Communication Beyond Spoken Words
Working with clients who do not use spoken language is one of the most important and rewarding challenges a BCBA can face. Communication is a fundamental human right, and building functional communication repertoires is often the highest-priority goal in ABA programming. For BCBA exam candidates, understanding the evidence base for teaching communication to nonverbal individuals and the range of augmentative and alternative communication (AAC) options available is essential.
The term "nonverbal" encompasses a wide range of presentations. Some individuals have never developed spoken language, while others may have limited speech that is insufficient for meeting their communication needs. The goal of communication intervention is not necessarily to produce speech but to provide the individual with an effective, efficient, and functional way to communicate their wants, needs, thoughts, and feelings.
Assessment of Communication Needs
Communication Skills Assessment
Thorough assessment is the foundation of effective communication programming. BCBAs should evaluate the individual's current communication repertoire across all modalities (vocalizations, gestures, facial expressions, reaching, leading) and in multiple contexts. Tools such as the VB-MAPP, which assesses verbal operants including mands, tacts, echoics, and intraverbals, provide a structured framework for identifying the individual's current level and appropriate targets for instruction.
Preference and Motivation Assessment
Identifying what the individual is motivated to communicate about is critical. Preference assessments reveal the items, activities, and social interactions that the individual values most. These preferred items and activities become the initial targets for mand (request) training, because the individual's motivation to access them provides a natural establishing operation that supports communication learning.
Motor and Sensory Considerations
The selection of an AAC system must account for the individual's motor abilities (fine motor skills needed for sign language or pointing, gross motor abilities needed for reaching or using a device), sensory profile (visual acuity, auditory processing), and cognitive abilities. Collaboration with occupational therapists and speech-language pathologists is valuable for evaluating these factors.
Augmentative and Alternative Communication Systems
Picture Exchange Communication System (PECS)
PECS is one of the most widely used and well-researched AAC systems in ABA. It teaches individuals to communicate by exchanging picture symbols with a communication partner. PECS follows a structured six-phase protocol:
- Phase I: Physical exchange. The individual learns to pick up a picture and place it in the communication partner's hand to request a preferred item.
- Phase II: Expanding spontaneity. The individual learns to go to their communication book, remove a picture, and travel to the communication partner to make a request.
- Phase III: Picture discrimination. The individual learns to select the correct picture from among multiple options.
- Phase IV: Sentence structure. The individual constructs sentence strips using an "I want" symbol followed by the picture of the desired item.
- Phase V: Responsive requesting. The individual learns to answer "What do you want?" questions.
- Phase VI: Commenting. The individual learns to comment on things in their environment using sentences like "I see" or "I hear."
Speech-Generating Devices
Speech-generating devices (SGDs), including dedicated devices and tablet-based applications, produce spoken output when the user selects symbols, pictures, or words. SGDs offer several advantages: they produce voice output that is understandable to unfamiliar communication partners, they can store large vocabularies organized across multiple pages, and they provide consistent, clear communication output. ABA procedures for teaching SGD use include prompting, differential reinforcement, and systematic vocabulary expansion.
Sign Language
Manual sign language is another AAC option. Signs can be taught using physical prompting with systematic fading, modeling, and differential reinforcement. Advantages of sign language include that it requires no external equipment and allows rapid communication. Limitations include that communication partners must understand the signs, fine motor requirements may be challenging for some individuals, and signs are less intelligible to unfamiliar partners than voice output from a device.
Functional Communication Training
Functional communication training (FCT) is the process of teaching an individual to use a communicative response that serves the same function as a challenging behavior. If a child engages in aggression to escape demands, FCT would teach the child to request a break using their AAC system. If tantrums are maintained by attention, FCT would teach an appropriate way to request attention.
Key elements of effective FCT include:
- Matching the replacement response to the function: The communicative response must produce the same type of reinforcement that maintains the challenging behavior.
- Ensuring efficiency: The communicative response must be at least as easy and quick as the challenging behavior, or the individual will continue to use the challenging behavior.
- Pairing with extinction: When safe and appropriate, no longer reinforcing the challenging behavior while reinforcing the communicative alternative produces the most effective results.
- Programming for generalization: The communicative response must be effective across communication partners, settings, and conditions.
Building Advanced Communication Repertoires
Initial communication training typically focuses on manding (requesting), but comprehensive communication programming expands to include tacting (labeling), intraverbal behavior (conversational exchanges), and listener responding. Building these additional verbal operants creates a well-rounded communication repertoire that supports social interaction, academic participation, and self-advocacy.
Choosing the Right AAC System
There is no single "best" AAC system. The optimal choice depends on the individual's motor and cognitive abilities, their communication environments, the availability of trained communication partners, and the individual's and family's preferences. BCBAs should base AAC decisions on assessment data and should be prepared to try multiple systems if the initial selection is not effective. Many individuals benefit from a multimodal approach that combines elements of different systems.
BCBA Exam Preparation
The BCBA exam frequently tests knowledge of verbal operants (mand, tact, echoic, intraverbal, listener responding), functional communication training, and AAC systems. Understand the phases of PECS, the principles underlying FCT, and how to select appropriate communication targets based on assessment data. Be prepared to analyze clinical scenarios involving nonverbal clients and recommend evidence-based communication interventions.