What communication strategies and resources are recommended to improve communication with a person with autism spectrum disorder?

Communication Strategies and Resources for Autistic Individuals

Use visual supports extensively, speak clearly and slowly with concrete language, minimize verbal load, and implement structured communication systems while actively involving family members in all communication strategies. 1, 2

Core Communication Principles

Visual Communication Strategies

• Implement visual supports as the foundation of all communication, including visual schedules, pictorial representations, step-by-step visual guides, and concrete examples to circumvent verbal processing difficulties. 1, 2, 3
• Use visual technology such as Videophone, Skype, iChat, or ooVoo for ongoing visual communication, particularly beneficial for sign language users. 4
• Provide visual aids and manipulatives to make abstract concepts concrete and accessible. 1

Verbal Communication Modifications

• Speak clearly, slowly, and distinctly but naturally, avoiding complex sentences when communicating complicated information. 4
• Minimize verbal load by using repetition, avoiding multi-step verbal directions, and pairing all verbal instructions with visual cues. 1
• Keep hands away from your face while talking and ensure good lighting with face-to-face positioning at the same level (sitting versus standing). 4
• Rephrase rather than simply repeating when the message is not understood. 4

Environmental Considerations

• Minimize extraneous noise (television, water running, other sound sources) during communication attempts. 4
• Do not talk while walking away or from another room; maintain visual contact throughout the interaction. 4
• Ensure speakers take turns and do not speak over each other. 4

Structured Communication Systems

Augmentative and Alternative Communication (AAC)

• Implement alternative communication modalities immediately for individuals with limited verbal communication, including the Picture Exchange Communication System (PECS), sign language, or other AAC systems to allow expression without verbal demands. 1, 2, 3
• Do not wait for speech to emerge before introducing alternative communication methods. 3

Attention and Engagement Strategies

• Get the person's attention before starting to talk, giving them a chance to focus attention on the communication. 4
• Provide pause time and encourage "give and take" strategies to allow the individual to develop independent critical thinking skills. 4
• Respond appropriately to the individual's attempts to initiate and express themselves, showing understanding and building on their communicative attempts. 4

Teaching Communication Skills

Explicit Instruction Approach

• Use explicit, systematic instruction rather than expecting communication skills to develop through discovery, as autistic individuals require structured approaches with direct teaching. 1, 3
• Break down communication concepts into smaller, sequential steps using forward or backward chaining with reinforcement for completion of each step. 1
• Teach vocabulary and social-pragmatic language skills explicitly as separate, structured skills. 1

Developmental Monitoring

• Use language development checklists or scales to ensure the individual is making communication gains within age-appropriate intervals. 4
• Expect communication acquisition (whether spoken language or sign language) to follow developmental milestones, monitoring through watching, observing, and measuring outcomes. 4

Family and Caregiver Involvement

Active Partnership

• Train family members as co-therapists, dedicating structured time to parent education on implementing communication strategies consistently across all daily routines and contexts. 2, 3
• Involve family members in education and consultation, identifying those who may need extra time in developing understanding of communication strategies. 4
• Coach parents and caregivers to communicate throughout daily activities and routines, including incidental conversation and background noises. 4

Reinforcement Strategies

• Motivate, encourage, and reinforce all attempts at communication, supporting semantic, grammatical, social-pragmatic, and verbal reasoning skills. 4
• Use differential reinforcement to reward correct responses and successive approximations toward target communication skills with immediate and concrete feedback. 1

Practical Implementation

Information Delivery

• When communicating complicated information such as time, date, or medication instructions, have the individual repeat the instructions back. 4
• Provide important information and instructions in writing as a supplement to verbal communication. 4
• Connect communication concepts to areas of special interest when possible to increase engagement and facilitate learning. 1

Transition Support

• Anticipate transitions and build breaks into the schedule, as autistic individuals often struggle with changing activities or settings. 2
• Prepare the individual before new experiences by describing what will happen, the sequence of events, and how to handle potentially stressful communication situations. 2

Common Pitfalls to Avoid

• Avoid assuming that verbal fluency equals understanding of social and emotional communication concepts; many autistic individuals need explicit teaching despite good language skills. 2
• Do not focus solely on behavior management without addressing underlying communication needs, as communication deficits often drive behavioral challenges. 3
• Avoid one-size-fits-all approaches; each person's communication abilities vary significantly based on their developmental level, cognitive abilities, and support needs. 2
• Do not use educational brochures or materials not developed specifically for individuals with communication differences without adaptation. 4

Assistive Technology and Devices

Low-Tech Solutions

• Use simple noncustom amplifiers in healthcare settings to improve real-time communication with individuals who have untreated hearing difficulties that may co-occur with autism. 4
• Employ free speech-to-text apps to convert spoken conversation to text when auditory processing is challenging. 4

High-Tech Options

• Implement smartphone apps and visual technology platforms that support communication across different contexts and with different communication partners. 4