Games and fun stuff to promote communication

Children get sick of being asked to talk or “perform” and may refuse, especially if your request for language seems purposeless to them. Games are a fun way for children to learn without even knowing they are learning. Newton (2004) discusses some key things to think about when deciding on what games to play. I discuss some of these below. But the key thing to remember is that, while learning to label things is important:
“Action words are more important than nouns or names because they are far more useful. Names can only be used for labelling.” p113

Sounds or words?

Words will be meaningless sounds to our children if we don’t help them understand those sounds. Some fun ways to help children recognise the meaning include:

* Sorting games – to help children recognise colours and understand descriptive words such as big and small, wet and dry, play sorting games. This could be a simple as getting them to find all the blue pegs while you are hanging the clothes on the line. Or sorting counters during Maths activities at school.

* Nonsense words – one of the things I use to prompt reluctant talkers to get involved is use nonsense or incorrect words to label or describe things that you are pretty sure the child is able to identify. For example, when reading a book identifying a dog as an elephant. Or if the child is requesting something, make wildly incorrect, humorous guesses until they correct you. And, from my experience, it usually brings laughter as well as the desired communication.

Which comes first? The request or the manners?

Newton (2004) suggests that it is much more important that your child learn to request something (eg. drink, biscuit) than learning “please” and “thank you”. However, once they have mastered the requesting, then you might want to teach these words. Some fun ways to expand on your child’s ability to request items:

* Hide and seek using an object – This will give you an opportunity to model and prompt requests.

* Sharing toys – play games where you limit the number of toys available so that you and your child, or the child and other children, have to request items and take turns. Or put toys just out of reach so that your child needs to ask for them.

Dramatic play, puppets and soft toys

Acting out every day activities in dramatic play can really help expand children’s language. Puppets, dolls and soft toys can also be a front behind which a child can “hide” if they are reluctant talkers. A child who will not talk with others may sit for hours “chatting” to or through their dolls, puppets and soft toys.

* Shopping – just like with many of us adults, shopping can be a favourite with children. Set up a sales counter, use picnic sets, toys, empty cartons and play money and you will have many opportunities for speech. In this game children will need to request things. You can also help them with counting and other phrases that might be used in real life shopping experiences. Also, take every opportunity to describe what you, other children or the child is doing.


* The sandpit – playing in a sandpit will also product a lot of opportunities for communication. Building roads, castles, villages, cakes…. So many different opportunities for requesting and describing activities will be made.

* Cubby houses – cubby houses also seem to be one of those things that hold their appeal across the ages. And some of the most exciting, communication producing cubbies are the ones built out of mum’s bedspread, pillows, chairs, the dining table etc. Again, requesting, describing and using useful “real life” language in a pretend setting can help increase children’s communication abilities.

Cooking together

There are some household or life activities that lend themselves to helping children communicate. Cooking is one of these. It provides you with opportunities to describe what you are doing, talk about the ingredients, request items and so on.

Drawing and craft

Drawing, painting and craft projects are also productive of similar opportunities as described for the cooking activities. Here are some tips:

* Rather than guess what your child has drawn, try saying “Tell me about your picture.” Write down what the child says, either on the back or on the picture itself, so you can read it together and talk about it again another time.

* As you do these activities, talk about what you are doing. Eg, “Snip, snip! We are cutting in a straight line!”

Giving instructions

Play games where children provide instructions verbally. For example, Simon says (replacing “Simon” with the child’s name), treasure hunts, obstacle courses. But make sure you have pictures and gestures lined up for the child to use as well as language if they are struggling with their words.


… But most of all, have fun LoL

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Shared reading can help with language development

Newman (2004) also discusses how books can be used to help with language development. Based on her recommendations, here are some guidelines to help you with choosing and using appropriate books. I will use my book, Dave is Brave, to illustrate these as it was written and illustrated with these guidelines in mind.

1- Start with books that have clear and expressive pictures.

The reason for this is that children are engaged or their attention is grabbed by things that interest or attract them. Colourful and clear pictures mean that the child does not have to be concentrating on the book to have their eye attracted to it. Colour and clarity catch the “corner of their eye”, so to speak.

Pictures will also give you the opportunity to label items and ask questions to prompt language attempts. If the child is interested and engaged by the pictures, they are more likely to attempt to communicate about the book, whether it be through gesture or speech.

2- Use books that show characters doing everyday, familiar things.

Books about unfamiliar topics will mean that the child is not able to use their prior knowledge or experiences to identify appropriate words that they might be able to use. If the content is familiar, through the reading process the child will learn words that will help them function or participate in their everyday life activities.

You can also develop your own books by taking a sequence of photos of everyday routines. These books can be a great resource to help expand your child’s vocabulary.

Talk about the pictures, suggest things that the people in the pictures might be saying, ask your child to label objects or identify what the person is doing. If your child’s language is developing, start asking them less obvious questions such as how they think the people in the photo might be feeling.

The activity plans that are sold in the Dave is Brave pack provide you with questions that will not only help develop your child’s language, but also their emotional intelligence. That is, it will help them understand what is going on socially and emotionally, and will prompt them to use language that will help them express this in everyday, real life.

3- Simple stories with few words and lots of repetition are especially good.

As mentioned in a previous post, repetition is a great tool for helping children develop language through imitation and modelling. A book with rhythm and rhyme can also help prompt memory of sounds and phrases.

Dave is Brave is written with this in mind. For example, the text is written with the frequent repetition of the phrase, “Golly was a bully, but Dave was brave.” The text is also rhythmical:
“Golly was a bully when he didn’t act like a friend.”


When interacting with the book, Newman (2004) suggests firstly that you read the book normally, with natural expression in your voice.

Next, ask questions of increasing difficulty depending on the child’s level of language development. Educators often talk about the different levels of questioning as “here, hidden and in the head.”

For example, looking at this picture from Dave is Brave:
“here”: What did Dave say?
“hidden”: How do you think Dave is feeling?
“head”: Is Dave a boy or a girl?

Thirdly, there may be times whey you will need to paraphrase books to make sure that your child understands the language. This relates to your family or classroom language culture – the words you use to describe something may be quite different to those used in another family/classroom.

Finally, get the child to anticipate or guess what words comes next. And example of this is the cloze activity that is part of the listening games on the Dave is Brave music CD. What I do is pause to encourage the listener to say some of the repeated words for me. The rhyme also helps with this.

For example, “This is Dave. He is …..”


My final recommendations?

Read often.

Read about things your child is interested in.

Have fun with it.

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Encouraging your child to respond

This post extends on the previous one, which discussed Newman’s (2004) advice for talking to your child who has communication difficulties. I want to focus in this post on her ideas about how to react when your child responds to you to ensure more communication attempts on their part.

1- “Respond immediately and positively” (p108)

Praise any attempts, even if they are not correct. Also, use “active listening” skills to ensure your child feels rewarded for their communication attempts, and to clarify meaning if you are unsure what they mean.

Active listening, according to Friswell, involves first stopping all other activity and intently focusing your attention on your child.

Second, look at the child – make eye contact, get down to their level by kneeling beside them if necessary.

Third, listen without interruption. Children struggling with communication may need more time to produce speech. Wait patiently, without rushing them or trying to finish their words or sentences. However, you may need to make encouraging sounds (uh-huh?) or use body language such as smiles and nods to give immediate feedback and encourage your child to persist with their communication attempt.

Finally, once they have finished, respond. In responding, make sure you focus on the positives first. A good rule to go by is: praise then re-phrase.

For example:
Jilly says, “Want duce in up.”
Adult responds, “Very good, Jilly. You want juice in your cup?”

This allows your child to confirm their meaning using a nod or shake of the head.

2 – “Be over the top in your response” (p109)

To begin with, it can be important to get overly excited about communication efforts alongside providing immediate rewards for any communication attempts. This Utube video has a good illustration of this, though the communication is using the PECs system rather than words.

However, be conscious that for some older children struggling with communication over-the-top praise can be received negatively as they may feel you are drawing undue attention to their difficulties. Like with everything, be tuned in to what motivates your child or student and respond accordingly.

3 – “Don’t correct pronunciation or what she has said” – re-phrase instead.

This is a widely accepted approach.

For example:
Jilly says, “Want duce in up.”
Adult responds, “Very good, Jilly. You want juice in your cup?”
Jilly nods. Adult provides her with juice in her cup.

There are some good examples of re-phrasing in this Utube Video.

However, the Lindamood program has suggested that correction of pronunciation is important. This links in with the importance of directly teaching children with disabilities new skills, rather than expecting them to simply “pick up” these skills through indirect modelling. It is also about children experiencing communication in a multi-sensory way – feeling and seeing sounds as well as hearing them. And, further, it is about helping children break down and sequence sounds in words. The program encourages children to look at the shape of the mouth, to feel how the tongue, lips and breath create the sound alongside simply hearing sound.

So an alternate approach may be:

Jilly: “Want duce in up.”
Adult: “Very good, Jilly. You want juice in your cup?”
Jilly nods.
Adult (using the gesture system discussed previously): “You say, ‘I want JJJuice in my CCCup.’” stressing the key sounds and drawing attention to the mouth movements that go with it.
Jilly: “duce in cccup.”
Adult: “That’s great! JJJuice.”
Jilly: “Jjuice.”
Adult: “Well done!!” and rewards Jilly with juice in her cup.

This way you are rewarding both her attempt at communication, and her correct speech.


References:
Friswell, J. (nd) Active Listening with Children in the Early Years. Retrieved 22nd September, 2009 from: http://clg.coventry.gov.uk/ccm/cms-service/stream/asset/?asset_id=15186020

Newman, S. (2004). Stepping Out: Using Games and Activities to Help Your Child with Special Needs. London: Jessica Kingsley Publishers.

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Talking to your child

Based on Newman (2004) pages 107 – 108

Newman discusses a series of things you need to consider when talking to your child who has communication difficulties. Here is my summary of her advice, and some hints about how you can achieve these:

1- Get your child’s attention – which usually means eye contact.
For children with sensory integration issues, pointing their ear towards you may be there way of paying attention. Or you may want to hold their hand and wait until they are still before you speak.

2- “Speak clearly and simply using natural intonation.” p107
Exaggerating expression or speaking/yelling loudly will not help your child to understand, even if they have a hearing impairment. It will only distort the sounds. Using inappropriate volume will also mean that your child will not learn about the different use of intonation and volume for different contexts. Eg. you might talk loudly outside, but use what teachers may call an “inside voice” indoors. You yell when you are angry or warning others, but speak calmly or with a smile in your voice in play situations.

3- “Repetition and consistency is very important.” I addressed this in the previous post.

4- Talk about everyday events and experiences, such as favourite games, videos, dinner, bathing and so on. Newman (2004) states, “Give her the language for what she is doing: ‘You are having a bath.’” (p107). If you repeat this regularly, your child will learn to connect the language with the experience.

5- Talk about the things your child is interested in. Watch what your child is looking at and label it, describe it. We have probably all done this with our very young children – “Look at that cow! Mooo! Moooooo! It is eating grass!”

6- Make sure your child can use the context to help them understand what you are saying. So if you are at the dinner table and you want to talk about what has happened during the day, make sure you have some cues such as photos.

7- Use body language to support your words. Use natural gestures to reinforce words, such as waving to reinforce the words “Bye-bye.” Makaton signs were designed for this purpose.

8- Pause and maintain eye-contact to encourage your child to respond. It may take longer for your child to process what you have said, and produce a response.

… I will talk more about helping promote children’s responses in my next post.


Reference:
Newman, S. (2004). Stepping Out: Using Games and Activities to Help Your Child with Special Needs. London: Jessica Kingsley Publishers.

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Teaching social language

“Repetition and consistency is very important. Repeat things as often as you can so that she learns the association between the object and the sound. It may take a very long time, with seemingly constant repetition of simple words and ideas, but it really important that you persist. Try to be consistent with the words you use for objects; for example, decide on your family word for toilet/loo/lavatory/bathroom.” (Newman, 2004, p107).


When I first met Isaac* I was warned that I would have to look out for him. He was very rough with other children, pushing, shoving and grabbing toys. I was told that all the disciplinary measures (eg time out, praise, encouragement) were not working. And staff at his preschool were concerned because he was due to go to school next year.

Isaac had a cochlea implant, implanted when he was two years old. Having a cochlea implant does not mean that the child is then “cured” and everything is fine. There will be some delay in terms of language experiences and vocabulary learning missed in the very early years. Further, while a cochlea implant enables a child to hear, it does not act in exactly the same way as our ears (Moore, 1997). For children learning to “listen” with cochlea implants it can be hard to differentiate between important sounds (eg. the words of someone talking directly to you) and unimportant sounds (someone talking close-by or other background noises).

So Isaac had difficulties with learning how language worked in social situations. He saw children sharing, children joining in each other’s play, children interacting. He wanted to be part of this. But he wasn’t picking up the important phrases that made the play work. The give-and-take of social language was difficult for him to catch. It was too quick, there was too much background noise and movement to distract him, and the actual words used weren’t always the same.

So instead of asking to share toys, he would take them. To him, it looked like this is what other children were doing.

Instead of asking if he could join in a game, or call a child’s name to get their attention, he would bump into them, or pinch them, or hit them. Not to hurt, but to get their attention.

And, while he was told not to do this, he didn’t know any other way to achieve the same thing. And his speech was often hard to understand as he was still learning how to articulate them clearly.

But, taking ideas from his speech therapist and early intervention teacher, we worked out a way to help change Isaac's behaviour.

Whenever Isaac went to barge into children’s games, we would jump in and follow this routine:

- Stand beside Isaac and draw his attention by putting a hand on his arm.

- Draw his attention to your mouth by first putting your open-palmed free hand to his chin, then bringing it back to your chin.

- Model how to get another child’s attention by looking at them and calling their name.

- Get Isaac to mimic this by bringing your open-palmed hand to his chin and saying, “Your turn!” and repeating the name.

- Repeat the process until the peer responds (use a physical prompt like tapping the peer on the shoulder to speed up the response if Isaac is beginning to lose interest).

- When the peer looks at Isaac (or yourself), bring Isaac’s attention to this by using the open-palm gesture as described previously.

- Then get Isaac to pay attention to your mouth using the open-palmed gesture.

- Model the words, “[peer’s name],Can I play?” [use exactly the same words every time]

- Get him to repeat this through the same process identified above

- Then get him to repeat it again whilst making eye-contact with the peer by drawing his attention to them using the open-palm gesture, then repeating the phrase, “[peer’s name], can I play?” and then saying, “Your turn!”

- Give lots of praise for his attempt, encourage the peer to respond.

- Wait until the child responds (help Isaac to wait and listen by cupping your hand around your ear and maintaining eye contact with the peer – whilst maintaining your hold on Isaac’s arm :) ).

- If the child says, “Yes” help Isaac get involved in the play appropriately. If the child says, “No” re-direct Isaac to a different game. This will be a natural reward for his language attempts.


This process took a little while for Isaac and his peers to get used to, but we persisted and did the same thing all the time, with specific care to keep the words and gestures exactly the same. This repetition helped Isaac understand.

And we were amply rewarded.

One day I was watching and playing with the children on the playground and distinctly heard Isaac say, “Can I play?” I watched as he persistently repeated this and kept moving to where his peer could see his face until the peer responded. Luckily, the answer was, “Yes”. And Isaac joined in with no help from an adult.


*While this story is built from my experiences with children who have hearing impairments, the names and some details have been changed.


Reference:

Moore, B.C.J. (1997). An Introduction to the Psychology of Hearing. Academic Press: San Diego.

Newman, S. (2004). Stepping Out: Using Games and Activities to Help Your Child with Special Needs. London: Jessica Kingsley Publishers.

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Ask Amanda - PECS system

Hi Amanda - I thought I'd get in early with a question for you - I am exploring the idea of adapting a PECS system to help Hannah cope in an inclusive classroom. Can you suggest some ways to introduce her to this, also how would it work in a classroom? ( Is it really that easy for a teacher to and child to use? it is the one I am considering because my experience is that teachers rarely ahve the time to learn signing and then use it consistently) Also - what should I include in it eg are there categories that are commonly going to be useful in kindy? Anecdotally I have heard parents say that using this system has helped their children increase utterance length due to the sentence strip. I have access to the 2008 pecs cd - if I find it is working I will probably consider buying an updated version - next year. Thanks a lot. Shelley of Mainstream Musings(using Kit's private blog address cos I am not very technologically able - sorry!

What is PECS?

First, for those who aren’t familiar with the term PECS, it stands for Picture Exchange Communication System. The most common picture system used in schools is Boardmaker, with more and more schools actually purchasing the CD for use in their inclusive classrooms. See Spectronics for more information.

However, for families this system is not always affordable. There are other picture systems that have been developed, but if you want some free downloads you can visit Visual aids for learning, Sparklebox and do2learn. Both of these sites have free, downloadable pictures of commonly used concepts at home and at school.

How are PECS used?

The idea behind PECS is that by using concrete objects (pictures), the child can communicate without having skills such as eye contact and shared attention (paying attention to the same thing as the person they are communicating with, and taking turns in conversation) (Charlop-Christy, Carpenter, Lee, LeBlanc, & Kellet, 2002). These abstract skills can be taught in a very concrete, hands-on way using the pictures.

For example, if you are finding it difficult to get your child to pay attention to what your are saying, giving them a picture can help focus their attention. If the child is trying to communicate something, but is struggling to engage in the give-and-take of conversation, exchanging pictures can be like using a “talking stick”. In this way, they are getting your attention, and you are able to respond to their needs.

Pictures can be used instead of speech, but are usually used to supplement speech. PECS has been shown to be effective in helping children develop increased vocabulary and functional communication (Charlop-Christy et al., 2002). That is, children develop the ability to communicate their needs, wants and feelings in a way that helps them participate throughout the day with fewer “meltdowns” due to the frustration of not being able to communicate.

PECS is used for children with a wide variety of difficulties, including children with Down Syndrome and Autism.

How do you teach young children to use PECS?

Applied behaviour analysis and incidental teaching are usually used to teach PECS (Wolery, 2000). Here are some ideas:

a) Put things out of reach so that the child has to request the object:
Make sure you have the picture card readily available. Do this as a game, and be prepared with extrinsic rewards such as stickers if necessary so that it does not become distressing for both the child and yourself. But the aim is to arrive at a place where getting what they want or need, and a hug or a smile is enough to make the activity rewarding for your child.

For example, if you want to teach your child to request to use the toilet (an important skill for school participation), first shut the toilet door. Assuming your child can’t open the door for themselves, that is. Then, blu-tack the picture representing the toilet to the door, making sure it is within easy reach of your child. Praise your child and immediately open the door when they point to, touch or pull the picture off the door and give it to you.

(picture from do2learn)

b) Modelling
Continuing with the above example, have everyone in the house use the same technique. When you want to go to the toilet, give your child the picture of the toilet before you open the door. This means that she will learn to apply the “word” to others, not just herself. And whenever you use the card, say the phrase, “I need to go to the toilet.”

c) Repetition
Don’t vary this routine, right down to what you say. Get her to try to say exactly the same thing every time she uses the picture as well. If you repeat the same phrase, it will become familiar. Your child will also be able to practice and develop an “imprint” of that phrase in their memory – this it will help the shaping of the sounds with their mouth, their hearing of the sounds and their understanding.

d) Prompt and wait
You may also need to have a phrase and a gesture that will help prompt her to use the picture and/or language. Again, this phrase should remain the same … and pass this on to the teacher of her inclusive classroom. Make it something simple, like pointing to the picture and saying, “What do you say?” Then give your child a minute or so to process what you have said, and have a go. If she is getting distracted, use the same gesture and phrase again. Repetition and familiarity with the prompt are important, though at first you may need to use more physical prompts like guiding her hand to touch the picture. But gradually, try and reduce the prompts you give.

How is it used in the classroom?

PECS, especially boardmaker, is used in a number of ways in schools.

Individual communication booklets:
This is where the child carries around a little booklet of key pictures in their pocket, or on a key ring clipped to their waistband. Here is an example from http://www.autismshopper.com/page8.html.

At school the communication booklet usually has pictures of key people, such as their teacher; self-help words, such as “toilet” and “hungry”; and emotions, such as happy or sad. They may also have pictures that represent key timetable features such as lunch, class and playground time.

Timetables and transitions:
Becoming more common are velcro timetables. This is where pictures representing the different activities of the school day are stuck to a strip of velcroe either to the board at the front of the room, or to the child’s desk. Each time a task is finished, the picture is taken of the strip. Therefore the child can keep track of what is going on. This benefits all children in the classroom.

PECS can also be used to break up and teach the steps in specific activities. See an example on the Spectronics website.

Rules:
The differing social demands of school can be quite challenging for the child. Therefore, PECS are often used to communicate the teacher’s expectations. For example, when sitting on the floor in front of the teacher the expectation is to sit quietly and keep your hands to your self. The teacher may stick the appropriate picture reflecting this on the board. They may also give a smaller version of the picture to the child to gain the child’s attention, then give a verbal prompt (shhh) and gesture (finger to lips). This really helps with the transitions and interactions that are an essential part of the school day. See and example here.

Social stories:
The example in the link above is also a demonstration of how PECS can be used also to develop social stories which will teach children skills to cope with the different social challenges of the school day. I discussed this in a previous post.

In sum, the most commonly used categories at school are:

Self-care, including words such as toilet, food, drink, hurt

Timetabling and transitions: desk work, circle time, craft, sport and so on.

Social skills, including greetings, key emotions (happy, sad), rules (sharing, sitting still and quiet, putting hand up)

PECS may also be used during literacy activities to develop story strips, as seen on the right. These are Boardmaker symbols.

Just a note about sign language: Makaton

Makaton sign language (they have a PECS too) is becoming more common within inclusive classrooms as it is based on natural gestures rather than finger spelling. For example, the natural good-bye wave is used for “good-bye”. The “T” that we use in a “time-out” gesture for basketball is used to signify the need for a toilet break.

Check with your school – you might find that these simple gestures can be used for some key phrases. They can be taught in the same ways as your would teach PECS.

Find out about the difference between Makaton and AUSLAN here.

References:

Charlop-Christy, M.H., Carpenter, M., Lee, L, LeBlanc, L.A. & Kellet, K. (2002). Using the Picture Exchange Communication System (PECS) with children with autism: Assessment of PECS acquisition, speech, social-communicative behaviour and problem behaviour. Journal of applied behaviour analysis, 35(3), pp213-231.

Wolery, M. (2000). Behavioural and educational approaches to early intervention. In J.P. Shonkoff & S.J. Meisels (Eds) Handbook of early childhood intervention (2nd Ed), pp179-203. Cambridge: Cambridge University Press.

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Ask Amanda ... a student who is under three and displaying aggressive behaviour

Amanda, I have a new student who is two and a half. He is extremely impulsive, he cannot have anyone near him that he is not being aggressive to them, to the point where if I am near and pick him up, touch him or in any way try to talk to or remove him from the situation (hitting repeatedly, punching, pushing etc.) he will with one hand try to stop me while continue to strike out at the child. I think he has some form of spectrum disorder, his other behaviors are what appears to the other adults including his parents to make him 'gifted' his speech is very articulate overly complex sentencing (he is 2) but he repeats everything (very clearly) which I think is echolalia (sp?) not cognitive language use.what can I do to help him stop hurting others.

I am meeting with the parents and right now I will just ask them how he is at home types of questions. I have only had this child for 2 weeks and want to set up a good relationships with them. I have learned to approach with caution when this type of issue arises. Thanks Beth


First I just want to apologise for taking so long to answer this very tricky question. The world has been spinning very fast lately.

But now I have time to sit, think and answer your question.

I can’t suggest a quick fix

This difficulty is not something that can be addressed easily. It will take time and some investment of energy. However, I may be able to suggest some practical things you can do to help improve things over time.

I will also shy away from suggesting a diagnosis etc. That is up to the psychologist, paediatrician or other medical professional.

Step one: Formal Observation

The first thing you may need to do is take a step back and really observe what is happening. It may even be worth getting a third party in, for example another staff member who works in your centre, to watch what is happening.

The purpose of this is to get a better picture of what is going on. It will help unlock some clues to why he may be behaving this way.

Observational tools:
The observations should be written down. This written account should be factual rather than an interpretation of what is happening.

There are many forms of written observations. But you may find a couple of these useful.
Firstly, the simple anecdotal observation (click here or here for more info). That is, the observer watches for a certain time period and records everything that is happening. Not just what the child is doing, but what others around him did and in what setting it occurred.

The second example is an ABC observation.

A= Antecedent: Write down everything that happened before the child began to display the inappropriate behaviour. This includes anything that other children did, what setting they are in, what was said etc.

B= behaviour. Record exactly what the child did.

C= consequences. Record the responses of those around him. That includes the response of the other children, as well as the response of the staff.


What might be the function of his behaviour?

Read this previous post for more information on funcational behaviour assessment. However, the description of the behaviour you have given suggests to me a couple of purposes the child’s behaviour might have. However, these are only guesses as they are not based on full observations as described above.

1. A reaction to proximity
He may have sensory integration issues and subsequently have difficulty sharing space and equipment. He may not be able to endure the proximity of others, and his behaviour is his way of communicating this.

I did read somewhere else that when reprimanded he says he won’t do it again. But if it is due to sensory integration issues, and he has difficulty with social communication, he may not be able to change this behaviour without consistent and explicit support. He will continue to react impulsively in order to protect himself from the intrusion of others.

If this is the reason for his behaviour, removing him from play may seem very unfair to him as he will feel he is being punished for his anxieties or for what other children are doing. And it is unlikely that he will be able to articulate this in any other way than trying to continue lashing out whilst being removed.

What can you do in this instance?
- Set up a safe space that he can retreat to without fear of intrusion. This can be done using a mat, book shelves, cushions or a chair and table. All children should be told that this is a quiet space and only one person can be there at a time. In this space place a couple of the child’s favourite games. But this is only a starting point as you don’t want to always isolate the child from other children.
- Have a routine session every day based on a turn-taking game. This needs to be a quiet, highly structured game where only one child has a turn at a time. Start with just one or two other peers, and sit between them and the child. Let the child pick the children he wants to play with in this session. As the child gets used to this routine you may find that you can start introducing more children and less structured games. But it may take some months before your intervention is not needed.
- Use the child’s echolalic language skills to teach appropriate communication alternatives to his aggression. For example, teach him to say, “Move, please!” using an appropriate hand gesture when children get too close.

This is not a comprehensive list, but it may be a start.

2. A desire for interaction but limited social skills
I have worked with a number of children who have an intense desire to interact with others and play the same games but end up ostracising their peers because they don’t know how to get involved without aggression. There was a boy who wanted to play tips, but kept being isolated by staff because he was running around punching children. It turned out this was his invitation or his request to play tips. When he was taught how to play, and taught specific language to ask others to play, he ended up with a nice little bunch of playmates.

So if this is the case it is again not surprising that the behaviour isn’t changing. He may not be able to identify why it is wrong, or exactly what behaviour you want him to stop. He may also have a sense that is it “not fair” that he is being isolated when other children are playing together - even if he couldn't articulate this.

What can you do in this instance?
It will be about teaching specific social and language skills. Your observations will be able to tell you which skills are most relevant, but here are some ideas.
Language (teach a gesture or makaton sign language to go with this):
- Can I play?
- Can I have a turn?
- That’s mine. You can have it later.
- Can you move, please.
Social skills:
- looking at facial expressions and identifying when others are sad.
- Turn taking
- Sharing space and equipment

How could you teach these?

Social stories:
My book, Dave is Brave, is like a social story. It demonstrates a sequence of events that occur in consequence of aggressive behaviour, with pictures to illustrate facial expressions and emotions of others. It also has key phrases like, “Can I play?” demonstrated as an alternative to aggressive behaviour. (Sorry if this sounds like advertising, but I wrote the book for children with these sorts of issues so you may find it useful)

You could use this, or you could work with the student to design your own short picture sequence. You could do this by taking photos (with parent permission) of a short role play. Two photo sequences could be:
1) photo of him watching others playing
2) photo of him role playing pushing another person
3) photo of another person being sad
4) photo of him sitting by himself, not able to play with others
Second sequence
1) photo of him watching others playing
2) photo of him asking, “Can I play?” with a smile and appropriate gesture
3) photo of another person smiling back
4) photo of him sitting with others, playing together.

You could also look into using PECS such as Boardmaker and those seen on the do2learn website. This will help make language more meaningful for him if he learns well through visuals.


Responding to aggressive incidents

While he is learning these new skills, you will still need to have a way of managing or responding to aggressive incidents.

If you think that his behaviour might be due to sensory integration issues, or a difficulty with the physical proximity of others, you might want to do the following:
- Manoeuvre yourself in between him and the child he is lashing out at.
- Firmly but calmly and gently say, “Stop” with a stop hand sign
- If he doesn’t stop after 2 or 3 requests, point to his quiet space and ask him to take his toy to that space, re-assuring him that he can come back to this play space when he is ready to be settled (choose a word he can understand and use that same word all the time, you may even have a picture of the quiet space and being “settled” to help him understand what you are saying)

As much as possible, avoid physical contact. Try and shepherd him to the quiet space rather than physically move him if possible. You may also find that taking his toy to the quiet space will mean he comes with you.

If you think his behaviour is due to poor social and language skills, follow the same process. But instead of just saying, “Stop” get him to repeat a key phrase such as, “That’s mine.” with appropriate gestures so other children can understand him.


Conclusion:

The bottom line is that anything you do will take time and energy. You and anyone else working with the child will need to be consistent, repeating exactly the same process and exactly the same words every time an aggressive incident occurs. Remaining calm will be very important.

And if one thing doesn’t work after you have given it a good go (eg one month), do another observation and analyse whether you might need to think about the behaviour having a different purpose behind it.

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Resilience....

“Resilience is the ability to manage and learn from difficulties and to bounce back after diversity.” (Department of Education and Children’s Services, 2007 p1)

Each of us has a different definition of what is a “disastrous” event, an event that makes us lose control of our emotions.

For some it can take something as little as the inability to find one’s keys, for others it takes significant life events like the passing of a loved one. That is because we each have differing levels of resilience.

There is some debate over just what makes one person more resilient than another, but personality, life experiences, emotional intelligence and self-perception will all influence how well we bounce back.

How facing risk can build resilience

A list of school safety rules as seen in the BBC news http://news.bbc.co.uk/2/hi/uk_news/education/8107858.stm

SAFETY RULES
Wearing goggles to put up posters
Five-page briefing on the dangers of glue sticks
Ban on running in the playground
Wet grass stopping PE lessons
Ban on playing with conkers
One person at a time in staff kitchen
Ban on sweets because of choking risk
Buoyancy aids for capable year 11 swimmers on a school trip to France

It may be suggested that some of these are a little over-the-top. But we want to protect our children. Isn’t that a good thing?

Like for most things, we need to do it in moderation. There is research that suggests that children who face either low or high levels of risk through their lives, whether it be physical or emotional risk, are likely to be less resilient than those children who have faced a moderate level of risk (Fergus and Zimmerman, 2005; Gill, 2007). If a child has not had to face and deal with any risk before, they are more likely to be anxious and unsure of how to deal with problems or challenging situations in their lives. They may not be familiar with the feelings associated with a healthy adrenaline rush and may not be able to cope with or use that emotion to their advantage.

On the other side, children who face high levels of risk in their lives are likely to be worn down by unhealthy levels of fear and anxiety. Every person has a breaking point, and there is a point at which fear and anxiety can limit our ability to problem-solve or manage our emotions.

But it is more complicated than that…

We cannot simply push children to face “moderately risky” situations and hope they will develop resilience. As mentioned before, we don't always know what can be defined as a "moderately risky" situation for a person. And we also need to think about what will help children learn good coping strategies.

Research suggests that children are more likely to be resilient if they have good role models, adequate supervision and good social/emotional supports (Fergus & Zimmerman, 2005). They also need to be educated on risks and problem-solving.

Let’s take the simple example of the glue sticks. We probably don’t need a five-page briefing on the topic. However, you will need to choose child-friendly glue sticks, supervise young children closely whilst using them and occasionally remind them that the glue is for the paper not for their mouths.

Coping skills

How we deal with every-day problems tells us a lot about resilience. What do our children or students do when they are faced with problems?
· Are they curious or do they show signs of anxiety or fear?
· Are they confident enough to make mistakes – and learn from them?
· Can they change their minds or ways of doing things when things don’t go the way they planned?
· Can they honestly express their feelings, or do they withdraw or hide behind humour or acting out?
· Can they defend themselves?
· Can they see the positives that come out of any situation?

Children with disabilities

For children with disabilities there is a number of factors that can influence their resilience.

For example, children with developmental delays or literacy difficulties might have frequently experienced failure in classroom settings if their needs have not been accommodated adequately. This is likely to influence their sense of self-efficacy. And this, in turn, can lead to refusal to attempt work they perceive as too difficult.

Children who have difficulty with higher order thinking skills such as reasoning, problem-solving, analysing will struggle to cope with every-day problems. For these children you may see frequent and sometimes violent outbursts. These could be due to anger, frustration, fear and other strong emotions they are not able to manage.

Children with language delays will find it difficult to use conventional problem-solving methods such as communication of feelings or negotiation.

Children with sensory sensitivities may be so overwhelmed by noise, sound, movement or touch that they are not able to control their response.

Education and emotional literacy

To build resilience, we need to think about specifically teaching our children or students the following:
- self-esteem and self-belief
- coping and problem-solving skills
- recognising and managing emotions
- self-defence mechanisms (preferably not of the violent kind)
- communication skills

In my posts this month I will try to share a few strategies, resources and programs that may be helpful.


References

Department of Education and Children’s Services (2007). Resilience. Issues in Society, 260, p 1-3.

Fergus, S, & Zimmerman, M.A. (2005). Adolescent Resilience: A Framework for Understanding Healthy Development in the Face of Risk. Annual Review of Public Health, 26, p399-419.

Gill, T. (2007). No Fear: Growing up in a risk averse society. London: Calouste Gulbenkian Foundation.

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Do you understand what I'm saying?

Image from "Dave is Brave" www.learn2bebuddies.com.au . Copyright Amanda Gray and Daniel East.

Jenny has just arrived home from the gym feeling stiff and sore. Tom has just come inside as the coldness of the evening has made it too uncomfortable to work any longer in his garden.

Jenny rubs her lower back. “Uhhh! I feel old!”

“Brrr. I’m freezing, too! I’m going to have a shower.”

Jenny watches him go with a perplexed look on her face. “What?”
Image from

Interpreting

Even if we hear what a person is saying, and are paying attention, sometimes we don’t correctly interpret what they are saying.

To interpret or work out what a person is saying you have to be able to make sense of the sounds you hear. You need to change the isolated sounds into words, then put those words together based on their sequence and how they are said to get the full meaning of what you have been told (Anderson, 2000).

Minor misunderstandings like that between Jenny and Tom can occur because of trouble hearing. But they also often occur because we all bring our own ideas or context to communication.

Jenny’s context was that she was sore and tired. Tom’s was that he was cold. So he interpreted the word “old” to mean “cold”.


What makes it hard to interpret sounds?

The size of your vocabulary
You need to share the same vocabulary with the person to whom you are talking (Anderson, 2001). Children can have a smaller vocabulary for a wide range of reasons. Children with developmental delays such as that associated with Down Syndrome may take longer to learn words in a way that means they can “retrieve” them easily. This means that they may have a smaller vocabulary (Buckley, 1993; Chapman, 2006).

We pick up most of our vocabulary through experiences with language and conversations (Cross, 2001). Children who have difficulties hearing will have smaller vocabularies due to limitations placed on their language experiences. Children for whom English is their second language will also have a smaller vocabulary.

Some conditions like dyslexia can influence how we process sounds (Stein, 2001). So while children with these conditions may be able to hear the sounds, it might take them longer to work out what these mean. These children may also have a smaller vocabulary, or mix up sounds more often. They may also struggle to hear changes in tone of voice, which will be discussed below.

Children who have Autism Spectrum Disorders may also have a smaller vocabulary. This is mainly due their limitations in social and emotional reciprocity, or empathy (Scott, Clark, Brady, 2000). This means that the motivation for their communication will come from their own interests, not based on an understanding of how communication influences their relationships with others (Autism Association of South Australia, 2009).

For example, a child with Aspergers may have a special interest in Maths and logical problems. This child may then have a big vocabulary relating to this subject. But in the context of other subjects, including language related to everyday tasks and social interactions, their vocabulary might be quite small.

These difficulties can also lead to problems with the other things you need to know in order to correctly interpret what people are saying (discussed below).

Your knowledge of the patterns of language
To understand what people are saying you need to have a good knowledge of how words fit together in a sentence. You also need to know how tone of voice can change what they mean. As discussed in a previous post , this can be difficult if you have trouble paying attention to and interpreting others’ facial expressions and body language.

Your knowledge of the subject being discussed
As mentioned previously, knowing the context of a discussion is important in helping us interpret what is being said (Anderson, 2001). It helps us put the sounds together and chose the right words to fit the context. It also speeds up the process of changing the sounds into meaningful sentences.

So if you have a child who is tired, or bored, or struggling to pay attention they are more likely to misinterpret what you are telling them to do.


The process of interpreting sounds and words relies on our skills in remembering and retrieving information we have learnt (Hick, Botting & Conti-Ramsden, 2005). I will talk more about memory in the next post.


References:

Anderson, C. (2001). Pragmatic Communication Difficulties. In R. MacKay and C. Anderson (Eds), Teaching Children with Pragmatic Difficulties of Communication, p24-38. David Fulton Publishers: Hampshire.

Autism Association of South Australia. (2009). What is Autism? Retrieved 16th May, 2009 from:http://www.autismsa.org.au/html/disorders/autism.html


Buckley SJ. (1993) Language development in children with Down syndrome - Reasons for optimism. Down Syndrome Research and Practice,1(1), p3-9. Retrieved from http://www.down-syndrome.org/reviews/5/

Chapman RS. (2006). Language learning in Down syndrome: The speech and language profile compared to adolescents with cognitive impairment of unknown origin. Down Syndrome Research and Practice, 10(2), p61-66. Retrieved from http://www.down-syndrome.org/reports/306/

Cross, L. (2001). Early Communication Development. In M.S. Lue (Ed.) A Survey of Communication Disorders for the Classroom Teacher, p35-54. Allyn and Bacon: Boston.

Hick, R.F, Botting, N., and Conti-Ramsden, G. (2005) Short-term memory and vocabulary development in children with Down syndrome and children with specific language impairment. Developmental Medicine & Child Neurology, 47, p532–538. Retrieved http://journals.cambridge.org/download.php?file=%2FDMC%2FDMC47_08%2FS0012162205001040a.pdf&code=7abb5653813d8fc667d2aaa56a4c8e16

Scott, J., Clark, C., and Brady, M. (2000). Students with Autism: Characteristics and Instruction Programming. Singular Publishing Group: San Diego.




Stein, J. (2001). The Neurobiology of Reading Difficulties. In M. Wolf (Ed) Dyslexia, Fluency and the Brain, p 3-22. York Press: USA.

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Why aren’t you listening? Disobedient or Distracted?

Picture copyright Daniel East - from "Dave is Brave" www.learn2bebuddies.com.au

“I’ve told him what to do a dozen times, but it goes in one ear and out the other!”

Have you ever heard that said? Well, it might be very near the truth.

But, despite what you might feel, a “good kick up the backside” is not the solution. We need to understand why our words have not stuck with the child.

What is involved in doing what you are told?

When you are told to do something you have to be able to hear, listen, interpret, remember and act on the instructions. If you have difficulties doing any one of these things you can seem “disobedient”.

In this post I want to talk about hearing.

Hearing

I won’t give you a biology lesson on hearing here. You might want to visit the Mayo Clinic if you are interested in how the ear works. For now, I just want to point out some reasons why a child might not be able to hear you.

Conductive hearing loss (ASHA, 2009; Australian Hearing, 2009; Moore, 1997)

Children who have recurring ear infections such as Otitis media, or even a build up of wax in the ear will find it hard to hear clearly. For others the bone and cartilage structure may interfere with the movement of sound through the ear to the nervous system that processes the sounds.

Children with Down Syndrome are shown to be at increased risk of ear infections and conductive hearing loss because of their susceptibility to infections and the smaller ear canal (Moss, nd).

Indigenous Australians have also been shown to be at increased risk of conductive hearing loss (Coates et al).

For some children, the treatment might be through antibiotics or grommets (MyDr, 2008). For others, hearing aids may be used.

Sensorineural hearing loss (ASHA, 2009; Australian Hearing, 2009; Moore, 1997):

This is when the cochlea or the nerves that carry sound to the brain might be affected. The levels of hearing loss may differ, but generally sensorineural loss cannot be fully addressed even if the child is using hearing aids. For children whose cochlea is damaged, cochlea implants can be used. For others, communication will be through the use of sign language.


The levels of hearing loss are described as mild, moderate, severe and profound. If you want to know what a child might hear depending on the level of hearing loss they have been diagnosed with, visit ASHA and the Medical College of Wisconsin (they have a great picture that is easy to understand). The Warren Centre also has a good diagram of what sounds equate to different decibel levels (as seen in the ASHA description).

Disobedience or Distraction?

If a child has an ear infection such as Otitis Media they will struggle to hear you call their name in a noisy room or if their back is turned to you. So if they don’t respond, it is that they haven’t been able to pick out your voice from all the other noises going on around them.

If a child has a hearing aid or a cochlea implant, it doesn’t mean that they have perfect hearing. They will struggle to hear you in noisy rooms, or if there is something or someone making a noise closer to them than you.

You also need to remember that children with hearing impairments may have smaller vocabularies and may struggle with understanding how sentences are put together. This is because their learning of language is interrupted by what they can and can’t hear. This may mean they find it hard to pick out the important bits in your instruction.

For example, if you say "Julie, can you put your book away in your book tray, please?" the child
may know you have mentioned a book and a tray, but not make the connection between the two. So the child may be confused about what exactly you want them to do with the two objects.

Next Time

In the next post I will talk about the difference between listening and hearing. Later I will also talk about some strategies and things to think about when giving instructions to a child who has a hearing impairment.

References
Australian Hearing (2008) Types of Hearing Loss. Retrieved 10th May, 2009 from: http://www.hearing.com.au/types-of-hearing-loss

American Speech-Language-Hearing Association. (2009). Type, Degree and Configuration of Hearing Loss. Retrieved 10th May, 2009 from: http://www.asha.org/public/hearing/disorders/types.htm

Coates, H.L., Morris, P.S., Leach. A.J., and Couzos, S. (2002). Otitis media in Aboriginal children: tackling a major health problem. Medical Journal of Australia 177 (4): 177-178 Retrieved from: http://www.mja.com.au/public/issues/177_04_190802/coa10271_fm.html

Mayo Clinic (2009). How do we Hear? Retrieved 10th May, 2009 from: http://www.mayoclinic.org/hearing-disorders/how.html

Moore, B.C.J. (1997). An Introduction to the Psychology of Hearing. SanDiego: Academic Press.

Moss, K. (nd). Hearing and Vision Loss Associated with Down Syndrome. Retrieved 10th May, 2009 from: http://www.deafblind.com/downmoss.html

My Dr (2008). Otitis Media in Children. Retrieved 10th May, 2009 from: http://www.mydr.com.au/kids-teens-health/otitis-media-in-children

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Using pictures

Are you Angry or Not?

(pictures from www.learn2bebuddies.com.au)

Tommy asks Jenny if he can play with the truck she is using. She says, calmly and politely, “No. I am playing with it. There’s another one over there.”

Tommy begins to cry and comes rushing up to you. “Jenny won’t let me use the truck! She is being mean! Waaaaa!”

How do you explain that Jenny wasn’t being mean, or angry? She just wanted to play uninterrupted. There are other toys she wanted to share with you...


Using pictures to teach pragmatics (following on from the previous posts)

Tom needs to learn the difference between the facial expression and body language that makes the word “No” represent bullying or “meanness” as opposed to the pragmatics that reflect a reasonable refusal. This is a complex concept for all young children to learn.

For some children you may be able to talk to them and use words to help them understand this. But talking about it assumes several important things. Firstly, if you reason with Tom you are expecting that he is able to hear the words and understand what they mean. If he has a hearing impairment, developmental delay or a language disorder, this may be a difficulty for him.

Second, you are expecting that he can imagine and relate to the actions and emotions reflected in the words you are using. Again, children with developmental delays, Autism, Aspergers Syndrome and other social or behaviour difficulties may struggle with this process.

So what can we do?

One way to approach the issue is to use pictures. There are a number of benefits to using visuals (Bondy & Frost, 2002; MacKay, 2000; Marion, 2007).

1 - They can attract attention
For example, children with autism will find it hard to make eye-contact with others. It may be difficult for them to process sights, sounds and movement all at once. Making eye contact may mean they struggle to actually “hear” what the speaker is saying. Other children may have difficulties concentrating, paying attention or directing their gaze to something when asked.

When you use a picture, you can help a child focus on a representation of the facial expressions and body language without having to process movement and sound as well. The child can also be given the picture to hold, or it can be held in their eye-line.

2 - They are permanent
You can allow the child to study the picture for as long as needed. The expression won’t disappear in a moment as it would from another child’s face.

3 - They can be carried around
You can use the picture in a range of situations. You can get the child to use it to communicate their own emotions. Or you can point to the picture to communicate what another child may be feeling. By doing this you are helping the child generalise the information, or apply it to different situations and different people. This, in turn, will help them develop empathy.

4 - They are concrete
You don’t have to use language and imagination. The picture is a concrete representation of an abstract concept. You are providing them with the “image” for their imagination. This is especially important if the child thinks in pictures rather than in words.

5 - They can be adapted to any age
You can use photos, pictures or line drawings. You can adapt the pictures to any age and to any child’s interest.


So, in Tom’s case, you may use two pictures such as those seen below (free download from http://www.do2learn.com/).

You may get him to chose which one he thinks reflects Jenny’s response. Then you may get Jenny to choose the one that reflects what she really meant. Then you help correct the miscommunication in a very concrete way.

Don’t expect immediate results. You may have to use this process many times depending on the child’s difficulty. The first step may be just getting the child to look at the picture.

But with repetition, patience, praise and reinforcement (such as getting the truck after he has played with another toy for a short while), Tom will learn the difference between a calm and friendly, “No.” and an angry, mean “NO!”

References:

Bondy, A., Frost, L. (2002). A Picture’s Worth: PECS and Other Visual Communication Strategies in Autism. Woodbine House: USA

MacKay, G. (2000). Primary-age Pupils with Pragmatic Difficulties. In R. MacKay and C. Anderson (Eds), Teaching Children with Pragmatic Difficulties of Communication, pp55-71. David Fulton Publishes: London.

Marion, K. (2007). Visual Supports for People with Autism: A Guide for Parents and Professionals. The Canadian Journal of Occupational Therapy, 75(5) p281.

Line drawings retrieved from:

http://www.do2learn.com/picturecards/printcards/2inch/imagegridsnowords/emotionsnoword.htm

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Facial Expressions, Body Language and Empathy

Billy was building a road out of blocks.

“Hey, Billy! Can I play?” Tim said eagerly.
Billy smiled, “Sure, you can play!”
“What can I do?” Tim asked.
Billy pointed to the end of the road, giving Billy a toy car. “Just sit over there.”
“Okay!” Tim said as he sat in the indicated space and started running his car along the block road.

Billy was building a road out of blocks.
“Hey, Billy! Can I play?” Tim asked shyly.
“Sure you can play!” Billy replied sarcastically, looking at Tim with a sneer.
“What can I do?” Tim asked falteringly.
“Just sit over there.” Billy pointed to the very edge of the mat, out of reach of the road and any blocks.
“Okay.” Tim sat in the indicated spot and watched as Billy turned away to continue building the block road.

(Image copyright Daniel East 2008. Illustration is part of the children's book, Dave is Brave, written by Amanda Gray. Visit www.learn2bebuddies.com.au for more information.)

Body Language, Facial Expressions and Empathy

These two vignettes illustrate how the same words, used in different ways, can hold very different meaning. That’s because communication isn’t just about the words we use. It is about how we use them.

The same words can have a very different meaning depending on what facial expressions, tone of voice and body language we use. These things let others know what we really mean, or the intent of our words.

There are also many unspoken rules we need to follow when we are communicating to get our message across successfully. For example, we speak differently to a friend that we would to our boss. We also need to take turns, keep to the topic of conversation and use conventions like “I have to go now” to end our conversations.

These things all combine to give us the social context of language and are referred to as pragmatics (Scott Lue, 2001, MacKay, 2000). If a child has difficulty with pragmatics their success in interacting with others will be affected. Not only will they misunderstand others’ communication efforts, but they may struggle to get their message across without misunderstandings, hurt and frustration.

For example, as we speak to and interact with others we use their facial expressions and body language to help interpret how they are feeling or reacting to us. As we empathise we adapt our behaviour (McKay, 2000). So pragmatics helps us tell when someone is not interested in what we are saying, and we stop talking. Or it helps us realise if our actions or words are hurtful. It can also help us recognise jokes, sarcasm or bullying.

But not all children learn these skills in the same way.

Children who may struggle to learn pragmatics

To learn the pragmatics of language you need to be able to see, hear and concentrate. You need to be able to analyse, remember and adapt what you have learnt to new situations. You need literacy skills such as knowledge of words, grammar and how context changes a word’s meaning. And you need to be able to guess at other people’s attitudes and recognise someone else’s point of view (Anderson, 2000).

Children who have vision impairments can miss body language and facial expressions (Scott Lue, 2001). Taking turns in conversations may be hard as their ability to use eye-contact may be limited. They may need to develop other signals to help their friends know they are listening.

For children with hearing impairments, developmental delays and language disorders learning new words and concepts may be difficult. They may struggle with finding the right words to match their body language and gestures so they can get their message across (Anderson, 2000).

Children with attention deficit disorders may find it hard to keep eye-contact and pay attention when interacting. They may miss important facial expressions and body language, thus missing how their words and actions may be affecting another person (Sinzig, Morsch & Lehmkuhl, 2008).

Children with developmental delays, such as children with Down Syndrome, may struggle with the complex process of analysing, remembering and adapting what they have learnt in one situation to be used in new situations (Buckley, Bird & Sacks, 2002; NSW Council for Intellectual Disability, 2006). So they may find it hard to interpret body language and facial expressions they are not familiar with.

But the children we read about most often as struggling with pragmatics are children with autistic spectrum disorders (ASD) (Scott, Clark & Brady, 2000).

Autism Spectrum Disorders

Children with Autism may have difficulties learning to speak. Children with Aspergers Syndrome may have a big vocabulary and speak well, but struggle with the pragmatics of language. But in both cases, their key difficulties will include:

• making eye contact
• recognising and responding to facial expressions, tone of voice and body language
• taking turns and
• empathising (Scott, Clark & Brady, 2000).

For example, a child with autism spectrum disorders may keep bringing the conversation back to their area of interest even if it is not relevant to the conversation. They may not show interest in what the other person is saying. They may echo or imitate a question they have been asked rather than respond to it.

Teaching pragmatics

We usually develop our knowledge about the rules of communication and socialisation by observing, practising and applying past experiences to our interactions (Scott Lue, 2001; MacKay, 2000). We start learning these skills as a baby when we first make eye contact with our parents. But, as previously mentioned, children with a range of different difficulties will not learn these skills in the same way. For these children it is about explicit teaching.

We can do this in many different ways. I won’t discuss this now as I think I can sense from your body language that you may be losing interest :-). But in the coming weeks I will blog about how modelling, prompts, rewards, pictures and social stories can help children with a range of disabilities learn to recognise, interpret and develop body language, facial expressions and empathy.


References

Anderson, C. (2000). Pragmatic Communication Difficulties. In G. MacKay and C. Anderson (Eds), Teaching Children with Pragmatic Difficulties of Communication, pp24-38.

Buckley, SJ., Bird, G., and Sacks, B. (2002) Social Development of Individuals with Down Syndrome – An Overview. Retrieved 10th April 2009 from http://www.down-syndrome.org/information/social/overview/

MacKay, G. (2000). Actions and interactions: the roots of pragmatic communication. In G. MacKay and C. Anderson (Eds), Teaching Children with Pragmatic Difficulties of Communication, pp6-23.

NSW Council for Intellectual Disability (2006). What is Intellectual Disability? Retrieved 10th April 2009 from http://www.nswcid.org.au/standard-english/se-pages/fact-sheets.html

Scott, J., Clark, C. and Brady, M. (2000). Students with Autism: Characteristics and Instruction Programming. Singular Publishing group: California.

Scott Lue, M. (2001) A survey of Communication Disorders for the Classroom Teacher. Allyn and Bacon: Boston.

Sinzig, J., Morsch, D. and Lehmkuhl, G. (2008) Do hyperactivity, impulsivity and inattention have an impact on the ability of facial affect recognition in children with autism and ADHD? European Child & Adolescent Psychiatry, 17(2) pp 63-72.

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