Nonverbal Autism
The term nonverbal autism is used to describe individuals on the autism spectrum who have limited or no verbal communication skills. However, it does not necessarily indicate intellectual disability.
Nonverbal autistic children should not be automatically considered intellectually impaired simply because they lack speech. This assumption can lead to under-stimulation, which in turn can cause anger, frustration, and/or depression in the child or adolescent.
Let’s dive in!
- What are the early signs of autism?
- When to see a professional
- How is nonverbal autism diagnosed?
- How do you work with a child who is nonverbal?
- Guidelines for Communication with nonverbal autistic children
- How can ABA therapy help with nonverbal autism
Let Leafwing professionals educate you and your child to develop the language skills that will help guide your child to reach their full potential.
What are the early signs of autism?
Based on research conducted in 2007, it was found that approximately 30-38 percent of parents of autistic children observed symptoms before their child’s first birthday. This number is unexpectedly high, considering that autism is often perceived as an issue that may not become apparent until later in childhood. In the majority of those cases, approximately 80 percent noticed signs by the time their child reached 24 months.
Early signs of autism include:
- not responding to their name by 12 months old
- not babbling or laughing along with their parents by 12 months old
- not pointing to objects of interest by 14 months old
- not playing pretend by 18 months old
- avoiding eye contact or preferring to be alone
- not meeting developmental milestones for speech and language
- repeating words or phrases over and over
- being upset by minor changes to their schedule
- flapping their hands or rocking their body for comfort
When to see a professional
Don’t let your child fall behind! If you notice they’re not hitting their language milestones, it’s time to seek professional help.
If your child is not babbling or talking, it may be necessary to consult a therapist or speech-language pathologist to determine if nonverbal autism is a possibility. Let LeafWing investigate and assist your child in developing their communication skills.
Language development and speech in older children can be evaluated using a standardized vocabulary checklist, such as the Language Development Survey (LDS). This assessment tool can assist in identifying language delays in children between the ages of 18-35 months by analyzing their vocabulary usage and word combinations.
How is nonverbal autism diagnosed?
First, the parent should obtain a definite diagnosis from a medical professional who will conduct a series of tests, which include
- physical examination
- MRI and CT scans
- blood tests
- and hearing tests.
These assessments enable the professionals to eliminate any other developmental or physical disabilities hindering the child’s speech.
When it comes to diagnosing nonverbal autism in children, it can be a difficult task. This is because there are no clear distinctions between different types of communication difficulties, and it can be hard to differentiate between language delays and autism-related communication problems. The lack of verbal output for children with nonverbal autism typically makes the challenges associated with diagnosis even more difficult.
Unlocking the puzzle of nonverbal autism in children can feel like navigating a maze of communication challenges, where clear distinctions are scarce, and diagnoses are elusive.
Once the parent has a diagnosis, a therapist will use some standardized assessment tools that assess young children with significant language and speech delays, such as:
- Gilliam Autism Rating Scale (GARS3) – is a comprehensive assessment tool that assesses communication, socialization, sensory functioning, play, self-help skills, and behavior in autism spectrum disorder patients.
- Autism Diagnostic Observation Schedule (ADOS-2) – assesses an individual’s behavior, communication, and social interaction skills.
The assessment tools help to identify deficits or unusual patterns that may indicate the presence of autism spectrum disorder.
How do you work with a child who is nonverbal?
The first step in working with a nonverbal autistic child is to establish trust and rapport. This can often be done by taking time to get to know them, showing interest in their interests and hobbies, and acting as a supportive companion. It is essential to use clear body language and gestures when communicating, as well as verbal communication if appropriate. Additionally, it may be helpful to use visual tools such as
- picture cards
- calendars
- simple visual schedules
to help children with autism better communicate what they need or want.
Nonverbal Autism: Visual Behavior Supports
Visual supports, such as pictures or other visual representations, can assist children in communication by facilitating the expression of emotions and frustrations. They also aid in comprehending social norms, such as initiating conversations and potentially reducing aggressive behavior.
Visual supports are like a superhero cape for children, guiding them on the path of good behavior and reminding them of the consequences that await if they stray. These magical tools not only help little ones remember the rules but also foster communication and build excellent relationships along the way!
Types of Visual Behavior
- First-Then Boards: breaks tasks down into smaller, easy-to-understand segments. It is a visual display of something that your child prefers and will receive or can participate in after they complete a task that they do not prefer.
- Contingency Maps: shows a child what will happen if they engage in a particular behavior. However, unlike a first-then-board, a contingency map depicts both sides of the coin – what will happen if the child does what is expected of them and what happens if they do not.
- Visual Daily Schedules: the expectation of the events in their day. Visual schedules help mitigate anxiety and lend a sense of predictability. You can create a visual daily schedule with photographs, drawings, or written lists, beginning with the first thing your child should do in the morning and ending with the last thing they should do at night.
Guidelines for Communication with Nonverbal Autistic Children
No matter where your child falls on the autism spectrum, they can communicate in some manner. Even if they are nonverbal, there are a variety of strategies that can be used to help them express themselves and build meaningful relationships with you and others.
- Encourage play and social interaction. All children learn through play, and that includes learning the language. Interactive play provides a delightful chance for you and your child to communicate. Play games that your child enjoys. Incorporate playful activities that promote social interaction. For example, singing, reciting nursery rhymes, and gentle roughhousing. During your interactions, crouch down close to your child so your voice and face are closer, increasing the chance of them looking at you.
- Imitate each other. Copying your child’s sounds and play behaviors will encourage more vocalizing and interaction. It also encourages your child to copy you and take turns. Make sure you imitate how your child is playing – so long as it’s a positive behavior. For example, when your child rolls a car across the floor, then you, too, roll a car across the floor. If they crash the car, you crash your car, too. Be sure not to imitate inappropriate behavior like throwing the car!
- Focus on nonverbal communication. Gestures and eye contact can build a foundation for language. Encourage your child by modeling and responding to these behaviors. Exaggerate your gestures. Use both your body and your voice when communicating – for example, by extending your hand to point when you say “look” and nodding your head when you say “yes.” Use gestures that are easy for your child to copy. Examples include clapping, opening hands, reaching out arms, etc. Respond to your child’s gestures: When they look at or point to a toy, hand it to them or take the cue for you to play with it—similarly, point to a toy you want before picking it up.
- Give time for your child to talk. It’s natural for us to want to fill in the missing words when a child doesn’t quickly respond. It is vital to give your child lots of opportunities to communicate, even if they are not talking. When you ask a question or see that your child wants something, pause for several seconds while looking at them enthusiastically. Watch for any sound or body movement and respond promptly. The promptness of your response helps your child feel the power of communication.
- Simplify your language. Be literal and obvious in your choice of language. Say precisely what you mean. Speak in short phrases, such as “roll ball” or “throw ball.” You can increase the number of words in a phrase once your child’s vocabulary increases.
- Follow your child’s interests. Rather than interrupting your child’s focus, follow along with words. Use simple words about what your child is doing. By talking about what engages your child, you’ll help them learn the associated vocabulary.
- Consider assistive devices and visual supports. Assistive technologies and visual supports can do more than replace speech. They can foster its development. Examples include devices and apps with pictures your child touches to produce words. On a simpler level, visual supports can consist of images and groups of pictures that your child can use to indicate requests and thoughts.
It is important to remember that clear and concise instructions are more effective for children. The level of language used should be appropriate for the child’s current language abilities. As the child progresses and succeeds, instructions can become more complex and include more language.
Respect your child’s current communication level. Though your child may be nonverbal, their thoughts and emotions are just as valid as those of a verbal person. It is essential to learn how to listen to the communication attempts that your child makes, such as gestures, facial expressions, vocalizations, or body language. Respect what your child can do rather than focusing on what they cannot yet do.
How ABA therapy can help with nonverbal autism
ABA therapy is effective in identifying and targeting skill development goals. It typically addresses skill deficits across various domains, which vary depending on the individual needs of the learner.
Behavior analysts must only use ABA-based treatment programs that are proven effective for specific difficulties. This is known as evidence-based practice. Treatment programs can be tailored to each person, but they all share a solid foundation of methods proven effective through repeated implementation in real-life situations.
Let Leafwing be your partner in unlocking your child’s full potential. We pride ourselves on creating a solid bond between your child and our therapy team, especially at the start of the ABA therapy program. Our staff is dedicated to building a positive relationship with your child, not just at the beginning but throughout the entire program. In the first few weeks, we focus on play and conversation to make your child feel at ease and enjoy their time with our Behavior technician. This ensures positive experiences and maximizes learning rates for extraordinary results.
Glossary Terms
Other Related Articles
- Autism Communication Strategies
- Autism and Communication Difficulties
- Why does ABA help children with Autism?
- How to start ABA therapy
Frequently asked questions about ABA therapy
What is ABA Therapy used for?
ABA-based therapy can be used in a multitude of areas. Currently, these interventions are used primarily with individuals living with ASD; however, their applications can be used with individuals living with pervasive developmental disorders as well as other disorders. For ASD, it can be used in effectively teaching specific skills that may not be in a child’s repertoire of skills to help him/her function better in their environment whether that be at home, school, or out in the community. In conjunction with skill acquisition programs, ABA-based interventions can also be used in addressing behavioral excesses (e.g., tantrum behaviors, aggressive behaviors, self-injurious behaviors). Lastly, it can also be utilized in parent/caregiver training.
In skill acquisition programs, a child’s repertoire of skills is assessed in the beginning phase of the services in key adaptive areas such as communication/language, self-help, social skills, and motor skills as well. Once skills to be taught are identified, a goal for each skill is developed and then addressed/taught by using ABA-based techniques to teach those important skills. Ultimately, an ABA-based therapy will facilitate a degree of maintenance (i.e., the child can still perform the learned behaviors in the absence of training/intervention over time) and generalization (i.e., the learned behaviors are observed to occur in situations different from the instructional setting). These two concepts are very important in any ABA-based intervention.
In behavior management, the challenging behaviors are assessed for their function in the beginning phase of the services. In this phase, the “why does this behavior happen in the first place?” is determined. Once known, an ABA-based therapy will be developed to not just decrease the occurrence of the behavior being addressed, but also teach the child a functionally-equivalent behavior that is socially-appropriate. For example, if a child resorts to tantrum behaviors when she is told she cannot have a specific item, she may be taught to accept an alternative or find an alternative for herself. Of course, we can only do this up to a certain point—the offering of alternatives. There comes a point when a ‘no’ means ‘no’ so the tantrum behavior will be left to run its course (i.e., to continue until it ceases). This is never easy and will take some time for parents/caregivers to get used to, but research has shown that over time and consistent application of an ABA-based behavior management program, the challenging behavior will get better.
In parent training, individuals that provide care for a child may receive customized “curriculum” that best fit their situation. A typical area covered in parent training is teaching responsible adults pertinent ABA-based concepts to help adults understand the rationale behind interventions that are being used in their child’s ABA-based services. Another area covered in parent training is teaching adults specific skill acquisition programs and/or behavior management programs that they will implement during family time. Other areas covered in parent training may be data collection, how to facilitate maintenance, how to facilitate generalization of learned skills to name a few.
There is no “one format” that will fit all children and their families’ needs. The ABA professionals you’re currently working with, with your participation, will develop an ABA-based treatment package that will best fit your child’s and your family’s needs. For more information regarding this topic, we encourage you to speak with your BCBA or reach out to us at [email protected].
Who Can Benefit From ABA Therapy?
There is a common misconception that the principles of ABA are specific to Autism. This is not the case. The principles and methods of ABA are scientifically backed and can be applied to any individual. With that said, the U.S. Surgeon General and the American Psychological Association consider ABA to be an evidence based practice. Forty years of extensive literature have documented ABA therapy as an effective and successful practice to reduce problem behavior and increase skills for individuals with intellectual disabilities and Autism Spectrum Disorders (ASD). Children, teenagers, and adults with ASD can benefit from ABA therapy. Especially when started early, ABA therapy can benefit individuals by targeting challenging behaviors, attention skills, play skills, communication, motor, social, and other skills. Individuals with other developmental challenges such as ADHD or intellectual disability can benefit from ABA therapy as well. While early intervention has been demonstrated to lead to more significant treatment outcomes, there is no specific age at which ABA therapy ceases to be helpful.
Additionally, parents and caregivers of individuals living with ASD can also benefit from the principles of ABA. Depending on the needs of your loved one, the use of specified ABA techniques in addition to 1:1 services, may help produce more desirable treatment outcomes. The term “caregiver training” is common in ABA services and refers to the individualized instruction that a BCBA or ABA Supervisor provides to parents and caregivers. This typically involves a combination of individualized ABA techniques and methods parents and caregivers can use outside of 1:1 sessions to facilitate ongoing progress in specified areas.
ABA therapy can help people living with ASD, intellectual disability, and other developmental challenges achieve their goals and live higher quality lives.
What does ABA Therapy look like?
Agencies that provide ABA-based services in the home-setting are more likely to implement ABA services similarly than doing the same exact protocols or procedures. Regardless, an ABA agency under the guidance of a Board-Certified Behavior Analyst follows the same research-based theories to guide treatment that all other acceptable ABA agencies use.
ABA-based services start with a functional behavior assessment (FBA). In a nutshell, a FBA assesses why the behaviors may be happening in the first place. From there, the FBA will also determine the best way to address the difficulties using tactics that have been proven effective over time with a focus on behavioral replacement versus simple elimination of a problem behavior. The FBA will also have recommendations for other relevant skills/behaviors to be taught and parent skills that can be taught in a parent training format to name a few. From there, the intensity of the ABA-based services is determined, again, based on the clinical needs of your child. The completed FBA is then submitted to the funding source for approval.
One-on-one sessions between a behavior technician and your child will start once services are approved. The duration per session and the frequency of these sessions per week/month will all depend on how many hours your child’s ABA services have been approved for—usually, this will be the number recommended in the FBA. The sessions are used to teach identified skills/behaviors via effective teaching procedures. Another aspect of ABA-based services in the home-setting is parent training. Parent training can take many forms depending on what goals have been established during the FBA process. The number of hours dedicated for parent training is also variable and solely depends on the clinical need for it. If a 1:1 session is between a behavior technician and your child, a parent training session or appointment is between you and the case supervisor and with and without your child present, depending on the parent goal(s) identified. Parent training service’s goal is for you to be able to have ample skills/knowledge in order for you to become more effective in addressing behavioral difficulties as they occur outside of scheduled ABA sessions. Depending on the goals established, you may be required to participate in your child’s 1:1 sessions. These participations are a good way for you to practice what you have learned from the case supervisor while at the same time, having the behavior technician available to you to give you feedback as you practice on those new skills.
As mentioned in the beginning, no two ABA agencies will do the same exact thing when it comes to providing ABA services; however, good agencies will always base their practice on the same empirically-proven procedures.
How do I start ABA Therapy?
In most cases, the first item required to start ABA therapy is the individual’s autism spectrum disorder (ASD) diagnosis report. This is typically conducted by a doctor such as a psychiatrist, psychologist, or a developmental pediatrician. Most ABA therapy agencies and insurance companies will ask for a copy of this diagnosis report during the intake process as it is required to request an ABA assessment authorization from the individual’s medical insurance provider.
The second item required to start ABA therapy is a funding source. In the United States, and in cases where Medi-Cal or Medicare insurances are involved, there is a legal requirement for ABA services to be covered when there is a medical necessity (ASD diagnosis). Medi-Cal and Medicare cover all medically necessary behavioral health treatment services for beneficiaries. This typically includes children diagnosed with ASD. Since Applied Behavior Analysis is an evidence based and effective treatment for individuals with ASD, it is considered a covered treatment when medically necessary. In many cases, private insurance will also cover ABA services when medically necessary, however in these cases, it is best to speak directly with your medical insurance provider to determine the specifics of the coverage and to ensure that ABA is in fact, a covered benefit. Additionally, some families opt to pay for ABA services out-of-pocket.
The next step to starting ABA therapy is to contact an ABA provider whom you are interested in working with. Depending on your geographic location, ABA agencies exist in many cities across the United States. Your insurance carrier, local support groups, and even a thorough online search can help you find reputable and properly credentialed ABA agencies near you. Our organization, LeafWing Center, is based in southern California and is recognized for aiding people with ASD achieve their goals with the research based on applied behavior analysis.
Once you have identified the ABA provider with whom you wish to work, they should help you facilitate the next steps. These will include facilitating paperwork and authorizations with your funding source. Once the assessment process begins, a BCBA (Board Certified Behavior Analyst) or qualified Program Supervisor should get in contact with you to arrange times in which interviews with parents/caregivers and observations of your loved one can be conducted. This will help in the process of gathering important clinical information so that with your collaboration, the most effective treatment plans and goals can be established for your loved one. This process is referred to as the Functional Behavior Assessment (FBA) and is elaborated on in different blog posts on our website. With regard as to what can be expected once ABA therapy begins, please read our blog post titled: When You Start an ABA program, What Should You Reasonably Expect from Your Service Provider?
