There is currently a great deal of debate in the field of speech-language pathology about the kinds of words that should be taught first to nonverbal (or minimally verbal) individuals with communication impairments. This debate mainly surrounds whether interventionists should first teach a broad range of specific, concrete words or a small set of abstract words that can be used across items and environments.
Clinical decisions like choosing first words should not be made randomly or based on practitioner preference. Important factors to consider include the values of the learner, his/her family, and community as well as and evidence from high quality research. A third critical factor to consider is the nature of the communication disorder itself. What are the baseline skills (and missing skills) of the individual we are trying to teach?
No diagnosis highlights the importance of this third factor more than autism spectrum disorder (ASD). As a well-known saying jests: “If you’ve met one child with autism, you’ve met one child with autism.” ASD presents with high variability both across children and within children, as children with autism may not develop skill sets in the same sequences as peers (Sundberg, Galbraith, & Miklos, 2007). However, the paramount deficits across children diagnosed with ASD are in social communication and social interaction—what SLPs would typically call pragmatic language (American Psychiatric Association, 2013). For instance, a child with autism may learn to say many things, but those utterances may simply be scripted from a favorite TV show and have no communicative purpose at all. Or a child with autism might learn to label many things in his/her environment, but the child might not know how to ask for those same items when he/she wants them. Therefore, when analyzing factor three, we cannot simply look at the forms of the skills missing in a child’s repertoire—especially for children with ASD. We must also observe whether or not the child has all of the foundational skills necessary to use the target skill effectively across all relevant social contexts.
Laura Mize, a pediatric speech-language pathologist, wrote a blog entitled In Defense of More—10 Reasons I Still Teach the Sign “More” First. The purpose of the blog was to support the continued teaching of the sign “more” as a first word to children receiving speech and language intervention. To that end, we will consider each point highlighted in Ms. Mize’s blog and specify why her rationale may not be validated by research or applicable to many children with communication impairments, especially those with ASD. This response is not meant as a personal attack against Ms. Mize, as we have read her blogs and feel that she has made important contributions to the field of speech-language pathology. Rather, this response is one way—in the age of “electronic conversations”—for offering a different viewpoint.
By Tracy Vail, MS, CCC-SLP, Autism Consultant and Heather Forbes, MA, CCC-SLP, BCBA