Reluctant Communicators- When Plan A doesn’t work

In all of my blog posts so far, I’ve talked about how wonderful the power of communication is…I mean, who doesn’t love to chat?! Who doesn’t want to tell a story, give an opinion, ask a question…?!

Well, actually quite a number of children with communication difficulties! I’m sure we have all experienced working with children who don’t have that burning desire to communicate (and how many of us can relate to that feeling ourselves, when we’re running on empty and the caffeine has worn off?!)

Children with complex needs often have fantastically supportive adults around them who can read what they want or need…This telepathy can be a useful skill but the problem is, sometimes our children no longer feel the need to communicate. We see them glance at the telly so we turn it on. Maybe they look a little rosy cheeked, so we take their jumper off. It’s 11am so they are probably hungry, let’s give them a yoghurt…

This pre-empting can often cause one of two problems:
1. The child gets frustrated at not having a choice in what happens to them, resulting in communication through behaviour,
2. The child becomes passive. They have learned that things happen regardless of how they think or feel. Communication seems to have no real value.

Today I’m going to focus on child number 2. How do we motivate a passive child? How do we find a way to develop intentional communication?

Plan A doesn’t always work. I’ve been there before; I’ve tried something that I think is guaranteed to work and then I am baffled when it doesn’t. So I now have a selection of back-up plans- Plans A, B and C!

PLAN A- Find a motivator… and then stop

Before I start working with any child, I always like to find out from class staff or family what the child is interested in…What really floats their boat!

And I always bring along my trusty tool kit of motivators which includes all of the usual things that SaLTs cram into their handbags- bubbles, a ball, an iPad filled with pre-stored music (theme tunes, chart hits), chocolate buttons, a cause and effect type toy, etc, etc! As you can imagine, my work bag is pretty big…!

Having a strong motivator provides the child with a reason to communicate. But the catalyst for communication really occurs when we suddenly stop that motivational activity- when we put the lid on the bubbles or pause the music.

And then we wait.

We wait for the child to indicate that they want more of this activity. This might be through a vocalisation or grasping for the object. Or it might be something as simple as making direct eye-contact.

After the child has initiated communication through some means,  I then like to introduce the symbol for the word ‘more’. I model its meaning and allow the child to become familiar with using the symbol as I frequently pause their motivational activity.

Sometimes I record ‘more’ on a Big Mack switch if the child needs more auditory reinforcement.

‘More’ is always a powerful word to start with when working with a reluctant communicator…and then once they’ve mastered ‘more’, you can introduce the symbol for ‘stop’ to increase their control of the activity!

PLAN B- The red herring

RED HERRING

Choice-making is often a great starting point for communication. But it’s not quite as simple as holding up 2 toys from which a child can make a choice.

Think of it this way- If you present a child with 2 highly motivating activities to choose from, the chances are that the child might think, “Both of these activities are fun…I don’t care which one we do!”

The child appears passive because they know they will get to play with something that they like regardless of what they do.

This is why I like to introduce a red herring-something that the child is disinterested in. I try to find the most boring thing possible, like a paper towel or a sock.

The child might think you are crazy, but they quickly realise that they better make a choice before they end up playing with a sock!

Once you have established some definite choice-making, you can gradually phase out the red herring and develop choice boards or simple choice pages on low or high-tech AAC devices.

The image below is a template for a Go Talk 4, looking at choice making when singing nursery rhymes, also incorporating ‘more’ and ‘finished’.

PLAN C- Creative silliness

I used to work with a child who was a bit of a puzzle to me. I tried every possible motivator I could think of, but nothing seemed to interest him.

One morning, I was supporting him in his classroom during an art activity. Whilst walking across the classroom to get some coloured card, I tripped- a full on, comedy fall, with my arms waving above me!

Then I heard a giggle.

I looked up and my ‘hard-to-motivate’ child was grinning at me! Yes!!! I’d found something that he liked!! Some of the children who we typically find difficult to motivate simply don’t find communication fun…And it’s our job to show them just how fun it can be!

So I made some ‘Simon Says’ style eye pointing boards with 4 symbols. He immediately loved this activity, enjoying the element of control by making me pretend to sleep, dance, cry or fall!

Children love a bit of creative silliness! ‘Simon Says’ is just one example but basically the sillier the better!

Another fun example is a game of ‘dress up’- you can get the children to choose an item of clothing and then who they want to wear it. You can even introduce symbols such as ‘like’ and ‘don’t like’ to expand on the communication, making comments as well as requests.

 

The important thing to remember is that once a child starts to demonstrate intentional communication as a result of Plans A, B or C (or other variations…!), build on that! They are demonstrating that yes, they DO want to communicate but they need reasons to do so. Let’s not be so quick to jump in, assuming the child’s wants and needs. Let’s give them a little time and the vocabulary to take back some control!

 

Communication on tour!

When I started working as a Speech and Language Therapist, I was based in a clinic- One small room, with one large, bright window. Don’t get me wrong; I’m not complaining- some Speech Therapists don’t even have a window…!

Even on wet, drizzly days (which was the norm, as I was working in Northern Ireland!), I used to glance out the window between appointments and think, “That’s where all the proper communication is happening- beyond that window!”

When I started working in schools, I could stretch my legs a bit more- joining students in the occasional cookery lesson, making use of the sensory room, sometimes even venturing outside with the children into the playground…it felt like a little taste of freedom!

So when some of my forward-thinking colleagues invited me to join them on trips beyond the confines of the school gate to support some of our students using alternative forms of communication, it didn’t take me long to grab my coat and a selection of core symbols!

This has now become a bit of a regular part of my job; something I refer to as ‘Communication in the Community’. Catchy, right?!

I see it as having 3 main functions:

  1. Real life communication experience- Many of the students who I work with are quite confident using their alternative forms of communication in the school environment. They don’t feel different or that they ‘stand out’ – In their class they have plenty of other friends using communication books, iPads, switches or eye-gaze devices to communicate.

Similarly, in their home-environment, they have support from their family who understand their communication system.

Once we venture out beyond the safe zones of school and home, there is the daunting prospect of communicating with people who have never interacted with anyone who  uses something other than their voice to communicate. This can make some of our children a little nervous, a little withdrawn or sometimes frustrated. By easing them in to the idea of communicating beyond their comfort zone, with a little bit of extra support, we can help to bridge that gap and boost their confidence.

  1. Motivation!! The best communication happens when our students are highly motivated! And let’s face it, sometimes it’s difficult to think of new, innovative ways to encourage our children to initiate communication, carry on a conversation, ask a question or make a comment.

But once you take them to a popular bargain store (naming no names…!), and they have a few pounds to spend, watch that student become incredibly motivated to let you know what they want! Or maybe it’s a trip to a cafe and they see a delicious chocolate fudge cake perched temptingly on the counter…Or perhaps it’s the local Pet Shop and you know they desperately want to pet that Guinea Pig..!

Every student is enthused by something different but once you find that motivation, those communication targets seem well within reach!

  1. Educating others- This ties in with my first point. It is so important for the wider world to understand that people communicate in different ways. We rarely see people using communication aids on TV or in the mainstream media (with the exception of the fantastic Stephen Hawking!).

What I find is that the general public are often very intrigued by the resources and technology that our students are using on our trips into the community. On a trip to the supermarket, a lady approached the young girl who I was working with and said, “Wow, what a great idea- having a little TV on her wheelchair!” I was then able to explain that actually, this was a communication aid, and my superstar communicator was able to demonstrate by introducing herself!

 

So if you think this sounds like an interesting idea and you fancy taking your communication session on a day trip, here are a few essential things that you may need to pack:

  • Core symbols- Core symbols consist of words that we use again and again across multiple activities. Even if your student is using a high-tech communication aid, I think ‘no-tech’ back-ups are essential. Sometimes technology lets us down or we need to take a step back if our student is working on new vocabulary.

I tend to wear core symbols on a lanyard around my neck or carry them in a small zippy wallet. The symbols that I tend to carry most often include:- ‘yes’, ‘no’, ‘more’, ‘stop’, ‘want’, ‘help’,’ like’, ‘don’t like’ and ‘something different’.

In an activity such as feeding the ducks at the park, the child can use these symbols to indicate that they 1) ‘want’ to feed the ducks, 2) that they want some ‘more’ bread but that they need ‘help’ to throw it in the pond, 3) that they ‘like’ the ducks and then finally, 4) that they want to ‘stop’ and do ‘something different’.

  • Custom-made communication boards- Our students’ communication books can help them to talk about most things that they want to, but if you are going somewhere new, you might need some specific vocabulary. It’s easy to quickly rustle up a communication board on software such as Boardmaker or Matrix Maker.

For example, I took some of my students to the Fire Station a few months ago and I made the communication board below not only for the students to use but also for me to model new vocabulary to them. As you can imagine they loved telling me to put on the helmet…!

  • A switch- If your student isn’t using a high-tech communication aid, they may want a way to greet others or to initiate communication. Something like a Big Mack Switch or a Talking Tin Lid is the perfect way to do this.                            Some of the children who accompany me on trips, like to use their communication book to tell me what they want at the cafe but then prefer me to then record their order on to a switch- That way, they can order their own food using the switch, without trying to reach the impossibly high counter with their communication book!

Another fun way that I’ve recently used a switch, was on a trip to the toy shop- I recorded, “I want to look at that toy!” on one girl’s switch and as we walked up and down the aisles of the store, she took great delight in pressing her switch to let me know when she’d seen something she wanted to have a closer look at!

 

If you are a Speech and Language Therapist and you like the idea of a change of scenery, give it a go! Take communication on tour! The students will love it and I’m pretty sure you’ll be ticking off targets with every trip out!

 

* With thanks to the team at Highfurlong School for always supporting new and innovative ways to promote communication!

Communication aids and icebergs

 

Imagine that you couldn’t speak.

And then one day, you were given a ‘voice’.

How would you respond?

Maybe you’d feel overwhelmed. You might initially remain quiet, unsure of what to say or how to say it. You might not know which words to use or how to put them together. After all, speaking is new to you- like a toddler learning to walk, you might feel a bit wobbly and unsure to begin with.

Or you might be incredibly excited, desperate to make your views known, to finally express yourself. Other people might be surprised by the things that you want to tell them- All these thoughts have been inside of you for such a long time; you’ve got a lot of catching up to do!

One of my favourite roles as a Speech and Language Therapist is working with children who are non-verbal, supporting them to find a means of communication that suits them. That might be something simple, like a paper-based communication book or it might be a very tech-y voice output communication aid!

What I find fascinating, is how having a voice helps to reveal that child’s personality. Language is an incredible tool, allowing us to be humorous, to show empathy, to question, to comment, make requests, etc, etc. And when a child discovers that they now have the means to do all of this, they might feel like Person A- a little apprehensive, needing a little guidance- or like Person B- excited, enthusiastic, unsure of how to use this new skill but desperate to get started!

I saw this infographic on Twitter a while back which sums the whole process up quite nicely. Unfortunately I don’t know who made it, but all credit to them for making a visual which demonstrates that learning to use a communication system actually involves a lot of ‘behind-the-scenes’ work. I’m going to use this iceberg to discuss some of the important factors that lie under the surface of helping a child to use their new voice effectively.

Most of the children I work with use symbols to communicate. I like to think of symbols as a unique, independent language in their own right-a child has to learn to attach a meaning to a symbol, just as those of us who are verbal, learn to attach meaning to a word. The child will not automatically know that something as abstract as two arrows means ‘more’  or that a stick man holding a yellow ball means ‘favourite’.

But yet these symbols are so powerful! When listening to a song, the child can now reveal their opinion and make requests- “I want more Justin Bieber! He’s my favourite!”

How does the child learn to use these symbols to make this impact? By seeing us, as educators, health professionals or parents, using them again and again! By constantly being immersed in symbols and everyday language skills such as joining 2 symbols together to make a phrase (e.g. “More music”).  All of these skills have to be modelled and taught- This is a process which involves careful planning and takes times.

What’s become clearer to me recently is that beyond learning the language skills of a new communication system, there is this entire ‘Pandora’s Box’ of social skills.

So again, imagine that suddenly you have been given a voice and you’ve discovered what a powerful tool it is- At times you might get over-excited and talk when other people are talking. You might find it difficult to listen or wait for your turn. You’ve been quiet for so long that your thoughts and feelings now seem urgent- you feel like you need to express them right away!

You might be unsure of how to initiate communication….Or you might say things that are deemed socially inappropriate at the wrong time.

Communication is a minefield! We want our new communicators to say what they want, to express themselves. But yet communication is so much more than words and sentences- it’s taking turns, it’s responding appropriately, it’s knowing when it’s ok to make that joke vs when it’s not ok!

As the infographic demonstrated, the voice is only the tip of the iceberg! Everything going on beneath the surface needs to be taught and explained to our children learning to use their new communication system- including these subtle social skills.

Maybe we do that through Social Stories or visual cue cards. Maybe we praise our children for effective use of social skills, rewarding them for good listening and turn-taking. Maybe we have group discussions on how our language can make other people feel good (e.g. compliments) vs how our language can hurt other people (e.g. insults). Whatever we do, social skills need to be considered in our work with children using communication aids, just as they would be in our targets for verbal children with speech, language and communication needs.

One of the simplest, most touching moments of my work as a Speech and Language Therapist was when I initially set up an eye-gaze communication aid for a young girl who I work with. I took it out of the packaging, went through the set up, calibrated her eyes with the screen and we played a few cause and effect games. Then we loaded up her communication software and together, we played around with the ‘Chat page’, having a simple 2 way interaction using the device.

That afternoon, the girl’s mum came into school to see the new device that her daughter would be using. I’d put the chat page on screen and as the child’s mum sat down, her daughter said “Hello”, using this beautiful, clear, crisp, child’s voice through her communication aid.

I saw her mum’s eyes well up with tears and all I could think was how powerful that one word was. ‘Hello’- a greeting, an acknowledgement of someone’s presence, a conversation starter….

It seems so simple, but there is so much weight behind it. Just like the iceberg, that one word was just the tip, the meaning was everything under the surface.

Over the years that have followed as I’ve worked with this child, her school and her family, I’ve tried to consider the iceberg model. Everything takes time and practice. Communication isn’t something that anyone perfects over night.

We want our children to communicate to the best of their ability; to use their voice to make friends and to feel involved. The more supportive input the child receives, the better the output!

Or to put it another way-the bigger the iceberg, the better!