The effect of using ‘full’ language when working with a child with autism: Adopting the ‘least dangerous assumption’

Abstract

A 10-year-old boy with autism was part of an evaluation of an innovative intervention focused on improving communication skills. His school was using the minimal speech approach (Potter and Whittaker, 2001) with all children in accordance with government guidance. The pupil’s receptive language had not been formally assessed due to his lack of cooperation in tests and his perceived low ability. Informal assessment indicated that the pupil had restricted receptive language and school targets included understanding of basic verbs. Researchers adopted the use of ‘full’ language and stimuli including written words to engage the child and to investigate motivation and competence. Post intervention the boy demonstrated better understanding of complex language and literacy skills than previously expected. Blanket adoption of the minimal speech approach and the low expectations of staff may lead to children’s abilities being underestimated.

Keywords

autism expectations full language intervention receptive language unexpected literacy

I Introduction

This article tackles the complex question of how adults might best talk to, and engage, children with autism. There is general agreement that difficulties with language comprehension appear at high rates in children with autism (Frith, 1989), and a wide range of receptive language ability is reported (Jarrold et al., 1997; Wetherby, 2006; Wing, 1996).

It can be very difficult to assess accurately the comprehension of non-verbal children who frequently fail to respond to instructions (Potter and Whittaker, 2001). A child’s appropriate response to spoken language may constitute a false positive if they conform by using situational cues or having memorized a routine. Alternatively, when a child fails to respond this can be attributed to their autism or a lack of willingness to comply. Needing frequent repetition of requests, needing to be guided to perform an action, having a lack of facial expression or moving away when spoken to and responding more positively when minimal speech is used can be indications of a receptive language impairment (Potter and Whittaker, 2001).

The UK Government guidance on teaching pupils with autism acknowledged the need for ‘a programme with a focus on communication, regardless of the language ability of the child’ (Department for Education and Skills, 2002: 18) and recommended the use of the ‘minimal speech approach’ (MSA) (Potter and Whittaker, 2001). Specifically, when talking to non-verbal children with autism who have difficulty understanding spoken language, adults should reduce their speech to ‘single words or two-word phrases (e.g. tidy, story, snack, lunch now)’ and ‘use gestures such as pointing, rather than speech, to show the pupil what to attend to or what to do’ (Department for Children, Schools and Families, 2009: 16). Potter and Whittaker (2001) base this advice on a study involving 18 children with autism aged between 2 and 6 years of age with severe communication impairments. Analysis of interactions between staff using minimal speech and children with autism highlighted the latter’s increased engagement, responsiveness and spontaneous communication. They identified the benefits of ‘proximal communication’ where adults used minimal speech and followed the child’s lead with an emphasis on social engagement. Potter and Whittaker (2001) advised against close face-to-face communication with children as this tended to increase adverse reactions unless the adult was using no or minimal speech.

This case study reports work with a child, Jack, where, in accordance with ‘good practice’, school staff had restricted the amount of language they habitually used. The research aim was to measure the effectiveness of a novel intervention by recording any changes in the child’s communication and exploring teaching staff’s perceptions of the intervention. The intervention was founded on the concept of ‘the least dangerous assumption’ (Donnellan, 1984), which focuses on capacities and challenges the implicit assumption that expressive language skills equate with intelligence. Since accurate assessment of comprehension is difficult it is ‘less dangerous’ to start by assuming understanding and adjusting language when comprehension difficulties become apparent. It also takes into account the growing evidence that people with autism may be unresponsive for a variety of reasons and benefit from support to overcome sensory and perceptual difficulties (Bogdashina, 2003), movement differences (Leary and Hill, 1996) and impairments in executive functioning (Christ et al., 2011; Joseph and Tager-Flusberg, 2004). The staff in the school where the research took place had all been previously trained in, and fully adopted, what was termed ‘restricted language’, which equated to a MSA. The researchers’ aim was to demonstrate high expectations of competence in the child, and they therefore did not use minimal speech. Instead they spoke in full sentences, with simplified vocabulary and structure, alongside visual materials, and informally assessed understanding. The intention was to gradually simplify language if children were demonstrating difficulty with comprehending full sentences. Research involved working alongside school staff and evaluating whether Jack was able to increase his level of participation, demonstration of understanding and expressive communication between base-line and post-intervention measures.

II Method

The case study reported here was part of a larger action research project in a special school for children with autism. Action research acknowledges the researcher and participants as having active roles in the research process and allows the researcher to promote change at the same time as describing, understanding and explaining. From an ethical standpoint it brings the needs and rights of the participants to the fore. These aims of action research are broadly expressed by Zuber-Skerritt (1996: 83) as being ‘to bring about practical improvement, innovation, change or development of social practice, and the practitioners’ better understanding of their practices’. The flexible and interactive nature of case studies (Robson, 2002) complements the action research process. The opportunity to observe ‘real effects in real contexts’ (Cohen et al., 2000: 181) contributes towards the researchers’ growing knowledge and understanding of the processes being observed.

1 Participants

Jack was one of four children, who were selected to participate in the research based on their teachers’ perception that they had greater communicative potential than demonstrated. Jack, a non-verbal boy with autism, was 10 years old at the start of the intervention. His Statement of Educational Need described him as having a severe intellectual impairment; he had no speech and very limited augmentative communication, restricted to the use of a small number of symbols, usually when prompted. Jack also presented with challenging behaviour which manifested as a lack of engagement with adult’s choice of task, loud vocalizations to protest, and pushing and hitting people when they tried to get him to cooperate. Jack’s apparent preferred activities included playing with water and sprinkling small items such as rice or lentils into trays. There was no formal speech and language therapy assessment on file, possibly due to his lack of cooperation in tests and his perceived low cognitive ability. School staff believed that Jack had restricted receptive language and their targets included his demonstrating understanding of basic verbs. This case study commences from the start of the intervention, and researchers had no contact with the school or children prior to the research.

2 Intervention

Staff were introduced to the intervention during a training session and through working alongside the researchers with individual children. The intervention was designed by the researchers, based on a set of principles, and evolved through ‘trial and error’ to better respond to individual strengths and needs. The general approach was to follow the child’s lead, identify items that would interest them and offer the opportunity to engage at a social level and respond by pointing. A developmental approach to representations was not adopted, and from the start Jack was given written words and letters to respond to alongside pictures and symbols. This accords with understanding that children with autistic spectrum disorder rely on visual stimuli to assist understanding (Potter and Whittaker, 2001) and that written words provide a stable visual code.

The specific characteristics of the intervention included:

speaking in complete phrases and using a range of vocabulary;

speaking slowly and quietly, and waiting longer than might typically be expected for the pupil to respond;

materials and resources to promote interest, interaction and fine motor skills (including pointing);

initial focus on activities where there was no ‘correct’ answer so that the student could not fail;

an attitude of expectation that the pupil would be able to respond;

close observation and commenting on pupil responses;

a willingness to take risks by introducing complex tasks and discovering the extent to which individuals could manage them whilst ensuring success through scaffolding the learning task;

literacy activities including reading and spelling accuracy tasks such as matching words and pictures and spelling activities;

reading comprehension tasks.

The researchers worked with Jack and his teaching staff 32 times over 20 months in individual ‘work’ sessions that took place outside the classroom and lasted between 20 and 30 minutes. The input was more frequent at the beginning of the intervention (i.e. at weekly or fortnightly intervals for the first 6 months) and less frequent (monthly) during the following year. All communicative attempts were reinforced by the researchers through specific comment and praise such as ‘I saw you look at that word’ or ‘good pointing’.

3 Data collection and analysis

Prior to the intervention data from school records, reports and targets, together with staff interviews and analysis of video data of classroom and individual work with Jack were used to complete a profile of his means, reasons and opportunities (MRO) to communicate. This documented teaching staff’s perceptions of Jack’s expressive communication skills, understanding of language and literacy skills. The MRO monitoring form had been developed in previous research (Dearden, 2005) based on the work of speech and language therapists (Money and Thurman, 1994). Recordings were made of the extent to which Jack could use informal ‘means’ such as vocalizations, gesture, pointing, facial expression, body language and behaviour as well as augmentative communication systems. ‘Reasons’ encompassed his making a request, refusing or protesting, and ‘opportunities’ looked at what staff typically did to encourage or motivate Jack to communicate. An observation of Jack working in the classroom setting allowed for some analysis of the teaching staffs’ use of language and Jack’s main means of communication.

During the intervention the researchers kept a log of each session and videos provided a rich source of observational data. Post-intervention (month 18) interviews with teaching staff were conducted by research assistants on placement from a local university. Staff were asked to comment on the outcomes of the project for the pupil and for themselves. These multiple sources of evidence were used to update the pupil’s MRO profile. The outcomes reported by staff were grouped into main themes and quotes selected to support data gathered from other sources. The researchers’ logs enabled purposive sampling of sessions that had elicited particular responses and/or high levels of engagement for further analysis of the video evidence and also provided descriptions of specific behaviours and responses.

Video data was used to detail examples of the pupil’s response to full speech and literacy tasks as well as the frequency of expressive communication including pointing and gesture. The frequency data involved analysis of six sessions from consecutive months from the first phase of the intervention (excluding month 2 when no session took place due to holidays) and two sessions from the final two months of the second phase of the intervention. Most sessions contained between 10 and 20 minutes of activity-focused work; consequently, 10-minute time slots of high engagement were selected in order to allow comparisons between sessions over time. An observation schedule of Jack’s means of communication was used to event-sample each 10-minute video clip. The frequency of Jack’s pointing to and/or selecting pictures, words and letters as well as his use of gestures that indicated engagement and enjoyment (bringing his hands to his face, clapping and gently touching adults) were collated into frequency tables.

III Baseline measures

1 Adult expectations and use of language

Prior to the intervention Jack had been described as motivated to communicate. Teaching staff reported feeling ‘stuck’ in knowing how to assess his communication potential and to enhance his abilities (teacher interview 1). Staff reported that they used one- and two-word instructions with one information-carrying word to communicate with Jack. Initial observations confirmed this (Table 1).

Table 1.

A sample of one-minute of interaction between teacher and pupil.

Time	Teacher speech	Teacher action	Pupil action
5.06	Let’s make it bigger		Put four marbles on construction
5.29	Jack build	Holds out construction piece	Takes piece and adds onto construction
5.30	Jack do	Holds out construction piece	Puts marble on construction
5.31	Good boy		Puts marble on construction
5.37	More, more	Holds out construction piece	Did not take piece
5.50	Good boy	Holds out construction piece	Takes piece and adds onto construction
5.51	There you go	Holds out construction piece	Takes piece and adds onto construction
6.06	We need some on this side too don’t we?	Holds out construction piece and points to other side of construction	Takes piece and adds onto construction
6.10	Yes good boy	Holds out construction piece	Signs ‘no’ and turns away

2 Understanding of language

The most recent speech and language therapy assessment dated back to when Jack was still attending nursery. Formal assessment of comprehension had not been possible at that time but advice to staff comprised the need to use clear, simple language supported with visual cues, and emphasizing key words in a sentence.

Pre-intervention Jack’s teaching staff viewed his understanding of language to be at a basic level and had identified targets for his development as being to ‘demonstrate understanding of his name and the names of children in his class, follow verb instructions to jump and turn (supported by signs and symbols) and show understanding of big, small and different colours’ (Individual Education Programme targets). They reported that Jack could understand some nouns and verbs and respond to one- or two-word instructions with one information-carrying word (interview 1).

3 Expressive communication

Prior to the intervention Jack’s main means of communication were described by his teacher as intentional but inconsistent and included being able to point to a small number of symbols. He used some consistent vocalizations, facial expressions, gestures and body movements. He also used a few signs (yes, no, thank you, bye, toilet, home) and had been encouraged to use symbols with limited success. His main reasons to communicate were described as expressions of his needs and wants, most typically in order to refuse and to object or to request a favoured activity.

Video analysis of Jack’s communication in the classroom confirmed that he used pointing to objects and symbols of things he wanted (e.g. computer). Most communication was through behaviour such as pushing people and objects away, hitting adults, turning or moving away, banging the table, biting his hand and fetching items he wanted. He signed ‘yes’ and ‘no’ in response to adult questions at one point. He also used vocalizations mainly when he was involved in a repetitive activity (sprinkling sand) or when he was pushing objects or people away.

Jack’s opportunities to communicate were dependent upon adults asking him questions, sometimes accompanied by symbols and signs. He did not join in the classroom routine so had fewer regular opportunities to communicate than his peers.

Objective evidence of Jack’s frequency of pointing prior to the intervention is limited. The initial observation video of him interacting in the main class does not allow like-for-like comparisons with the individual work session because he was only exposed to the opportunity to point to pictures once during the observation. The notes from this observation give an indication of the frequency and type of pointing he was using:

Jack chose between two simple reading books and [teaching assistant] held his hand to draw it along the words as she read. She asked him to point to pictures and mostly took his hand and assisted his point. Once or twice he pointed at the picture spontaneously. (Log entry, observation, month 1)

4 Literacy skills

Prior to the intervention Jack was reported to occasionally point to words and match the letters of his first name when prompted (teaching assistant interview 1). His literacy targets were to find a specific book on request, identify the beginning and end of the book, match colour words and use magnetic letters to learn letter sounds (Individual Education Programme targets).

IV Results

1 Receptive language

The first interaction researchers had with Jack is reported in Table 2. He was given a magazine to look through and was immediately responsive as the researcher commented on what he appeared interested in. From the beginning of the intervention, Jack interacted with the researchers, showing interest in the materials presented, making frequent eye contact and responding to questions and instruction presented in sentences with several information-carrying words. Some examples of responses to phrases are presented in Table 3. During follow-up interviews teaching staff reported that Jack could understand sentences with two or three information-carrying words including nouns, verbs, adverbs, adjectives and prepositions (teaching assistant interview 3a).

Table 2.

A sample of one-minute of interaction between researcher and pupil.

Time	Researcher speech	Researcher action	Pupil action
0.48	Who’s interesting you there?		Vocalizes and turns pages
0.57	You don’t like that, you don’t like this one?	Points to picture	Vocalizes hits table with one hand, other hand turns page
1.00	No do you like Wall-E better?		Signs ‘yes’ and turns page
1.05	There’s lovely picture of Wall-E	Point to picture	Vocalizes and point to the picture of Wall-E
1.10	Yes he’s on there, I wonder if you’ve got that DVD at home?	Points to picture	Signs ‘yes’, turns away from magazine and puts both hands in sand/sprinkle tray
1.14	You have, you lucky thing, I want to see that, does it make you laugh Jack?		Takes hands out of tray and turns back to magazine
1.22	Is it funny?		Puts hands under the table and appears to be signing ‘yes’
1.29	I did not see your hand as it moved under the table, does it make you laugh? I think you might be saying yes but your hand was under the table so I could not see.		Vocalizes, points to picture, looks at researcher then back to the picture
1.38	Is it Wall-E?	Leans forward to have a closer look at what Jack is pointing to	Points to word and looks at researcher
1.43	Yes that’s an ‘a’		Moves finger to point to next letter/s
1.48	That’s an a, l, l, e,		Moves finger to point to each letter looking at researcher in between each point

Table 3.

Examples of pupil’s appropriate responses to ‘full’ language.

Session and month	Pupil’s response
Session 2, month 3	When asked where he would put written phrases (which were read to him), he responded quickly by putting ‘I am hot’ on the picture of a person lying on the beach (selected from a wide number of pictures).
Session 4, month 4	Pointed to pictures of ‘the lady with the green hat’, ‘the man with the walking stick’ and ‘the person with the red coat carrying a baby’ on a page in a story book.
Session 5, month 5	Signed ‘no’ to ‘Would you put ketchup on your cornflakes?’ signed ‘yes’ to ‘Would you put custard on your apple pie?’ signed ‘no’ to ‘Would you put ice cubes on your apple pie?’
Session 11, month 5	Pointed to the ‘joyful’ symbol and signed happy in response to ‘How was Handa feeling?’ after having been read the story.
Session 23, month 16	Placed speech bubbles on the correct character in Rude Rabbit story book in response to ‘who said this’: ‘you look silly’, ‘give me a sweet’, ‘what daft glasses’, ‘give me a big kiss’, ‘I will show them’, ‘read this’, ‘how rude you are’, ‘I don’t like you’ demonstrating understanding of the text in the story.

2 Expressive language

The frequency of Jack’s pointing to pictures, words and letters increased in work sessions (Table 4) as well as his use of positive gestures. The reduction in pointing in month 4 coincided with the session initially being introduced by his teaching assistant, who used a minimal speech approach. (At this point in time there had not been a change in the behavior of the teaching staff who were sceptical about the approach being used.)

Table 4.

Video analysis of frequency of independent pointing and gesture.

Month	1	3	4	5	6	7	19	20
Independent pointing to and/or selecting pictures, words, letters	42	32	16	38	47	47	45	59
Gestures	10	12	1	4	11	15	33	25

Jack continued to use the means of communication (pointing, gesture, vocalizing) that he had pre- intervention; however, there was a shift to more frequent and consistent intentional communication for a broader range of reasons. For example, as early as the second session Jack was making choices beyond his own immediate needs and wants by pointing to pictures in the picture book You choose:

Clear pointing to a choice of pictures (often pointing twice to the same picture), e.g. travel on a train, eat jelly, wear a jester’s hat, have a pet dragon, wear no clothes, be a chef and lie on the beach. Several clear ‘yes’ signs in response to ‘do you want that one.’ Reached out to touch A at one point and seemed to be indicating he was enjoying the interaction. Signed ‘no’ to ‘do you think the dragon has got fire coming out of its mouth?’ Signed ‘yes’ to being a chef and lying on the beach (signing appeared to increase as he got more involved in the activity and responded to full language). (Log entry, session 2, month 2)

Over time Jack started to show signs of being more motivated to initiate communication; for example, when he wanted to go to the zoo he found ‘2009’ printed on a piece of paper and covered the nine with his finger to approximate the word zoo. Jack scanned pages of typescript on staff notice boards to find the word ‘computer’ to show staff what he wanted. One of Jack’s teaching assistants noted the most significant change as being his ability to communicate more freely and clearly: ‘He gets his point across easier and is more willing to listen, focus on learning tasks and communicate.’ (teaching assistant interview 3a). She notes that Jack’s aggressive behaviour had reduced. His teacher also commented that Jack had ‘become a better communicator with enhanced reading skills’ (teacher interview 3b).

3 Literacy skills

During the intervention Jack demonstrated an ability to match words and pictures, spell words (with and without matching) and sequence words into sentences. There were also times when Jack appeared to learn new tasks following only one or two demonstrations. This log entry records Jack matching words to pictures and spelling words with four letters.

Jack was very calm and co-operative in this session. He showed genuine enjoyment of the story ‘Oi get off our train’. He pointed to words of names of animals in the story (from a choice of six) and demonstrated learning of the word ‘crane’ (pointed to it correctly 3rd time) … finding some words immediately (seal, elephant). Lovely smile at the end of the last page … appeared to enjoy the humour. Matched words with four letters (all beginning with ‘d’) to pictures … needed teaching but picked up the idea of drawing a line between the word and the picture. Spelt words with four letters using letters on post-its … very quick learning (matched letter to model of word first then spelt without model). Clearly very pleased with himself and would have carried on longer if we’d had the time. (Log entry, session 10, month 7)

Further brief examples of Jack’s completion of literacy tasks developed by the researchers are presented in Table 5. The intervention increased Jack’s opportunities to demonstrate his knowledge and ability to learn. Staff commented on how much he enjoyed books, was easily bored and liked new challenges as demonstrated in the following log entry:

Multiple choice involving verbs … what’s the person/animal doing in the picture? Jack did this really quickly and the teacher commented ‘he’s ahead of you’. He did especially well in response to a picture of a cat asleep on a wall … Jack signed sleeping then pointed to the words lying, dreaming and sleeping … Sounds like quiz … animal that sounds like rat (correctly chose cat and signed cat at 3rd attempt) … now/cow, log/frog, boat/stoat (able to comply when I read words to him) then got the idea and did last three on his own without me reading the words. (Log entry, session 32, month 19)

Table 5.

Examples of response to literacy tasks.

Session and month	Tasks and pupil’s response
Session 5, month 5	Matched pictures and words from choice of three words not read out (car, food, eggs, bag, tortoise). Showed the ability to recognize words after one demonstration (umbrella, jumper).
Session 8, month 7	Choosing words from choice of four to go with picture book: ‘Now let’s look at the next one can you remember what that is?’ Jack picks up ‘fish’ from choice of four words. ‘Good boy that says fish and it is a fish. Now what is this one can you remember this one?’ Jack picks up ‘bear’ from choice of four words. ‘Well remembered. That says bear and it is a bear.’
Session 10, month 8	Matched pictures and words beginning with the same letter, words had not been read to him (chair, cow, cake, cloud, computer, bell, butterfly, balloon, bat). Spelling words by sequencing letters on a grid (matching) drum, mud, meat, met, computer (then trying some from memory) meat, mop, pet, top (variable success but getting the idea of sequencing letters from first to last)
Session 11, month 8	Sentence completion ‘Which animal took the fruit? The “something” took the pineapple, who took the pineapple let’s look through book to find the right page’ Jack pointed to correct animal symbol. ‘The “something” took the banana who took the banana’. Jack pointed to correct animal symbol.
Session 29, month 19	Sequencing words to complete the sentence beginning with ‘the sun’. Correctly chose six individual words (lit the fuse on the rocket) and placed them in order to make the sentence (the sun lit the fuse on the rocket) with adult saying which word came next but not reading the words or pointing to them.

4 Perceptions of teaching staff

During interviews the teaching staff were asked for their views not just on the child involved in the study but also about their perceptions of the intervention and changes in their own behaviour. One teaching assistant specifically noted the change in the way she spoke to Jack stating that even though she would not have thought of using such complex language she could see the pupil ‘understood more than I thought’. This resulted in her adapting her language and providing him with ‘more opportunities to express his understanding’ (teaching assistant interview 3d). Another teaching assistant explained:

I was originally trained to use single words when talking to the children, now I speak more fluently and with longer sentences and it turns out that children with autism do actually understand a lot of talking and they pick up on a lot more things than I thought … I thought it was negative at the beginning because of lots and lots of language that was being used with the children, but over time I have realized it works and that is what you have to do to see if they understand. (teaching assistant interview 3e)

V Discussion

Evidence suggests that Jack made changes throughout the course of the research, in terms of his level of engagement with adult choice of activity, responsiveness through rates of pointing to show understanding and express himself, and demonstrations of literacy skills. These changes may be attributed to a number of aspects of the intervention related to the discovery that he was able to understand more complex language than staff had been using. At the beginning of the project Jack was clearly already able to point, select symbols and initiate communication when he wanted to request something. Following increased adult expectations, exposure to full language and literacy tasks, Jack demonstrated his ability to respond to more complex questions. Therefore by increasing his opportunities and reasons to communicate, the under-estimation of his cognitive abilities and literacy skill became evident. We contest that he had the means (ability to point) and cognitive ability to follow instructions prior to our intervention but was not being given the opportunity to demonstrate these as he was dependent on adult choice of activity.

Although Potter and Whittaker (2001) stress the importance of attempting to assess the receptive language of pupils, and using minimal speech only where necessary, it appears that – in Jack’s school at least – a more blanket adoption of the approach was in force. Whilst agreeing with much of the government guidance (Department for Children, Schools and Families, 2009) in relation to supporting pupils with autism, the researchers have reservations about adults reducing their speech to single words and two-word phrases based on limited knowledge of pupils’ levels of understanding. This risk is particularly prevalent when working with minimally-verbal children where their lack of response can so often come to be seen as cognitively based. Complexity of assessment of children with impairment of verbal and non-verbal communication can lead to assumptions about their ability to understand spoken language and consequently their intellectual ability. Whilst communicative competence is considered to lead to positive outcomes (Bogdashina, 2005), links have frequently been made between language impairment and intellectual ability (Lord, 1985; Manolitsi and Botting, 2011; Pry et al., 2005). ‘Linguistic deficits are seen as one aspect of a general cognitive disability in encoding and higher order processing’ (Lord, 1985: 267). This is exacerbated when children do not use gesture or point to indicate choices. When children fail to respond to speech there is invariably an impact on staff’s view of the child and consequently their expectation of the child’s performance. Low expectations frequently lead to poor performance (Jussim and Harber, 2005) and so a cycle of potentially inaccurate assessment of the child can be established. This may lead to the potentially dangerous assumption that ‘non-verbal’ equates to severe learning difficulties, which in turn leads to the minimal speech approach being adopted.

Findings suggest that the greatest barrier to Jack’s progress may have been the assumption of limited ability by the teaching staff. This was based on his performance in assessments, his lack of responsiveness and the way in which he chose to spend his time when left alone, i.e. repetitive ‘sprinkling’ of a range of substances. His behaviour gave the impression of a child with severe intellectual impairment. The adoption of the minimal speech approach meant that Jack did not have the opportunity to show that he could understand much more complex speech than he was typically exposed to.

Staff were initially very sceptical about the approach adopted by the researchers. They repeatedly questioned the researchers’ use of language and warned that the students would not understand. Staff initially interpreted Jack’s responses as random answers. When he correctly selected written words from a choice of two or three they presumed that this was due to chance, no matter how many repetitions he completed correctly. However, once he was consistently identifying the correct word from a choice of six, staff began to recognize that Jack could read. The fact that Jack had not been seen by the speech and language therapists working in his school presumably indicates that his language was thought to be at the same level as his cognitive abilities. As Jack was 12 years old by the end of this intervention this mis-apprehension could have deprived him of many years of more appropriate education. It may also be significant that his challenging behaviour has reduced since his ability to understand has been recognized.

When working with children with autism the least dangerous assumption would be to use clear concise sentences, with pauses in between to allow time for processing (Breakey, 2006; Sage, 2006), which is gradually limited if and when children show evidence of not understanding. This should be linked to on-going informal assessments that do not follow a developmental model. Jack needs a continuing creative education that enables him to develop, and demonstrate through simple pointing, increasing levels of literacy, understanding and knowledge. The increased uptake of accessible technology, including speech output devices, may provide a way for Jack to increase his spontaneous communication although his tendency to throw items when frustrated would need consideration. There is a danger inherent in the blanket adoption of the minimal speech approach. Limiting language unnecessarily could potentially lead to reducing the opportunities of non-verbal children.

Footnotes

Declaration of conflicting interests

The Authors declare that there is no conflict of interest.

Funding

This work was supported by Nottingham City Council Children and Families.

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