Promoting Intentional Communication in Children with CCN: Matching Strategies to Potential Sources of Difficulty

Transcription

1 Promoting Intentional Communication in Children with CCN: Matching Strategies to Potential Sources of Difficulty Dr. Cynthia Cress University of Nebraska-Lincoln Abstract: Learning to gesture or used aided AAC for intentional purposes seems simple until we see children who struggle with this skill. Many children with complex communication needs (CCN) develop communication through atypical strategies and face particular challenges at connecting their individual behaviors to results in social and communicative contexts. Sometimes listeners do not easily detect or interpret communication behaviors of children with any combination of physical, sensory, social, cognitive, or other developmental impairments. Sometimes children have difficulty associating their combination of voluntary and involuntary behaviors with the communicative effects in their environment. Sometimes children, particularly children with autism spectrum disorders, have difficulty generalizing their communication behaviors across contexts to build a consistent sense of their efficacy at getting their messages across to others. For all children with CCN, consistent, prompt, and spontaneous initiation of meaningful communication that is understood and responded to by partners is a lifelong process of balancing strategies and the results accomplished in communication with others. This presentation presents an intervention strategy suitable for working on intentional communication through all modalities, and then systematically addresses common difficulties that arise for children with CCN in each step of this strategy. We ll use video examples of children with CCN who have various difficulties with pre-intentional communication, and problem solve about how our intervention can structure the child s experiences to fill in missing pieces and help overcome these sources of difficulty Word Abstract: I. Scope: Who is our target population? Children who are not yet intentional communicators (e.g. reaching & looking) Adults or children who rely on gestures and partner interpretations for most messages Children or adults who produce symbols if prompted but don t initiate their messages Children and adults who can act on things in ways we understand but aren t telling us Children or adults who don t understand or plan how their behavior is interpreted by us (clinical and video examples will be provided for all of the major headings below) A. Partner-Perceived Communication Spontaneous Behaviors: Reflexive B. Partner-Perceived Communication Spontaneous Behaviors: Reactive C. Partner-Perceived Communication Intentional Behaviors D. Intentional Behaviors vs. Intentional Communication

2 II. Intervention Approaches for Preintentional Communicators A. Responsivity Models Temptation create an opportunity and need to communicate or interact Trigger whatever children do naturally in response to the opportunity or context (follow your child s lead) Touch meaningful and prompt response to the child s behavior respond to the meaning as if it was an intentional gesture B. Why does responsivity work? Research shows that responsivity is a reliable method to increase intentionality Children start to recognize that their own behavior has meaning to others Most children then start doing trial and error learning to see what behaviors get results The more consistently, contingently, and sensitively we respond, the more effectively the child makes these connections C. Why Can Responsivity Affect Actions not Reinforced? In intentional communicators or in typical development, responsivity helps to expand a child s repertoire because: Infants are watching around them (radar) Infants relate that world to themselves Infants mirror or take turns in behaviors Infants explore possible new behaviors Infants use trial and error learning without adult prompting, and judge its social effects D. Gaps for Infants w/disabilities Infants may be missing all those radar and trial and error learning strategies Infants may attend to or respond atypically to events and social interaction Infants may have behaviors and preferences that are hard to interpret Infants may not easily connect their behavioral causes to the event results E. Modeling in Early Intervention Temptation create an opportunity and need to communicate or interact Model show the child a behavior, gesture or word that meets this need and encourage them to produce it Touch meaningful and prompt feedback on the child s effectiveness in producing the target behavior and getting results F. Limits of Modeling for Preintentional Children If I don t know that my OWN behavior is meaningful to you Then I don t see why your behavior is meaningful to me either (a harder skill) If I can only think about two things at once my behavior + object - you re not involved

3 Responding with the same behavior to a model requires radar and abilities to recall/process the models and socially imitate them - where many kids with disability have gaps G. Children learn by doing They don t learn by watching (mostly) or by being acted upon If I didn t do it (child), I didn t learn it If I didn t do it for my own purpose, I m unlikely to do it again for a purpose If I didn t do it for my own purpose at the time when I had that intent, I didn t learn what you thought I was learning III. Tempt-Trigger Intervention Tempt: Adapting the activity, partners, and environment to naturally elicit behavior Trigger: Individual s spontaneously initiated behavior (current skill) Transfer: Helping the child produce a new form or function of behavior immediately after the individual produces their current behavior (i.e. the trigger) no work for child Touch: Tangible and immediate feedback to the successful behavior and its outcome NOTE: each of the problems listed below will be associated with 4-5 examples of strategies to address that aspect of preintentional communication there was insufficient space here A. Temptation problems/strategies I m not interested in many things I play alone, little social mirroring or turns* I m TOO interested in a few things I seek or avoid strong sensation or events I can t do the actions needed for this I give up easily if frustrated or bored B. Trigger Problems/Strategies Child s behaviors are hard to interpret They don t do anything to communicate A Communication Signal Inventory helps us to see a child s behavior as a communication attempt and to begin interpreting these signals. Behaviors are off and on, highly variable Most triggers are negative reactions C. Transfer Problems/Strategies I don t know new things my body can do* I m not watching for new things to try (radar)* I don t relate what I see - to what I do or want* Child doesn t want to do it if it s your idea We want to transfer a vocalization (word)

4 I don t notice YOUR role in getting results I don t want you touching me D. Touch Problems/Strategies I m not aware of what my body just did I m not connecting the effect to the cause without prompting trouble with trial and error learning* I don t know what I can do next to take a turn I get distracted by things pretty easily Disclosure statement: The author (Dr. Cress) has no conflict of interest and no financial or nonfinancial interests in the contents of this presentation.

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