All children develop language at different rates in various ways. Verbal communication is always the primary goal for children receiving speech and language therapy. However, some children begin to develop frustration behaviors or begin avoiding interactions when they learn that they are not able to express their wants, needs, feelings, or stories. There are various diagnoses that effect the development of expressive communication skills. Some children may not even have any formal diagnosis, but are still not developing verbal communication well enough to express themselves. This is when your therapist may consider use of augmentative or alternative forms of communication (AAC).

All people and children express themselves using various forms of communication. We all naturally use gestures, verbal communication, and written communication to express ourselves. We nod to say yes, we wave to say hi. Children who understand language but can’t seem to express themselves, often create their own gestures to communicate wants and needs. In speech therapy, we often introduce basic use of sign language to further encourage communication between a child and their family. Knowledge of any form of communication leads to increased knowledge of verbal communication simultaneously. By signing “milk” to a parent, the child learns that words and actions have meaning. They also learn that their communicative attempts must be directed toward another person. While the children are learning to use sign language to express themselves, this gives the parents and the therapist an opportunity to model use of verbal communication by labeling what the child is asking for. Typically developing children will often use sign language until they have developed enough verbal communication to fully express themselves. Then they seem to instinctively “drop” the sign language when it’s no longer needed.

Other children may not develop an interest in sign language. Children diagnosed with severe motor disorders, often have difficulty expressing themselves with sign language due to the motor abilities necessary to effectively produce individual signs. Other children do not seem to attend visually to a parent or a therapist modeling signs. Another option for communication is use of picture communication. This is similar to adults using written communication. Photographic and line drawn pictures are introduced to allow the child to choose what toys they want to play with, what actions they want to engage in, what food they want to eat, etc. The child is required to find the picture, select it, and hand it to an adult (parent, teacher, therapist). This again teaches the child that communication involves another person. It also shows the child that interacting with the adult in this manner helps them achieve their wants and needs. Verbal communication is still modeled to help increase awareness and use of verbal labels. Children who learn to understand more abstract pictures can also begin forming sentence using picture communication. This teaches the child basic grammar forms used in verbal communication.

A third option for communication is use of a speech generating device. Some children use sign language and picture communication until verbal language develops. For some children, verbal communication may never develop. There is no formula for a therapist to use to determine whether or not your child will be a verbal communicator. Beginning trial therapy with a speech generating device does not indicate that your speech therapist has given up on your child’s verbal communication. What it does indicate is that your therapist wants your child to be able to effectively communicate with peers and adults. It is very difficult for a child to communicate with other peers and unfamiliar adults using sign language. Although some preschool children and early educators know some sign language, the number of people that your child is able to communicate with will be profoundly impacted. Children using picture communication have a difficult time communicating and interacting with their peers. Many children who use picture communication only use it to request. Use of a speech generating communication device gives your child a voice in their world. It is readily understandable to all communication partners. It allows them to greet peers and family, refuse actions and objects, request, ask questions, and basically allows them access to all the language that is used by their typically developing peers. Not all children who use speech generating devices are completely nonverbal. Some children may have significant articulation impairments, making it difficult for others to understand their communicative attempts. For example, clients with cerebral palsy often have decreased oral motor skills due to low muscle tone, leading to decreased speech intelligibility. Speech generating devices are also appropriate for these clients. Many of these children will imitate the device as it “talks,” improving and practicing their verbal communication skills.

Use of speech generating devices has significantly increased for children diagnosed with autism spectrum disorders. They are almost always necessary for children with multiple handicaps. However, they are also being used by children with apraxia, cerebral palsy, Rett syndrome, and many other diagnoses. What we here are Rehab Dynamics are most concerned with, is giving your child the best opportunity to learn language and communicate with family and peers as early as possible. We would rather begin pursuing these options when the children are 2-4 years old and may grow out of using these techniques, than wait until they are 7, 8, 9, or even older, and have no means of communication. Verbal communication will still remain the long term goal for your child, and will continue to be addressed during speech therapy sessions.

If you think your child would benefit from sign language, picture communication, or use of a speech generating device, please consult your speech language pathologist. Your speech therapist can also direct you to research that shows how use of augmentative and alternative forms of communication increase verbal language development, not prevent it. If you are not currently a client at Rehab Dynamics, you can contact our office at 419-841-1840.