If you're the parent of a non-speaking or minimally speaking autistic child, you've probably typed some version of this question into a search bar, late at night, after a hard day. You've heard program names in passing. More Than Words. CST. PECS. AAC. And you want one clear answer: which one is right for my child, and where do I even start?
Here's a plain answer, with one more option next to the ones you've already found. I'm Dr. Catherine C. Acotto, PhD, CCC-SLP. I'm a speech-language pathologist, and I've spent 26 years and more than 50,000 hours with non-speaking and minimally speaking autistic children. Every child I've ever worked with was communicating. You already sense that about your own child. What most parents were never handed is a way to read it.
What is a communication program, really?
A communication program trains the people around your child to build your child's communication, rather than only working with your child directly. That's the thread that runs through every program below. You're the one who's with your child across the whole day. That makes you the most powerful communication partner your child has.
The programs differ in three ways: who gets trained, what method they use, and what goal they're aiming at. Once you see those three things side by side, the choice usually gets much clearer.
Hanen More Than Words: what is it, and who is it for?
More Than Words is a parent coaching program for parents of young autistic children, and of children who may benefit from social communication support. It's led by a Hanen-certified speech-language pathologist, in person or online. You learn to support your child's social communication through everyday play and daily routines.
You learn what motivates your child to communicate, how to use your child's strengths to set realistic goals, how to make your interactions together last longer, and how to talk so your child understands you. It tends to fit parents of young autistic children when the goal is shared attention and back-and-forth interaction in daily life.
What is the WHO Caregiver Skills Training?
Caregiver Skills Training, often called CST, comes from the World Health Organization. It's for families of children aged 2 to 9 with developmental delays or disabilities. It runs as nine group sessions and three home visits, and it's designed to be led by trained non-specialists, such as nurses and community workers. There's also an online version for caregivers.
You practice using play and daily routines to build communication, engagement, daily living skills and positive behavior. It also covers caregiver coping, because the parent's own state matters. It tends to fit families who want a broad, practical program that covers more than communication alone.
What is AAC partner training?
AAC stands for augmentative and alternative communication. It means any tool that gives your child another way to communicate: picture boards, signs, a speech-generating device, an app on a tablet.
AAC partner training trains the people around the AAC user, not only the child. You learn how to show your child the symbols or the device, how to wait and respond, how to create chances for your child to communicate, how to honor every attempt, and how to keep the system available across your child's whole day.
It fits any child who uses, or could benefit from, an AAC system. The American Speech-Language-Hearing Association (ASHA) says there are no prerequisites for AAC. ASHA also names untrained communication partners as a barrier to device use. A device works best when the people around your child know how to use it with them.
What is PECS, and what are its six phases?
PECS is the Picture Exchange Communication System, created by Andy Bondy, PhD, and Lori Frost, MS, CCC-SLP. It's a structured, picture-based system. Your child learns to communicate by exchanging a picture, starting with a request for something they really want, then building from there.
It moves through six phases:
- How to Communicate: your child exchanges one picture for an item or activity they really want.
- Distance and Persistence: your child uses single pictures in new places, with new people, and from farther away.
- Picture Discrimination: your child chooses from two or more pictures to ask for favorite things.
- Sentence Structure: your child builds a simple sentence on a sentence strip, starting with an "I want" picture.
- Responsive Requesting: your child answers questions like "What do you want?"
- Commenting: your child comments in response to questions like "What do you see?"
PECS fits a child who needs a concrete, visual way to start communicating, especially for asking for things and communicating on their own.
How do I choose between them?
You may not have to. These programs aren't in competition, and a child can use more than one at the same time. A child might use PECS or a speech-generating device while their parents also use More Than Words or CST strategies to build engagement and turn-taking.
A simple way to think about it:
- More Than Words when the goal is back-and-forth interaction and social communication in daily life.
- Caregiver Skills Training when your family wants a broad developmental and caregiving program.
- AAC partner training when your child uses, or should be supported to use, an AAC system, and the priority is consistent support from the people around them.
- PECS when the immediate goal is a specific, structured picture exchange system, starting with requesting.
Where does Silence to Signals fit?
Every program above asks the same thing of you first: notice your child's communication. Follow their lead. Respond to their attempts. But none of them hands you a structured way to read what your child is already sending before you respond.
That's the layer I work in. I call it interpretation, and it makes every other strategy more accurate.
It started with my research. My 2014 Arizona State University dissertation followed Emma, a seventeen-year-old autistic girl whose aggression and self-injury filled two hours of a five-hour school day. Teaching her to ask had already been tried, and it changed very little, because it fell apart the moment the answer was no. What changed things was what I did in that moment. That cut the duration of those episodes by 64% in a big box store, 74% in a grocery store and 81% in her classroom, and it held at six-month follow-up.
That work became the Silence to Signals Communication Framework. It treats a behavior as a signal to tune in to, and it's built around the six-stage SIGNAL Path: See the Child, Interpret the Behavior, Get in Sync, Normalize Symbols, Anticipate Breakdowns, Layer Communication.
Silence to Signals comes before any tool or technique, and it's taught to you, the parent. You learn to watch your child's signals closely, to build a Signal Inventory of what they're already doing, and to catch a quiet signal before it grows into a full meltdown. When you read the signal early, it doesn't need to get louder to be heard.
My husband, Carmen, and I built it into a course for parents, because a framework this useful shouldn't stay inside a therapy room. You have something no specialist has: the hours with your child, and the relationship.
Frequently asked questions
Does Silence to Signals replace my child's therapy?
No. It adds to what your child already has. It sits underneath whatever therapy, AAC system or school program your child already has, and makes it more accurate.
Can I use PECS or AAC and Silence to Signals at the same time?
Yes. You use the framework to read the signal, and the AAC system gives your child a form to send it.
What if my child's hardest moment seems to come out of nowhere?
It rarely does. It was building before you noticed, from a quiet signal to a full meltdown. Stepping in earlier takes very little once you can see it coming.
Is this only for young children?
No. The framework is about reading signals, and signals don't expire with age.
Your next step
You don't have to sort all of this out tonight, and you don't have to choose between these programs. Start with the one skill underneath all of them: reading your child's signals.
Get the free Transition Signal Guide. It walks you through the transition signal, the one your child sends right before their hardest moment, so you can step in while it's still quiet.
Dr. Catherine C. Acotto, PhD, CCC-SLP
0 Comments