At EAP, we are often asked if we have a speech therapist on board or a speech therapist to recommend. Our general response is that a good quality ABA (Applied Behavioural Analysis) programme should be able to address and teach individuals with autism to communicate effectively and hopefully speak fluently as well. The ability to pick up fluent speech is dependent on a few factors, such as the severity of autism of the child, the age of the child when starting treatment, the intensity of the hours of the ABA programme as well as the quality of the ABA programme.
The basic principles of ABA have been outlined here. In summary, whatever behaviour we reward (be it through giving
attention, social reinforcement or external motivation) will increase. Also, good quality ABA programmes are able to break skills down effectively, pair the
skill with reinforcement and provide sufficient practice in order to help that
skill become established.
In order to successfully work on speech development using the principles of ABA just mentioned, let’s expand upon each of those principles. We also should try to see it from the perspective of a child with autism - for them, learning speech would be the same as us trying to learn a foreign language.
- Breaking skills down
ABA principle here is to break complex skills down to their component parts.
Practically, here are some examples of how we at EAP would break down the
complex skill of speech:
a. Choose one language
We advise parents to choose only one language to introduce to their child, as a bilingual or multilingual approach can be further confusing to a child with autism who is already having difficulty understanding language and producing words.
b. Make comments instead of asking questions
Many of us tend to ask young children questions when they do not know how to answer them. For example, “Hellooo, what’s your name?", "Are you cute?", "How old are you?", "What are you doing?", "Where are you going?", "Are you in school?”, and sometimes, we do not even wait for an answer before barraging them with questions.
If a child is unable to answer these questions, we are setting the child up to be unsuccessful. It would be much more beneficial if we could make statements and model language instead. For example, ‘Hi!”, “You look cute”, “You are a big girl now”, “Oh, you are eating!”, “We are going to bathe”, “We are going to school”.
c. Model language by using only 2-3 word phrases
Children learn through imitation and it is very important that we understand that a child with autism may have difficulty focusing (attention), imitating and cooperating. Additionally, if the to sentences are too long and complicated, they may not catch the words and instead shut down.
d. Expect only one-word communication initially
At EAP, we use techniques like the Requesting Strategy and Phrase Completion. In both strategies, we utilise items and activities that are very motivating for the child in order for the child to be willing to communicate and hopefully speak.
For Requesting, we would set up opportunities for the child to request verbally for an item they really want, for example the iPad. Instead of insisting that the child says “I want iPad” or "Can I have iPad?”, we try to get the child to say only the word “iPad”. Also, we only give the child 2 opportunities to be unsuccessful before modelling the word ‘"iPad" and giving it to the child immediately.
For Phrase Completion, we would set up opportunities for the child to complete a phrase such as “Ready, Set, ____” or “One, two, ____”. When paired with a fun activity that the child likes, the child may likely finish the sentence. As the child becomes more confident with words, the child could complete the last two words and then eventually the whole sentence. This works really well for songs, too!
e. Teach other prerequisite skills
It is important that a child with autism learn all other foundational and prerequisite skills simultaneously. For example, the ability to attend and focus, the ability to imitate as well as the ability to cooperate. It is also essential that the child is exposed to a variety of fun play and interactive activities so the child is more motivated to communicate as well!
- Pair with positive reinforcement
The ABA principle of reinforcement is essential in strengthening a desired behaviour, like communication or speech. We want to positively reinforce any form of communication including non-verbal communication, picture-based communication and most of all, verbal communication. In the initial stages, we want to positively reinforce any form of vocalisation on the child’s part as well!
At EAP, we give lots of positive attention, social praise, interactive reinforcement and especially what the child is communicating for appropriately. Most importantly, we model the word of the item the child is communicating for, in a clear and loud voice, so the child is reinforced with that word.
- Provide Sufficient Repetition
It is vital that the ABA principle of repetition is practiced in order to sufficiently expose a child to language as well as to provide sufficient opportunities to communicate and to speak.
At EAP, our children in the full-time programmes receive about 6-7 hours of one-to-one therapy daily. Our EAP team is trained to provide a minimum of about 20 opportunities per hour for a child to communicate. This adds up to a total of about 120-140 opportunities a day to vocalize, verbalise or just communicate.
Even with all the above mentioned strategies, there are times where our children may require an additional breaking down strategy of exposing them to only 3-5 words per day in order to provide even more sufficient practice.
We then measure progress by evaluating whether there is an increase in the:
- Frequency of speech a day by the child
For example, a child may speak a few words a month before starting ABA therapy with us, then progressing to saying a few words a day, then a few words an hour, and we stop counting when we need to use a clicker!
- Variety of words used
We also want to increase the variation of words that a child uses and will start to expose the child to more words, bearing in mind that if the child is enrolled in our EAP ABA programme, the child will be taught many receptive and expressive skills simultaneously, and this adds to the database of vocabulary for each child.
- Length of sentences used
When we start working with a child, we recommend to use shorter 1-3 word phrases. But as the child progresses with speech, we start to use longer sentences and start to expect the child to speak in phrases as well.
Lastly, do remember that whatever behaviour you give attention to will be strengthened and become established. Do try some of these strategies and do try not to unintentionally reinforce inappropriate ways of communication, such as tantrums or aggressive behaviours.