POINT OUT WORDS

Many people talk about autism, many know someone living with autism, but the science and the public discussion of autism are dominated by that fraction of autistic people who can speak to communicate. Those whose autism is more severe are all too often overlooked: they are excluded from scientific research as unable to comply with experimenters' instructions, and they get shortchanged when it comes to community placements and education. They are the most in need of clinical therapeutic and educational interventions, yet they get left out of the picture.

Of those people with autism who lack communicative speech, some are more skilled at receptive language than their expressive difficulty might suggest. This disparity between what can be spoken and what can be understood correlates with motor and especially oral motor abilities, and thus may be a consequence of limits to oral motor skill.

In a user-centred design process partnered with autistic clients and their therapists in Bangalore, India, we have developed Point OutWords (http://PointOutWords.online/), an iPad app-based communication training system targeted at this neglected population. Whereas many teaching and learning strategies adapted from methods for non-autistic people end up working against autistic cognition by asking people with autism to do what they cannot easily do,

Point OutWords works with autistic individuals and their caregivers: Beginning from the cognitive strength of perceiving localised details, caregivers model and develop skills in manipulating puzzles, then build up to pointing at letters on a keyboard. In feasibility work with the NHS Peterborough Neurodevelopmental Service, we have shown that those who engage with Point OutWords are exactly whose who understand more speech than they can produce. A future multi-centre trial will specifically target these children, and will additionally investigate other predictors of treatment response, and their implications for augmentative and alternative communication.