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Creating opportunities for communication.

While providing speech and language therapy to 50 school-aged children with profound disabilities, I noticed that many of the students communicated very little with their teachers and aides during familiar daily routines such as eating, grooming, toileting and preparing to go home. In part, this lack of communication can be attributed to the disabilities which prevent or limit the children's use of speech, gesture (sign language and pointing) and/or facial expression. However, observation of the teachers and aides revealed that these well-intentioned caregivers did little during these daily routines to elicit communication and active participation from the children. The students were not required or expected to participate, not because they were unable, but because the caregivers could perform the routines efficiently and almost automatically. The need for actively involving each student was inadvertently overlooked.

Conversations with a number of parents revealed similar scenarios: "I can feed, dress or toilet my child more quickly and efficiently than he can alone or with my help. I'm often so pressed for time that I find I just do things for him without his active involvement." This was reported by parents of children with and without disabilities, often "guilty" of the same thing. Personally, I know that I tied shoes and cut meat for my son far longer than I needed to, not because he couldn't handle the tasks, but because I didn't have time to wait for his slower performance. I had been doing it for so long that I forgot he was now able to do these tasks himself. Many times our daily routines were altered to allow my son greater inolvement and independence, all because he loudly complained, "Mom,

I can do it myself!"

Unfortunately, many children with developmental disabilities lade this independent initiative, and so they passively relinquish active involvement in everyday activities -- if they ever developed it at all. And caregivers continue to give care without realizing that valuable opportunities for communication and involvement are being lost.

By modifying familiar daily routines in school, we were able to elicit greater communication, interest and involvement from our students. They were encouraged to make choices, requests and ask for help when needed. They used verbal and nonverbal communication to direct the actions of the teacher, and to indicate "no" in an acceptable manner. In short, they learned the power of communication, and in the process gained greater control over their lives.

The techniques we used for increasing student communication can and should be used in the home as well. The method your child uses to communicate is not important. Speech or vocalization, eye gaze, pointing or gestures (such as sign language), change in body position or facial expression, and communication devices or "mini" communication boards can all be effective, as long as your child has ample opportunities to interact with you and other communication partners throughout the day. The following are some do's and don'ts for increasing your child's communication during familiar daily routines:

1. DO create opportunities to direct the actions of others.

Begin an activity with your child, then pause, shift your attention away, or leave something out of the activity so that your child has to attract your attention to continue the activity. Examples: Interrupt feeding; put drink, utensils or materials in sight but out of reach; set up the TV or tape player but forget to turn it on.

When your child, using speech or nonverbal communication, indicates that your help is needed, first give your attention to the child ("What do you want?"); then see if your child can indicate the nature of the problem (by vocalizing, pointing or pulling on you). React in a way that lets the child know that he has communicated successfully ("Oh, the TV is off! Do you want me to turn it on?").

2. DON'T anticipate your child's wants and needs.

Let your child make the request or direct your actions. Example: Don't automatically clear the path or open doors for your child. There won't always be someone there to do it, so your child should learn to ask for help when needed. If he asks for a drink, let him direct you through the steps of getting a cup and beverage by drawing his attention to the elements and sequence of events ("What do we need? Where is your cup?"). Use spoken language to reinforce and expand on your child's words, gestures, eye gaze or communication boards ("You're looking at the refrigerator. Yes, the milk is in the refrigerator. I'll get it for you.").

3. DON'T assume what your child wants or doesn't want.

Create opportunities for choicemaking to give your child a greater degree of control over his environment. Your child can be involved in many decisions throughout the day: what article of clothing to wear; what cologne or perfume will be used in grooming; what food or drink to have; which activity to do next. Begin by giving your child two choices to pick from. He can indicate his choice by a look, point, head nod, etc. If your child makes the "wrong" choice (i.e. he picks chocolate milk when you think he likes white milk better), respect the choice. Either your child will learn something about the consequences of the decision or you will learn something about his preferences.

4. DO use the "branching-out" technique when choice-making.

Once your child can reliably pick from two objects or activities, he may be ready to "branch out." This a technique for increasing the number of choices a person makes by moving from the general to the specific. For example, at snack time ask: "Do you want to eat or drink?" If the answer is eat, then ask, "cookies or crackers?" If he says cookies, then ask, "Oreos or chocolate chip cookies?" Similar "branching-out" questions can be used during grooming ("Do you want to wash your face or brush your hair first? Do you need a comb or toothbrush? Do you want Crest or Aquafresh?") or selecting leisure activities ("Do you want music or a toy? Your keyboard or tape player?").

5. DO create opportunities for yes or no responses, if your child has a reliable yes or no response. "Yes or no" is a difficult concept for some children, and may not always serve a child's needs. Basically, "yes or no" questions fall into two categories: 1) identity-type questions (i.e. "Is this a cookie?"); or 2) preference questions (i.e. "Do you want a cookie?"). Frequently, a child will not be able to answer an identity-type question, but shows he knows the function of the object (i.e. eats a cookie). If your child shows he knows an object's use or can make a choice between two objects, then answering "yes" or "no" to a question regarding the object's identity may not be that important. Far more significant to you and your child is your child's ability to express preference (i.e. indicating "Yes, I want this" or "No, I don't want that"). This type of yes or no response provides your child with a greater degree of control over his life, and should be elicited frequently during every routine. Model an exaggerated yes or no response if your child's response is subtle or not easily understood by other communication partners. And remember, if your child indicates "no!" -- respect it so he learns the power of that little word ! Conclusion

Creating opportunities for communication in your home can be rewarding for all involved. You may find that you are talking more with your child, drawing him into a more active and assertive role. Your child will be responding more, and may begin to initiate communication as well. Recognize and reinforce your child's subtle and not-so-subtle attempts to control his environment and the people in it. This increased participation may be your child's only way of reminding you, "Hey, Mom (or Dad), I can do at least some of this myself!"

Patricia L. Mervine is a speech/language pathologist in Bucks County, Penn. She lives in Langhorne, Penn., with her husband Lance and 1O-year-old son, Gregg.
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Copyright 1992 Gale, Cengage Learning. All rights reserved.

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Author:Mervine, Patricia L.
Publication:The Exceptional Parent
Date:Jun 1, 1992
Words:1350
Previous Article:Learning about facilitated communication.
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