Beyond Words: Understanding and Initiating Non-Verbal Communication

Happy new year! Becca has spent the beginning of this year quite sick. We spent Christmas Eve at the Children's Hospital to follow up on some previous testing that we had done earlier in December. Once Becca saw the hospital building, she started to cry in protest. She cried for the duration of the appointment and didn't stop crying until we left the building and got into the car. People who observed at the hospital thought that she was in some sort of pain or discomfort. The truth of the matter is that she was simply communicating to us that she did not want to be in the hospital.

Then after the holidays, she got sick again - once she returned to school. I have been giving her a decongestant tea blend, made up of turmeric, cinnamon, licorice, and ginger root, and I usually add eucalyptus honey. Yesterday, when I made her the tea she took two sips and gave me a disapproving look. I asked her what was wrong and she pushed the tea toward me, gesturing for me to taste it. I tasted it, and realized immediately what the problem was. I had forgotten to add the honey. I apologized and thanked her for letting me know. Once I went to the kitchen and added the honey, she was a happy camper and drank her tea without further protest.

People have said in the past that Becca doesn't communicate due to Autism. But this is simply not true. Becca communicates, and she communicates quite a bit. She doesn't use WORDS yet to communicate. She communicates using gestures, specific sounds, facial expressions, eye contact, and visual aids. She expresses disapproval by making gagging sounds (which has often caused confusion in public, especially in restaurants), she makes requests by placing my hands on the items she wants, and she asks me to play Baby Shark by saying "doo doo doo doo doo doo". Communicating with Becca requires learning the nuances of non-verbal communication, and learning how to express yourself in a way that she can grasp and understand.

Contrary to what people might believe, most non-verbal individuals do understand verbal communication. While it may take Becca longer to process what is being said, she understands everything that is being said around and about her. I tell everyone to be very careful what they say in front of her, because she understands them. She laughs when things are funny, she smiles when she is greeted, cries when she is corrected, stomps her feet in protest when she is told "no". She stops when we say "stop", and sits when we say "sit", and follows most other directions, too. So when we communicate with her, we use simple language and try to pair words with visuals or gestures so that she can retain the meaning of the words.

In addition to body language, there are other systems that are designed to help non-verbal individuals find their voices. Collectively, these devices or systems are known as Augmentive and Alternative Communication (AAC) devices. AAC incorporates the individual's full communication abilities and may include any existing speech or vocalizations, gestures, manual signs, and aided communication. AAC is truly multi-modal, permitting individuals to use every mode possible to communicate. By recent estimates, well over 2 million people who present with significant expressive language impairment use AAC.

Typically, AAC includes unaided and aided modes of communication. Unaided modes of communication include non-spoken means of natural communication (including gestures and facial expressions) as well as manual signs. These modes of communication often require adequate motor control and communication partners who can interpret the intended message. Aided modes of communication include those approaches that require some form of external support, such as a communication boards with symbols (e.g., objects, pictures, photographs, line drawings, visual-graphic symbols, printed words) or computers, handheld devices, or tablet devices with symbols that generate speech through synthetically produced or recorded natural (digitized) means.

Becca has traditionally relied heavily on unaided forms of communication, but we have recently introduced aided communication by introducing visual schedules and PECS boards. The Picture Exchange Communication System (PECS) is a way for non-verbal individuals to communicate without relying on speech. To communicate, people use cards with pictures, symbols, words or photographs to ask for things, comment on things or answer questions. Becca has done well with this system and is now being evaluated for a more robust version of this system on a tablet that she can take with her to facilitate communication in different settings. We are excited about the prospect of introducing such a device because this will provide more opportunities for even deeper communication, reducing frustration while improving independence and enhacing social interactions.

Just because a person doesn't have words, does not mean that he or she does not communicate. Building relationships and teaching these individuals involves spending time with them, understanding them, observing how they communicate best, and entering with them into their world. And once we do that, there will be no limit to the wonderful "conversations" we will be able to have with our non-verbal Autistic loved ones.