big goal for both parents and professionals. And I can tell you right away that I have made each and every one of these seven mistakes. So I think you’re gonna get a lot out of this episode.

But before I get to that, I’d love to give a shout out to a listener who left me a five-star rating and review on my iTunes podcast page. This is from DRM517 who said, “What awesome information that I can use on a daily basis.” And this makes me really happy because for that person and hopefully for you, I am thrilled to hear that some of the strategies you’re learning on this podcast are actually helping you and you’re able to apply those strategies to everyday life. So I would love it if you haven’t done so already if you could subscribe to my podcast and leave me a rating and review, that would be awesome. And maybe I’ll be able to give you a shout out sometime in the near future. But let’s get started with today’s episode on teaching kids to talk in sentences.

Welcome to the Turn Autism Around podcast for both parents and professionals in the autism world who want to turn things around, be less stressed and lead happier lives. And now your host, autism mom, behavior analyst, and bestselling author, Dr. Mary Barbera.

Hey everyone. It’s Dr. Mary Barbera here and I thought I would pop on and present the seven big mistakes parents and professionals make teaching kids with autism to talk in sentences. So this seems to be a really big issue for kids. You know, many kids with autism, well, some kids with autism don’t talk at all, but then there is a lot of kids that do talk, but they’re not conversational. So it goes from, you know, one, two-word utterances and then maybe sentences and then maybe conversational. But there’s a lot of mishaps along the way. So today I thought I would cover this important topic.

I see this pretty much every meeting I’ve ever been at. Every IEP I’ve ever looked at, every client or even in my online courses, my private membership groups, there’s a lot of stress around, you know… first it’s the, I want my child to talk. And then once you get some words, then it’s, I want my child to talk in sentences and I want them to be conversational.

And those things don’t always go lockstep easily along the way. For those of you that don’t know me, I have been in the autism world for two over two decades now. First, as an overwhelmed and confused parent who was actually, I was in denial for over a year when my first… When my husband first mentioned the possibility that my son might have autism. He was… Lucas was just 21 months old when my husband mentioned it. My husband’s a physician, so I should have probably trusted him a little bit more to know what was going on with Lucas’s development. I didn’t know really anything about development. I didn’t know it was my job to keep an eye on it. I trusted the doctors that everything was going as planned.

And in my defense, Lucas did regress around the age of 15 months, but it wasn’t a complete regression. He didn’t stop talking completely. He didn’t get, you know, self-injurious behavior right away. I mean, there was nothing abrupt and I was pregnant with my second son, Spencer. So it was a very confusing time. But anyway, I was in denial. I told my husband I never ever want to hear the word autism again.

And then along the way, I became a board certified behavior analyst, wrote a bestselling book called The Verbal Behavior Approach. This is all outlined, my journey and my progression from overwhelmed parent to professional and bestselling author and online course creator are all outlined in my first podcast episode, which you can go to marybarbera.com/1 to hear more about my journey and lessons I’ve learned as both a parent and professional.

But one of the things is with Lucas is he always had some language. Like he actually started saying hi and started making animal sounds and stuff very early, like seven, eight months of age. So he always had some language. Even when he regressed, he still had some words. I, unfortunately, didn’t know how to get words out of him. I didn’t really know anything about autism or how to help him. But along the way, I’ve learned. So he was diagnosed with autism a day before his third birthday. And over the years I became a behavior analyst in 2003, I wrote my book in 2007, earned a Ph.D. in 2011 and for, since 2003 I’ve been working with hundreds of clients directly and training thousands of people around the world. The last four years I’ve focused more on training people, parents, and professionals, online so that I don’t have to leave my home and it’s a lot more efficient to get the word out online.

So if you are interested in learning more about how you can join me online besides, you know, consuming these free resources, which is great, you know, free video blogs, free Facebook group page, and also the podcast, the best way I know how to help you is for you to actually join my online courses, which you can find out more about. If you go to marybarbera.com/workshop, you can sign up for our free workshop based on whether you’re a parent of a young child, parent of an older child, or a professional. We have a few different options there. And you’ll find out more about my philosophy, my approach, my step by step methods because as you’ll see when I talk about the seven mistakes, you’ll see how complicated this all is. So that hopefully gave you a little bit of catch up for those of you that don’t know me well, but I hope that you will stay tuned for these, for these mistakes.

So, um, as I said, there are… There’s a lot of pressure, a lot of push, a lot of ways to measure progress is that parents go like, my child’s saying two to three words, sentences now. My child is, is an… And it’s just a kind of a gauge that many people use to say like, okay, they’re making progress or they’re not making progress. And it’s a lot more complicated than that. And so the mistake number one, well let’s just dive into these mistakes real quick.

So mistake number one is focusing on, like saying too many words. If a child is completely not talking and you don’t know where to start, one of the best places to start is not to use so many words to bombard the child. So for instance, if you’re going up the steps, you’re not going to, you shouldn’t say, Johnny, let’s go up the steps. We’re going to take a bath, blah, blah, blah, blah, blah.

Because if the child isn’t talking and they have autism, they are most likely also having comprehension issues. Typically developing kids sometimes have expressive language delays, but they understand everything. Usually, kids with autism that aren’t talking are also having poor comprehension abilities. Not always, but I’d rather err on the side of caution to think like, I can’t just talk like full sentences to the child because… and I demonstrated this in video blogs I did, both at ABA conferences. One last year I believe, and the one year before. So I demonstrated this first with a professor from Turkey who translated my book into Turkish. My book is available in 12 languages, I think.

So the man who translated my book into Turkish was at the ABA workshop, pre-conference workshop. He came up and I demonstrated him trying to teach me in the Turkish language, how to say water, water, water. So how to instead of him just saying in a foreign language, which I have no idea about Turkish, you know, blah blah blah, blah, blah. He said water, which was something like, it was something really easy. It was either hope or something that sounded like hope, that was either up or water. And so I was quickly able to say like, oh, that’s apart of… That means water. So if I’m speaking some unknown language and I say, [inaudible], you know, and that might mean here’s some cold water, would you like a sip? I just say ayoubi, ayoubi, ayoubi. And so breaking things down into one-word utterances, which I’ve demonstrated on the two video blogs in the past is really what I mean by not bombarding kids with too much language. Really make it simple, really break it down into one-word utterances. And those one words hopefully are one to two syllables. They’re short words.

Which brings us to mistake number two. So mistake number one is using too much language with kids that aren’t talking at all. Mistake number two is setting goals and keeping track of words and sentences and phrases instead of worrying about syllable length. So I learned this probably only about five or six years ago. Now, I’ve been a BCBA since 2003 so a very long time, but only about five or six years ago did I go to a workshop that really solidified this for me. It was by Dr. Barbara Ash, and she’s a speech and language pathologist and a board certified behavior analyst at a doctoral level, and she gave a workshop, which was phenomenal. And I’m hopefully going to be able to interview her for a podcast coming up. I’m going to reach out to her because she, she is phenomenal.

Anyway, at the workshop she really taught us to focus on vowel sounds first, elongate them like eee, and aah. Also, she taught us that we really need to go with one syllable, two-syllable words, even when we’re talking about sentences. The black cat ran away is five words, but it’s the black cat ran away is like six syllables, but refrigerator is five syllables. So it’s really, you know, when we think about sentences that have five-syllable words in them, it can get really complex. So after Barbara Ash’s workshop that I attended, I was much more into syllable length. Tracking that, engaging with that, setting goals for increasing syllable length, not a word and sentence length. So that is mistake number two.

Mistake number three is jumping into carrier phrases. And I did a video blog on carrier phrases awhile back. And for those of you that may not know what carrier phrases are: carrier phrases are usually… The first carrier phrase that a lot of people teach is “I want”. So a child might begin to say ball and music and water and cookie. And then all of a sudden people want to expand that length utterance, and so they start adding, I want. A few problems with this. And is the first problem is it can be… The child then becomes prompt dependent. So if a child says water… And then he spontaneously says water and then you say, say it like a big boy or something like that, or use your sentences, then you make the spontaneous language prompt dependent on trying to go for more. And that just kills the motivation to speak. And I see this all the time and I want to prevent that from happening by not, you know, by really pointing out that that is a mistake.

Okay, so carrier phrases, the other thing… I’ll tell you a little story about carrier phrases for a second. So I had a little client and I only saw her every couple of months for whatever reason, funding reasons, and she was doing pretty well. She had, you know, she didn’t have any really spontaneous language when I got there. But you know, over the couple of months that I saw her, she got someone and two-word utterances, and then there was a three-month break. And so then I went in to see her at daycare and she had a therapist shadow her at preschool. So she, the therapist, brought her to the table, and the little girl’s name was Faith. And the therapist would hold up cards and it would be like a picture of a ball or a picture of whatever. And so Faith I noticed right away was saying, that’s a ball, that’s a cat. And I’m like, who taught her that side?

And then the therapist did say that, that the mom had taken Faith to a private speech therapist to… Probably thought, well, she’s got one, two words, let’s add “that’s a”, but the problem is, is that we didn’t have verbs and adjectives. And those are the things that I would start adding to those nouns. And so then we were trying to teach her, what’s your name? And we wanted her to answer, Faith. So we held up a picture of Faith. And then the therapist goes, who’s that? And she said that’s a Faith. And that’s what the problem is with carrier phrases. So that’s a, is a carrier phrase. I want is a carrier phrase. And then a lot of people do I want, and then they want the child to put please on the end.

So now we’re talking a carrier phrase plus manners that these parts of the language of the sentence don’t mean anything to the child. So it’s a big problem. And the final issue with the whole carrier phrase thing is, which I think is mistake number four. So it kind of merges in with three and four is the articulation.

So mistake number four is not considering articulation as you expand your length of utterance. So if a child is not clear with water, so say they’re saying warrior or something like that. So then you go adding, I want warrior, you know, so then it sounds like, I want warrior, and now we have an unintelligible mand or request, and then it really becomes problematic.

So articulation also, you have to… you can’t just plow through and go like, I want four-word utterances no matter at what cost. Because if your child suddenly is not understandable to two strangers or to caregivers or teachers or do assistance, they will look and sound more impaired and they will be more impaired. So I think one of the biggest mistakes I see is not considering articulation as we expand the length of utterance. And while we’re on this mistake, I will point out that, you know, there seems to be some… I don’t even want to call it turf wars, but I’ll call it turf wars between, you know, speech pathologist like I’m not a speech pathologist; I’m a board certified behavior analyst. And so my approach to language is through a behavioral approach, but I’ve worked with hundreds of speech pathologists who have been absolutely amazing.

And you know, as I said, I got some of my best advice from Dr. Barbara Ash and other speech and language pathologists. I did a podcast interview with Rosemary Griffin, who is an SLP and BCBA. That’s episode number ten, marybarbera.com/10 if you want to listen to that. So I am all for working with speech pathologists, and especially when it comes to articulation, but it just, first before we, there’s many parts of the world where finding a speech pathologist or even a speech pathologist with any knowledge of ABA is really tough. So my philosophy is, yes, when a speech pathologist is available and they have expertise with autism and articulation, and they know a little bit about ABA and they’re willing to coordinate with your care, great. But we also need to use common sense and not just plow through, making our articulation, pretzel, blah blah, and now we add iowa, and now we add please, and then the child just disintegrates.

So I see a lot where people are saying a child is completely nonverbal. And then I go in and actually they do have some words, but no one really knows how to get those words clear. There are all these carrier phrases. We have a little boy, well I guess he’s grown up now, but his mom found my course about four years ago, my online course. And his name is Nicholas, but people call him Nick, and he was considered nonverbal and on a device. And he was being taught to say and to type or to pick out on the augmented device, my name is Nicholas. So my name is Nick-uh-less, which is six syllables just for Nicholas. My name is Nicholas, right. So where when I, you know, recommended in my courses is what your name? Nick. It’s one syllable.

So we really have to stop thinking about, we have to start thinking about what’s the best articulation wise, what’s doable and the carrier phrases in their articulation and the syllable length and the focus, too much on too much language all goes hand in hand. So it seems like all these mistakes are kind of merging together, and they definitely are.

Okay. So mistake number five… and at the end, I’ll review all these mistakes, but mistake number five is thinking that once a child is talking in short phrases or sentences, and many of them may be rote, like teaching a child to say, I am five years old. When really the answer really for typical kids is five. How old are you? Five, not I am five years old, right? But just say the child has these rote responses of the sentences. The mistake is thinking that those short phrases that are probably rote are going to translate into normal comprehension and normal conversational skills. And there’s a lot more mountain to climb after you do get even spontaneous little short phrases and sentences. There’s a whole other huge mountain to climb.

I use the analogy, if you’re in a Spanish class and you’re speaking English and you… English is your only language and you’re taking Spanish a Spanish class, but you haven’t had Spanish one, two or three, and all of a sudden you’re in Spanish four. You haven’t mastered Spanish level one, two, and three, so a lot of things are going to go right over your head. You’re not going to understand, you know, maybe you’ll be able to pick out a word here or there, but you’re gonna miss a lot of the context. You’re gonna, you’re not gonna have the comprehension. And the idea that mistake is basically thinking that, you know, just like getting sentences isn’t really going to lead to the skills that you want and the conversational skills.

So the kids that I’ve worked with who have started out non-vocal and progressed to conversational, it’s been years and years of hard work and systematically building the language. So within my online courses, I use the VB-MAPP by Dr. Mark Sundberg as the base assessment for my courses. Except for the toddler course, I don’t even get into the VB-MAPP assessment. I just use my little one-page assessment just to get things going.

But even after the VB-MAPP, it only brings you to a four-year-old level of language. And there’s a lot more to language than a four-year-old level. And a lot of people that get to the top of the VB-MAPP, they’re like, they think that the child then should just start learning naturally. But it may have taken… The child may be eight or 10 years of age or maybe even five or six, but they still might be a year or two below language abilities. And I have found that the kids that get to that point really need language for learning, then language for thinking, the language for writing, which is whole other mountain to climb and they need the intraverbal sub-test. And, and my intermediate learner course really covers that. So that’s part of the verbal behavior bundle.

But so mistake number five again is just thinking that once you get some sentences, that you’re home free and that things are going to be easy. Actually, things get more complicated the higher the language, because not a whole lot of people are talking or speaking or researching what to do. Okay.

So mistake number six is focusing too much on language and not enough on self-care, behavior reduction, leisure skills, pre-vocational skills. Length of utterance is not really a great way to measure success because while we’re teaching a child language, we also have to worry about other things like problem behaviors. And self-care. And I just think it’s not a great gauge of how well a child is doing. And it sometimes gets really frustrating for parents and professionals to constantly be like, well, they’re still at a one-word length utterances. They’re still at a two-word length of utterance. They’ve got these wrote phrases, but you know, years are going by and they’re not conversational.

And unfortunately being conversational, being fluent with the conversation, and going driving and going to college those things are happening for some of my former clients. They absolutely are. For my son, you know, he’s in his early twenties, he’s not conversational. He has a lot of skills. He can understand the basics. He can use language to get his needs and wants to be met. Our major concerns are just keeping his problem behaviors, major problem behaviors at or near zero, leisure skills, vocational skills, safety skills, just a whole bunch of other things. And if we measured Lucas’s progress by the length of utterance and how many sentences he had and how conversational he was, it would be a pretty defeating situation.

So I’ve learned a lot over the years, and some of that learning and some of these mistakes, all of these mistakes I made with Lucas, like absolutely. But I’ve also avoided the mistakes for, you know, hundreds of clients. And now that I train people within my online courses, I teach them to avoid the pitfalls as well. Okay.

And then the final mistake is mistake number seven is looking at the trees and not the forest. As you can see, these things all go together. My big three, I came up with this, I think after I wrote my book. My book was written in 2007, so it’s been over a decade old. But I came up with my big three things that I believe kids with autism need most, and adults with autism. And that is, the ability to request your wants and needs, eventually to a stranger but especially to your caregivers, to your teachers, your assistance. And that can be vocally, by sign, by picture exchange, by augmentative communication. But these things are not mutually exclusive. Like if a child is considered non-verbal or non-vocal and using a device, I still don’t agree with bombarding language and making them constantly produce long sentences unless the child really likes that and as good at it, I don’t really want to make it harder and harder and have the child prompt dependent.

So my big three are the ability to request your wants and needs to a caregiver and then hopefully eventually to a stranger. Number two is major problem behaviors at or near zero. And this is extremely important as kids get older. So I think as people focus on like how many, you know, adjectives do they have, or how many, you know, feature function class exemplars do they do? And meanwhile, the kid is having major problem behaviors that are a risk safety-wise to themselves, to others.

So the big three are, the second one is major problem behaviors at or near zero. And so very little or no aggression, self-injurious behavior, property destruction, those major problem behaviors. And then the third big thing that I think kids need is independence with self-care, especially with toileting. They’re going to be safest if they can use the toilet independently or nearly independently. So that’s why I think there is really way too much focus on teaching kids to talk in sentences. I think it leads to prompt dependency and kids that, you know, are having problem behaviors.

You know, I had this little kid once came over to my house for an evaluation and he was throwing a tantrum. He was asking for chips and I had a baggie of chips, but I was giving him like one chip at a time and he was like screaming, I want chip, I want chip. And I was like, I’m giving you a chip, I’m giving you a chip. And his mom said he wants the whole bag. And so how do you teach the children to ask for the whole bag? That’s where things get tricky, right? And you know, some kids can learn to ask for the whole bag. Some kids, whatever neurologic deficits or such that teaching them to ask for the whole bag isn’t going to work, isn’t going to work at least, right this second; maybe is never going to work. But we can’t just say like, oh, I saw in one of Mary’s videos that this child learned all this. And so I’m going to try to teach Tommy all this. It’s like you have to do it very systematically. It’s like building a pyramid. You want the bass to be completely solid so that you’re not on shaky ground as you keep going up.

And that I think is a big, is a big consideration. So let me review the seven mistakes one more time. So mistake number one is using too many words when talking to kids who are nonvocal and not pairing one word at a time. So what you can do is you can really go forward and be like, you know, water, water, water as you’re handing child water, not expecting them to say water if they don’t talk at all yet. So that’s mistake number one.

Mistake number two is setting goals and keeping track of words and sentences instead of syllables.

Mistake number three is jumping into carrier phrases like, I want, adding manners like please, or adding carrier phrases. Like that’s a really bad idea.

Mistake number four is not considering articulation as you expand. And whenever possible, we want to encourage a speech and language pathologist to help us with articulation errors.

Mistake number five is thinking that once a child is talking in short phrases or sentences, normal comprehension and conversation will come naturally.

And mistake number six is focusing too much on language and not enough on self-care, behavior reduction, leisure skills, and pre-vocational skills. And also requesting with one-word utterances or with a picture exchange or with an augmentative device, because requesting your wants and needs is really the hallmark of what we should be doing.

And then mistake number seven is not looking at the forest but looking at the trees and being to tit for tat in terms of programming.

So I hoped you enjoyed those. I would like to encourage you all to check out my online courses, because while I provide free weekly video blogs and a free podcast and there’s so much free information on the internet, really the only way to for me to really go over all of these systems and more of a step by step approach and to help you whether you’re a parent or professional, um, is for you to join one of my online courses and join my community. So you can find out more at marybarbera.com/workshop and I will hope to see you next time.

Thanks for listening to the Turn Autism Around podcast with Dr. Mary Barbera. For more information, visit marybarbera.com.