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!


The wonder of kids’ TV

I’d forgive you for reading the title of this post and thinking you’ve stumbled on to the wrong blog. A Speech and Language Therapist hailing kids’ TV as a ‘wonder’?!  Maybe she’s being sarcastic…?

Kids’ TV has been scrutinised and debated for as long as I can remember- From disapproving experts berating the Teletubbies for having their own special language to, back in my day (How old does THAT phrase make me sound?!), when programmes like Power Rangers and Ninja Turtles were criticized for being too violent…only to make a comeback a decade or two later.

It’s important to have these debates. We know that children under 5 have this incredible brain plasticity, quickly forming neural pathways as a result of everyday experiences. This is both amazing and frightening for parents, educators and health professionals, knowing that what our children are exposed to plays a role in moulding their ideas, attitudes and to a certain degree, their personalities.  Quite a responsibility…!

Recently, I saw an article on a Facebook page about Sesame Street introducing a new character. This caught my attention as when I was a child, I loved Sesame Street…In fact, I probably watched it until I was way past their target age demographic! Let’s face it; a picture of Elmo is ‘click-bait’ for most of us… But this article was both touching and surprising.

The writers of Sesame Street have created Julia- a character who has Autism. Julia has made friends with Big Bird and the gang but she exhibits traits of Autism that we often see in young girls- In her opening scene, we see her so engrossed in her colouring-in that she doesn’t respond to questions and comments from the others. She struggles with social skills, like greetings and initiating communication and is echolalic (repeating words and phrases that others around her have used).

But what is much more important than Julia’s difficulties is the fact that she still wants to play and interact in her own way with those around her…And the other characters accept this, integrating her into their games, adapting them to include her preferences.

Sesame Street has always been known for its catchy songs to help children learn the alphabet, numbers and shapes- But how much more important is it to educate our children to accept others, to be tolerant and caring individuals? And how brilliant for our children who have speech, language or communication difficulties, to finally see characters on TV who they can relate to?

Of course, Sesame Street is not the first kids’ TV show to make this connection. Mr Tumble has pretty much single-handedly made Makaton signing mainstream since his show ‘Something Special’ first aired in 2003. Suddenly, children with communication difficulties were no longer this minority group that no one talked about- They were signing, playing and having fun, demonstrating to everyone that people can communicate in different ways.

However, I’m under no illusion that all children’s television is some beautiful beacon of inclusivity. While writing this post, I stumbled on an article in The Guardian, dated July 2015 with the headline, ‘Children’s TV pretends disability doesn’t exist’. It specifically hones in on kids’ channels such as Nickelodeon and Disney and how their programmes fail to include and embrace children with disabilities.

One child in every twenty in the UK has a disability. Many of these children may have ‘invisible disabilities’ including speech, language and communication needs. It’s not that we need TV programmes to be the prime source of information on disability for our children- it’s that we need real life to be represented and for our children to have role models in the media who aren’t all carbon copies of each other.  We want our children to feel fairly represented in the programmes that they watch and for parents to use topics raised in children’s TV programmes as conversation starters to help children to better understand themselves and others.

I am heartened that programmes such as Sesame Street see the importance of this. I’m hopeful that other children’s TV programmes will follow suit. ..And in the meantime, as parents, educators and health professionals, that we continue to help our children to understand that uniqueness is something to be celebrated and not something to be scared of. If TV programmes can help us in broaching these tricky conversations, then let’s use them as a springboard!

If you want to start by checking out Julia’s first day down on Sesame Street, have a look at this link: