Saturday, February 28, 2015

Guest blog! Great information about AAC and functional use of language from SLP Heidi Maloney


There are many different types of Assistive Technology that aim to teach children with special needs to communicate.  It is important to first understand the foundations of normal communication development and the different levels or stages in order to target where to begin intervention for children who are either nonverbal or who do not yet use language functionally.

First, what does it mean to use language functionally?  Functional language is our ability to use everyday communication to get our needs met, to ask and answer questions, comment, and to share turn-taking conversation with others.  We use functional language differently in different settings, for instance, when talking to family members and friends, we are typically more at ease and less formal.  When speaking with strangers or people out in the community, we typically use more formal and structured (socially appropriate) types of language.  There is a big stretch between being able to say: “I want juice” and “I just saw a red bird fly by!” or better yet “I had a great day, how was yours?”

It is a huge hurdle for many children, especially those with inherent language disorders, to first interpret language and then to use it in the many ways for which it is intended.  Overall, the goal is for communicators to have the ability to say everything they want or need to say and more.  Debilitating diseases, such as Cerebral Palsy and symptoms of disorders, such as Autism Spectrum Disorder (ASD), both affect a child’s ability to communicate in very different ways and present differently between individual children.  Cerebral palsy, for instance, typically does not affect cognition and receptive language.  

Receptive language is the understanding or comprehension of language.  These children typically have difficulty coordinating the muscles around the mouth and tongue to produce speech. The respiratory coordination that is needed to support speech can also be affected. Some children with cerebral palsy may not be able to produce any sounds, others may be able to produce sounds but have difficulty controlling their movement enough to produce speech that is clear and understood by others. 

So imagine that you are able to interpret what is said around you and to have the desire to make a comment, tell a joke, or to share a story with a friend, but without the “vehicle” to do so.  ASD is very different from this scenario, but no less frustrating or severe.  Imagine that spoken words do not seem to have meaning, especially when in phrases and more complex language.  Language itself does not make any sense.  Or maybe there is absolutely no desire to communicate at all yet.  The long continuum (or spectrum) of language difficulties associated with ASD can range from mild to severe.  Some children with ASD make only sounds, while others may say words or “rote phrases”.  Would we approach teaching communication to these children in the same way?  Hopefully, not!

Through the years, there have been many wonderful breakthroughs in the use of Assistive Technology to target individual needs and to begin teaching language or to help support people with communication. 

The Picture Exchange Communication System (PECS) was developed in 1984 by Lori Frost, MS, CCC-SLP, and Dr. Andrew Bondy. The goal of (PECS) is to teach children with autism a fast, self-initiating, functional communication system. PECS begins with the exchange of simple icons but rapidly builds "sentence" structure.  The idea of using picture icons or symbols to teach and use language has been utilized and developed for years, with black and white line drawings (Bliss symbols) to Picture Communication Symbols (PCS) by Mayer-Johnson.  Another popular communication system currently used is the Pragmatic Organisation Dynamic Display communication system that is really a specific way of organizing the symbols. 

As a Speech-Language Pathologist, I have used many forms of Assistive Technology with many different individuals and their individual needs.  I currently work in a public school system in the kindergarten through grade-four population.  In addition, I work with private clients that are typically more medically involved.  Through the years, through the use of picture icons, I have begun to develop a meaningful and practical system that is based on the foundations of communication. 

The Hanen Centre for Communication has provided support strategies to educators and families for many years, and they indicate four stages of early communication:
  • Discoverers - react to how they feel and to what is happening around them, but have not yet developed the ability to communicate with a specific purpose in mind.
  • Communicators - send specific messages directly to a person, without using words.
  • First Words Users - use single words (or signs or pictures).
  • Combiners - combine words into sentences of two or three words.
In addition to the stages are the functional uses of language, pragmatics, which are defined by the American Speech-Language-Hearing Association (ASHA) as:

§  Using language for different purposes, such as
§  greeting (e.g., hello, goodbye)
§  informing (e.g., I'm going to get a cookie)
§  demanding (e.g., Give me a cookie)
§  promising (e.g., I'm going to get you a cookie)
§  requesting (e.g., I would like a cookie, please)
§  Changing language according to the needs of a listener or situation, such as
§  talking differently to a baby than to an adult
§  giving background information to an unfamiliar listener
§  speaking differently in a classroom than on a playground
§  Following rules for conversations and storytelling, such as
§  taking turns in conversation
§  introducing topics of conversation
§  staying on topic
§  rephrasing when misunderstood
§  how to use verbal and nonverbal signals
§  how close to stand to someone when speaking
§  how to use facial expressions and eye contact

As functional communicators, we tend to forget how amazing it is that we are able to use language in all these different forms!  When you think about communication, think about a baby’s first few years of life and all the ways they begin to interact: crying, babbling, pointing, saying first words, stringing a few words together, asking questions.  These certainly do not happen overnight!

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Come back tomorrow to read more from guest blogger Heidi Maloney! In the meantime, please visit me at www.Facebook.com/SpeechTeachTherapy if you enjoyed this article and would like to learn more about speech, language, and communication!

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