Many preschool children who have been diagnosed with autistic spectrum disorders do not talk or communicate with other people. They often do not even attempt to initiate communication with other people by establishing eye contact, gesturing, pointing, leading them to what they want, or vocalizing. The reasons and advantages of teaching non-verbal preschool autistic children to use pictures/photos to communicate are: 1. To give the child a way to successfully communicate with other people via a universally recognized and understood communication system 2. To teach the child to INITIATE communication with other people 3. To "jump start" the child's VERBAL SPEECH and language, as the ultimate goal is for these children to communicate by TALKING. However, as a speech/language pathologist who has been working with preschool children diagnosed with autistic spectrum disorders for the past 23 years, I have learned 2 very important things: 1. Some of these children will never become functional speakers, so they need to have one or several alternative communication systems that they can use in order to communicate with other people 2. Being able to "TALK" and being able to "COMMUNICATE" with other people are two very different things. Certainly, the young autistic child who can talk clearly has an advantage over the non-speaking child. However, often these children who can talk are merely repeating words, phrases, sentences they have heard, and they often say these things out of context and to nobody. Often, if you hear your young autistic child talking, he/she is saying nothing of any relevance to anybody. There may be nobody in the room or a lot of people in the room, it doesn't really matter to your child. It then becomes our job to teach this child to use his words, i.e. to "talk" with meaning, intent, and purpose to a communicative partner, i.e. to learn to "communicate" with other people. As you go through the step-by-step process that I have outlined for you, I welcome your input, i.e. thoughts, questions, comments, via my e-how inbox. I will do my best to help you in any way that I can.
Make a list of MOTIVATING items that your child wants/likes and any other items you feel would be important for your child to communicate to you that he/she wants or needs. Commonly requested picture categories include food and drink, inside play activities, including your child's favorite toys, books, and videos, and outside play activities. Pictures of "yes," "no," "not a choice," and "uh-oh" are also highly recommended and will be discussed in more detail later.
Compile your photos/pictures, about 2 x 2 in size, using foods depicted on food labels, a camera to take photos, or various computer software programs including clip art, or one of the following commercial software programs that you may need to purchase if you are unable to get them through your local school district and speech pathologist: the Boardmaker picture software by Mayer-Johnson at mayerjohnson.com or the PECS (Picture Exchange Communication System) by Pyramid Educational Products at pyramidproducts.com I recommend the Boardmaker software program, as it has over 3000 pictures and is easier to use. Print your pictures on cardstock. Laminate your pictures, organize them by category, and, using velcro, keep them in a 3-ring binder.
Next, make your picture choice boards to correspond with the different picture categories you have chosen; i.e. a food/drink board, an inside play/activity board, an outside play/activity board. I use half of an 8x11 laminated manila folder to make each of the choice boards. These choice boards should be laminated and mounted at your child's eye level and strategically placed in the corresponding areas in which the activities take place. For example, the food/drink picture board could be mounted on the front of the refrigerator or on a kitchen cabinet. The inside play/activity picture board should be mounted in the play room/area, etc. The outside play picture board could be mounted near or on the door most frequently used to go outside.
Next, you need to teach your child what each individual photo or picture represents by pairing it with the actual item, food, toy, etc. Always remember to hold the items and pictures up by your cheek so that your child will look at your face as you say the name of the item while pointing to/showing your child both the item and its corresponding photo/picture. Start SLOWLY; this process will take time. It's best to start by teaching only 2-3 highly motivating items in each category.
Next, using small velcro dots/squares, mount the 2-3 pictures that you have chosen in each category on their corresponding picture choice boards. Your child then needs to be taught to remove a desired item from the picture choice board and hand it to you. You want to hold up 2 of the actual items you have chosen in a specific category, 1 item that you know is highly motivating for your child, and 1 that he/she really doesn't like. You hold up each item, labeling it for your child as you show it to him/her. Hopefully, your child will reach for the highly motivating item. Whichever one he/she reaches for, you immediately physically help him/her remove its corresponding picture from the picture board and hold out your hand for him/her to put the picture in your hand. Ideally, this initial training process works better with 2 people---one person to help your child retrieve the picture and to help him/her release the picture into your outstretched hand. Once your child has given you the picture you then again hold the picture up by your cheek and clarify your child's communicative intent by saying, for example, "Banana; You want a banana" I then pause for a moment and say "banana" again while holding the actual banana up by my cheek and pointing to my mouth, trying to get the child to VOCALIZE---TO SAY ANYTHING AT ALL, as VERBAL SPEECH is ALWAYS my ULTIMATE GOAL. But remember, at this point you are only stimulating and encouraging verbalization, NOT REQUIRING verbalization. So don't prolong the process of giving your child what he/she has requested via the pictures by waiting for an accompanying verbal response. You then immediately give your child the banana. Initially, it is important to positively reinforce any and all attempts your child makes to communicate with you via his/her pictures by making every effort to give him/her what he/she wants. As your child gets better at this process, you want to start taking steps backward and moving farther and farther away from your child so that he/she has to walk to you to give you a picture. The ultimate goal for your child is to have him/her be able to independently go to one of his/her picture choice boards, take off a desired food, toy, activity, etc., find a parent/sibling/caregiver, etc., even if they are in another room or part of the house, and hand them a picture, thus communicating his/her basic wants and needs. At this point, you should also move the pictures around on the board
There are 4 additional pictures that are very important to teach: "yes," "no," "not a choice," and what I call "uh-oh" A "yes" picture can be drawn by making a basic smiley face with an arrow above the face pointing up and an arrow under the face pointing down, indicating a head nod for "yes." The Boardmaker software program has this picture. Similarly, for "no" a basic face with a frown mouth and arrows going out from each side of the face---to the right and left---representing shaking your head for "no." The Boardmaker software program has this picture. Again, when you teach these concepts, you say "yes" or "no" while simultaneously nodding/shaking your head. The "not a choice" picture can be made by making a clear overlay that is the same 2x2 size of your pictures with a red X drawn across the overlay in permanent red marker. This overlay can be placed on a picture if your child chooses something that is not available at that time; i.e. maybe you ran out of bananas. But maybe you have bananas, but you just don't want your child to have one right befor dinner. In this case, you could use a FIRST, THEN board. This can be a smaller board with a black line drawn down the middle, and the word FIRST printed at the top of the left side of the board and the word THEN printed at the top of the right side of the board, with a place for one picture in the middle of each side of the board. So you put say a picture of chicken on the FIRST side of the board and a picture of a banana on the THEN side of the board. You again show your child while pointing to the pictures and saying "First chicken, then banana." The "uh-oh" picture is one that I made up that can be used similarly to the "not a choice" picture. For example, a sibling just ate the last banana; your child sees him/her eating the banana and decides he/she wants one, too. But the bananas are all gone---"Uh-oh" I use a face with the mouth open and a hand on the forehead for "uh-oh." Again, you hold up the picture to your face and act it out the same way, mouth open hand on forehead while saying "Uh-oh, bananas are all gone."