Alternative Communication

Visual cues are an important support as the brain still processes visual information relatively normally and this can therefore be used to compensate for problems with processing auditory information. This enables the child to communicate despite their difficulties with spoken language and this can reduce the frustration and behavioural problems that so frequently arise. Visual cues take a number of different forms including signs, pictures, symbols and written language etc. Some children with LKS have particular difficulties (for example, with gesture, interpreting visual cues including facial expression or lipreading) that can make it very difficult for them to use some of the alternative communication methods.

Children in the early stages of the disease or those who have not regained sufficient spoken language to enable them to use this functionally, may benefit from signing which has the advantages of being quick, portable and not dependent on having specific pictures or symbols to hand. Experience with children who sign shows that this will not prevent them from developing spoken language if they are capable of this and indeed, there has been some suggestion that it may even help to promote it. Some children benefit from systems such as Makaton, which provide basic levels of signing. Others progress beyond this to a more sophisticated system such as British Sign Language which enables them to express themselves using complex language. Signing is not successful in all children and should therefore be monitored carefully to determine its usefulness. Nevertheless, gauging the success of signing is dependent on providing the child with adequate opportunity to learn the signs and it is important that these are used consistently across the whole day and in all contexts (for example, home and school).

For children with more significant learning difficulties or autistic spectrum type problems, the use of concrete visual cues such as objects, pictures or symbols can be very helpful. Visual cues provide the child with more time to process the information compared to spoken language or sign language and tend to look like the object they are representing thereby providing the child with more concrete clues.

Visual cues can also be used in a way that helps to make the two-way nature of the communication process more explicit (for example, handing a picture of the desired object to another person) which is important for children who do not readily understand this process. The Picture Exchange Communication System (PECS) is an example of a programme, which aims to develop the underlying understanding of the communication process. Children are taught explicitly about the ‘give and take’ nature of communication through explicit demonstration of this process by actually handing over a picture or symbol as they make their request. PECS also encourages children to initiate communication rather than wait for others to approach them. It is important to choose highly motivating material.

Cued articulation involves the use of simple hand signs to show the position of the tongue for consonant sounds in children who have articulation problems.

Written instructions can be useful as a means of supporting or supplementing spoken instructions in children who can read. Those who are being taught to read may benefit from the additional use of colour to reinforce the different categories (nouns, verbs etc) as described by Lea. Vance also described the process of ‘graphic conversation’ to develop reading skills through the use of speech balloons to record a child’s story. See the Reading List for further details.

It has been suggested that a visual rather than a phonological approach to teaching reading may be best. This would mean teaching the child the whole word at once (usually written under the visual symbol or picture, or even stuck to the real object) and allowing them to recognise the overall pattern of the written word, rather than sounding out the individual letters and then trying to blend them and pronounce the word. Once a child has reading skills, this in turn can be used to improve auditory analysis.