Enhancing the communication development of toddlers with autism spectrum disorders

Communication functions are often rooted in intent (Quill, 1995); as such, communicative intent needs to be considered in relation to the function of communication (Wetherby & Prizant, 1989). Three broad categories of communicative functions that are applicable to both preverbal and early verbal communications of young children are social interaction, behavior regulation, and joint attention. Although communicating for behavior regulation functions appears to be a relative strength compared to joint attention functions for preschool-age and older children with ASD, research in our laboratory and elsewhere suggests that gesturing for the purposes of behavior regulation and joint attention are both relatively rare in toddlers with ASD, whereas gesturing for the purpose of social interactions is more commonly observed (Neitzel, et al., 2003; DiLavore & Lord, 1995). Thus, in individualized assessment and planning for the toddler with ASD, it is important to examine the use (or nonuse) of communication for each of these three broad categories.
It is critical that the examiner identify the conditions under which the child consistently responds to others’ communication and how the caretaker may modify the situation to increase the child’s understanding; this will help the evaluator to make recommendations on how parents and other caregivers could modify their communicative input to the child to enhance attention and comprehension processes (Quill, 1995). For example, was the child’s response differentially affected when the adult did any of the following: spoke more slowly, used shorter sentences, repeated certain words, used expressive gestures, provided motivation for the toddler (e.g. caretaker provides two choices including the child’s favorite toy train and a doll the child routinely disregards), or used communication in a routine context (e.g. “Time for lunch,” when the child could see or smell food being prepared). In general, toddlers are better at understanding adults’ intentions than they are at understanding the specific words, and this may be especially apparent in assessing children with autism (Carpenter, Pennington, & Rogers, 2001).
Finally, another area to consider during the assessment process is object play behaviors. Both expressive language and symbolic play are considered forms of representational or symbolic behavior. Earlier forms of object play also may be important foundations for language development. If, for instance, a child engages in play with a variety of objects, and if the parent frequently talks to the child about the child’s focus of attention (as was the case in research by Watson, 1998), then the child’s play behavior will afford the parent with opportunities to model a broader diversity of vocabulary in talking to the child, in a context that appears to enhance the language development of children with autism (Siller & Sigman, 2002). In addition, functional play, or playing with objects in conventional ways, provides a basis for the child to make predictions about what other people are likely to be saying when they communicate about a particular object (Chapman, 1978). The evaluator should document the child’s number of different action schemes (e.g., rolling a ball, putting blocks into a box, spinning the wheels on a toy car), as well as the complexity of action schemes in symbolic play (e.g., a one step scheme might involve putting a doll to bed, whereas a two step scheme might involve feeding a doll and then putting the doll to bed), and their level of constructive play (Wetherby et al., 2002).