Little Acorn: Strategies to communicate

The first word from a child is highly anticipated and can signal so much: the child’s interest, his or her needs, and/or the initial step in communicating.

Our son’s, Little Acorn, first was “mom.” It happened at six months, and we had witnesses. People came up to me after the church service and said, “We heard it. He definitely said “Mom!”

I remember, pen-in-hand, marking and dating that one on the developmental checklist. He was ahead of the curve, and we joked that he would be talking in full sentences by eighteen months. Little Acorn continued to identify objects and could name anything in the room that we pointed to. The list was long. He loved “seek and find” books. We’d point to a picture, and he would identify them. It never occurred to us that we were doing all of pointing, and he was never extending his finger to point. This is a red flag for developmental delay—no gestures such as pointing, waving, and other appropriate hand motions.

Little Acorn hit every milestone marker for language up until eighteen months. He had speech, and while he seemed to still have many grunts and moans we weren’t too worried, because he had the desire and the ability of back-and-forth conversations. But we hit a wall when it was time to start putting those words together for functional speech and using them to communicate. The two-word phrases didn’t come. “See flag” was just “flag” “flag” “flag” noticing every American flag as I pushed him around town in his stroller. He did not seem to notice anything else. He seemed hyper-focused on flags. And he was. I just didn’t have a name for it at the time. As we drove through our Hoosier neighborhoods he noticed every basketball goal that we passed. He called them “boingy” for the vibration that occurred when a ball hit the rim. “Boingy” “boingy” “boingy.” Another hyper-focus.

Those first single words used to identify objects, alone, are just speech. Yet, while they are the building blocks to communication, it’s important to understand that communication is broader than speech. Communication is more important than speech. The verbal expression needs to be meaningful, and it has to be an exchange between two or more people. This is where we were lacking.

At the age of 28 months our son had a vocabulary of over 250 words. This sounds like a likely estimate made by two, young, first-time parents, because most 24- to 30-month-olds have an expressive vocabulary of around 200 words. But this was not an estimate. My husband and I made a list the night before our son’s diagnosis.

“How many words can he say?”

“He has quite a few. Think of the all the books we’ve read and looked at where he can i.d. the pictures.”

“You know language will come up tomorrow. They’re going to ask us how many words he can say. Is it more than 100?”

“Definitely.”

“200 or 300?”

“Let’s make a list. Seriously, start writing”

In regard to speech, we walked into his autism assessment with confidence. Even though we were the ones who requested an autism evaluation we came armed with every resource to prove otherwise. But as soon as they saw the list I could see “It” in their eyes. Almost as though the impressive list wasn’t a defense against an autism diagnosis but rather supporting evidence for it. It was an impressive list of more than 250 words which included the following:

• Alligator
• Helicopter
• Giraffe
• Octagon
• Rectangle
• Jesus
• School bus

They then asked, “And how many of those words does he pair with others?”

"A few, but not many of them,” we answered in defeat.

As soon as we suspected our son had a language delay my husband and I laid out all the options. We heard speculation that using sign language or picture cards would delay speech further. But we agreed that we could give each one a shot. Remember, we had been told that our son may NEVER communicate with us. We had nothing to lose. My stomach still drops recalling the conversation that led me to accept communication over speech. Communication became an absolute necessity, and speech now was thought of as a luxury or added bonus.

With angst my husband asked, “What if he can’t tell us about being mistreated or picked on? What if he is in pain and can’t communicate that to us?”

In this moment, the priority changed from making sure our son could talk to giving him tools to communicate. Trying to accept that his communication may never come in the form of speech became easier to accept over time as we saw progress with different communication strategies. He was able to express hunger, bathroom needs, pain, and emotion by simply removing a card from a dry erase board and handing it to me. No words. Just a picture on a poorly-laminated two by three-inch card. Even without words we had accomplished the goal. He was communicating! We were then able to attempt the next hurdle---helping him get his words out. It was clear that there was a lot in his little mind that needed to get out.

A mixture of amateur (my research) and professional (speech therapist session one hour a week), our approach to communication was a hybrid, trial-and-error one. Over time, this is what we used to help our son communicate and, later, speak.

Strategies for Communication and Speech Development (in no particular order):

1. Sign Language

We used the “more” sign for everything for a while. We would make him sign “more” before doing anything (more bites of food on plate, getting down from seat, getting toy). Create opportunities for them to ask for things. Do not anticipate their needs, and give them everything you think they want. We then worked to pair more with the word—“more, play, please” “more, apple, please”. Don’t get hung up if they aren’t making the sign perfectly or saying the word perfectly—just that they are making the effort to communicate. Building confidence in them is the main goal. Asking = gets you want you want. Instead of signing more our son would flap his arms and moan something that sounded like “more”. That was good enough for us; he was verbalizing his wants. Over time we replaced the “more” with “want” or “need”. We would keep adding to create a full sentence. This took months, but it worked for us.

• “more”
• “more, please”
• “more, food, please”
• “want more food, please”
• “I want more food, please”

2. PECS (Pictures Exchange Communication System)

These were miracle workers for us and are simple pictures labeled with the word. I laminated five to ten major ones: eat, diaper, thirsty, library, park, etc. and put magnets on the back. I hung a magnetic dry erase board at his level so he could get these when he needed them. Every time we sat down to eat I would put the “eat / hungry” one in front of him so he understood what it meant. I did the same when I changed his diaper. Or when we read a book. Or played with toys. It took about a month of me doing this, and just when I thought it wasn’t working, he began to use to cards without me prompting him.

3. Action & Carrier Words

Use action words that they can see and repeat the action word three times. For example, run a toy truck up a ramp and say “go go go!” Or pick them up and say “up up up!” and then say their name and give them a turn, “Jimmy’s, turn,” and allow them to drive the truck up the ramp. Keep taking turns back and forth. It may take many times before they begin to say this phrase.

Once they get comfortable with the action word phrase then add a carrier word: “Go, go. Go truck.”

After they are comfortable with the carrier word then add a descriptive word: “Go red truck.”

5. Allow room for response, and don’t talk all the time.

The latter part, not talking all the time, cannot be stressed enough. My husband and I may have done more harm than good by interrupting or putting words out there in an attempt to assuage the desired effect on our end. Talk to him just like you would converse with anyone else. Encourage back-and-forth communication, even if his response is babbles, nothing, or unintelligible speech. The interaction is more important than the content. Model what a conversation looks like. During this time I also tried to avoid text messages when I could and would put myself on speaker phone when talking to people on the phone so he could hear back and forth communication.

6. Repeat Everything Back That They Say

Reinforce and encourage any speech! Let them know that you are hearing and, more importantly, are listening to what they have to say. i.e. “Yes, that’s a car!”

Lastly, be willing to ditch a system that doesn’t work or use a combination of systems if needed. Get down on their eye-level, and try to see their needs. Their expression of these needs are what you are trying to help facilitate. My son knew my needs as his first sentence was “I’m makin’ coffee,” as he stirred his chocolate syrup into his milk.

We knew our son’s thoughts and the desire to communicate were not missing. Sometimes he had a hard time coming up with the words. We had to be persistent and consistent. It was tiring, but every time I felt defeated or like giving up, our son reassured me with the results I was praying for. I had to remember that he was operating on his time and readiness, not mine.

Such is the rollercoaster of receiving the autism diagnosis. Your little acorn may be working on a different timeline. It should also be said that we understand everyone’s needs are different, and our writings for HSJ are hopeful strategies that we feel is our duty to share, not a broad strokes solution for all.