Social Communication and SLD

Introduction

One of the core features of autism is ‘persistent difficulties with social communication and social interaction‘ (APA, 2013). Therefore, all autistic children and young people are likely to have difficulties around social communication and interaction but these communication differences will often be even more evident in those with associated learning difficulties. Difficulties may include:

  • Joint attention
  • Understanding verbal and non-verbal communication
  • Using eye contact
  • May have limited verbal communication
  • Difficulty communicating wants and needs functionally
  • Understanding the behaviour and actions of others
  • Repetitive language (echolalia)

This section will outline strategies to support the child or young person’s social communication skills. As in all areas of the child or young person’s functioning using strengths and interests will increase their engagement and learning. A video clip from Ros Blackburn, an autistic adult describing how her parents used her interests to support her communication and learning can be viewed below.

Link here for encouraging interests and learning.

A Speech and Language Assessment will highlight the child or young person’s receptive language skills (understanding of language), expressive language (how effectively the child or young person uses speech or an alternative means of communication) and social engagement. The assessment report will contain important information for supporting the child or young person’s communication. There are some informal assessments which can be carried out by parents or educators: For example:

  • Silver, K., 2005. Assessing and developing communication and thinking skills in people with autism and communication difficulties: a toolkit for parents and professionals. Jessica Kingsley Publishers
  • Schopler, E., Lansing, M.D., Reichler, R.J. and Marcus, L.M., 2005. PEP-3: Psychoeducational profile. Pro-ed

It can also be helpful to consider the stage of the child or young person’s communication which can be described as:

  • Pre-intentional communication
    The child or young person responds in an involuntary or reflexive way, usually to signals related to physical comfort such as pain or hunger
  • Voluntary communication
    Children and young people react to situations by engaging in behaviours. The behaviours could be interpreted as protesting, wanting more or seeking attention
  • Unconventional communication
    Children or young people communicate with intention, but may do so in an unconventional way, such as using their body position which must be interpreted by adults
  • Conventional communication
    Children or young people use a range of behaviours or vocalisations to communicate intentionally with those around them

Link here for more information on the stages of communication

Children and young people with autism have differences in how they develop attention. Autistic children tend to focus primarily on objects or visual stimulation that interests them, and so can appear unaware of other people in their environment. This can make communication and interaction more difficult. When supporting attention, it is important to consider what the child or young person’s stage of attention is. 

Typically, attention develops through stages at the child ages. Below is an outline of a typical attention development for children aged 1 – 6 years. 

The Development of Attention Levels

Often autistic children and young people function at Stage 1 – 3 stage of attention which means they can attend to one source of information at a time. This will mean they are unable to do two tasks at once, such as watch TV and respond to their name. Attending to one thing at a time is called monotropic processing. For autistic children or young people often the focus of their attention is primarily on objects or visual stimulation that interests them, and so they can appear unaware of other people in their environment. Monotropic attention can result in difficulty listening to the teacher while engaged in an activity, or completing a task when distracted by something happening outside the window. When a teacher or a parent wants to get the child or young person’s attention, they need to be the most interesting thing in the room. Incorporating the child or young person’s interests when interacting can help to achieve this. Preference assessments can be used to collect information on the child or young person’s interests which can then be used when supporting communication and interaction.  

Link here for an example reinforcement assessment

Link for reinforcement inventory

An attention checklist and strategies for developing attention based on the child or young person’s level of attention can be found in Elklan’s book ‘Language Builders for Pupils with SLD,’

Joint Attention

In addition to monotropic processing, autistic children have differences in joint attention. Joint or shared attention is when a child uses eye contact and gestures such as pointing, to share experiences with others. It is an important skill which helps children learn social interaction and language skills. For example, developing skills such as turn taking, or reading facial expressions require joint attention. If a child or young person is unable to focus on what the adult is communicating about it will also impact on the development of language. For example, a parent may point to a dog, and say ‘dog.’ However, if the child is not aware that the adult is pointing or does not understand what they are pointing to they will not associate ‘dog’ with the animal in their environment.

Attention Autism

The Attention Autism programme, developed by Gina Davies, aims to encourage joint attention in a fun, captivating group setting. An overview of the Attention Autism programme can be found in the Centre’s Best Practice Resource using the link below. 

Link for the Attention Autism programme

 

Intensive Interation

Intensive interaction is an approach for enhancing the communication abilities of children and adults who have severe sensory problems, severe learning difficulties and/or autism (Jefferies 2009).

Intensive Interaction uses body language to communicate with adults and children in a way that establishes attention and emotional engagement. During this approach the adult or child is referred to as partner/communication partner. Intensive Interaction is a shared process; something we do together (Caldwell, 2008). 

Body language consists of nonverbal signals used to communicate. This includes body movements, facial expressions, pitch, tone, rhythm, speed and posture. Body language helps a person tune into how the other person is feeling. When communicators are sensitive to how the communication partner is feeling it allows the development of trust and emotional engagement. Intensive Interaction focuses our attention ‘not only on what our partner is doing but how they are doing it’ (Caldwell, 2008). 

There are two processes that underpin Intensive Interaction:

  1. Infant- mother paradigm: infant initiates (sound or movement), mother confirms and baby moves onto something new (e.g. baby says ‘ahh’, the mother answers with ‘ahh’, the baby moves onto something else). The mother’s repetition of the baby’s sound or movement seems to act as a release mechanism. 
  2. Mirror neuron system: the operation of a network of nerve cells in the brain. The mirror neuron system allows us to recognise what another person is doing and therefore be able to imitate their action.

(Caldwell, 2008)

Communication through body language allows us to pick up and share how our communication partner is feeling. A continuing open-ended conversation and pathway is then created and shared through interactions involving actions and feelings (Caldwell, 2008). 

Where to start

Observe your communication partner- what are they doing? Follow your partner’s lead, they lead the activity. 

Then to build on the interaction follow these principles – the three R’s:

Respond to your partner’s behaviour, through imitation, joining in, pleasurable face/body language/voice or running commentary. These responses will arouse your partner’s interest. Stay ‘in tune’ with your partner. Allow pauses to watch and wait for your partner to do something next in the activity. 

Repetition of activities provides rehearsal that will gradually expand the duration and complexity of the activity. Repetition provides security, familiarity, predictability and a sense of structure and control. 

Repertoires of known and familiar activities are created through the interactions. This provides a sense of confidence to the leaner to try new activities. It also creates opportunities for the practitioner to make initiations during the flow of the activity. 

During activities observe how your partner responds to your responses and then change your behaviour as a result. 

(Hewett 2010)

During Intensive Interaction the practitioner is teaching and observing their partner learning the ‘fundamentals of communication’. These ‘fundamentals’ include: 

  • Enjoying being with another person
  • Enhancing concentration and attention span
  • Developing the abilities to attend to the other person
  • Taking turns in exchanges of social behaviour
  • Sharing personal space
  • Using and understanding eye contact and facial expressions
  • Using and understanding non-verbal communication
  • Using vocalisations with meaning
  • Learning to regulate and control arousal levels 

(Nind & Hewett 1994, cited in Jefferies 2008). 

Click the following links for further information and reading on Intensive Interaction.

Link here for Intensive Interaction video featuring Phoebe Caldwell

Link here for the Intensive Interaction Institute

Receptive language skills refer to the understanding of verbal and non-verbal language. Having a receptive language difficulty presents challenges in following verbal instructions and understanding the actions of others. This may leave the child or young person feeling confused, anxious or unaware that an instruction has been given. Intolerance of uncertainty is strongly linked to high levels of anxiety in young people with autism (Boulter et al 2014). Consequently, autistic children or young people may opt out of tasks and / or experience high degrees of stress.

If a child or young person has a wide vocabulary, it can be assumed that their understanding of language is good. However, this is often not the case and children, and young people may mask their difficulties with receptive language by following learned routines, being on their own agenda, or copying the behaviour of others if they are able to do this. It is important that communication is pitched to the child or young person’s level of understanding. Reviewing Speech and Language Therapy assessment and recommendations where available will support this. 

Strategies to Support Receptive Language Skills

Autistic children and young people will benefit from reducing verbal language and using visual supports to base communication. Visual supports are non-transient and stay in place for as long as the child or young person needs to process and understand the information. 

Link here for more information on using visual supports

Using visual supports to aid receptive language skills

  • Support the child or young person’s understanding of what is happening throughout their day through visual schedules. A starting point can be an object of reference, for example, showing car keys to indicate a journey or showing the dog’s lead to communicate that it is time to take the dog for a walk. When a child or young person understands this a first/then schedule can then be introduced. However, it is important not to rush adding in more items as it may confuse or overwhelm the child or young person. 

First/ Then Schedule Example

Link here for video about introducing a first/ then schedule
Link here here for more information on visual schedules

• Presenting choices visually can help the child or young person understand what is available, for example holding up the items, or using a photograph or symbol. Limit verbal interaction while doing this, for example saying only ‘juice or milk?’ while showing the objects or using a photograph or symbol.  This can be presented on a choice board, tray of snacks or box of toys. When introducing choice, it is important to limit the number of choices to begin with as the child may become overwhelmed. Starting with two options, a preferred and non-preferred item can help to teach the concept of the system. 

Choice Board 

Link here for a video about introducing a choice board
Link here for an example choice board

Supporting Verbal Information

As outlined, supplementing verbal communication with visual supports will assist with understanding. When using verbal communication, the following tips will support the child and young person’s attention and understanding:

  • Speak slowly and clearly, with short direct phrases also allowing more time to process. It is estimated that allowing 10 extra seconds will help processing.
  • Reduce the number of questions used, and instead use more comments and observations. An example is: ‘Great cat drawing!
  • Consider the environment in which communication takes place. Children and young people who have monotropic attention will find it difficult to understand language in noisy, highly stimulating environments. Turning off background sounds such as the television, or ensuring silence in the classroom, is important when communicating with the child or young person.  This helps them to know where to focus their attention.
  • Get on the child or young person’s level and be in their line of vision. 
  • Get in proximity close to the child or young person – but know your audience.
  • Use the child or young person’s name at the start of the sentence
    • E.g. “Jack, it’s time for break”
    • Instead of “It’s time for break, Jack” 
  • Wait for the child or young person to orientate to you before communicating.
  • Become animated.
  • Remember the child or young person’s sensory processing needs, for example difficulties in filtering background noises and other sensory input.
  • Make sure they are paying attention before you ask a question or give an instruction either verbally or through a visual support. The signs that someone is paying attention will be different for different people.

Background

For communication to take place an individual needs to have a message they wish to communicate and a knowledge of who they are giving that message to. This process is called communication intent and can be an area of difficulty for autistic people. The child or young person may not innately understand that communication is a two-way process with another person. This may result in the child or young person having limited communication initiation, or they may make verbalisations or gestures which are not directly to another person. Moreover, if the child or young person is feeling frustrated because they cannot get their needs met, they may engage in behaviours of concern rather than asking for help or making a request. 

As stated, communication is a two-way process, requiring at least two communication partners – someone to share the message and someone to receive and respond to it.  The term ‘expressive communication’ refers to how, why, when, where and with whom the person shares their ideas, needs and wants with others in their environment.  

When focusing on expressive communication is it important to think about the following three factors: means, opportunities and reasons. It is useful to consider the following graphic, with the aim of supporting young people with SLD and autism by ensuring an interplay between all three of these equally important areas:

Means, Reasons and Opportunities Diagram

Means refers to the expressive communication method the person uses. This might be: 

  • spoken/verbal language
  • vocalisations
  • gesture
  • eye pointing
  • small changes in facial expression or eye gaze
  • an augmentative communication system such as symbol or picture exchange, writing, communication book or high-tech communication aid or app (e.g. Pro Lo Quo or PECS app).

Reasons to communicate is also referred to as functional communication and includes: 

  • establishing joint attention
  • greeting others
  • addressing wants and/or needs (requesting something or asking for help)
  • requesting information
  • giving information
  • asking questions
  • protesting
  • expressing feelings 
  • making choices

Opportunities to communicate require: 

  • at least one communication partner, but might be more when in a group activity
  • a time and place for the communication exchange
  • a shared language/communication system
  • shared interests
  • joint attention
  • sensory regulation (calm and alert state)

Strategies 

  • Information about the child or young person’s communication preferences can be shared using a communication passport. To view an example communication passport please click here: My Communication Passport.
  • It is essential to establish a functional communication system, appropriate to the young person’s level of understanding.  Some children may use verbal language and others may require an alternative means of communication.  It is important that a speech and language therapist assesses and implements an appropriate communication system to ensure that it can be used effectively by the young person, and is also understood by the supporting adults.
  • Once this system has been established, the young person may need support to direct their communication effort towards a supporting adult and generalise this skill across places, people and times of the day i.e. do they pass a sentence strip on their PECS book to someone in order to get their needs met? Are they able to get the attention of someone who is in a different part of the room or whose attention is with another young person? Can they use this exchange system during different activities and not just, for example, snack time? Link here here for distance and persistence.
  • It is important to think about how often young people with autism and SLD are provided with reasons and opportunities for communication in their day, across home and school.  For example, in a well-structured lesson the supporting adults may anticipate everything the child wants or needs, or the pupils may have all they need.  Why would a child communicate if everything they need for an activity is already set up for them?  Could opportunities be provided to ask for anything as part of the activity or to make a choice within the activity?
  • Situations can be carefully engineered to provide increased reasons and opportunities for expressive communication.  For example:
    • Pausing during a preferred activity, such as being pushed on a swing, to allow the child or young person to request ‘more’ or ‘again’.
    • Activate a wind-up toy, let it deactivate, and hand it back to the child, waiting for them to request that it is wound up again.
    • Open some bubbles, blow some, close the container and give the container to the child, offering them the opportunity to ask for the bottle to be opened.
    • Blow up a balloon and slowly deflate it; then hand it to the child or hold it up to your mouth and wait for them to request ‘Blow’.
    • Example teaching strategies for asking for help:
    • Put a desired food item or toy in a see-through container that the child can’t open without help, while the child is watching. Then put the container in front of the child and wait.
    • During snack time, provide all but one item that the child needs.  For example, providing a yogurt but no spoon provides the opportunity for the child to gain your attention and request it.
    • Build in motivation by using a game or activity of interest. For example, if the young person likes jigsaw puzzles pick a simple puzzle you know the child can do independently.  Provide all but one of the pieces, creating a reason to ask or signal for help.
    • If the child does not request ‘help’, ‘more’ etc. after a delay then the supporting adult should go ahead and do the activity again or provide help. The supporting adult should also be observant of any indicators of frustration, and immediately offer help, even if it has not been requested by the child or young person.
    • Remember that these requests may not be verbal. The child’s preference may be for non-verbal means of communication, such as using a card to request ‘more’ or ‘open’.  All communication is valid.
  • Get to know the child or young person’s communication style.  They may need extra time to respond during interactions before completing a communicative act. Remember to look for any communication act, such as eye pointing, gesture or vocalisation.  If the child or young person uses an alternative means of communication, it is important to be aware of other ways they might try to communicate.  Focusing on the communication aid may mean that you miss another communicative act. If you are not sure what the message was, check with the child or young person by repeating it back to them.  It is important not to pretend to have understood their message.
  • It will be easier for the young person to communicate about something they are looking at. Ensure that materials or topic resources are in their line of vision to provide context for their expressive communication attempts.
  • Model language during activities by saying key words during everyday activities.  For example, say ‘open’ while taking the lid off a yogurt pot at lunch time, or ‘coats off’ after play time.
  • Providing choice allows the child or young person to have some autonomy and independence. Choices may include a selection of items for break, music at circle time, what activity they want to do at playtime etc.  As much as possible, ensure that choices are provided visually, using a Choice Board at the appropriate level of symbolic understanding. Symbolic development refers to the process of a child or young person understanding how objects or photographs represent a real-life concept.  Link here for an outline of the stages of symbolic development Choices should be limited to what the child is able to cope with. For example, some will only be able to make an informed choice between two items.  Any more than this might result in the child being overwhelmed
  • Respond promptly to communication efforts. This is particularly important for young people who struggle with initiating and directing the communication towards supporting adults, as it provides reinforcement that using communication is a powerful way of addressing needs/wants.

Background

One of the core features of autism is ‘persistent difficulties with social communication and social interaction’.  Social communication and interaction skills relates to the ability to use language, or other means, to communicate with others in a social context.  These aspects of communication are sometimes referred to as pragmatic skills.

Our communication is made up of three aspects: speech, language and pragmatics.  Pragmatics is everything but the words:

  • awareness of the listener 
  • tone of voice
  • social reciprocity (the two-way flow of conversation)
  • maintaining a conversation
  • repairing a conversation
  • understanding others’ intended meaning
  • closing a conversation

For those with SLD, it is important to support their social communication, as well as the language system they use.  Social skills targets for this profile should focus on foundational social skills such as:

  • Turn taking
  • Shared attention and interaction with adults and peers 
  • Shared enjoyment
  • Listening and attention 
  • Appropriate social behaviours (e.g. how to greet strangers versus how to greet close friends; how to start a conversation)
  • Engagement as part of a group task

Strategies

  • The Attention Autism Programme supports the development of attention, as well as the related skills of social interaction and engagement by encouraging group participants to take part in turn taking games and shared group activities. Link here for more information on Attention Autism
  • Turn taking games encourage joint attention, interaction and shifting attention focus during the game.  Formal games requiring turns, such as fishing games might be motivating but informal games, such as catch, cause and effect toys and specific motivating resources can be used to create an element of turn taking with the young person Link here for intensive interaction section
  • Passing objects related to the topic or theme to peers during circle time and other group activities to encourage social engagement.
  • Teaching social skills individualised to the person. For example, the student with verbal language might ask inappropriate questions to visitors to the school. It is then important to teach specific targets in relation to this area of need.
    A useful structure to follow is that of Jed Baker’s Social Skills programme of:
    1. Initial instruction with visual supports to support comprehension.
    2. Role-playing the skill with the supporting adult.
    3. Reviewing the skill steps with corrective feedback, perhaps using videoing as a way of reinforcing the understanding for the student.
    4. Generalisation to “real-life” situations, with the visual supports to reinforce the targeted skills.
      Link here for turn taking
      Link here for factors to consider when teaching new skills