How to improve communication with a person with ASD

There are two patterns of interaction among children and individuals with ASD: one more inhibited profile, who struggle to initiate social interaction and tend to remain isolated, focused on their own interests; and another profile that seeks contact and connection with others but often fails to use appropriate strategies and also ends up experiencing difficulties in social relationships. Therefore, at a therapeutic level, it is recommended to work on social skills through everyday situations, for example, using role-playing techniques, both individually and in groups.

Sometimes it's not easy to communicate with a person with ASD, but don't be afraid to try.

Some practical tips might be:

• Ask their caregivers or family members what the best way is to communicate with the person with ASD. What they like, what makes them nervous, etc.
• Use simple language , without double meanings or ambiguities.
• Create or find the right context for communication to take place, trying to avoid excessive noise, stimulation, or light.
• Give the person with ASD enough time to respond.
• Be patient and don't expect them to respond in the way you would expect from someone without a neurodevelopmental disorder. It's necessary to make the effort to adapt to their way of communicating.

There is a variety of interesting books available for families. Some of the most recommended titles are:

• "The Denver Model of Early Intervention for Young Children with Autism: Language Stimulation, Learning, and Social Motivation" by Sally J. Rogers and Geraldine Dawson. The Denver Model, for children under 6 years old, is the first comprehensive and empirically tested intervention model designed specifically for young children with autism.
• "A Different Mind: Understanding Children with Autism and Asperger's Syndrome," by Peter Szatmari.

• "Young Children with Autism," by Equipo Deletrea (Editorial Deletrea)
• «Invisible Worlds», by María J. Portella (Tibidabo Ediciones, 2018)
• A Parent's Guide to Autism (AUTISMSPEAKS).

There are various resources that may be of interest to teachers.

Some references we can recommend are:

• " Access to the curriculum for students with ASD. TEACCH Program ", by Gary Mesibov and Marie Howley (Published by Autismo Ávila)
• "Autism: From Theoretical Understanding to Educational Intervention," by Theo Peeters (Published by Autismo Ávila)
• Resources for Educators Child Mind Institute .

One of the main difficulties that children and adults with ASD have is managing social interaction and communication.

There are some recommendations we can follow to improve this listening:

First, it's important to know what they understand and at what level. It's important to know if the message we're conveying is reaching them, if they have the capacity, and even the context, for these people to receive this message.

• Establish eye contact and make sure they are paying attention. I can ask, for example, if they can listen to me for a moment.
• Let them know in advance that I need their attention and that afterwards they can continue doing that task or playing.
• Position yourself close to the child or adult; do not speak to them from a distance.
• Try to speak with an appropriate tone and volume ; raising your voice will not make you more audible or improve communication.
• Use short, clear messages . Be patient and give them time to process the information and respond.
• If necessary, it is advisable to say the message verbally , accompanying it with a drawing or gesture .
• Once the message has been given, wait and repeat it if necessary. If there is no response, calmly approach the person and accompany them to the place you are asking them to go.

It is important to keep in mind that frequent repetition of instructions teaches people not to listen.

In this case, we would need to determine if the person with autism is not understanding the message due to its complexity or because they are distracted. In other words, we need to know if it's a problem with understanding the message or with communication. In these cases, we must find ways to help the person with ASD understand the message: positioning ourselves close by, using simple language, using visual aids, trying to anticipate what will happen, and avoiding changes in routine. All of these strategies will facilitate their understanding of the message we are trying to convey.

One of the difficulties some people with ASD face is social interaction and communication. They often don't realize they are behaving inappropriately or don't perceive the impact their behavior has on others. They struggle to empathize with others and understand if they are making them uncomfortable or causing them distress.

To avoid this potential rejection, we can work on turn-taking. This means helping the person with autism understand that there are speaking turns and that maintaining interpersonal distance is important both in conversation and during games. It can also help them understand the importance of controlling the impulse to constantly explain everything without realizing that the other person also needs their space and may want to respond to everything being explained.

We can also train social skills, both verbal and non-verbal, through role-playing , that is, creating fictional situations in which they can practice these skills so that when they are in the natural environment it will be easier for them.

Sometimes it's also necessary to explain social rules to them, which aren't easy for them to understand. The goal is to help them memorize and internalize these rules, even if they don't fully grasp the reasons behind them, so they can then apply these concepts to more natural contexts.

It is quite common for people with ASD to have other difficulties and sometimes other disorders - we call it comorbidity - such as ADHD, so we have people with attention difficulties, hyperactivity, and management is already more complex.

In daily activities, such as showering, dressing, or eating, it's important to establish a routine, a sequence that allows you to tell the child what they will be doing during the day and in what order. Rules and routines give them security because they allow them to anticipate events. Children with ASD are often very cognitively rigid and need this security and structure.

One helpful element is using a visual schedule to anticipate daily activities; this will facilitate compliance and reduce disruptive behaviors.

And above all, keep your messages simple and clear ; repeating something many times won't necessarily make them understand better. Sometimes it's necessary to repeat the message once or twice and give the child space to process it. Sometimes we give too many instructions in a row, and we overwhelm the child.

In most cases, problematic behaviors result from unmet needs and desires, communication difficulties, or a lack of appropriate control over one's physical and social environment. Therefore, problematic behaviors generally serve a purpose.

Techniques for reducing and managing inappropriate behaviors

• Anticipation and prevention:
  • Change activity: we can do something else that we know he likes as an alternative to something that is irritating him.
  • Allow them to express what bothers them or what they no longer want to do.
  • Warning: tell them they are doing something inappropriate, explain the consequences they will receive if they do not stop the negative behavior, and also give them an alternative way to do it appropriately.
• Time out (toddlers)
• Extinction
• Positive reinforcement

Regarding the use of mobile phones or electronic devices, it's important to approach it the same way as with all children and teenagers. Limiting usage is crucial, establishing specific days and times for use , and clearly indicating this in a visual format (on paper or poster board). This way, there's no doubt or misinterpretation about when and for how long they can be used.

It's also helpful to provide positive reinforcement when they follow through and to establish and agree upon a privilege, such as a little more playtime another day, if necessary, adapting it to their age. If they don't comply with the agreement, you can agree to not use the device another day, if needed.

It is important to anticipate, limit, and comply with what has been agreed.

It's not good to force communication, but rather to show them the benefits. It's always important to respect the person's situation, consider the cost of these situations, and avoid overwhelming them with communication if they find the situations complex.

We should try to ensure situations where this communication is likely to be successful. We need to create a pleasant environment where everyone feels comfortable, and then test different communication methods to see what works best.

It is very important to respect the right of people with autism to interact with others. The environment must be adapted to allow them to communicate; this effort must come from others as well, not just from the person with autism.

In summary, don't overwhelm the person and keep in mind the different patterns we can find: people who want to communicate but lack strategies, and others who don't, for whom it is difficult and we shouldn't generate too much stress for them.

Isolation is never good. It's important to find their interests (even if they're usually limited) to motivate them to go out. Find things they enjoy that they don't find at home, such as walks in nature, going to the pool, etc.

Regarding employment, if you find a job that suits your needs, you will have to look for some occupational resource such as a day center, an occupational therapy service or a special work center where the context and support help the person with autism.

It is important to emphasize that it should not be the person with autism who makes the effort, but rather we, the resources or the context, should try to adapt to the characteristics or needs of the person with autism.

Another way to participate in activities that motivate them is through those organized by associations, which help foster moments of interaction and social communication. There are always a variety of options, from recreational and sports activities to weekend outings, workshops, and more.

Some organizations where you can find information about these activities and resources include Associació Aprenem Autisme and the Friends Foundation . You can also find those closest to your home on the website of the Spanish Autism Confederation .

In the classroom, to ensure that a student has understood what is being asked of them, we must approach them and ask them directly if they have understood, because sometimes we assume that they are understanding us and this is not the case.

The teacher must adapt to the student, not the other way around. The classic trial-and-error method doesn't work with people with ASD. As a starting point, it's important to consider the student's own interests.

It's important to keep in mind that they have difficulty adapting to new situations and changes. A structured environment with routines and activities is essential. Using visual schedules and timetables is helpful. Provide them with all the necessary materials and resources to complete tasks and gradually increase their independence.

In these activities, visual elements should take precedence over textual ones, as this facilitates comprehension. It will also be important to work on declarative functions, such as asking for something or offering something, to help them adapt and reduce stressors.

It is important to praise him frequently and ignore some disruptive behaviors, as long as they are not self- or other-aggressive.

It's important not to constantly use the word "NO." It usually indicates that someone is angry or that something is wrong, but it doesn't offer guidance on how to do it or how to do it better. Use it sparingly and only when immediate attention is needed (in emergencies).

It is important that the teacher adapts, but also the context, the classroom and the subject to the characteristics of the student.

There are strategies that are useful in the classroom to help students with ASD :

• Seat the student near the teacher.
• Provide them with a pleasant, distraction-free workspace with enough room to work.
• Assign him a partner who can help him with communication, who can be a support.
• Use visual aids with images or drawings to help students understand what the teacher is explaining. We can even go further and adapt these images or explanations to the child's interests to capture their attention. For example, if we know the child likes trains or dinosaurs, we can make them the focus of our classroom examples (instead of saying, "a car travels at 40 km/h," we can say, "a dinosaur travels at 40 km/h").

It must be said that most of the strategies used with students with autism are also effective and helpful for the rest of the student body because they facilitate communication. Ultimately, making these adaptations is a worthwhile investment because the entire group benefits.

There are also specific communication training courses for working with people with ASD:

• Educatio is an organization that offers high-quality courses for teachers, family members, therapists, etc.
• PECS Spain offers training in communication and augmentative and alternative communication (AAC) systems.
• TEACCH Method as a life support tool (from early childhood to adulthood).

Children and adults with ASD have difficulty identifying and expressing emotions. Clearly, emotions can and should be addressed through work.

It is important to work in a coordinated manner in the different spaces that are part of their immediate environment: school, institute, home, mental health center, and to use common strategies so as not to generate frustration for them.

First of all, it is important to name and put words to the feelings we observe; we will be helping them to learn about emotions and to be able to learn by imitation.

The level of distress in the child or individual must be taken into account, but activities designed to address emotions in these students can also be beneficial for others. Using visual aids will facilitate this process.

Some activities might be, for example:

• Emotion cards (identifying facial expressions, identifying the emotions of different characters based on social situations, memory game )
• Emotional thermometer to help regulate anger and/or anxiety
• Identifying bodily sensations linked to emotions in order to work on self-regulation, stories.

There are different websites with interesting resources to work on this topic, both with children with ASD and for the rest, such as pictoaplicaciones , auticmo.com or elsonidodelahierbaelcrecer .

It's true that there are few resources, especially for adults. And those that exist are linked to disability. These only function when there's a case of autism spectrum disorder (ASD) with a disability, as is the case in Catalonia with the Specialized Services for Mental Health and Intellectual Disability (SESMDI), which are similar to Child and Adolescent Mental Health Care Centers (CSMIJ) with outpatient follow-up. It's true that these are limited resources.

Regarding residential resources, there are more, but they have limited spaces. Then there are employment inclusion resources that help people with ASD to develop safely within a work environment.

We have a significant social and health challenge to generate more resources.

The important thing is to reinforce any strategy used to initiate communication, as long as it is an adaptive strategy.

I would recommend preparing situations in which the person with ASD has to ask for help to get something. I would prepare the environment so that they encounter some difficulty in getting what they want and the need to communicate. I would position myself close to the person so they can easily find me, or I would place the communication folder nearby so they can give me the corresponding pictogram, etc. Later, I would gradually increase the difficulty, the distance from us, and so on.

Even so, it's important to keep in mind that to be successful, you must start by using strong, primary reinforcers and gradually replace them with less powerful ones. If augmentative and alternative communication (AAC) systems cannot be used, real objects can be used (for example, leaving a water bottle nearby so the child can fetch it if they are thirsty), and you should never extinguish any communicative attempt; value all attempts, as the important thing is that they communicate, regardless of whether it's with pictograms or gestures.

Personal objects can be used to distract them or give them security, external stimuli can be reduced, and environments where the person with ASD feels safe and protected can be facilitated.

Like any other person with ASD, they also have some difficulties in the area of interaction and communication, so we should relate to them in the same way we do with all people with autism.

There is no single most suitable professional profile; it is recommended that intervention for individuals with ASD be carried out by a multidisciplinary team (pediatric neurologist, psychiatrist, psychologist, nurse, social worker, occupational therapist, social worker, etc.) depending on the clinical characteristics and severity of the case. There is no single treatment; rather, an individualized therapeutic plan must be developed for each person.

The educational landscape is complex, and it's important to remember that each child has a unique profile and specific needs. These children make an extra effort to learn at their own pace, and sometimes the educational needs and diversity of each child, with or without autism spectrum disorder, are not sufficiently considered in the classroom.

It's important to personalize teaching, taking into account different intelligences and adapting the learning process to each child. Undoubtedly, teachers try to do the best they can, but more training in this area and perhaps more resources within the system are also needed.

As a teaching professional, I have to say that it's very difficult to address all the diversity that exists in classrooms. Even so, there are strategies, like those we've mentioned in other questions, that can help:

If the centers have the necessary resources, they can organize small groups, put two teachers in the same classroom and thus attend to diversity, and provide specific training in ASD.

At the curricular level, there are individualized plans. This document, which must be developed jointly by the family, the Psychoeducational Guidance and Counseling Team (EAP), and the student's tutor at the beginning of the school year, should outline the student's learning objectives and the necessary curricular and environmental adaptations. It is also important to conduct a quarterly assessment to allow for adjustments based on the student's progress.

There are several factors that can trigger anxiety in people with ASD:

• Communication difficulties
• Difficulties in understanding and managing social relationships
• Sensory processing abnormalities
• Rigidity

Anxiety that people with Asperger's syndrome can also experience in a communication and relationship situation.

In these distressing situations, the first thing we should do is make adjustments to the physical environment (reducing uncertainty, decreasing sensory overload, adjusting the level of demands, avoiding a succession of frustrating situations, etc.) and the social environment (adjusting our language, maintaining a calm attitude, being patient, giving time, etc.). Working on emotional regulation strategies, socio-communicative skills, conflict resolution, strategies for coping with fears, and cognitive and behavioral flexibility will be a way to help these individuals.