E012 · Communication & interaction
Difficulty communicating needs
Does this young person have a need they cannot yet reliably communicate in a form that the people around them recognise?
Phoenix Encyclopaedia
Overview
Communication is broader than speech.
A young person may communicate through:
- speech;
- gesture;
- facial expression;
- body movement;
- sign;
- symbols;
- pictures;
- writing;
- typing;
- AAC;
- behaviour;
- proximity;
- withdrawal;
- leading another person towards something;
- repeated actions;
- changes in regulation.
Difficulty communicating needs occurs when a young person cannot reliably express what they need, when communication becomes inaccessible under stress, or when others fail to recognise the form their communication takes.
Needs might include:
- help;
- a break;
- pain relief;
- reassurance;
- clarification;
- more time;
- food or drink;
- sensory change;
- escape from danger;
- privacy;
- connection;
- stopping an activity;
- saying no.
A young person who cannot reliably communicate a need may eventually communicate through distress.
This does not make distress meaningless.
It often makes it urgent communication.
Phoenix Encyclopaedia
What this might look like
A young person might:
- become distressed instead of asking for help;
- leave rather than say they need a break;
- wait until needs become extreme;
- repeat a phrase without being able to clarify what is wrong;
- use behaviour that adults interpret as challenging;
- struggle to say no;
- agree automatically;
- communicate effectively when calm but lose access to speech under stress;
- use very different communication methods in different environments;
- rely heavily on familiar adults to interpret them;
- struggle to describe pain;
- find open-ended questions difficult;
- use gesture or movement more effectively than speech;
- become silent when overwhelmed;
- need AAC despite being able to speak.
Speech ability does not determine communication competence.
Phoenix Encyclopaedia
Developmental expression
At this stage
Early childhood
Young people may rely heavily on gesture, body movement, behaviour, early language, symbols or familiar adults.
Communication breakdowns may quickly become distress because adults cannot identify what is needed.
Early childhood
Young people may rely heavily on gesture, body movement, behaviour, early language, symbols or familiar adults.
Communication breakdowns may quickly become distress because adults cannot identify what is needed.
Middle childhood
Expectations increase for verbal self-advocacy.
Young people may be expected to explain difficulties, ask for help and describe feelings even where these skills remain unreliable.
Early adolescence
Needs become more private and socially complex.
Young people may avoid using communication supports because they fear appearing different.
Later adolescence
Self-advocacy becomes increasingly important across healthcare, relationships, education, employment and independent living.
Communication access becomes central to autonomy.
Choose each stage to see how the presentation and surrounding expectations may change over time.
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Strengths and differences
Young people who communicate differently may demonstrate:
- strong visual communication;
- highly precise language in familiar contexts;
- effective written communication;
- meaningful gesture;
- creativity;
- persistence;
- rich communication through interests or activity;
- strong responsiveness to trusted communication partners;
- distinctive expressive styles.
The aim is not to make every young person communicate in the same way.
It is to ensure they can express meaning, make choices, refuse, seek help and participate.
Phoenix Encyclopaedia
Top tips
- Treat behaviour as potentially communicative.
- Make multiple communication routes available.
- Do not require speech when another mode works better.
- Give processing time.
- Use concrete questions where helpful.
- Teach ways to request help, pause, stop and clarification.
- Ensure AAC is available when it is needed, not locked away for special sessions.
- Notice what changes under stress.
- Respect refusal.
- Check understanding.
- Reduce communication demands during dysregulation.
Try asking
“How does this young person already tell us that something is wrong?”
And:
“What communication route remains available when speech becomes difficult?”
Phoenix Encyclopaedia
Things needing careful planning
Consider communication around:
- pain;
- illness;
- safeguarding;
- toileting;
- hunger and thirst;
- sensory overload;
- consent;
- refusal;
- conflict;
- emotional distress;
- transitions;
- medical appointments;
- unfamiliar adults;
- trips;
- transport;
- emergency situations;
- preparation for adulthood.
Every young person should have a reliable way to communicate:
- yes
- no
- stop
- help
- break
- something is wrong
Phoenix Encyclopaedia
Practical support principles
A useful sequence is:
Observe → recognise existing communication → expand available modes → practise functional communication → generalise across people and settings
Helpful approaches include:
- AAC;
- communication boards;
- visual supports;
- symbols;
- sign;
- written choices;
- typing;
- communication passports;
- structured choices;
- concrete questioning;
- increased processing time;
- modelling communication without demanding immediate imitation;
- consistent vocabulary;
- familiar access to communication tools;
- specialist speech-and-language input where appropriate.
Communication support should prioritise function and agency.
The measure of success is not simply increased speech.
It is greater ability to influence what happens.
Phoenix Encyclopaedia
Don’t assume
Do not assume that:
- speech is always the best communication mode;
- a speaking young person does not need AAC;
- AAC should only be introduced after speech has failed;
- behaviour without speech has no communicative meaning;
- silence means agreement;
- echolalia or repeated language is meaningless;
- a young person who says “yes” has necessarily understood or consented;
- communication difficulties sit only within the young person.
AAC is communication access, not a last-resort substitute for speech.
From understanding to support
Phoenix Atlas connections
Core
- AAC and multimodal communication
- Visual communication supports
- Communication adaptation
Often useful
- Relationship and trust building
- Co-regulation
- Structured choice
- specialist speech-and-language input where indicated
A broad label such as “speech and language” is not sufficiently specific for the Atlas intervention layer.
The Atlas should distinguish actual approaches and supports — for example AAC, visual communication, communication-partner strategies and specialist assessment — rather than treating a professional discipline as one intervention.
Phoenix Encyclopaedia
Evidence and cautions
Speech should not be treated as the highest or most legitimate form of communication. Professional guidance states that AAC has no prerequisite skill hierarchy and should be considered early when communication needs are not being met. It also treats multimodal communication, participation, protesting and refusal as legitimate functions. (1)
Systematic reviews do not support the concern that AAC prevents speech development; AAC can improve communication and may support speech for some young people, though outcomes vary. (2; 3)
Phoenix treats consent and refusal as central outcomes. Reviews note that AAC intervention has often emphasized requesting, so evaluation should also ask whether support increases access, understanding, expression, choice, refusal, self-advocacy and participation. (4)
Phoenix Encyclopaedia
Public evidence sources
- 1. Augmentative and alternative communication — professional practice guidance.
- 2. Augmentative and alternative communication and speech production in autism — systematic review.
- 3. The role of augmentative and alternative communication for autistic children — review of systematic reviews.
- 4. Aided AAC interventions supporting broader communicative functions — systematic review.
Phoenix Encyclopaedia
Possible explanatory lenses
Difficulty communicating needs may be explored alongside autism, developmental language differences, speech differences, learning disability, motor differences, anxiety, selective mutism, sensory overload, trauma, executive-function differences or other developmental and environmental factors.
The practical starting point remains:
How can this young person reliably make themselves understood — especially when the need matters most?
About this entry’s source
Open Beta · read the evidence notes and limitations
Source status describes the underlying material. The current site edition is Open Beta; the evidence notes and limitations remain part of the entry.
Phoenix Atlas · Open Beta
Explore connected approaches
These Atlas entries link to this topic for a specific reading purpose. Follow the connection and its limits in the entry; it is not an automatic intervention recommendation.
- A008 · Functional assessment
- A009 · Positive Behaviour Support
- A017 · Communication partner strategies
- A018 · AAC and multimodal communication
validation is being completed by subject matter experts