Communication Repair & Self Advocacy Karen Anderson, PhD ASHA, November 20,

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1 Communication Repair & Self Advocacy Karen Anderson, PhD ASHA, November 20, Why the focus on communication repair now? The bar has been raised Early identification, amplification, and intervention has increased expectations Greater numbers of children with hearing loss are entering the mainstream rather than programs for children with hearing loss Parents, especially those of children with CIs, expect their children to function well in the mainstream Building a successful student: For the child who has hearing loss Maximum audibility of speech Consistent amplification wear Attention to language building and effective communication from a young age Ready to learn at school entry Has at least the minimum skills and knowledge expected at school entry Has socialization skills Traditional focus of Deaf Education Can s/he hear as much as possible? Language, language, language Playing catch up for growing academic delays Reading/comprehension delays Cultural aspects of being Deaf Auditory training (maybe) Mainstreamed but seen as a different learner Today s Learner with Hearing Loss Early identified and early amplified Attention to communication development from early infancy Better audibility for speech than ever before Enters school with language skill level commensurate with peers A great start but no guarantee for success! School entry and determining needs: Eligibility for specialized instruction: Does the student have learning discrepancies or needs that will prevent him from learning in the general education setting without specialized instruction (& related services)?will s/he be able to show proficiency toward educational benchmarks without SpEd? Section 504: Does the student have a disability condition that limits his/her full participation and access to general education? Present level of performance Eligibility for specialized support services requires a present level of performance Typically for students with hearing loss: Hearing loss in relation to eligibility criteria Language (receptive/expressive/total) in comparison to age peers If no sizable delay is noted, a child may not be eligible for services from a SLP, DHH teacher or educational audiologist. 1

2 What is required for school success? A correlate from the field of vision loss to consider The Expanded Core Curriculum for Children and Youths who are Blind & Visually Impaired The Existing Core Curriculum English language arts other languages, to the extent possible mathematics science health physical education fine arts social studies economics business education vocational education history What is required for success? The Expanded Core Curriculum This is the traditional focus for students with hearing loss compensatory or functional academic skills, including communication modes orientation and mobility social interaction skills independent living skills recreation and leisure skills career education use of assistive technology sensory efficiency skills self-determination (self advocacy) Socialization and the Hidden Curriculum Social skills include: Rules of conversation Responding to social cues Saying hello and goodbye Communication repair Cooperating by taking turns Responding appropriately to questions Being sensitive to the feelings of others Making eye contact Smiling Being polite Problem solving (including self advocacy) Supporting others by giving them attention and helping Having interesting things to say Reinforcing and acknowledging other s comments Controlling aggression and other inappropriate behaviors Socialization more than making friends In his theory of cognitive socialization, Vygotsky believed that cognitive development and learning was dependent on sharing through language and continual cooperation among learners. Communication problems and differences in modes of communication often adversely impact the ability of students who are deaf or hard of hearing to develop friendships (Luckner, Schauermann & Robb, 1994). Present Levels of Performance should include the Hidden Curriculum Hearing Loss Self Advocacy and independence Language skills Functional listening in quiet/noise at varying Communication style distances Communication repair skills Needs due to barriers to classroom listening Optimal access to the general education curriculum requires: Full audibility of speech everyday, all day Predictability in teaching and classroom control (one person talking at a time) FM for ALL group instruction (SG/LG) Teacher taking the responsibility to add visuals, check for comprehension Student taking the responsibility to advocate for own needs. 2

3 Competence in communication Repair Competence in repairing communication is based on three skills: (1) the ability to persist in the communication process until comprehension is achieved (2) the ability to take on the perspective of the communication partner, allowing for the recognition that a communication breakdown has occurred and (3) the development of effective alternate communication options. Need for communication repair training Competency in communication repair is typically learned experientially and/or incidentally. Children with disabilities often have difficulty developing repair strategies without instruction. Researchers have suggested a relationship between communication breakdowns or lack of repairs and problem behavior. Children with disabilities more often render a message that is unclear, incomplete or less conventional and are often less able cope with the frustration or respond to the respond to the clarification in an acceptable manner. A place to start. It s not all about audibility and language or language delay Success is also about how a person communicates your style Children can have communication styles that do not help them: Socialize Advocate for what they need Be perceived as capable and equal communicators Personality + experience + skills all develop COMMUNICATION STYLE: Types of listener characteristics Passive Tends to withdraw from conversations Frequently bluffs or pretends to understand Tends to resist social interactions May resist talking with others Aggressive Attempts to dominate conversations May seem overbearing or hostile Could be perceived as having a bad attitude Assertive Reciprocates in conversations Is respectful and considerate of others Expresses needs honestly and openly Takes responsibility for managing communication difficulties (adapted from Tye-Murray, 1998) Rules of conversation Agree to pay attention to who is talking No one person does all the talking Participate in choosing and developing a topic Take turns in an orderly fashion Add information relevant to the topic Provide enough information to convey the message without being too chatty People with hearing loss often exhibit in their conversations: Disrupted turn taking styles Modified speaking style Inappropriate topic shifts Superficial content Frequent clarification 3

4 Communication breakdown A breakdown occurs when the message is not properly perceived and the conversation is interrupted May be due to talker or listener Repair strategies incorporate verbal and nonverbal activities in order to keep the conversation going when speech is unclear or misunderstood Strategies are initiated by the talker or as a result of the listener s request Communication repair from the start. Young children develop repair strategies as they experience communication breakdowns It is an integral part of the language acquisition process Awareness evolves regarding the needs of participants in communication interactions Repair strategies are an early developing mechanism Relatively unsophisticated language learners are sensitive to feedback that their messages are not understood They are able to adjust so they can accommodate to be understood during conversations Strategies used to provide clarification change with age Hearing loss and communication failure Communication breakdown occurs frequently when hearing is fragmented As talkers they may have difficulty in communicating their messages due to speech and voice characteristics In order to overcome communication failure they need to learn to adopt strategies to facilitate understanding and being understood, especially in educational settings Reminders for our children There are many ways we use to understand one another (speech, sign, writing, pictures, gestures, showing) EVERYONE experiences communication breakdowns because of sender speech errors, noise, receiver hearing loss, not clearly enunciated, poor angle for speechreading, distance, etc. EVERYONE has a responsibility to fix broken communication situations! So don t they already know how to repair communication? One study compared children with normal hearing to children using total communication The two groups used different strategies to respond to communication breakdown Children with hearing loss were more likely to revise what they had said Children without hearing loss were as likely to repeat as to revise, and also provided background cues In a follow up study both groups of children revised their utterances AND modified non-linguistic information, such as changing intonation or facial expression to get their message across As the hearing children became more linguistically skilled they used fewer non-linguistic revisions Children with hearing loss used linguistic responses less often than any other type of revision and relied heavily on non-linguistic information to clarify messages Next steps needed? People with normal hearing learn to use repair strategies spontaneously through everyday auditory experiences Children with hearing loss have diminished auditory experiences so they require formal instruction in the use of communication repair strategies Will communication repair instruction REALLY help? A study of 9-12 year olds set up 7 groups, each with 3 hearing children and 1 child with hearing loss 4 of the 7 children with hearing loss were trained in communication breakdown management There were fewer communication breakdowns for those who were trained They added effective revision strategies to the frequently used strategy of repetition Repetition Slow repetition Clear repetition Emphasize key words Louder repetition Nonverbal Show/Expression Sign/Spell Write/Draw Revision Expansion to 2 sentences Use alternate words Alter grammatical form Addition Simple addition Defining terms Adding back-ground 4

5 Speech Intelligibility and Repair 2002 study of 10 children with normal hearing and 16 children with severe/profound HL (mean of 89dB HL) All were diagnosed with hearing loss in the first 2 years of life and wore hearing aids (mean aided PTA 42 db HL) All had age-appropriate expressive language skills All rated on a scale of 1-5 in speech intelligibility and divided into either poor speech intelligibility (PSI) or good intelligibility (GSI) groups HL/PSI used more repetition fewer strategies used! HL/GSI responded inappropriately more than NH or HL/PSI ( enough already ) NH used addition, cue, and expansion significantly more than the HL groups NOTE: revision, cue, expansion require language ability to draw upon synonyms and related words Implications Typical language tests used may not be sensitive enough to detect differences in language (synonyms), and especially in pragmatic use of language Children with hearing loss do not spontaneously learn how to cope with communication breakdowns as individuals with normal hearing do Need to take into account differences, i.e. listener to child with poor speech intelligibility may not understand enough to benefit from linguistic context Communication repair training for children with poor speech intelligibility focus on key word and simplification strategies Communication repair training for children with good speech intelligibility focus on expansion and addition strategies Identifying current repair strategies - how 12 colorful pictures depicting a situation (i.e., bicycle rider watching a man stealing jewelry from a store) 5 test sets of pictures total (can intersperse test pictures with non-test pictures to maintain motivation) Each child is shown a picture and asked to describe what he/she saw Teacher says huh and after the child responds with a description, the teacher says what and after the next response says I did not understand 1 sentence x 3 repair strategies x 5 pictures So how do you work on communication repair? Conversational tracking procedures: Phase 1: student repeats a sentence, therapist adds cues until the student can repeat several sentences correctly Phase 2: student repeats a sentence and uses communication repair strategies until he can repeat all sentences correctly Phase 3: listening conditions and tasks become more real-life challenging the student to listen assertively Communication repair scenarios People who acknowledge their hearing difficulty were noted as more likeable, sincere, reliable and were preferred as conversational partners over people who bluffed and did not acknowledge their hearing difficulty Children who are matter of fact about not hearing perfectly will be more accepted by peers When and how do they let others know? Using acknowledgement scripts helps! Developing communication repair scenarios Individually tailored to situations a child encounters when new people are met Developed through a conversation with the child and role-playing Examples, meeting someone new at: The ball pit at Burger King Starting cub scouts Joining a sports team Birthday party Going to summer camp Communication repair scenarios are also important for how to handle questions like What are those things in your ears? Development of self esteem and acceptance of life- long amplification wear begin with how we coach children to explain their hearing loss and amplification devices to others start early! 5

6 Communication Repair at School - BE PREPAIRED TO REPAIR! Does it seem important for you to know this information? Do you have time to figure it out before the class settles down and the teacher is ready to start? If the teacher is about ready to start and you still don t know, what can you say or do? Some hearing tactics. Seating - ask to move as needed to hear Develop a signal with the teacher to let her know you cannot hear her well Get up and close the classroom door Class notetakers Pass the FM microphone (including Oprah use of the yardstick) Ask teacher to repeat student names as she calls on them so you can locate them quickly Discuss use of a talking stick to ensure one-at-a-time discussions Shaping an independent adult Independence and self advocacy goals are not usually included on IEPs, or not until the student is older Students need to own their hearing loss and become responsible they know more than their teachers usually! Expectations for responsibility and independence should grow over time. SEAM for School Success: Student Expectations for Advocacy & Monitoring Expected participation skill performed - Examples Wears hearing aid(s) or cochlear implant (CI) processor(s) full time. Does self-test (baa baa, mmm mmm), listening to each device after it has been turned on. Inserts (or attempts) earmolds and puts on hearing aid(s) or cochlear implant processor(s) Recognizes that s/he needs to ask adult before device(s) are removed. Knows that s/he is expected to report all issues with device(s). Wears/brings hearing aid(s) or CI processor(s) to school every day. Managing the classroom for success Teacher has PREDICTABLE routines Visuals (page #, homework on board) Only 1 person talking at a time Instructional style review, introduce new concept, integrate into what was known, check for understanding Seating flexibility as noise changes, allow to close classroom door Teacher encourages communication repair & independence Improving School Performance: School team (including educational audiologist/slp) ensures: Access to the general curriculum Optimal audition, addressing acoustic barriers, recognizing affect of HL on PACE of learning Special education supports needed Language gaps (that may not show on tests) Pragmatic/socialization skills Minimization/closing academic gaps Compensatory skills Communication repair Self advocacy/independence Monitoring communication function Handout prepared for participants of ASHA Short course for Special Interest Division 9 Childhood Hearing Disorders. 6