DHACA® method implementation strategies by parents of children with Autism Spectrum Disorder

Maria Luiza da Conceição Marques dos Santos; Ivana Arrais de Lavor Navarro Xavier; Fádja Auxiliadora Alves e Silva; Lauany Beatriz Pedroza da Silva; Ana Cristina de Albuquerque Montenegro

doi:10.1590/1982-0216/20262839925

Artigos Originais

DHACA^® method implementation strategies by parents of children with Autism Spectrum Disorder

Estratégias de implementação do método DHACA® utilizadas por responsáveis de crianças com Transtorno do Espectro do Autismo

Maria Luiza da Conceição Marques dos Santos; Ivana Arrais de Lavor Navarro Xavier; Fádja Auxiliadora Alves e Silva; Lauany Beatriz Pedroza da Silva; Ana Cristina de Albuquerque Montenegro

http://dx.doi.org/10.1590/1982-0216/20262839925 Revista CEFAC, vol.28, n3, e9925, 2026

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Abstract

Purpose: to investigate the strategies adopted by parents of children with autism spectrum disorder in implementing the DHACA^® method.

Methods: cross-sectional, qualitative, exploratory study using primary data collected through structured interviews with caregivers of children undergoing speech-language-hearing intervention with the DHACA^® method. The interviews were transcribed, categorized, and coded to identify patterns according to the content analysis proposed by Bardin.

Results: the analysis showed that family members adopted various communication support strategies. They used the DHACA^® book, articulated with the child's interests, and made it constantly available and accessible at home. Communication partners also demonstrated engagement with the method and the appropriation of the proposed strategies, favoring its functional use in the child's daily life. Other categories emerged during the interview, such as barriers, context of use, communication partners, and impact on the family.

Conclusion: family members used strategies suggested by therapists, such as modeling and physical, visual, and verbal cues, and provided daily communication opportunities using the DHACA^® communication book. These strategies enhanced the development of children's communication skills and the participation and engagement of close communication partners.

Keywords

Autistic Disorder; Communication; Speech-Language Pathology; Assistive Technology; Child Development; Family

Resumo

Objetivo: investigar as estratégias adotadas pelos pais de crianças com Transtorno do Espectro do Autismo na implementação do método DHACA®.

Métodos: estudo transversal de abordagem qualitativa e de natureza exploratória, com uso de dados primários, coletados por meio de entrevista estruturada com responsáveis de crianças submetidas à intervenção fonoaudiológica com o método DHACA®. As entrevistas foram transcritas, categorizadas e codificadas, permitindo a identificação de padrões, conforme a análise do conteúdo proposta por Bardin.

Resultados: a análise evidenciou que os familiares adotaram diversas estratégias de apoio à comunicação. Observou-se ainda a utilização do livro DHACA® articulada aos interesses da criança, bem como sua oferta constante e acessível no ambiente domiciliar. Além disso, os parceiros de comunicação demonstraram engajamento no método e na apropriação das estratégias propostas, favorecendo o uso funcional no cotidiano da criança. Outras categorias, surgiram durante a entrevista, como: barreiras, contexto de uso, parceiros de comunicação e impactos no contexto familiar.

Conclusão: os familiares utilizaram estratégias sugeridas pelos terapeutas, como modelagem, dica física, visual, verbal, além de oferecer oportunidades diárias para comunicação com uso do livro de comunicação DHACA®. As estratégias potencializaram o desenvolvimento das habilidades de comunicação das crianças e a participação e engajamento dos parceiros de comunicação próximos.

Palavras-chave

Transtorno Autístico; Comunicação; Fonoaudiologia; Tecnologia Assistiva; Desenvolvimento Infantil; Família

Referências

1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Washington (DC): American Psychiatric Publishing; 2013. https://doi.org/10.1176/appi.books.9780890425596

2. Lord C, Brugha TS, Charman T, Cusack J, Dumas G, Frazier T et al. Autism spectrum disorder. Nat Rev Dis Primers. 2020;16;6(1):5. https://doi.org/10.1038/s41572-019-0138-4 PMID: 31949163.

3. Yu Y, Ozonoff S, Miller M. Assessment of Autism Spectrum Disorder. Assessment. 2024;31(1):24-41. https://doi.org/10.1177/10731911231173089 PMID: 37248660.

4. Zeidan J, Frombonne E, Scorah J, Ibrahim A, Durkin MS, Saxena S et al. Global prevalence of autism: A systematic review update. Autism research. 2022;15(5):778-90. https://doi.org/10.1002/aur.2696 PMID: 35238171.

5. Maenner MJ, Warren Z, Williams AR, Amoakohene E, Bakian AV, Bilder DA et al. Autism and developmental disabilities monitoring network, 11 sites, United States, 2020. MMWR Surveill Summ. 2023;72(2):1-14. https://doi.org/10.15585/mmwr.ss7202a1 PMID: 36952288; PMCID: PMC10042614.

6. dos Anjos BB, de Morais NA. Experiences of families with autistic children: An integrative literature review. Ciências Psicológicas. 2021;15(1):e2347. https://doi.org/10.22235/cp.v15i1.2347

7. Mihandoust S, Khademi M, Radfar M. Stages of grieving in fathers of autistic children: A qualitative study. European Review for Medical and Pharmacological Sciences. 2021;25(24):7698-708. https://doi.org/10.26355/eurrev_202112_27616 PMID: 34982431.

8. Naicker VV, Bury SM, Hedley D. Factors associated with parental resolution of a child's autism diagnosis: A systematic review. Front Psychiatry. 2023 Jan 5:13:1079371. https://doi.org/10.3389/fpsyt.2022.1079371 PMID: 36683975.

9. Naidoo M, Govender S. Parental participation in supporting the development of communication skills in autistic children. Int Journal of Early Child Spec Educ. 2022;14(1):791-801. https://doi.org/10.9756/INT-JECSE/V14I1.221093

10. da Silva VVF, da Silva Rossato FGF. The use of assistive technology for augmentative or alternative communication for people with TEA in a third sector institution. Rev. Foco. 2023;16(6):e2421. https://doi.org/10.54751/revistafoco.v16n6-167

11. Gardiner S, Bowden C, Kennedy S, Waddington H. A systematic qualitative review of parent perceptions and experiences of augmentative and alternative communication for their autistic children. Review Journal of Autism and Developmental Disorders. 2025. https://doi.org/10.1007/s40489-025-00515-z

12. Montenegro ACA, Silva AGS, Queiroga B, Lima RAS, Xavier IALN. Method for Developing Communication Skills in Autism - DHACA: Appearance and content validation. CoDAS. 2024;36(3):e20230138. https://doi.org/10.1590/2317-1782/20232023138en PMID: 38126457.

13. Tomasello M. Origens culturais da aquisição do conhecimento humano. 2nd ed. São Paulo: Martins Fontes; 2003.

14. Montenegro ACA, Lima RASC, Xavier IALN. Autismo Comunica: Comunicação alternativa promovendo acessibilidade comunicacional. In: Araújo ANB, Lucena JAPL, editors. Relatos de experiências em Fonoaudiologia. Recife: Editora UFPE; 2021. p.17-31.

15. Montenegro AC, Leite GA, Franco NM, Santos D, Pereira JEA, Xavier IALN. Contributions of alternative communication in the development of communication in children with autism spectrum disorder. Audiol., Commun. Res. 2021;26:e2442. https://doi.org/10.1590/2317-6431-2020-2442

16. Montenegro ACA, Silva LKSM, Bonotto RCS, Lima RASC, Xavier IALN. Use of a robust alternative communication system in autism spectrum disorder: A case report. Rev. CEFAC. 2022;24(2):e11421. https://doi.org/10.1590/1982-0216/202224211421

17. Santos ACFS, Xavier IALN, Queiroga BAM, Rosal AGC, Lima RASC, Montenegro ACA. Speech-language-hearing teletherapy for children with autism spectrum disorders during the Covid-19 pandemic. Rev. CEFAC. 2023;25(1):e10422. https://doi.org/10.1590/1982-0216/202325110422

18. Barbosa FCOL, Montenegro ACA, de Queiroga BAM. The effects of the DHACA method on expressive communication in children with autism spectrum disorder. CoDAS. 2025;37(3):e20240148. https://doi.org/10.1590/2317-1782/e20240148en PMID: 40197957.

19. Manzini MG, Figueiredo MO, Manzini ACG, Martinez CMS. Occupational therapy and alternative communication: Collaborative intervention with communication partners of a child with cerebral palsy. Cadernos Brasileiros de Terapia Ocupacional. 2021;29:e2057. https://doi.org/10.1590/2526-8910.ctoAO2057

20. de Freitas FAF, Montenegro ACA, Fernandes FDM, Delgado IS, Almeida LNA, Alves GADS. Communicative skills of children with autistic spectrum disorder: Clinical and family perception. Rev. CEFAC. 2021;23(4):e1521. https://doi.org/10.1590/1982-0216/20212341521

21. Bardin L. Análise de conteúdo. São Paulo: Edições 70; 2011.

22. Deniz E, Francis G, Torgerson C, Toseeb U. Parent-mediated play-based interventions to improve social communication and language skills of preschool autistic children: A systematic review and meta-analysis protocol. PLoS One. 2022;17(8):e0270153. https://doi.org/10.1371/journal.pone.0270153 PMID: 35969530.

23. Carta A, Casula L, Manca S, Puci MV, Puseddu G, Fucà E et al. Cooperative parent mediated therapy for Italian children with autism spectrum disorder: A clinical experimental study in a community healthcare service in Italy. Front Child Adolesc Psychiatry. 2025;4:1544344. https://doi.org/10.3389/frcha.2025.1544344 PMID: 40667447.

24. Sennott SC, Light JC, McNaughton D. AAC modeling intervention research review. Research and Practice for Persons with Severe Disabilities. 2016;41(2):101-15. https://doi.org/10.1177/1540796916638822

25. Montenegro ACA, Xavier IALN, Lima RASC. Método DHACA Desenvolvimento das Habilidades de Comunicação no Autismo. Ribeirão Preto: Booktoy, 2025. 148p. ISBN 978-85-71481-36-7.

26. Syriopoulou-Delli CK, Gkiolnta E. Review of assistive technology in the training of children with autism spectrum disorders. Int J Dev Disabil. 2020;68(2):73-85. https://doi.org/10.1080/20473869.2019.1706333 PMID: 35309695.

27. Santos S, Boechat G, Do Carmo J. Alternative and enhancemental communication strategies for autistic children. Rev Observ Econ Latinoam. 2024;22(5):1-22. https://doi.org/10.55905/oelv22n5-140

28. Kasari C, Freeman S, Bass W. Empathy and response to distress in children with Down syndrome. J Child Psychol Psychiatry. 2003;44(3):424-31. https://doi.org/10.1111/1469-7610.00132 PMID: 12635971.

29. Shire SY, Jones N. Communication partners supporting children with complex communication needs who use AAC. Communication Disorders Quarterly. 2014;37(1):3-15. https://doi.org/10.1177/1525740114558254

30. Romano N, Chun RYS. Augmentative and Alternative Communication use: Family and professionals' perceptions of facilitators and barriers. CoDAS. 2018;30(4):e20170138. https://doi.org/10.1590/2317-1782/20162017138 PMID: 30043827.

31. Yau SH, Choo K, Tan J, Monson O, Bovell S. Comparing and contrasting barriers in augmentative alternative communication use in nonspeaking autism and complex communication needs: Multi-stakeholder perspectives. Front Psychiatry. 2024;15:1385947. https://doi.org/10.3389/fpsyt.2024.1385947 PMID: 38919639.

32. Donato C, Spencer E, Arthur-Kelly M. A critical synthesis of barriers and facilitators to the use of AAC by children with autism spectrum disorder and their communication partners. Augment Altern Commun. 2018;34(3):242-53. https://doi.org/10.1080/07434618.2018.1493141 PMID: 30231643.

33. Oliveira JJM, Schmidt C, Pendeza D. Parent implemented intervention and parent empowerment for autism spectrum disorder. Psicologia Escolar e Educacional. 2020;24:e218432. https://doi.org/10.1590/2175-35392020218432

34. Berenguer C, Martínez ER, De Stasio S, Baixauli I. Parents' perceptions and experiences with their children's use of augmentative/alternative communication: A systematic review and qualitative meta-synthesis. Int J Environ Res Public Health. 2022;19(13):8091. https://doi.org/10.3390/ijerph19138091 PMID: 35805750.

35. Bertalha RM, Mendes M. O direito à Comunicação Alternativa e Ampliada nas escolas para pessoas não verbais: uma questão de inclusão. Anais do Congresso Internacional de Direitos Humanos. 2023;1:2433. Available at: https://trabalhoscidhcoimbra.com/ojs/index.php/anaiscidhcoimbra/article/view/2433. Accessed on September 7, 2025.

36. Wing L. The continuum of autistic conditions. Acta Psychiatr Scand Suppl. 1988;338:3-13. https://doi.org/10.1007/978-1-4899-0792-9_7

37. Yau SH, Choo K, Tan J, Monson O, Bovell S. Comparing and contrasting barriers in augmentative alternative communication use in nonspeaking autism and complex communication needs: Multi-stakeholder perspectives. Front Psychiatry. 2024 Jun;15:1385947. https://doi.org/10.3389/fpsyt.2024.1385947 PMID: 38919639; PMCID: PMC11197385.

38. Nunes DRP, Barbosa JPS, Nunes LRP. Alternative communication for students with autism at school: A literature review. Rev Bras Educ Esp. 2021;27(4):655-72. https://doi.org/10.1590/1980-54702021v27e0212

39. Silva MPSF, Moreira GNO, Freitas ASS, Montenegro ACA. Morphosyntactic development in autistic children by implementing the Development of Communication Skills in Autism (DHACA) method. Rev. CEFAC. 2025;27(1):e6724. https://doi.org/10.1590/1982-0216/20252716724

Submetido em:
03/10/2025

Aceito em:
28/01/2026