For some people with CdLS, non-vocal or non-verbal strategies will need to be considered. For these individuals it may not be possible to achieve normal or even adequate speech for communicative purposes. Instead the ultimate goal should be to communicate at a level adequate to meet communication needs. Examples of available strategies include a communication board; American Sign Language; American Indian Hand Talk or Amer-Ind gestural code; Blissymbolics; Total Communication; Pantomime; a manual alphabet; eye-blinking encoding; or electronic communication aids.
For children with severe upper-limb malformations there are gestural-assisted and neuro-assisted strategies available. Unfortunately almost all augmentative communication strategies are difficult to learn for children who have difficulty understanding nonverbal or gestural communication. Regardless of the disability, it is important that all individuals be taught some means of indicating "yes' and "no."
Before considering the use of augmentative or alternative communication, a number of factors need to be considered. These include the level of cognition, motor abilities, receptive language abilities, and the motivation to communicate. It will often be most beneficial when speech-language pathologists function as communication therapists rather than as speech therapists and consult as appropriate with professionals such as physical therapists, occupational therapist, physicians, psychologists, social workers, vocational counselors, nurses, and teachers.