Promoting Communication Skills Through Everyday Routines

1. Promoting Communication Skills Through Everyday Routines Presented by: USF Clinical Instructors: Aleisha LinckVanAmburg, MS CCC-SLP Amy Davis, MS CCC-SLP USF Graduate Student: Jennifer Cooper, BS

2. Agenda-Introductions-Types of play-Group activity focusing on non-verbal communication-Developing meaningful language/communication through play-Group Activity focusing on promoting language development using common household items-Positive Behavior Strategies andEnsuring positive child outcomes through caregiver responsiveness-Developing appropriate family centered goals and strategies for the IFSP.-Knocking down barriers towards progress

4. Name that Feeling Introductions: What is it like to feel different? • Think of a time when you felt different from everyone else. • Think of a word that best describes how you felt at that time: One Word Only. • Walk around the room and introduce yourself to other providers using, instead of your name, the one word that best expressed how you felt. • For Example, I was once at a family gathering for my sister-in-law who is from Lebanon. Everyone in the room was speaking Portuguese. I couldn’t understand anything that was being said. I felt very isolated. • Shake the providers hand and say “Hello, I’m Isolated.

5. Name that Feeling, cont. • How did you feel introducing yourself in this manner? • What were some of the words used? Positive or Negative? • What are the implications of positive versus negative words? • Does anyone have a particular experience where you felt different that you would like to share? • How do you think this relates to our families and children in the Early Steps Program, particularly parents/caregivers of children who have obvious physical and/or cognitive differences?

6. Types of Social Play

8. Types of Social Play: A Growth Model(Based on M. Parten’s stages of play, 1932)

9. Solitary Play • Typical of 2 year olds • Lowest level of social play • Child is playing while totally alone in his or her own world, even if surrounded by other children • (Hughes, F., 2009)

10. Onlooker Play • Typical of 2 year olds • Occurs when a child observes other children at play • The child is involved as a spectator, may offer suggestions/ask questions • Not an active participant • (Hughes, F., 2009)

11. Parallel Play • Parallel play represents a point between the socially immature level of solitary play and the socially sophisticated level of genuine cooperation • Most common type of play observed in all ages • Children play separately within the same activity, at the same time, and in the same place, and are aware of their peers • Parallel play often draws children into cooperative activities • Some psychologists state that parallel play is a safe way to set the stage for more intense group interactions • (Hughes, F., 2009)

12. Associative Play • Most common among 3-4 year olds • Resembles parallel play in that the child is still engaged in a separate activity • Associative play incorporates a considerable amount of sharing, lending, taking turns, attending to the activities of one’s peer and expansive communication. • Example: Two children are painting at adjacent easels, and while each is producing a separate work of art, there is a discussion about their painting or any other topic, a sharing of materials, and a genuine interest in socializing that may be more compelling than the activity itself. • (Hughes, F., 2009)

13. Cooperative Play • Most commonly observed in 4 year olds • Represents the highest level of social maturity • Occurs when two or more children are engaged in a play activity that has a common goal, that can only be realized if all participants carry out their individual assigned roles. • Example: Several children in the sandbox decide that they will build a city; one child works on the road, two children work on the bridge, and others dig a tunnel and build towers. • (Hughes, F., 2009)

14. Which type of play is demonstrated in these pictures? Example #1 Example #2

15. Which type of play is demonstrated in these pictures? Example #3 Example #4

16. Which type of pay is demonstrated in these pictures? Example #5 Example #6

17. Types of Communication Group Activity

19. What is Nonverbal Communication/Signaling? • Nonverbal communication (also called nonverbal signaling) can include: • eye movements/eye gestures • body language • physical proximity • vocal volume and vocal intonation • rate of speech • emphasis on specific words. • People communicate as much or more information through nonverbal channels than they do through verbal channels.

20. What is Nonverbal Communication/Signaling? • Nonverbal signaling is complex and children learn to decode nonverbal meaning at a very early age. • The ability to understand nonverbal signaling requires simultaneous processing. • The ability to deliver nonverbal signaling requires coordination and execution of simultaneous communication modalities. • Children who are not speaking will rely on nonverbal communication.

21. Why focus on Nonverbal Communication? • When children show deficits in nonverbal signaling, their overall communicative abilities are severely limited. • They have trouble understanding what other people are trying to tell them. • Likewise, people often misunderstand the child because they can’t interpret what he or she is trying to say. • This can result in frustration, behavior issues, emotional shut down, social isolation, limited effort for communication, etc.

22. Teaching Nonverbal Communication/Signaling • Prerequisite skills: attention, vision, hearing, eye shifting, precise limb movements, ability to modulate voice, normal cognition, normal story comprehension. • Teaching nonverbal signaling requires breaking down a simultaneous process into component parts so the child focuses on one aspect at a time.

23. Hierarchy for Teaching Nonverbal Communicative Skills/Signaling: Most children learn nonverbal signaling on their own. When they don’t, it can taught by having the child watch and see examples of the skill, then practicing how to deliver it.

24. Eye Gaze/Eye Gestures • Eye skills emerge in a sequence: • 1 month: • Deictic Gaze-infant is able to direct his eye movement toward a particular object • Mutual Gaze-Caregiver and child look at one another • Precursors to more complex eye skills that will be used for communication • 3 months: • Gaze Coupling-a turn taking behavior where the caregiver and child look at the same object

25. Eye Gaze/Eye Gestures • Eye skills emerge in a sequence: • 9 months: • Joint attention-indicates intentionality to communicate • Eyes shift in two different patterns: • 1. object  person  object • 2. person object  person

26. Eye Gaze/Eye Gestures • A child’s ability to use his eyes as a tool for communication lays the foundation for later communicative acts • Joint attention is a prerequisite for making requests and using words for intentional communication • Eye Gaze and joint attention can also be referred to as SOCIAL REFERENCING • Social Referencing is one of the earliest indicators of pragmatic development: • ASD • Severe hearing or cognitive impairment

28. Teaching Eye Gaze/Eye Gestures Corresponding Strategies/Activities: • Eye Messages: using pictures of caregivers or other people and have the child identify eyes/eyebrows and related emotions (happy, sad, scared, angry, etc.) • Model eye gaze towards an intended item or person. Cue the child when they are requesting an item or object either verbally or gesturally to clarify what they desire by using appropriate eye gaze. Display a confused demeanor to encourage appropriate eye gaze to clarify their intent. • Engage the child in a discussion with a familiar adult about topics that invoke feelings of happiness, sadness, fear and anger.

29. Voice Messages (Suprasegmentals) • Voice Messages include: • Intonation in speech • Vocal volume • Rate of speech • Emphasis on words

30. Teaching Voice Messages (Suprasegmentals) Corresponding Strategies/Activities: • Use several different tones in voice for different emotions (happy, sad, angry, scared). Overemphasize them for the child and have him match your tone with an appropriate picture of the emotion(in a book). • Read a fairytale to the child with exaggerated vocal inflection. Then have the child retell the story to another child and/or adult using vocal inflection.

32. Body Messages (Physical Gestures) • Body messages include: • Body movements • arms (crossing arms) • hands (pointing, moving hands while talking) • head/neck (shaking head, nodding, leaning head to one side, etc.) • Etc. • Facial expressions • Eyes/eyebrows (squinting, raised eyebrows, etc.) • Mouth (smile, frown, open, closed, etc.)

33. Space Messages (Proxemics) • Space messages can include: • Little space between speaker and listener • I’m interested in talking to this person • The conversation is less formal • I like this person • I feel comfortable with this person • I like the conversation/I want to keep talking • A lot of space between speaker and listener • I’m not very interested in the conversation • The conversation is more formal • I don’t like this person • I’m in a hurry to end the conversation

34. Coaching Language Development Through Play • “Playing with Toys”, video of speech pathologist coaching a child’s grandmother how to “play” with her grandchild. • http://www.youtube.com/user/babble

35. General Rules for Promoting Language Development through Play • Offer choices for the child • Use open ended questions while playing to expand language. • Avoid correcting or testing. • Establish predictable play routines throughout the day. • Be consistent with your language. • Use clear, concise words/phrases. Try not to “over talk”.

36. Play Interest Survey Play Interest Survey • Can be used for: Ideas to help motivate a child to communicate. Playing games. Positive behavior intervention strategies. Understanding a child’s preferences Avoiding toys or games that cause a child to withdraw or induce negative/perseverative behaviors

37. Toys and Play • Suggestions for 18-24 months of age and 24-36 months of age. • Listening, Reading and Language Concepts • People Play Activities • Play during Routines • Writing and Fine Motor Play • Number and Letter Play

38. Utilizing Common Household Items for Play • Dixie Cups, Straws • Cotton Balls • Plastic spoons, bowls, plates • Cardboard Boxes • Ice Cube Tray • Hot Wheels • Blocks • Bubbles • Empty Containers/Food Boxes • Stuffed Animals • Mr. Potato Head • Towels/Clothing Items • Crayons • Paper Bags • Books/Magazines • Tupperware/ Pots and Pans • Blankets/Pillows • Food- Pudding, Yogurt, Rice

39. Sharing ideas for play with common items. • In small groups, come up with at least three activities using common items previously listed to promote language development. • Verbal Language • Non-Verbal Language • Joint Attention

41. Positive Behavior Supports

43. Old Ways vs. New Ways Old Way • General intervention for all behavior challenges • Intervention is reactive • Focus on behavior reduction • Quick fix New Way • Intervention matched to purpose of the behavior • Intervention is proactive • Focus on teaching new skills • Long term interventions

44. Positive Behavior Support • An approach for changing a child’s behavior • Is based on humanistic values and research • An approach for developing an understanding of WHY the child has challenging behavior and teaching the child new skills to replace challenging behavior • A holistic approach that considers all of the factors that impact on a child, family, and the child’s behavior

45. Research • Effective for all ages of individuals with disabilities 2-50 years old • Effective for diverse groups of individuals with challenges: mental retardation, oppositional defiant disorder, autism, emotional behavioral disorders, children at risk, etc. • PBS is the only comprehensive and evidence-based approach to address challenging behavior within a variety of natural settings.

46. Functional Assessment Features • Clear description of behavior • Events, times, and situations that are predictive • Describes consequences that may maintain the behavior • Formulates a hypothesis

47. Behavior is Communication • Behavior communicates a message when a child does not have language • Used instead of language by a child who has limited social skills or has learned that challenging behavior will result in meeting his or her needs • Children engage in challenging behavior because “it works” for them • Challenging behavior results in the child gaining access to something or someone (i.e., obtain/request) or avoiding something or someone (i.e., escape/protest)

48. Describing Communicative Behavior • Every communicative behavior can be described by the form and function. • Function: the reason or purpose of the communicative behavior • Form: the behavior used to communicate

49. Functions of Communication • Request object, activity, person • Escape demands • Escape activity • Request help • Request social interaction • Comment • Request information • Request sensory stimulation • Escape sensory stimulation

50. Forms of Communication • Words • Sentences • Point to a picture • Eye gaze • Pulling Adult • Crying • Biting • Tantrums