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FAKE vs REAL: Communication Support

A 2 panel cartoon by Autball.  1: A white box at the top reads: FAKE COMMUNICATION SUPPORT.  A red adult sits at a table with a blue/purple adult and a green/blue child. The red adult says to the other adult, “Communication is so important for reducing frustration and challenging behaviors (which are so hard on the rest of us!), so let’s see what we can do to get them talking.” On the table are only two options: a binder labeled “Speech” and a binder labeled “PECS.”  2: A white box at the top reads: REAL COMMUNICATION SUPPORT.  A green adult sits at a table with a blue/purple adult and a green/blue child. The green adult says to the child, “Communication is human right, and you deserve to be heard. We’re gonna try all the respectful methods of communication available to us until we find what works best for you.” On the table are many more options: Picture Cards, Speech, a letterboard, a pen and notepad, Sign Language, and an AAC device.

Communication support is a desperately needed thing for so many autistic people and their families. So unlike some of the other things I’ve posted about this week, this is 100% a worthy goal. Unfortunately, many places that claim they can offer it are not delivering. 

In some cases, they simply don’t have the education to properly support communication needs (I’m looking at you, ABA). Other times they do have the proper education (ie Speech Language Pathologists) but they will gatekeep certain methods of communication, either because they believe harmful myths about them or they haven’t been trained in that particular method. Also, not every SLP knows about Gestalt Language Processing, so even an otherwise great therapist could be missing some information.

So here are some questions to ask when trying to figure out if someone is truly capable of offering well-rounded, neuro-affirming communication support:

Are they more concerned with making the client easier to deal with for others, or are they focused on the client’s rights, needs, and wishes? (We’re looking for the second one.)

Do they address the client directly, or do they speak as if the client isn’t even in the room? (We’re looking for the first one.)

Do they see speech and language as a behavioral thing? (Verbal Behavior and PECS are dead giveaways - and we want a NO.) 

Do they understand that an inability to produce speech has no bearing on a person’s ability to think and feel? (YES.)

Do they only push for speech, see speech as the end goal, or value speech above all other methods of communication? (NO.)

Do they honor things like echolalia, pointing to objects, and bringing an adult over to something they want as valid communication? (YES.)

Do they honor things like refusal to participate, crying, and meltdowns as valid communication? (YES.)

Do they believe that things like pacifiers, AAC, or responding to “non-functional communication” discourages speech/“functional” communication? (NO.)

Do they know about Gestalt Language Processing and believe it is a thing? (YES.)

Do they require “pre-requisites” before they will try alternative communication methods? (NO.)

Do they require the client to earn time on their AAC device or remove the device when they deem it a distraction, essentially taking away their voice? (NO.)

Do they know who to send you to if they aren’t personally trained in an approach they think would be more helpful? (YES.)

Obviously, trying to find someone local to you with all the green flags and no red ones is kind of like trying to find a unicorn for most people. But if you have a choice between two or more therapists, you can at least go with the one who has more right answers and be ready to advocate/educate when needed. 

If you literally have only one option available to you and it’s not a good one, you can either be ready to advocate at every turn or just choose not to use their services. Yeah, that’s allowed! Not every autistic person needs speech therapy, and not all communication support has to be directly administered by a professional. You as the parent or caregiver will play a huge role in supporting your person with their communication needs, and luckily there are online resources and virtual trainings that can help you do that.

P.S. What’s the difference between PECS and picture cards, you ask? PECS is a whole ABA-based program that uses a limited set of picture cards and should be avoided for several reasons. Meanwhile, plain old picture cards are something that can be made and used by anyone without any specific program. Links to more on that below, along with other additional resources.

This is part 1 of a 5 part "FAKE vs REAL" series about the ways harmful practices are being made to sound more appealing through the co-opting of language and how to spot the differences between helpful and harmful approaches.

Part 1 on Neuro-Affirming Practice here

Part 2 on Self Regulation Skills here

Part 3 on Frustration Tolerance here

Part 4 on Sensory Desensitization here



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