Promoting Communication Skills Through Everyday

RoutinesPresented by:

USF Clinical Instructors:Aleisha Linck VanAmburg, MS CCC-SLPAmy Davis, MS CCC-SLP

USF Graduate Student:Jennifer Cooper, BS

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 and Ensuring positive child outcomes through caregiver responsiveness-Developing appropriate family centered goals and strategies for the IFSP.-Knocking down barriers towards progress 

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.

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?

Types of Social Play

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

Solitary Play

Onlooker Play

Parallel Play

Associative play

Cooperative play

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)

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)

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)

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)

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)

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

Which type of play is demonstrated in these pictures?

Example #3 Example #4

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

Types of CommunicationGroup Activity

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.

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.

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.

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.

Hierarchy for Teaching Nonverbal Communicative Skills/Signaling:

Eye MessagesVoice MessagesBody Messages

Space MessagesNonverbal Messaging

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.

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

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

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

Teaching Eye Gaze/Eye GesturesCorresponding Strategies/Activities:

1. Eye Messages: using pictures of caregivers or other people and have the child identify eyes/eyebrows and related emotions (happy, sad, scared, angry, etc.)

2. 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.

3. Engage the child in a discussion with a familiar adult about topics that invoke feelings of happiness, sadness, fear and anger.

Voice Messages (Suprasegmentals) Voice Messages include:

Intonation in speech Vocal volume Rate of speech Emphasis on words

Teaching Voice Messages (Suprasegmentals)Corresponding Strategies/Activities:

1. 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).

2. 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.

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.)

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

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

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”.

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

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

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

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

Positive Behavior Supports

Old Ways vs. New WaysOld 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

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

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.

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

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)

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

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

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

Functional Analysis Interview Define behavior (describe what you see) Describe frequency and intensity Explore possible setting events Identify predictors (triggers) Identify maintaining consequences Identify current communicative functions Describe efficiency of the behavior Describe previous efforts Identify possible reinforcers

Possible Hypothesis (Example) When Brendan transitions from one to place to another, he

tantrums (prolonged whining, crying, screaming and dropping). This behavior is increased in public places and when he is tired. This behavior is maintained if he is picked up, commanded to comply or allowed to remain where he is longer.

BeforePBSN.mpg AfterPBSN.mpg

Intervention Plan Focus Proactive environmental changes

(Social story, within activity schedule)

Teaching new skills to replace problem behaviors (How to follow a schedule to support transitions)

Eliminating natural rewards for problem behavior (No extension of time, commanding, or picking up)

Maximizing clear rewards for appropriate behavior (Positive comments, getting a favorite book, McDonald’s

afterward)

Developing Outcomes, Goals, and Strategies for an IFSP

Developing High Quality Outcomes Developing high-quality, functional outcomes sets the stage for

creating high quality goals and strategies. Outcomes, goals, and strategies must align. Outcomes should be developed collaboratively with the family and

written in language familiar to and used by the family. Outcomes should include components that clarify for each IFSP team

member the following: exactly which person is the focus of the outcome what behavior/action is targeted what family or child activity or routine is associated with the behavior/action the criterion for determining when the outcome will be met

Outcomes Need to: Be Measurable

Observable behavior/actions Includes conditions under which the behavior/action will occur Includes a criterion to determine when the behavior has been acquired

Be Developmentally Appropriate Reflect outcomes that are age appropriate, individually appropriate and

culturally relevant for the child and family Use Active, Person-referenced Language

Written to describe who the focus of the outcome is, what they will do using action words to describe behavior Example: Alex will participate in play activities by reaching for toys on the right and

left side of him when playing on the floor…

Types of Outcomes Child Outcomes:

Focuses on the child’s development and use of skills w/in daily routines and activities

Family Outcomes: Addresses priorities/skills that are needed to support the family and may or

may not be linked to enhancing the child’s development Functional Outcomes:

Include family or child behaviors/skills that support engagement, participation, and interactions in everyday activities and routines Family: improve flow/efficiency of daily routines ad activities, improve interactions

among family members, etc. Child: participate more, interact more, be more engaged, be more independent, etc.

Example Outcomes Aesha will participate in play activities at home and in playgroup at

day care by using sign language or pointing to tell us what she wants during play activities. We know that she can do this when she can indicate what she wants without becoming upset during most of her play activities in a week.

Ethan will participate in play time, diaper change, reading time, and feeding by making sounds to interact with family members, imitate sounds of others, use sound to gain attention of caregivers, or communicate pleasure or displeasure with an activity. We will know he can do this when he makes 4 different cooing or babbling sounds during three 5 minute interaction/play times in one day.

Developing High Quality Goals Goals are logically connected to and support the achievement of IFSP

outcomes Goals should be functional, measurable, and developmentally

appropriate Goals are short-term (“in-between steps”)

Goals include statements of behaviors or actions that are expected to be acquired or completed within a few months using timeframes that are meaningful for families.

Developing High Quality Goals1. Identify a selection of skills or behaviors that relate to the outcome and

write goals for smaller steps to achieve skills or behaviors2. Identify the current level of support for the behavior to occur and

systematically alter the level of support provided. 3. Identify how the child or family currently does the behavior or skill and

systematically alter the expectations for doing the behavior or skill. Example: For Ethan’s outcome of “making sounds to communicate and participate in family interactions”, related goals could include making any sound such as cooing or babbling after a parent makes a sound, then imitating a sound made by parents, then make sounds with facial expressions, and make sounds to get attention when parents aren’t looking at him.

Developing High Quality Strategies Strategies reflect who will be involved, how they will be involved, and

where the activities that support the outcomes and goals will occur (people, materials, places)

When developing strategies use: Interests and preferences of the child Naturally occurring routines and learning environments Materials the child or family already uses during the routines People who regularly participate in the routines

These considerations make strategies functional and meaningful

Using Natural Environments when creating strategies

If natural activities and routines are used for addressing outcomes and goals, the child will have multiple opportunities to learn and practice skills throughout the day.

Natural Environments can include Family and Community Family learning environments might include:

Family routines (e.g., cooking, shopping) Parenting/caregiving routines (e.g., bedtime, bath, diaper

changing) Child routines (e.g., brushing teeth, dressing, eating) Literacy activities, play activities, physical play activities (e.g.,

reading books, playing with cars, playing on play sets) Entertainment activities (e.g., TV watching) Family rituals (e.g., saying grace at meals, holidays)

Using Natural Environments when creating strategies Community learning environments might include:

Family excursions (e.g., running errands, riding the bus) Family outings (e.g., visiting friends, shopping) Play activities (e.g., outdoor playgrounds) Community activities, recreation activities (e.g., swimming), Children's activities (e.g., petting zoos, fairgrounds) Art/entertainment activities (e.g., festivals, music activities) Church/religious activities

Using Interests and Preferences when creating strategies Identifying child or family interests and preferences helps the team develop

strategies that are likely to lead to goals and outcomes being achieved. When the team considers the existing materials involved in a specific child

or family routine, strategies for addressing the outcome are more natural and might result in the family utilizing the strategy more frequently.

Natural materials might include: Favorite or preferred toys and games (for the child and family) Favorite or preferred books and art materials Favorite or preferred chairs, pillows, or blankets Favorite or preferred food, juice, plates, cups, or utensils Favorite or preferred clothes or shoes Items that use a favorite color or character

Using Natural Supports when creating strategies Within family and community environments, there are people with

whom the child or family regularly interacts. Early intervention activities are more engaging and effective when these individuals are included as participants in the strategy or help support implementation of the strategy.

Participants might include: Parent/caregiver Siblings Friends Relatives (e.g., aunts, uncles, grandparents) Day care providers/respite providers/baby-sitters Providers from the Early Steps team (i.e., ITDS, OT, SLP, PT, other

specialist) Members in community locations (e.g., librarian, bus driver,

shopkeeper)

Knocking down barriers towards progress Discussion:

Implementing the previous strategies can significantly improve parent buy in…Why?

What types of barriers have you experienced with your clients that continue to persist over time?

What strategies have you used? What worked well? What was the outcome?

References

Florida Department of Health, Children’s Medical Services. (2011). [CD-ROM]. Tools for Early Steps Teams: Toolkit.

Hughes, Fergus. (2009). Children, Play, and Development. CA: SAGE Publications.

Parten, M. (1932). Social Participation Among Preschool Children. Journal of Abnormal and Social Psychology, 28 (3): 136-147.

Quill, Kathleen. (2000). Do-Watch-Listen-Say: Social and Communication Intervention for Children with Autism. Brooks Publishing co.

Veale, Tina K. (2012). Preschool Social Language Therapy. LinguiSystems, Inc.