Cómo ayudar a los niños con autismo a aprender a comunicarse


Una de las metas más urgentes en el tratamiento de niños en el espectro autista es ayudarlos a desarrollar habilidades de comunicación.

Cuando los niños no tienen un desarrollo típico de las habilidades lingüísticas, es posible que no tengan una forma efectiva de transmitir sus deseos y necesidades.

Como resultado, corren el riesgo de desarrollar berrinches, agresiones o conductas autolesivas como reemplazo. Estos comportamientos no solo son potencialmente dañinos, sino que a menudo no se comprenden.

Ahí es donde entra en juego la capacitación en comunicación funcional (FCT, por sus siglas en inglés). La FCT implica enseñarle a un individuo una forma confiable de transmitir información con lenguaje, señales y/o imágenes para lograr el fin deseado. Se llama “funcional” porque no solo enseña a los niños a etiquetar un artículo (es decir, asociar la palabra ROJO a una imagen de una manzana) sino que se enfoca en usar palabras o señales para obtener algo necesario o deseado: una comida, un juguete, una actividad, un viaje al baño, un descanso de algo.

La FCT implica el uso de refuerzo positivo para enseñar a los niños sobre el lenguaje y la comunicación, para aumentar su capacidad de interactuar de manera efectiva con otros para satisfacer sus necesidades.

Cómo funciona la capacitación en comunicación funcional

Stephanie Lee, PsyD, psicóloga clínica del Child Mind Institute, explica cómo funciona cuando un médico implementa la FCT. Ella comienza, dice la Dra. Lee, al identificar algo que el niño está muy motivado en lograr, por ejemplo, su comida, juguete o actividad favorita. Eso servirá como la recompensa natural por usar una señal o una imagen que represente esa cosa.

“Entonces, si al niño realmente le gustan sus Tortugas Ninja o Thomas el tren, o si la comida favorita de un niño es Cheetos, tomamos ese artículo y luego le enseñamos al niño una señal o una imagen que representa ese artículo”.

Inicialmente, el niño está preparado para lo que la Dra. Lee llama “aprendizaje sin errores”, en el cual el terapeuta guía al niño a usar la señal o la imagen y obtener la recompensa.

Esta comunicación con refuerzo se repite, cada vez dando como resultado la recompensa obtenida, hasta que el niño pueda tener éxito con cada vez menos indicaciones del terapeuta.

“A medida que atenuamos ese impulso, el niño se vuelve cada vez más independiente en su comunicación”, dice la Dra. Lee.

Una vez que los niños usan de manera confiable la palabra, la señal o la imagen para ese elemento cuando el elemento está presente, el siguiente paso es que “generalicen” o lo usen fuera de la situación específica en la que se les ha enseñado.

Por ejemplo, si un niño mira televisión y quiere unas papas fritas, podría usar el letrero como una forma de obtener esas papas, señala la Dra. Lee. Ese tipo de uso espontáneo o esporádico de la habilidad también debe reforzarse con el tiempo.

Después de que una palabra o señal en particular se usa de manera consistente, se pueden agregar otras nuevas para construir gradualmente el repertorio del niño.

“Una vez que el niño ha aprendido este sistema de comunicación, que la señal o la imagen que está utilizando deben ser recibidos por otra persona para que puedan obtener su artículo, entonces, de manera lenta pero segura, podemos enseñarle un nuevo letrero o presentar una nueva imagen”, explica la Dra. Lee.

Metas en la FCT

La rapidez con que los niños progresan con la FCT a menudo depende de su funcionamiento o nivel cognitivo. Para los niños con necesidades más complejas o con un deterioro del lenguaje más significativo, podrían ser necesarios muchos ensayos para obtener algunas señales o imágenes.

“Pueden terminar con un pequeño repertorio de comunicación funcional”, señala la Dra. Lee, “pero es el repertorio que más necesitan: los alimentos que les gustan, usar el baño, ese tipo de cosas”. Los niños con necesidades menos complejas y cuyo nivel de funcionamiento es más alto, en realidad podrían terminar logrando la misma cantidad de lenguaje, si no más, que los niños de su edad con un desarrollo típico”.

Algunos niños podrán hablar en oraciones completas, utilizando un dispositivo de asistencia técnica. Otros adquirirán solo palabras únicas. “Con este último estaríamos buscando determinar las metas más apropiadas para ellos”, señala la Dra. Lee.

El beneficio se compararía con el esfuerzo que se necesitaría para lograrlo. Es importante recordar que el tratamiento se adapta a las necesidades y habilidades específicas de cada niño.

La capacitación en comunicación funcional a menudo se imparte individualmente con un médico que es un patólogo del habla y del lenguaje o un psicólogo conductual capacitado en análisis de conducta aplicada (ABA).

Los padres tienen un papel importante en reforzar la capacitación, practicar lo que el niño aprendió y usarlo en una variedad de situaciones. Cuando la FCT se realiza en la escuela, los maestros deberían ayudar a los niños a practicar las señales que han aprendido.

La FCT y los comportamientos problemáticos

El entrenamiento en comunicación funcional se desarrolló originalmente, en la década de 1980, como una forma de reducir los comportamientos problemáticos asociados con el autismo, incluidos las autolesiones y la agresión.

La idea era que estos comportamientos se derivan de la incapacidad de comunicar las necesidades de manera efectiva.

Para utilizar la FCT para mitigar el comportamiento problemático, explica la Dra. Lee, el punto de partida es observar la función de esos comportamientos, lo que los médicos llaman una “evaluación funcional”. Eso requiere una observación atenta del niño.

Si un niño se golpea la cabeza contra la pared, se bofetea o si golpea a otro niño, ¿cuál es la función de este comportamiento? “Para llegar al fondo de estos comportamientos, observamos los antecedentes y las consecuencias. ¿Qué prepara el escenario para el comportamiento? ¿Cuándo sucede? ¿Cuándo no sucede? ¿Con quién pasa? ¿Qué suele suceder después?”

Si el catalizador de las conductas problemáticas parece ser algo que el niño no puede comunicar, entonces enseñarle una forma más confiable de comunicar sus necesidades puede extinguir esa conducta.

La Dra. Lee enfatiza que la FCT solo funciona para reducir el comportamiento problemático si puede evaluar correctamente la función del comportamiento para ese individuo. “El tipo de comportamiento o tipografía, ese es el término técnico, realmente varía según el individuo”, explica.

“Y puede variar para un individuo en diferentes puntos. Por ejemplo, alguien podría comenzar con un comportamiento autolesivo y luego volverse agresivo, si encuentra que la agresión es más eficiente”.

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