For children with complex communication needs, being heard is important – and possible



A student uses an iPad with a specialized app as part of her applied behavioral analysis (ABA) therapy while Phyllis Watson, CCC-SLP, AAC looks on.

Communication is not just saying something, it’s about being heard — a powerful statement from Frances Hesselbein, leadership authority and former CEO of Girl Scouts of the USA.

Communication is fundamental to all aspects of life and is a foundation for learning. Yet for children with complex communication needs and some children with disabilities, communicating can be challenging – and frustrating.

Why do we communicate?

  • To express our wants and needs
  • To share information
  • To socialize and form relationships

Children who have difficulty communicating may cry, vocalize or act out to communicate, or in frustration, some children become lost in the classroom, while some may withdraw because they feel different or misunderstood.

The ways in which children communicate with others can influence how they are perceived and how they perceive themselves. Fortunately, there are assistive devices and techniques that can help children who have complex communication needs express themselves. Technology can help children with communication challenges find their voice, show their personalities, and open up a whole new world for them and those around them.

Finding a voice

An important first step in identifying strategies to help a child communicate is to assess their needs and the ways in how they communicate. At ATECH Services, the team of therapists and specialists works with the child, their family, and their school to evaluate their medical, physical, orthopedic, cognitive and communication needs.

Solutions might include identifying the best wheelchair to aid the child’s mobility and provide support so they can participate in activities or figuring out a reliable mode of communication for them. For instance, children who seemingly “can’t communicate” may use facial expressions, eye gaze, simple signs and gestures, or pictures to express themselves. For some children, a simple picture board will help; for others, augmented alternative communication (AAC) technology can help.

Jacob is a teenager with cerebral palsy who is unable to speak. He also has cortical vision impairment and uses a wheelchair for mobility. Working with his family, we identified Jacob’s home access needs and provided specific modification recommendations and equipment, such as an elevator, shower modifications and a special lift to help move Jacob safely. He was fitted with a custom power wheelchair, and has learned to control it independently using switches. Jacob also learned to use an ECO AAC device, which he operates using two-switch scanning and auditory prompts to communicate. He loves that he is able to tell people what he wants and thinks, participate in school, and even email family members and friends.

A child who has autism may be able to speak, but may not actually be communicating. Rather, he may simply repeat words he hears. Many children like Shrihaan can learn to use pictures or letters to communicate wants, needs and ideas. Shrihaan attends the Ready Set Connect! autism treatment program, where applied behavior analysis (ABA) therapists and AAC specialists are helping him learn to communicate using an iPad outfitted with a special Language Acquisition Through Motor Planning (LAMP) app, Words for Life.

Being able to clearly communicate ideas, wants and needs through pictures or spelling can help reduce behaviors and frustrations that may arise out of a child’s inability to communicate through speaking alone. AAC solutions can truly unlock a child’s personality, and help them communicate and learn at home and in school, and improve self-esteem. But to maximize a child’s opportunity for success, several steps must be taken to find the best AAC solution, such as:

  • Matching features like picture symbols, manual sign or a speech-generating device, with the child’s physical, sensory, cognitive and environmental needs
  • Identifying the language representation system that best meets the needs of the child and the people with whom they interacts (their “team”)
  • Selecting access and mounting solutions, including switches, joystick, eye gaze and scanning for children with motor impairments
  • Programming and customizing devices to meet the child’s communication and functional needs
  • Training the child’s family, teachers and others and coordinating the use of AAC solutions at home and school.

Introducing an AAC device into a child’s life can be truly life-changing for them and their family. A child who once screamed and acted-out may become one who goes to school, participates in her classroom and begins to make friends.

Mikayla is a teen who has multiple differences that create challenges in school. She loves learning and loves school, but as she moved from elementary to middle to high school, modifying the curriculum to meet her needs became more difficult. In her freshman year, Mikayla and her support team were introduced to assistive technology, which made it possible for her to participate in class, do homework and communicate with her teachers and peers. By the end of her freshman year, her parents and teachers were amazed at how swiftly Mikayla adapted to the technology and how excited she was to demonstrate her abilities and what she had learned alongside her classmates.

Communication is a two-way street

While technology and other assistive aids make it possible for children with complex communications challenges and disabilities to interact with the world and express themselves, remembering to use fundamental communication techniques with them is key to their feeling accepted and valued.

For instance, use the child’s name to get their attention. Use humor, facial expressions and vocal tone to let them know you want to communicate with them. Be in the moment and talk about the things that are interesting and meaningful to them. While you are engaged in an activity, talk about it. Explain what you are doing as you do it. Communicate for different reasons, like sharing an opinion (I don’t like that), making an observation (that is really big), or even tell a joke.

When communicating with a child who communicates differently, we often feel we need to do all the talking, but communication is a two-way street. Instead of a running commentary, pause to cue the child that it is their turn to communicate. Or perhaps use a verbal cue (“big or little”) or physical prompt (touch the child’s arm). However you do it, give the child a moment to use their “voice.”

Everyday activities offer a wealth of opportunity for two-way communication. Ask the child to make choices, such as what they want to wear, eat or do. Present information in a way that is meaningful. For instance, use cereal packets when discussing breakfast options so they have a visual cue to help them choose, or ask them to look at or point to a desired item or vocalize, verbally or using a communication device. Remember to use communication methods that work well for the child and you’re on your way to helping him grow, learn and show off their personality. 

Phyllis Watson, CCC-SLP, AAC specialist, and Julie Irwin, M.S.,CCC-SLP, ATP, are clinicians at Crotched Mountain ATECH Services in Concord. ATECH offers comprehensive assistive technology services to people of all ages and abilities throughout New Hampshire.

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