I have discovered that when people with typically verbal family members think about speech therapy, most assume that it exclusively involves the process of teaching appropriate verbal speech.  This certainly can be the case, but when an individual isn’t capable of producing vocal sounds or putting them together in ways recognizable to others, the approach is on teaching communication. 

I have also sometimes encountered individuals who think communication cannot happen without verbal speech, and that genuine thoughts and needs aren’t being expressed in the absence of the spoken word. If that truly were the case, what exactly is the point of reading or the written word?  What communication needs to be valid is simply a shared understanding and recognition of a symbol and how it relates to what is being desired, thought, and expressed- and many things can serve in that capacity.

There are studies supporting that the use of modified sign language, often referred to as “Baby Signs,” with babies and young toddlers promotes earlier communication and reduces unwanted behaviors such as tantrums. Children who are exposed to these techniques often acquire effective verbal skills more quickly than their non-signing peers.  For these reasons, I did Baby Sign and Signing Time with both Hannah and Tony from infancy.

For Tony, who has more significant struggles with getting his muscles to do what his brain wants them to (motor planning), he was never able to reproduce more than a few of the simpler modified signs (eat, more, and cracker are the ones he does best). When his verbal language regressed, we therefore needed a different method for helping him express his wants.  This was of paramount importance because in those earlier years, we had hours upon hours of screaming meltdowns a day- even in the home environment.

One of the more common approaches for non-verbal individuals is the Picture Exchange Communication System, or PECS for short, and this is what we ended up using.  Under the direction of his first speech therapist, what we did was took actual photographs of only a few of the foods and drinks Tony most often wanted.  The pictures were printed about 3 inches by 2 inches (they needed to be big enough for him to grasp and pull off because of the severity of his fine motor delays), laminated, and then I used Velcro dots to attach them to the refrigerator.

Teaching PECS to Tony wasn’t very hard, but it did take consistency and patience.  If he brought me his sippy cup because he wanted a drink, I would walk him to the picture for the cup, help him grasp it if necessary, and hand-over-hand assist him in supplying me with the picture.  I would then say “Drink. You want a drink,” after which I would fill his cup.  After about two weeks, he was bringing me the pictures on his own. 

Once he was doing that successfully, I taped black and white line drawings of the items to the corner of the picture and would point to the drawing and the picture before I got him the item.  These drawings needed to be small enough not to obscure the actual main item in the picture. After a couple of weeks, I replaced out one or two of his pictures with larger line drawings of the item.  When he was using those consistently for what he wanted, I replaced all of the pictures with line drawings and then expanded the selection. 

I also began shrinking the size of the drawings gradually.  The last version of his PECS binder had images that were one-inch squares (I converted to this to promote the use of a pincer grasp and indeed it did, but he certainly could not have started out with this size because of his fine motor deficits) and included dozens of movies and TV shows.

Ultimately, this binder was replaced with an iPad mini equipped with TouchChat HD, an app that is based on PECS.  In the early stages of teaching this app, we started out with the four-screen setting because his pointer finger aim wasn’t good enough to hit anything smaller.  So, each category had to have multiple pages with only 3 items and an arrow leading to the next page.  His fine motor has improved enough that his pages can now have 25 image buttons, but any smaller and he wouldn’t be able to accurately “hit” the items he wants.

What I did to teach Tony that TouchCHat was now to be used in the place of his binder was sit him down with a bowl of popcorn (a highly preferred food item), show him the sequence of “buttons” to push to request it, and then I prompted him to request every piece of popcorn he wanted.  That may sound harsh, but he needed that kind of repetition to reinforce learning the use of this device as a means of communication.  By the end of the first day, he was using it to ask for all of his food wants.

As you read this now, you may not personally have a kiddo that would require you to know any of this info.  But you may someday soon run across someone with a non-verbal loved one who is experiencing what we initially did- a wait of many months for a speech therapist.   When that happens, point them to this post and give them a hug from me if they want it. Also, for these parents, I recommend an incredibly useful book that was shared with me by a speech therapist, More Than Words, by Fern Sussman.