Nurturing Communication in Kids With Autism

We know young children with autism benefit from support as early as possible to help them build social and communication skills that they may not be developing on their own. That usually means getting help from a professional who works with autistic children, but parents are encouraged to learn to use the same techniques to practice regularly at home.   

In typically developing children, early social communication skills appear in a natural sequence, beginning with basic nonverbal communication — like looking at someone, pointing to something, or imitating what another person is doing. One of the earliest signs of autism is a delay in these early skills.

“In the same way that a child can’t run without first learning to sit up, stand, and take their first steps, there’s a predictable sequence that has to happen before social communication skills like language can develop,” explains Cynthia Martin, PsyD, the senior director of the Autism Center at the Child Mind Institute. She calls these early social building blocks “precursors to talk.”

These skills are the foundation not only for language but for many kinds of engagement and interaction as children grow, from playing with other kids to reading nonverbal cues to learning from other people.

The most effective early support for these skills in autistic children follows that same developmental sequence that occurs without prompting in neurotypical children. Helping them build these foundational skills has been shown to improve their ability to develop language and interact socially as they grow.

The kind of therapy most experts recommend for helping kids develop communication skills is called naturalistic developmental behavioral intervention (NDBI). Naturalistic means that the teaching of skills occurs in a natural way — within the context of play or during a daily routine. Developmental means that it aims to help a child move though the typical sequence of development. Behavioral means that it uses strategies of behavioral therapy like reinforcing, modeling, and prompting. An intervention is a structured way to teach skills.  

NDBIs aim to help kids develop social and communication skills in a play-based, child-led way. Parents can use NDBI techniques to enhance communication with their children at home, as part of everyday play and routines like getting dressed or brushing teeth.

Earlier forms of training for young children with autism were more regimented. ABA, or applied behavior analysis, initially involved taking children through a predetermined set of exercises. But it was found that skills developed in the context of daily life are more likely to be remembered and used.

“It’s one thing to have a kid sit at a table in front of a set of three pictures, and say, ‘Find the T-shirt,’” Dr. Martin explains. “It’s a totally different thing to be at home and say, ‘OK, it’s time to get dressed. Find your T-shirt!’”

One popular NDBI program called  Project ImPACT — which stands for Improving Parents as Communication Teachers — works with parents of children ages 1-8 who have social communication delays, including those who have been diagnosed with autism spectrum disorder. Since neurotypical children develop these skills without prompting, Dr. Martin notes, it’s not intuitive for parents to know how to nurture them.

Project ImPACT identifies four groups of skills young children need to develop as building blocks for later, more sophisticated social interaction:

Social engagement: Using eye contact, facial expressions, gestures, and words to engage with others and share interests and attention. Social engagement is the basis of being able to learn from others.

Communication: Understanding and using facial expressions, gestures, sounds, words and sentences to interact. Children start with nonverbal communication, through eye contact and vocalization, then add gestures, like reaching, giving, and pointing, before they start using words. When children can’t communicate effectively they may develop problem behavior to try to get their needs met.

Imitation: Copying others helps children learn new skills and show interest in others. “Imitation is an important skill for kids to learn in the context of interactions with other people — it’s a way to connect with other kids — but also in the context of general learning,” adds Emilie Weiner, BCBA, a behavior analyst in the Autism Center at the Child Mind Institute.

Play: Interacting with toys and other objects for fun helps children learn social, motor, and problem-solving skills. Pretend play with other kids also strengthens the foundations for language skills.

Project ImPACT teaches parents to use a set of techniques that have been shown in research to be effective for developing communication skills. These techniques include:

Focus on your child: Parents learn to start by joining their child in an activity of the child’s choosing, letting them lead the activity. Get face-to-face with your child and hold objects they are interested in near your face, to encourage them to look at you. Become part of the play by handing them things or imitating what they are doing. If they are playing with cars, get another car and imitate what they’re doing. If they are splashing in the bath, splash with them.

Use animation: Show excitement about your child’s activity, using big gestures and exaggerated facial expressions. Use simple language to talk about what you and the child are doing. Vary the volume and pitch of your voice, to make it stand out to your child. Use attention-getting words and phrases like “Wow!” and “Oh no!” Then wait and watch for their attention. When you get a reaction, respond with simple language and imitate what they are doing.

Model and expand communication: Use simple language to talk about what you and your child are doing. Stress important words and repeat them several times. Expand your child’s communication by adding new words. The idea, explains Dr. Martin, is that you match your language to whatever length your child’s utterances are and then go up one more word. “So if your child is predominantly speaking in one to two words, then you need to limit what you’re saying to two to three words. And you want to phrase things as statements, not questions.”

Create opportunities: Prompt your child to show or tell you that they want something by setting up an opening and then waiting and watching. The key is that you don’t just anticipate what their needs are, says Alexis Bancroft, PhD, a psychologist in the Autism Center at the Child Mind Institute. “Maybe you say something like ‘What do you want?’ Then you wait for them to look at you or show you in whatever way they can and then give them the thing they want.”

Playfully obstruct: One way to prompt communication is to playfully block a child’s activity and wait for them to respond. You start by choosing a word or phrase to warn them you are about to interrupt. If they’re pushing a car, you can say, “Beep, beep!” and block the car with another car. Wait for a response, and then move the car and say, “Move!”

Take balanced turns: Introduce the idea of taking turns by watching your child, narrating what they are doing, and then taking a turn yourself. When you take a turn, you model play skills. “If you are building with blocks, you model a new way they could build with blocks,” says Ms. Weiner. “You’re modeling behaviors and skills that you want your child to seize or to engage in, but not forcing them to engage in them.” Having two sets of toys can facilitate this kind of interaction. “With your set, first you imitate what your child is doing, and then you model a new way to do it and narrate what you are doing,” explains Dr. Martin.

Set up communicative temptations: Put fun things in sight but out of reach to prompt your child to say or show you what they want. Offer one cracker and prompt them to ask for more. “Instead of them just helping themselves to the snacks, you create a little barrier,” says Dr. Bancroft, “so that the child has to take that extra step.” Instead of having all the toys out and available, you might put things on a shelf where the child can see but not reach them without your help, or in bins where the child can see them, but they can’t open them themselves.

Teach new skills: At whatever level your child is communicating, prompt them to use a slightly more complex skill by modeling it, and reward new behavior.Pause before giving a prompt, gain your child’s attention, and use simple language. Use only one prompt at a time, then give the child time to respond, such as counting to five in your head before giving another prompt. If you need to prompt a third time, give more support so they can be successful, such as helping them point to it. For instance, if you want the child to point to bubble toy, the first prompt might be to show your child the toy and wait. The second might be to say, “What do you want?” The third might be to help them point to the bubble toy.

Project ImPACT recommends using these techniques during as many activities as possible, and outside the house as well as at home. And while the goal of using them is to encourage children to engage and communicate more, there are benefits for parents, too.

These techniques can also help parents connect with kids who don’t respond typically. “When an autistic child doesn’t respond as much as a parent might hope — like not making eye contact, smiling back, or showing interest — the parent may start to feel discouraged,” explains Dr. Bancroft. “Because they’re not getting that response, a parent might naturally pull back a bit themselves. But when parents have tools to help their child engage more, it can really strengthen that back-and-forth connection. It supports a more mutual, rewarding relationship between parent and child.”