Children with autism have language delays that make communicating difficult for them.
Autism is a complex developmental disability that affects one in 110 children. Individuals with autism struggle with both language and social interactions, which makes communicating extremely difficult. Many different speech devices and systems exist to enable people with autism to communicate. Since cognitive and physical abilities may vary greatly, criteria for selecting an appropriate device depend on each person's situation.
Considerations
Autism is a "spectrum" disorder, meaning that there is a range of symptoms and severity that affects individuals differently. Higher-functioning individuals with autism or those with Asperger's Syndrome (a condition similar to autism that was recently included as an "autism spectrum disorder" by the American Psychological Association) have better verbal and conversational skills than lower-functioning individuals. However, they still have issues and struggle with nuances of spoken language, particularly with figures of speech and sarcasm. They tend to literally interpret what they are told and not read into body language and tone of voice.
Many individuals with autism are nonverbal, though researchers have been unable to pinpoint a precise number. Nonverbal individuals do not possess functional speech skills. They can make sounds and possibly say some words, but they are unable to adequately express their needs or have a conversation.
Some individuals also have physical disabilities, which further limits what types of assistive technologies they can use. Individuals sometimes lack age-appropriate fine-motor skills as well, which presents another challenge for implementing some communication systems.
All of these factors vary from person to person. However, a wide variety of assistive communication devices is available; no matter what the level of disability there should be a viable option to meet the person's communication needs.
PECS
In 1985, Andrew Bondy, Ph.D., and Lori Frost, M.S., SLP/CCC, created a system called PECS, or Picture Exchange Communication System. They used the system at the Delaware Autistic Program with success. They later formed a company, Pyramid Educational Consultants, which produces PECS materials and offers training workshops for parents and professionals.
PECS uses small picture cards to teach individuals to request desired objects. The cards have Velcro on the back and are accessed by a book that the person can carry with him. Initial training involves teaching the person to realize that when she uses the picture card to request something she will immediately get the item pictured on the card. The object will vary, depending on what that particular person finds motivating. Often early objects are edible treats.
Once the person masters that concept, a nondesirable-object picture card is placed next to the desirable-object card. For example, one card may show a sock and one may show candy. If the individual gives the sock card, he gets the sock. This teaches that you get what is on the card, not necessarily what you want. To get the desired item, the person must choose the correct card.
The system builds up from this simplistic model and eventually includes cards with verbs and adjectives in addition to nouns. Sentences are constructed on "sentence strips," which are a plastic strip with Velcro on which cards can be arranged. This allows more in-depth communication as the person gains skill using the system, rather than just exchanging individual cards.
Low-Tech Devices
A wide variety of inexpensive, electronic devices exists for students with autism. Many of the devices allow users to record personalized messages. The person with autism presses a button to play the message. Messages usually convey basic needs or wants. Useful messages include food- and hygiene-related requests.
Items not specifically marketed to individuals with autism often make useful assistive communication devices. Talking picture frames, keychain recorders and digital audio recorders make inexpensive speech-output devices.
Devices specifically for nonverbal students include: Cheap Talk, Voice in a Box, Big Mack, Talk Pad and Step-by-Step Communicator. These devices all offer recordings associated with PECS-style icons. For example, a recorded message may be "I have to use the bathroom" and the button for the message shows a toilet. These devices cost from $50 to $300 as of May 2010.
Language Master, another speech-output device, comes with cards that the student swipes through a slot. The device "reads" the card aloud. Users record the messages on the cards. More expensive, elaborate devices are available for students as well.
High-Tech Devices
More expensive, elaborate devices are available for students as well. Popular high-tech augmentative communication devices include: Vantage, Vanguard, Springboard, ECO2, EcoPoint, V, VMax, Eye Max, Tango, Express, M3 and DynaWrite. These devices offer touch screens with versatile programmability. Programmable keys allow users to customize pictures with specific words or phrases: When the student touches a key the device will speak the programmed message. Voice quality has improved drastically, so devices no longer sound as robotic or stilted.
Prices range from $2,495 to $15,045 (without extra equipment or software features), as of May 2010. The prices for these devices prohibit most families or facilities from purchasing them without insurance, grants or multiple funding sources. Many families acquire one of these devices through Medicaid. Aside from price, the biggest drawback for these devices is their fragility. Though they all feature durable construction, falls, drops or exposure to fluids may necessitate expensive repairs.
Combining Devices
Communication skills affect all other areas of a student's learning. Multiple communication devices used together offer the student the greatest access to language. Systems like PECS offer portable, durable communication for many situations where a more complex device wouldn't work well, such as at a swimming pool or in bright outdoor light (which makes the backlit screen harder to see). Both the low- and high-tech devices offer speech output, which allows conversation where PECS may not, such as in a car. By using a variety of speech devices and systems, a student's access to speech and conversation can be maximized.
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