Total Communication

What is Total Communication

Total communication involves using any means of communicating. Children with speech and language difficulties or more complex special needs may need support to initiate and take part in communication and interaction. This means making use of all the ways of communicating which are available to the child.

This may include:

Speech and spoken language

Makaton or Signalong signing


Picture symbols


Real objects

Voice output communication aids and computer based systems. 

Who uses Total Communication? 

This could be: children with speech and language difficulties, Parents, Speech and Language Therapists, Teachers and Early Years Practitioners, SENCos, any one who spends time working with or supporting children with communication difficulties.

Adults working with children with communication difficulties sometimes need to interpret the meaning of what the child is communicating. Children’s communication needs may change over time, for example they may benefit from use of signs and symbols initially, while their spoken communication skills are developing or they may continue to need to use other ways of communicating to support or replace spoken language. 

Why use Total Communication? 

Children who have difficulties learning to understand and use spoken language to communicate, need support to communicate to the best of their ability. Total communication makes use of the skills a child has, such as non-verbal communication: body language, eye gaze, eye contact, gestures, movements and vocalisations. Children may also learn to use Makaton, point to or look at photos, symbols or objects to communicate. This may replace or support speech and spoken language. Sometimes children are provided with a Communication Book or a Communication Passport to enable them to communicate with familiar and less familiar people. A Communication Book provides symbols for a child to choose and make sentences with and a Communication Passport provides information about the child’s needs and how to communicate with them. Children with more persistent, long term speech and language difficulties may need Communication Books, passports and or a communication aid, such as a voice output communication aid or computer based systems, to enable them to communicate.

Intensive Interaction:

Intensive Interaction is a practical approach to teaching early communication skills to children and adults who have severe and profound Learning Disabilities and/or Autism. These children or adults are generally at the earliest stages of their communication development and need to learn the fundamental skills that precede using spoken language. These early communication skills include sharing your attention with another person or object, understanding and using eye contact, facial expressions and gestures, taking turns and developing more meaningful vocalisations. The person using Intensive Interaction will follow the child’s lead and allow their actions and behaviours to guide the session. It is an approach that can be used at any time and in any place, if the child is feeling playful or sociable. Alternatively, it can be scheduled into the day at a specific time, when the adult can give their full attention to the task in hand and there are fewer distractions for the child. The Speech and Language Therapist supporting your child will be able to advice whether Intensive Interaction is a suitable approach to use, and can help the key adults in the child’s environment to get started.

Picture Exchange Communication System (PECS)

The Picture Exchange Communication System (PECS) is an approach used to develop functional communication skills. It can be used with children as young as preschoolers with a variety of communicative and learning difficulties, including Autism. It teaches children to exchange a picture for a desired item from their environment, for example if the child wants a drink she/he will give the picture of a drink to an adult, who will then give the child the desired drink. It prompts children to initiate communication, with developing spontaneous communication as the goal. PECS follows a clear programme divided into phases. It starts by using single pictures to communicate needs, the child will then learn to discriminate and choose between pictures, finally moving on to combining a number of pictures into a sentence. The speech and language therapist supporting your child can advise if PECS is a suitable approach for your child. If PECS is an appropriate approach she will help to implement it in your child’s environment, whether it is home and/or preschool.

Alternative and Augmentative Communication (AAC)

Children with special needs can have complex physical and communication difficulties and might need assistance to develop their potential to communicate. The speech and language therapist can give advice on how to develop the communication potential of your child, support the preschool to implement strategies to develop communication and investigate alternative and augmentative forms of communication. 

Assisted forms of communication can be:

Signing and gesture


Pictures and symbols

Technology and communication aids.

Signing and gesture

Some children benefit from using signs and gestures to develop their communication and become more independent at interacting. For some children spoken language is too fast, signing key words with speech helps to slow down the interaction, gives extra visual clues to support understanding of spoken language and also helps them to remember what has been said. Examples are Makaton signing (used in CBBC programmes such as Mr Tumble), British Sign Language(BSL), Signalong and finger spelling. 

Real objects / Objects of reference

Using real objects with children with communication difficulties can encourage them to make choices and interact. Holding up an orange and an apple and letting the child choose which one she would like, by pointing or looking at it, can be a powerful way to communicate for some children. Objects can also be used to help children anticipate and understand what will happen next. Showing a favourite bath toy indicates its bath time. 

Pictures and symbols

As the child learns the meaning of pictures and symbols, an effective way to communicate can be achieved by pointing with fingers, hand or eyes to photos, symbols or words. Photos, symbols or words can be used individually or grouped in a page, chart or stored in a book. Communication charts and books are useful to be used in any environment, don’t need any batteries and can be organised by topic pages.

Communication aids and technology

A communication aid helps a person to communicate with others around him/ her and can range from simple picture charts, letter/alphabet boards, battery operated devices with recorded messages to complex software and technology.
Before selecting a communication aid the speech and language therapist will evaluate the child’s individual needs and abilities and discuss personal preferences. Sometimes other professionals might also be involved when there are physical and sensory limitations which can limit the use of a communication aid.