Determining Best Methods for How to Teach Individuals with ASD to Communicate

Valentino, A. L., LeBlanc, L. A., Veazey, S. E., Weaver, L. A., & Raetz, P. B. (2019). Using a prerequisite skills assessment to identify optimal modalities for mand training. Behavior Analysis in Practice, 12, 22-32.


Many children with Autism Spectrum Disorder (ASD) have difficulty communicating their wants and needs. When unable to communicate effectively, some children engage in less adaptive behavior, like tantrums. To overcome communication challenges, providers and caregivers may decide to teach the child to communicate in a different way. It is common for children with ASD to be taught to communicate using sign language or by exchanging pictures. Each method of communication has advantages and disadvantages that should be considered. For example, sign language is an established language and does not require any materials, but it may not be understood by all social partners. Picture exchange can be understood by most social partners, but it requires the child to carry the pictures at all times and can limit the complexity of language.

Children with ASD differ in which communication method is easiest and quickest to learn. This study examined whether an assessment of prerequisite communication skills could predict which communication method would be easiest to teach to children with developmental disabilities, which included several individuals with ASD.

Who was involved?

Thirteen children aged 2-8 years old were included in the study. The sample included both primarily English-speaking and Spanish-speaking children who were diagnosed with either developmental disability or ASD. Five individuals with ASD were part of this larger sample, with all children in this subgroup listed as primarily English-speaking. Notably, all of the children with developmental disability (non-ASD) in the sample were two-years-old. The individuals with ASD ranged in age from 3-8 years old (average age = 5.3 years old). At the start of the study, children did not yet communicate their wants and needs by any means but were working on learning to request with a single word as a primary goal of their language program while receiving applied behavior analysis (ABA) services in a center-based program or home program.

What did they do?

First, preferred items were determined for each child. Next, the child’s prerequisite skills for each communication method was assessed. For sign language, the assessment examined whether the child imitated motor movements. For picture exchange, the assessment examined whether the child was able to match pictures of items to other pictures and to the items themselves. For speaking vocally, the assessment examined whether the child imitated one- and two-syllable sounds. Following this prerequisite skills assessment, children were taught to use sign language, picture exchange, and vocal speech to request three separate items, each assigned to one communication type. The most effective communication method was then used to teach any item(s) that were not learned with the other methods.

What was the outcome?

All children learned to request the items using at least one of the three communication methods, and approximately half the children learned to request items using multiple methods. Twelve of the thirteen children learned to request using picture exchange, eight learned to request using sign language, and one child learned to request by speaking vocally. Picture exchange was also learned fastest. The results indicated that a prerequisite skill assessment may be helpful in ruling out which communication methods are unlikely to be appropriate at a given moment in an individual’s development; it may not directly predict which method will work best for someone.

What are the strengths and limitations of the study?

Strengths: Several communication methods were assessed and measured in the same way across participants.

Limitations: The assessment did not predict success with any given method, although it did suggest what methods were unlikely to be helpful at the time of the assessment. The study was also limited to requesting three objects, each of which were initially taught with a different communication method. Finally, the researchers acknowledge that the training conditions to use each method were not equal. For example, use of pictures or sign language can be prompted while vocal speech could not. Also, approximations of words were not reinforced during vocal teaching, which may have decreased the likelihood that a child would persist in vocalizing toward the correct word.

What are the implications?

Alternative methods of communication (e.g., picture exchange, sign language) can be useful for some children as they work toward developing verbal speech. In order to ensure that treatments are most effective, a prerequisite assessment might be helpful in determining what methods of communication are not appropriate for a child. On the other hand, providers could focus on teaching sign language or picture exchange and monitoring progress with data to determine which method might be most efficient for that individual. Also, for children who don’t show a particular effectiveness/efficiency pattern, selecting a communication method can be based on other important factors (e.g., relative advantages and ease of use, caregiver/child preference).