Characterization of circles of communication partners of children with autism spectrum disorder

ABSTRACT

Purpose  :to characterize the communication partners of children with autism spectrum disorder (ASD) according to social circles.

Methods:  a descriptive observational study, conducted at a speech-language-hearing teaching clinic, interviewing the caregivers of 31 nonverbal and/or minimally verbal children diagnosed with ASD. The study used the "Circles of Communication Partner in Autism Spectrum Disorder", based on the social circles concept from the Social Networks Protocol. Data were entered into a Microsoft Excel spreadsheet and analyzed using descriptive statistics.

Results:  communication partners were identified across all five social circles. In Circle 1, the mother was the most frequently cited partner (96.77%), followed by the father (58%) and siblings (35.48%). In Circle 2, prominent partners included grandparents (77.5%), aunts/uncles and cousins ​​(52.1% each), neighbors (51.61%), and friends (16.12%). A progressive reduction was observed in Circle 3, with mentions of schoolmates (41.93%). Regarding Circle 4, teachers were the most frequently cited paid professionals (54.8%), followed by therapists (19.3%). In Circle 5, unknown partners, such as supermarket staff (9.6%), retail clerks (12.9%), and strangers (22.5%), were mentioned.

Conclusion:  the results demonstrate that the primary communication partners of children with ASD are concentrated in the closest circles, particularly the nuclear family, with the mother playing a prominent role.

Keywords:
Autism Spectrum Disorder; Social Inclusion; Communication; Autistic Disorder; Speech-Language Pathology

RESUMO

Objetivo:  caracterizar os parceiros de comunicação de crianças com TEA de acordo com os círculos sociais.

Métodos:  trata-se de um estudo observacional descritivo, realizado numa clínica escola de Fonoaudiologia, no qual foram entrevistados os responsáveis por 31 crianças diagnosticadas com o Transtorno do Espectro do Autismo (TEA) não falantes e/ou minimamente falantes. Utilizou-se o Instrumento de Investigação dos Círculos de Parceiros de Comunicação no Transtorno do Espectro do Autismo (ICP-TEA) embasado no conceito de círculos sociais do Protocolo Social Networks. Os dados foram alocados em planilha digital do Microsoft Excel e analisados por meio de estatística descritiva.

Resultados:  foram encontrados parceiros de comunicação das crianças entre os cinco círculos sociais. No Círculo 1, a mãe foi o parceiro mais citado (96,77%), seguida pelo pai (58%) e irmãos (35,48%). No Círculo 2, destacaram-se os avós (77,5%), tios e primos com 52,1% cada um, vizinho (51,61%) e amigo (16,12%). Já no Círculo 3 observou-se uma redução progressiva, com menções a colegas de escola (41,93%). No que concerne ao Círculo 4, constatou-se que, dentre os profissionais pagos, os professores foram os mais citados (54,8%), seguidos por terapeutas (19,3%). Já no Círculo 5, os parceiros desconhecidos foram citados como os funcionários de supermercado (9,6%), vendedores de loja (12,9%) e pessoas desconhecidas (22,5%).

Conclusão:  os resultados evidenciam que os principais parceiros de comunicação de crianças com TEA concentram-se nos círculos mais próximos, especialmente no núcleo familiar, com destaque para a figura materna.

Descritores:
Transtorno do Espectro Autista; Acessibilidade Comunicacional; Comunicação; Autismo; Fonoaudiologia

INTRODUCTION

Autism spectrum disorder (ASD) is a neurodevelopmental condition characterized by impairments in communication and social interaction, and repetitive and restricted patterns of behavior, interests, and activities, with intensity varying depending on the activity and the individual¹.

Given these communication challenges, augmentative and alternative communication (AAC) stands out as a tool to foster functional communication development in children with ASD². Since many of these individuals learn easily through visual stimuli, the use of AAC and the incorporation of visual cues by communication partners facilitate contextual understanding³. Consequently, AAC supports language development, enhances participation, aids comprehension, reduces frustration, and helps regulate behavior. Furthermore, evidence indicates that AAC intervention does not hinder speech development⁴.

AAC facilitates the inclusion of individuals with complex communication needs (CCN), expanding their opportunities for communication and social interaction. Successful AAC use relies heavily on the engagement of communication partners (i.e., all individuals interacting with AAC users) to ensure consistent use across different contexts⁵. These partners may include individuals with social ties to AAC users (e.g., parents, friends, siblings, and grandparents) and those in educational or caregiving roles (e.g., teachers, caregivers, and healthcare professionals)⁶.

Thus, the communication partner's involvement, according to their skill level, consistent AAC use, sensitivity, and patience, can influence interactions with individuals with CCN⁷. Trained partners increase the likelihood of AAC use and enables its consistent application across all social environments. On the other hand, a lack of communication partners familiar with AAC strategies and resources can delay language development in users of this type of communication⁸.

These partners can be categorized into five social circles, ranging from closest to most distant in relation to the individual with CCN, who is positioned at the center. This classification makes it possible to identify communication partners, goals, and methods within each context, and specific training needs⁹. Circle 1 includes close family members, caregivers, and others with whom the individual lives, typically parents and siblings. Circle 2 encompasses friends and close relatives, people with whom the child plays, spends leisure time, and shares similar interests. Circle 3 includes acquaintances with whom the individual does not socialize extensively or for prolonged periods, such as classmates and school cafeteria staff. Circle 4 refers to professionals who are paid for their time during interactions, such as therapists, teachers, doctors, and caregivers. Finally, Circle 5 comprises unknown partners, representing “everyone else,” such as shopkeepers and members of the community.

Figure 1
Circles of communication partners

Communication partners directly influence the frequency, functioning, and quality of AAC use, affecting aspects such as the vocabulary employed, communicative intentions expressed, support for emotional regulation, and opportunities for social participation for children with ASD¹⁰. Consequently, characterizing these partners’ profiles, as proposed by the Social Networks protocol⁸, allows for the identification of support gaps and training needs, serving as a valuable strategy to inform personalized interventions and expand the child's communicative circles¹¹.

Hence, this study aimed to characterize the communication partners of children presented with ASD, according to social circles.

METHODS

The study was approved by the Research Ethics Committee (CEP) of the Universidade Federal de Pernambuco (UFPE), Brazil, under approval No. 6.617.543 and CAEE No. 68575723.7.0000.5208, in compliance with the standards recognized by Resolution 466/2012 of the National Health Council, Ministry of Health, Brazil.

The children's parents/guardians were informed about the study objectives and signed an informed consent form before starting data collection.

This is a descriptive observational study conducted at a speech-language-hearing (SLH) teaching clinic linked to an outreach program that provides SLH services to children with ASD.

The researchers interviewed the parents/guardians of 31 nonverbal and/or minimally verbal children diagnosed with ASD. Eligibility criteria for participation included being 2 years to 5 years and 11 months of age and having a diagnosis of ASD based on criteria defined by the American Psychiatric Association in the DSM-5 (2013). It excluded children with comorbidities associated with ASD (e.g., associated malformations and/or genetic syndromes), neurological disorders, and physical, intellectual, and sensory impairments.

The study developed the “Investigation Protocol for Circles of Communication Partners in Autism Spectrum Disorder” (ICP-ASD) (Appendix) for data collection, based on the content of the “Social Circles and Communication Partners” section of the Social Networks protocol⁸. The latter is not a standardized test for clarification purposes; rather, it is an assessment and planning protocol that enables qualified professionals to gather and interpret information that may influence the nature of AAC interventions. According to the authors, the protocol comprises 10 sections: I. Identifying information; II. Individual skills and capabilities; III. Circles of Communication Partners (CCP); IV. Modes of expression; V. Representational strategies; VI. AAC tool selection techniques; VII. Interaction support strategies; VIII. Conversation topics; IX. Communication types; X. Summary of general information.

Hence, this study developed an exploratory and descriptive protocol, grounded in the CCP concept from the Social Networks protocol, to initially identify communication partners. The original protocol was not required, as the study did not involve instrument adaptation or validation.

CCP information was gathered through interviews with parents or caregivers, during which the child’s communication partners were identified and categorized. CCP data were analyzed based on the frequency of individual mentions within each circle. Each research participant could name more than one partner per circle, and every individual mention was counted.

Thus, the percentages refer to the proportion of participants who mentioned a specific partner, regardless of whether other partners were also named within the same circle.

The Social Networks protocol serves as a structured communication interview for individuals with CCN and their communication partners. In this regard, the protocol is a new assessment tool designed to help professionals assist individuals with CCN and their communication partners in setting communication goals, planning interventions, and monitoring progress over time^8-12.

The data obtained were entered into a Microsoft Excel spreadsheet and analyzed using descriptive statistics via the Statistical Package for the Social Sciences (SPSS), version 23, employing absolute and relative frequency distributions.

RESULTS

It is important to clarify that the caregivers were asked about the children’s communication partners across different social circles. For each category analyzed, the response was classified as “yes” if the caregiver mentioned at least one communication partner belonging to that social circle. The classification “no” was assigned when the caregiver did not mention any communication partner from that social circle.

In Circle 1, the mother was mentioned by 96.7% of the participants, making her the most frequently cited partner. The father was cited by 58.0% and siblings by 35.4%, as shown in the chart below.

Figure 2
Percentage characterization of communication partners in Circle 1

In Circle 2, grandparents were the most frequently mentioned partners (77.5%), followed by neighbors (51.6%), aunts and uncles (48.3%), cousins ​​(48.3%), and friends (16.1%).

Figure 3
Percentage characterization of communication partners in Circle 2

In Circle 3, the individuals mentioned included schoolmates (cited by 41.9%), a doorman (12.9%), a lunch lady (9.6%), people from church (6.4%), a grandmother's friend (3.2%), and a cousin's husband (3.2%). Additionally, 41.9% stated that the child has no partners in this circle.

Figure 4
Characterization of communication partners in Circle 3

In Circle 4 (paid professionals), teachers were the most frequently cited (54.8%), followed by therapists (19.3%), teacher's aides (12.9%), and therapeutic companions and child development assistants (3.2%). Health professionals were mentioned by 35.4%. Additionally, 16.1% stated that the child had no partners in this circle.

Figure 5
Characterization of communication partners in Circle 4

In Circle 5 (unknown partners), supermarket employees (9.6%), shop assistants (12.9%), strangers (22.5%), and street sweepers (3.2%) were mentioned. However, 61.2% stated that the child had no partners in this circle.

Figure 6
Characterization of communication partners in Circle 5

DISCUSSION

The data obtained revealed a significant concentration of partners in the closest circles (Circle 1 [immediate family] and Circle 2 [friends and close relatives]), and a lower frequency of partners in the outer circles, such as Circle 4 (paid workers) and Circle 5 (unknown partners). These results align with studies by Balestro and Fernandes (2019)¹³, who identified the family as the child’s primary emotional bond and social group, and by Beukelman and Light (2020)⁴, who also highlighted the frequent presence of family members and friends as AAC facilitators. This finding also corroborates previous research identifying the nuclear family as the setting with the highest number of interactions⁷.

In this context, parents and siblings will be the primary interaction partners using AAC with the child. Thus, investing in family participation is a powerful strategy to enhance the child's communication development¹⁴.

Another important observation was the overwhelming presence of the mother in Circle 1, indicating her potential central role among the various partners, which corroborates existing literature^15,16. However, this maternal centrality can compromise the mother's social, emotional, and professional life, leading to a caregiving burden associated with the child’s ASD¹⁷. Furthermore, the chronic stress experienced by many mothers impacts maternal health, manifesting as metabolic changes and obesity, and reduces resilience to physical stress¹⁸. In the present study, mothers were cited by 96.7% of respondents, whereas fathers were cited by only 58.0%, representing a 38.7 percentage-point difference between these two parental figures. This finding aligns with existing literature, potentially reinforcing the concentration of communication and caregiving demands on the mother (and the resulting stress and burden) when compared to the father¹⁹.

An analysis of the results from Circles 1, 2, and 3 reveals that classmates are rarely recognized as close communication partners. Considering the literature, this scenario may constitute a barrier to effective social inclusion (Fisher, Shogren, and Halle, 2013)²⁰. However, since this study did not directly assess aspects related to social isolation and participation, such interpretations should be viewed with caution. Thus, the results suggest that the school setting may not be fully leveraging its potential to foster communication, social interaction, and peer friendships¹⁶.

Furthermore, it is important to consider that the children assessed were 2 years to 5 years and 11 months old, a developmental stage characterized by limited autonomy in the functional use of AAC across various social contexts, such as school.

Although the literature often cites health professionals and therapists, including SLH pathologists, they did not constitute a majority of the partners identified in this study. The low frequency of mentions regarding therapists and SLH pathologists as communication partners may stem from how the concept of “communication partner” is understood, with greater importance attributed to individuals with whom the child engages in spontaneous, everyday interactions within family and social environments.

In the context of this study, while professionals play a role in the therapeutic process and the development of communication skills, they were likely not perceived by families as communication partners in the same sense as family members, caregivers, and peers.

These results reiterate the importance of having SLH pathologists present and active in therapy and in fostering interactions within contexts relevant to the child’s daily routine, thereby helping to expand their network of communication partners and facilitating social inclusion²¹. Additionally, SLH pathologists should be responsible for training partners to recognize interaction opportunities and employ strategies that promote communication across various settings⁴. Thus, intervention should focus on promoting functional communication to foster communicative competence, which may vary by context depending on the partners, environments, and communication goals involved¹⁰.

Another factor worth highlighting, according to research by Light et al. (2025)²², is that various professionals lack AAC knowledge and training. This leads to difficulties in facilitating effective communication and can hinder interaction between professionals and AAC users.

In this context, the results show a decrease in the presence and diversity of communication partners as social circles expand to include less familiar figures. This reaffirms literature findings indicating that AAC users are at risk of having fewer and lower-quality social relationships⁶. Limiting partners to the child’s closest circles can restrict opportunities for their communicative development, language functioning, and social inclusion. Furthermore, it often triggers feelings of loneliness in individuals with CCN, who may feel ignored in spaces not designed to meet their communication requirements²³. It is worth noting the scarcity of studies specifically exploring the positive impacts of expanding the communication partner network, which underscores the importance of research such as the present study.

A limitation of this study is the difficulty reported by interviewees in recalling all the child's communication partners, which may have influenced the completeness of collected data. Another limitation concerns the categorization proposed by the protocol: in some cases, a grandmother plays a maternal role in the child's daily life; yet, based on the protocol's definition, she was assigned to Circle 2 rather than Circle 1. Hence, this classification may not adequately reflect the bond and actual frequency of interaction between the child and this caregiver. Additionally, individual variability among participants may have influenced the number of partners listed in certain circles. Therefore, the data must be interpreted with this diversity in mind.

Thus, further research is needed to expand the investigation into factors that facilitate or restrict the participation of non-family partners, such as classmates, teachers, and healthcare professionals, and to examine the impact of intervention strategies aimed at training these individuals. Such studies could contribute to the development of more inclusive practices that foster meaningful social interactions and support the full communicative development of these children.

CONCLUSION

The results indicate that the primary communication partners for children presented with ASD are concentrated within their closest circles, particularly the immediate family, with the mother playing a prominent role. Partners from wider social circles had limited participation, suggesting restricted opportunities for social interaction, which may compromise the functional use of AAC across different contexts.

The study findings highlight the importance of identifying and training communication partners for nonverbal or minimally verbal children with ASD, as well as employing intervention strategies that expand and diversify communicative opportunities in various social settings, thereby fostering the child's engagement with a broader network of communication partners.

ACKNOWLEDGMENTS

Gratitude is extended to the Coordenação de Aperfeiçoamento Pessoal de Nível Superior - CAPES, CNPQ, and FINEP, for their financial support.

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A study conducted at the Universidade Federal de Pernambuco, Recife, PE, Brazil.

Financial support

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), process number 88881.926979/2023-01, and Financiadora de Estudos e Projetos (FINEP), process number 2170/22

Data sharing statement

The data used in this study are publicly available and easily accessible; no further sharing is required. For further information, the authors may be contacted via email upon request.

Artificial Intelligence tools statement

The authors used OpenAI's ChatGPT-4 (2024) during the preparation of this study to improve its grammar and fluency. After using this tool, the authors reviewed and edited the content as necessary. Hence, they assume full responsibility for the content of the publication.

APPENDIX - INSTRUMENT FOR THE INVESTIGATION OF CIRCLES OF COMMUNICATION PARTNERS IN AUTISM SPECTRUM DISORDERS - ICP- ASD)

(Adapted from the Social Networks Protocol [Blackstone & Berg, 2012] and the Communication Assessment in Autism Spectrum Disorder [ACOTEA] [Montenegro, 2021])

Name: ____________________________________ DOB: ____________________

Respondent: _________________________________ Relationship: _____________

Date: _____________________ Pre-intervention ( ) Post-intervention ( )

Interviewer: __________________________________________________________

The child’s communicative profile

Does the child use augmentative and alternative communication?

1. Circles of communication partners

Circle 1: Which members of the nuclear family (i.e., those who live in the same house and with whom the child has close, daily contact) interact (communicate) with the child?

( ) Mother ( ) Father ( ) Sibling(s) ( ) Caregiver/nanny ( ) Others

Who? ___________________________________________________

Circle 2: Which members of the extended family (relatives who do not live with the child), close friends, or neighbors interact (communicate) with the child?

( ) Grandparents ( ) Cousins ( ) Aunts/uncles ( ) Neighbors

( ) Neighborhood friends ( ) Classmates ( ) Others

Who? ___________________________________________________

Circle 3: Who are the people the child knows, spends little time with, and yet interacts and communicates with?

( ) Building or school doorman ( ) School cafeteria workers ( ) Others

Who? ____________________________________________________

Circle 4: Which health and education professionals interact with the child?

( ) Therapists ( ) Teacher ( ) Physician ( ) Others

Who? ____________________________________________________

Circle 5: Who are the strangers with whom the child occasionally communicates?

( ) Retail salesperson ( ) Waiter/waitress ( ) Cashier ( ) Others

Who? ____________________________________________________

Please, preferably select a single person (the communication partner who stands out the most) in the questions below:

2. Who spends the most time with the child?

( ) Mother ( ) Father ( ) Grandparents ( ) Other: ___________________

a) On average, how long (in hours) does this person spend with the child during the day?

_________________________________________________________

b) How does the child communicate with this person?

( ) Speech ( ) Alternative communication ( ) Gestures ( ) Body/facial expressions ( ) Crying ( ) Writing/drawing ( ) Other:

_________________________________________________________

c) Are these forms of communication effective (i.e., can the person understand the child most of the time)?

( ) yes ( ) no

3. Who interacts better with the child (i.e., who can talk or communicate better)? Who understands the child better?

( ) Mother ( ) Father ( ) Grandparents ( ) Other: _______________________

a) On average, how long (in hours) does this person spend with the child?

_____________________________________________________________

b) How does the child communicate with this person?

( ) Speech ( ) Alternative communication ( ) Gestures ( ) Body/facial expressions

( ) Crying ( ) Writing/drawing ( ) Other: ______________________________

c) Are these forms of communication effective (i.e., can the person understand the child most of the time)?

( ) yes ( ) no

4. Who does the child most enjoy interacting with? This is the person the child likes to spend time, talk, play, and share interests with.

( ) Mother ( ) Father ( ) Grandparents ( ) Other: _______________________

a) On average, how long (in hours) does this person spend with the child?

_____________________________________________________________

b) How does the child communicate with this person?

( ) Speech ( ) Alternative communication ( ) Gestures ( ) Body/facial expressions

( ) Crying ( ) Writing/drawing ( ) Other: ______________________________

c) Are these forms of communication effective (i.e., can the person understand the child most of the time)?

( ) yes ( ) no

5. Who is the person most willing to learn strategies to communicate better with the child?

( ) Mother ( ) Father ( ) Grandparents ( ) Other: _______________________

6. Is this person also the most willing to teach strategies to others who interact with the child?

( ) Yes ( ) No

Correspondence

Corresponding author: Ana Cristina de Albuquerque Montenegro, Rua Professor Arthur de Sá, s/n - Cidade Universitária, CEP: 50674-420 - Recife, PE, Brasil, Email: [e-mail]

Conflict of interests

Nonexistent

Chief Editor

Giédre Berretin-Felix

Associate Editor

Raphaela Guedes

Publication Dates

• Publication in this collection
  09 Nov 2026
• Date of issue
  2026

History

• Received
  07 Apr 2026
• Reviewed
  17 Aug 2026
• Accepted
  28 Aug 2026