disabilities communicate helps to guide occupational ­

­ therapy domain tasks such as requesting drinks or foods during mealtime

practitioners to better support and facilitate the communication
that is necessary to increase successful occupational engagement
in all environments.
By collaborating with the children, their families, as well as
other service providers, occupational therapy practitioners can
design and implement specific strategies to facilitate communi-
cation among children with disabilities to increase the children’s
participation and engagement in occupations. This collaboration is
critical to ensure services that are cohesive and consistent.
School-Based Communication Interventions
A number of specific strategies can be implemented to facilitate
communication for children with disabilities, including the follow-
ing methods.
1. Using Multiple Communication Modes. It is important to
recognize and value the significance of students with disabilities
using multiple communication channels, especially nonsymbolic
communication (Bruce, 2005). As Bruce suggested, related service
providers need to not only recognize and respond to nontraditional
communication attempts including nonsymbolic, beginning level
communications such as vocalization, movements, facial expres-
sions and other behaviors, but also support the development of
traditional and symbolic forms of communication.
AAC also provides a systematic means for communication for
children with disabilities, which can lead to increased competence
and repertoires. With such a primary goal in mind, occupational
therapy practitioners play an important role, along with SLPs and
other team members, using a collaborative interdisciplinary model
for assisting with choosing, implementing, and evaluating appro-
priate AAC devices to help students with disabilities meet their
current and future needs. Occupational therapy practitioners can
contribute valuable input regarding AAC device placement along
with a child’s fine motor, visual motor, and visual perceptual skills,
which will enhance the a child’s ability to access and participate in
communication related activities. Occupational therapy practitio-
ners can also role-model how to react to the child’s communication
attempts or lack of attempts in a way that supports and prompts
the child to actively pursue his or her needs rather than passively
having these needs met.
2. Using scripted routines. Scripted routines is a strategy that
provides “structured opportunities for beginning communicators
to practice using attention-getting, acceptance, and rejection sig-
nals in the context of naturally occurring activities” (Beukelman &
Mirenda, 2005, p. 279). Scripted routines consist of four elements:
(a) touch cue, (b) pause, (c) verbal feedback, and (d) action. SLPs
and AAC specialists have training and expertise in using scripted
routines to facilitate communication of students with disabilities.
They can teach and model the use of scripted routines to other
service providers, including occupational therapy practitioners, to
facilitate communication for students who may benefit from this
technique.
Occupational therapy practitioners can assist SLPs and AAC
specialists with creating appropriate scripts for ADLs or other
and relaying the need to use the bathroom. Such scripts are impor-
tant for the child’s sense of autonomy, self-confidence, and worth,
as well as some level of control over the environment. Occu-
pational therapy practitioners can use this method to enhance
interactions for child occupations and can also provide pertinent
insights regarding students’ interests, needs, and necessary adapta-
tions to fully utilize scripted routines.
3. Implementing milieu teaching. Milieu teaching, also known
as naturalistic teaching and incidental teaching, consists of specific
strategies to teach communication skills in everyday activities
and routines (Kaiser & Trent, 2007; Sigafoos & Mirenda, 2002). All
milieu teaching strategies have the following in common: (a) com-
munication facilitators use existing or arranged natural environ-
ments to create opportunities for beginning communicators, such
as children with severe or multiple disabilities; (b) communication
facilitators provide needed prompts such as verbal, gestural, mod-
eling, partial or full physical prompts to assist students with dis-
abilities to make appropriate requests; and (c) requests made by
the beginning communicators are always followed by functionally
related and natural consequences (Kaiser & Trent, 2007; Sigafoos
& Mirenda, 2002). These basic strategies are implemented easily
within the natural environment. For example, James is provided
with most items needed for a desired task in the classroom but with
some important parts missing. Those parts are not in a spot where
James can easily access them by himself. He is encouraged to use
a variety of pictures, gestures, and words to communicate what
he needs to complete the desired task while being reinforced for a
positive communication experience. Occupational therapy practi-
tioners can also support these communication experiences as part
of an interdisciplinary team to reinforce positive communication
strategies for children with severe or multiple disabilities.
4. Following children’s lead, and teaching choice making. In
working with students with disabilities, following a child’s lead
can enhance his or her interest and motivation when engag-
ing and participating in daily occupations. This in turn increases
communication opportunities and facilitates building on already
existing communication skills. Teaching children with disabilities
to make choices is an important aspect of communication. Choice
making relates to meaningful occupations, demonstrates respect
for an individual’s dignity and rights, and increases the opportu-
nity for children with disabilities to communicate their wants and
needs. When providing services to children with disabilities, there
are often multiple opportunities to facilitate choice making; for
example, have a student with disabilities choose who to sit next
to in art class. Through choice making, children with disabilities
experience a sense of autonomy, self-control, self-determination,
and increased interest and motivation to participate in activities
and occupations. Choice making supports a child’s engagement in
meaningful occupations, which is a central component of occupa-
tional therapy services.
5. Providing appropriate prompts. Occupational therapy practi-
tioners and other service providers need to know how to utilize
appropriate prompts to facilitate communication skills of children

Early Intervention & School Special Interest Section Quarterly

ISSN: 1093-7242
Chairperson: Dottie Handley-More • Editor: Meira L. Orentlicher • Managing Editor: Cynthia Johansson
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2
with disabilities. Service providers can provide verbal, gestural,
modeling, partial, or full physical prompts based on the i­ ndividual
needs of the child in order to facilitate communication skills and
repertoire. This allows therapists to create a rich environment
to support the development of communication skills while also
increasing participation and engagement. For example, when Ali-
son, a child with severe disabilities, walked to the cafeteria with
a walker, she stopped in the middle of it and failed to respond to
the natural cue to walk to her table. Modifying the natural stim-
ulus and offering a visual cue by putting something colorful on
the lunch table did not help. The occupational therapist provided
prompts, including gesturing (pointing to the lunch table to sit
down) and a partial physical prompt (touching her elbow) to
assist Alison to walk and sit at the lunch table. Such prompts can
be phased out and eventually replaced by natural cues to allow
the child to gain greater independence with the task and increase
success in the school environment. Through coaching and role
modeling, occupational therapy practitioners can teach other ser-
vice providers how to grade prompts in a way that best engages
the child and encourages independence and success in school and
other environments.
6. Experiencing the power of natural consequences. Using nat-
ural consequences is an effective way for students with disabilities
to experience the power of communication and to develop their
communication repertoire. When a child with severe disabilities
uses a picture schedule to indicate what he or she wants, service
providers, teachers, aides, and peers must be prepared to provide
whatever is indicated promptly to ensure that the natural conse-
quence is linked to the direct communication effort. In the begin-
ning teaching phase, even at times when such requests may not
be appropriate, the consequence should still occur to provide
positive reinforcement for the communication attempt. Service
providers can gradually replace the inappropriate requests with
appropriate ones, as the child begins to understand the connec-
tion between his or her communication and the natural conse-
quences. This technique is effective when used with therapists
but also is a way to increase opportunities to communicate with
peers. Occupational therapy practitioners have essential skills to
assist with grading activities, which can provide support to the
interdisciplinary team to appropriately address communication
skills through this technique. During the process of facilitating
communication of students with disabilities, providing natural
consequences to any communicative attempts is an essential and
effective strategy and will encourage the students to continue to
communicate and engage.
7. Peer-mediated approaches. Another way to increase student
engagement is to provide the student with disabilities with a
peer buddy. This method is also known as peer supports or peer-
mediated approaches and is a means to build upon the experience
of natural consequences. Carter and Kennedy (2006) described
how this system requires the peer to be educated about the rea-
son for his or her involvement, expectations of the teacher, the
student’s general communication methods, and basic strategies
to help facilitate engagement and communication. This system
then allows the student with disabilities to practice engaging in
communication and other activities with a peer, and will provide
a natural consequence for the student with disabilities’ commu-
nication attempts, which is motivating and encouraging (Carter
& Kennedy, 2006). Occupational therapy practitioners can help
peers recognize and appropriately respond to the child’s attempts
with nonsymbolic and symbolic communication and under-
stand the chosen communication modes through coaching and
modeling.
3
Conclusion
Along with parents and families, service providers to children
with disabilities, such as occupational therapy practitioners, play
a significant role in facilitating communication of children with
disabilities. Successful interventions with children require clear
communication from the child of his or her interests, comfort
level, understanding, and frustrations in order to provide client-
centered and occupation-based services. By understanding basic
means to help facilitate communication, occupational therapy
practitioners can not only increase the success of their own inter-
ventions but also support the child’s engagement in his or her
occupations.
The seven strategies presented in this article to assist with
facilitating communication for children with moderate, severe,
or multiple disabilities are not exhaustive and are intended to
provide a starting point for occupational therapy practitioners to
expand their repertoires when working with children who pres-
ent with communication needs. Communication is a core compo-
nent of working with any child with moderate, severe, or multiple
disabilities and should be considered by all service providers in
order to promote the most successful interactions. Through the
use of an interdisciplinary model and the introductory strategies
discussed, service providers will be better able to meet children’s
communication needs. Facilitating communication is an achiev-
able task and ultimately will empower a child to engage with his
or her environment while increasing successful participation in
school occupations. ●
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Keli Mu, PhD, OTR/L, is Associate Professor and Chair in the Department of
Occupational Therapy at Creighton University, School of Pharmacy and
Health Professions, Boyne Building, Suite #154, 2500 California Plaza,
Omaha NE 68178; kmu@creighton.edu.
Anna Domina, OTD, OTR/L, is Assistant Professor and Academic Clinical
­Education Coordinator, Department of Occupational Therapy, Creighton
University, Omaha, NE.
Jacy VerMaas-Lee, MA, OTR/L, is Assistant Professor and Director of the
­Pediatric Therapy Clinic at Creighton University, Omaha, NE.
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permission.