Finding a Voice: How AAC, PECS, and Sign Language Support Nonverbal Children with Autism

Imagine being in a foreign country where you don’t speak the language. You’re hungry, but you don’t know how to ask for directions to the nearest grocery store or restaurant. Once you find a place to eat, the menu has no pictures, so ordering is a challenge. The waiter tries to help, but the food looks unfamiliar and unappetizing. You can’t read the signs for the bathroom, so you wander into the kitchen and get shooed away by an annoyed chef. Frustrating, right?

Now, imagine living in that situation for months or even years with no way to communicate your wants or needs. This is the reality for many nonverbal children with autism. Constant frustration can lead to behaviors that others may not understand, such as head banging or hitting. These behaviors are often a way for children to cope with their inability to communicate. A child banging his head may be trying to relieve a headache he can’t describe, or another child might hit others simply because he’s hungry and unsure how to get food.

Functional communication is the ability to use language or other communication methods to meet basic needs, interact with others, and engage in daily activities. For children who are nonverbal, it’s vital to provide a way for them to express themselves.

Challenges with Vocal Imitation:

For some children, imitating speech can be difficult due to issues like articulation challenges or motor coordination. Some may struggle to process auditory information, while others may not be motivated by sounds. This is where alternative methods of communication come in.

Why Sign Language Can Be a Good Option:

Sign language can be an effective communication tool for many children with autism, particularly those who are visual learners. Visual learners tend to process and remember visual information more easily than auditory cues. Sign language taps into this strength by offering clear, concrete representations of words and ideas. For children who struggle to process multiple visual choices or need things in front of their field of vision to attend to them, sign language can be especially helpful. An added benefit is that the “device” for sign language – the child’s own hands – is always available.

Why PECS Might Be a Better Fit:

The Picture Exchange Communication System (PECS) uses pictures or symbols to represent words and concepts. It can be a great option for children who have difficulty with motor skills or fine motor coordination required for sign language. One of PECS’ biggest advantages is its versatility. While not everyone knows sign language, most people can understand pictures. This can help the child communicate across different environments, fostering independence.

PECS is also adaptable to situations where a listener isn’t present. For example, a picture can be placed on a Velcro strip for the child to use on their own when no one is available to exchange it with. Busy caregivers can monitor this board to understand their child’s needs. This can be particularly useful for children who aren’t socially motivated or may hesitate to interact. Much like being in a foreign country and not remembering the word for a hamburger, seeing a picture on a menu can remind the child to request it.

Advanced AAC Devices:

There are many Augmentative and Alternative Communication (AAC) devices that can take communication a step further. These range from tablet apps like Proloquo2Go to more specialized devices like Dynavox. These systems use pictures of people, objects, and activities to help the child communicate, but they also have the added feature of speech output—so when the child selects a picture, the device speaks the word. Devices like these can hold many more pictures and categorize them for easier access compared to a basic PECS board or binder.

For children with motor challenges, there are devices like Tobii Dynavox, which uses eye-tracking technology to select items, eliminating the need for hand use. For children with good motor coordination, typing on a keyboard may be an option, allowing them to use text-to-speech programs.

Will Using These Systems Prevent Verbal Speech?

Many parents worry that using sign language, PECS, or AAC devices might reduce their child’s ability to develop verbal speech. Research shows the opposite is true. Using any communication system helps strengthen the brain’s language processes, which can make it easier for the child to develop verbal speech in the future. Therapists often pair spoken words with these alternative communication methods (e.g., saying a word while using a picture), which helps the child understand spoken language. The reduced frustration and improved social engagement from these systems may even encourage the development of verbal communication.

Finding What Works Best:

The most important thing is to find the communication system that works best for your child. Every child is different, and the right method will depend on their unique needs and abilities. The goal is to support the child in finding a way to communicate that helps them express themselves, engage with others, and participate in everyday activities.

1. Consult with Professionals:

• Work with speech-language pathologists, occupational therapists, or behavior analysts to develop and implement the best communication strategies for your child. These professionals can provide individualized guidance based on your child’s unique needs and abilities.

2. Consider an AAC Evaluation:

• If you're unsure about which communication method or device would work best for your child, consider scheduling an AAC evaluation with a qualified professional. An AAC evaluation is a thorough assessment that looks at your child's communication skills, needs, and preferences. The evaluation helps determine which type of AAC system (e.g., sign language, PECS, or an electronic device) would be most effective and tailored to your child’s abilities. This professional evaluation ensures that the chosen system will support your child in reaching their communication goals and provide long-term benefits.

5. Be Patient and Consistent:

• The development of functional communication is a gradual process. Be patient and provide consistent opportunities for the child to use their chosen communication method. Reinforce their efforts with positive feedback and encourage them to use the system throughout daily activities.

6. Monitor Progress and Adjust as Needed:

• Regularly assess how well the communication system is working for your child. If they’re showing frustration or difficulty with their current method, consider adjusting or introducing new strategies. Some children may progress from PECS to AAC devices as they develop more complex communication needs.

7. Promote Social Interaction:

• Encourage social engagement by setting up opportunities for your child to interact with peers or adults using their communication system. Social interactions are key for developing communication skills, and PECS or AAC devices can provide a structured way for your child to participate.

9. Focus on Reducing Frustration:

• Address your child’s frustration by providing clear, accessible ways to communicate their needs. When children feel heard and understood, their behaviors may become more manageable, and their desire to communicate may increase.

Keep in mind that using alternative communication methods does not hinder verbal language development. In fact, research suggests that the use of AAC systems can support and enhance verbal language skills. Focus on building both receptive and expressive language skills, and provide consistent opportunities for verbal communication, even as you use alternative methods.