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Rachel Cortese, MS Ed, MS CCC-SLP Headshot

What Nonverbal Kids Can Gain From Technology

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Many parents and teachers of children with special needs wonder if using technology to communicate is a good idea, or if it will stifle and get in the way of oral speech production. I'm asked this question almost every day in the office -- I can feel their worry, I know their concerns. It's a really good question that needs a full answer. Screen Sense is a perfect forum to clear up the misconceptions and explain the benefits of technology for kids with special needs and without.

As children progress through typical stages of language development, they are usually quick to find oral speech to be the easiest and fastest way to get a message across. But for some children with a variety of speech, cognitive or physical impairments, verbal speech is not an effective way to communicate.

It's important to remember that we communicate in many different ways. We use facial expressions, gestures and body language, writing and oral speech, to name a few. Ultimately, when we need to get our needs met, we are going to use whatever seems most efficient at the time. Children will naturally gravitate toward the mode of communication that's easiest, and, when they are able, oral speech production is typically the most efficient. But for children who do not have reliable oral speech, supplementing with technology, sign language or pictures can be an important stepping stone on the path to building effective communication. We call these other forms of communication Augmentative and Alternative Communication (AAC). Think about AAC as a supplement to other forms of communication, not as a replacement.

When a child's speech and language milestones are delayed, he needs a way to communicate wants, needs and feelings. If oral language production is hard, supplementing with AAC can help build the foundational language and communication skills that will serve him well as he continues to develop. In this way, technology is truly a beautiful thing. It gives voice, words and expression to an inner world that may otherwise lay dormant without the tools to access and express it. Who can forget The Diving Bell and the Butterfly, the memoir and movie about Jean-Dominique Bauby, the irrepressible French editor of Elle magazine, who suffered a stroke that left him in what's called locked-in syndrome. The only thing he could move was his left eyelid. The urge to express himself was so powerful for Bauby that he dictated the whole book by blinking that eyelid to choose one letter at a time. In the same way, young children are wired to articulate and share their experiences, and if verbal speech is impeded, assistive technology can help them discover the joys of expressing themselves.

The iPad is a popular choice in assistive technology because it's relatively cost effective, other kids will think it's cool and there are hundreds of dedicated AAC apps. These apps can be programmed to use pictures, words, phrases or sentences so that a tap of a button generates a message. More sophisticated apps allow the user to type a unique message and produces voice output. But there are many products on the market dedicated to generating speech besides the iPad, and some others may work better, especially for children in the earlier stages of language development.

In choosing a speech-generating device, keep in mind that a child using it should be progressing through stages in the same way a child with typical speech development would be on a trajectory to more sophisticated language. While handing a child an iPad might be the easiest, most readily available and socially acceptable way to generate and supplement oral speech, the iPad may not be the first choice for building communication skills in children who have not yet developed speech production.

Since language is symbolic -- a word or a picture represents an object, for example -- children must develop the capacity to represent things mentally and symbolically in order to speak. The same is true of assistive technology; they have to understand that a picture represents a real life experience. For example, a child can hand you a picture of a glass of water, indicating that she wants water, even if she can't say the word. In order to do that, she needs to understand that the picture represents the actual thing, water.

It's also important to remember that communication happens between two or more people. Interaction is an important component of communication and children must learn to send and direct messages to another person in order for their communication to be intentional. This is true for both verbal speech and AAC. A child who uses speech must direct the word "water" toward a communication partner -- a parent, for example -- with body positioning, eye contact and intention in order to actually send the message. Interaction can be a challenge when using technology to communicate. Pressing a button may generate speech, but unless the child understands that she needs to direct the output toward a communication partner, tapping a picture on the screen and generating a word or a sentence won't have much utility for communicating.

Some lower-tech options, such as the Picture Exchange Communication System (PECS), created by Lori Frost and Andy Bondy, may be better at fostering the underlying cognitive representational skills necessary for speech, as well as the intent to communicate, which comes before speech, whether produced verbally or generated by a device. PECS follows a structured teaching hierarchy, where a child learns to identify and discriminate between pictures (just as a verbal child does with words they hear and will eventually use) before they learn to exchange a photograph of an object and then a picture symbol for a real-life object. Later, the child learns to combine pictures and words. For example, instead of just exchanging a picture of juice, they may combine the symbol for "I want" and "juice" together on a sentence strip to begin to expand their language, in the same way that children who use spoken language begin to combine words. Because of this type of hierarchical teaching, there is some evidence that children who use AAC may learn the underlying cognitive representational skills necessary for speech. Children must first learn to think symbolically in order to use language, and PECS is designed to facilitate symbolic and representational thinking.

A low-tech system like PECS has its drawbacks. It can be time-consuming to make materials and difficult to implement. Eventually, switching to a speech-generating device like the iPad will be tremendously advantageous for children and adults who will continue to rely on AAC as an effective method of communication. A licensed speech language pathologist can help sort out the options and help determine a child's readiness for the multitude of devices, apps and modes of communicating that are currently available.