All parents want their children to speak, but this may not always be within our control.

Around 25-30% of children diagnosed with autism are non-verbal or minimally verbal (NVMV), meaning they use fewer than 20 words for communication. Such children require alternative methods to effectively communicate within their communities. This method is known as Augmentative and Alternative Communication (AAC).

AAC serves two primary purposes:

• Alternative Communication: Used when speech is absent or not functional.
• Augmentative Communication: Complements speech with additional methods.

AAC methods vary widely, from simple gestures, picture boards, and writing, to advanced technologies such as communication apps and speech-generating devices.

While verbal communication remains a primary goal, there is limited evidence that this approach effectively benefits non-verbal or minimally verbal autistic children. For instance, an early intervention centre in Australia found that over 50% of autistic children exhibited similar language abilities even after receiving 15-25 hours of therapy per week for 14 months. Despite this, AAC is often considered a last resort, typically sought after years of unsuccessful interventions.

Autism is a spectrum, and verbal autistic individuals also have diverse communication needs. Some verbal autistic adults continue to:

• Speak intermittently – can speak sometimes but not always
• Have unreliable speech – may say things that do not match their preference or intended meaning
• Speak accurately but not sufficiently – can speak orally and accurately but not completely to meet their needs

Instead of focusing solely on the ability to speak, we should be looking at how the child can be supported to communicate immediately. AAC should be considered based on the child’s overall communication needs, not just their ability to speak.

Using various communication methods tailored to a child’s strengths and needs, like visual aids, helps autistic children understand and express themselves better. This approach benefits all autistic children, whether they are verbal or non-verbal. They should be supported to communicate in the way that suits them best, whether through speech, pictures, typing, writing, or other methods.

Communication, not oral speech, should be prioritised. Autistic individuals should always have an effective means to communicate. This means:

• They can say whatever they have to say.
• They are not limited to simple requests.
• They can create grammatically correct sentences if they choose to
• Their communication is relatively easily understood by others.

If speech is not an effective and reliable way for an autistic person to communicate, they should be provided with an AAC system. They should also receive support to learn, use, and maintain their communication devices for as long as needed, which for some may be a lifelong process. Additionally, effective communication means using the language the person is most fluent and comfortable with, even if it is not the dominant language of the area.

Choosing the method of communication should be up to the user. Denying an autistic person the option of AAC is like stopping a deaf person from using sign language or hearing devices. Accepting autism includes accepting the way they choose to communicate.

We should strive to ensure that all autistic individuals feel included and supported in their chosen method of communication.

This article was adapted from an article by Yong Ennie, Speech-Language Therapist, PERMATA Kurnia Centre.