Promoting Communication Skills Through Everyday Routines - PowerPoint Presentation

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Promoting Communication Skills Through Everyday Routines

Presented by:

USF Clinical Instructors

:

Aleisha

Linck

VanAmburg, MS CCC-SLP

Amy Davis, MS CCC-SLP

USF Graduate Student:

Jennifer Cooper, BSSlide2

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

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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.Slide5

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?Slide6

Types of Social PlaySlide7
Slide8

Types of Social Play: A Growth Model

(Based on M.

Parten’s

stages of play, 1932)Slide9

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)Slide10

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)Slide11

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)Slide12

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)Slide13

Cooperative Play

Most commonly observed in 4 year olds

R

epresents 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)Slide14

Which type of play is demonstrated in these pictures?

Example #1

Example #2Slide15

Which type of play is demonstrated in these pictures?

Example #3

Example #4Slide16

Which type of pay is demonstrated in these pictures?

E

xample #5

Example #6Slide17

Types of Communication

Group ActivitySlide18
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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

.Slide20

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. Slide21

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. Slide22

Teaching Nonverbal Communica

tion/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. Slide23

Hierarchy for Teaching Nonverbal

Communicative Skills/Signaling:

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. Slide24

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 objectSlide25

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  personSlide26

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 impairmentSlide27
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Teaching Eye Gaze/Eye Gestures

Corresponding Strategies/Activities:

Eye Messages:

using pictures of

caregivers or other people and have the child identify

eyes/eyebrows and related

emotions (happy, sad, scared, angry, etc.)

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.

Engage the child in a discussion with a familiar adult about topics that invoke feelings of happiness, sadness, fear and anger. Slide29

Voice Messages (

S

uprasegmentals

)

Voice Messages include:

Intonation in speech

Vocal volume

Rate of speech

Emphasis on wordsSlide30

Teaching Voice Messages (

S

uprasegmentals

)

Corresponding Strategies/Activities:

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).

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. Slide31
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Body Messages (P

hysical

G

estures)

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.)Slide33

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 conversationSlide34

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 Slide35

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”.Slide36

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

Play Interest SurveySlide37

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 PlaySlide38

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, RiceSlide39

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 AttentionSlide40
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Positive Behavior SupportsSlide42
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Old Ways vs. New Ways

Old 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 interventionsSlide44

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 behaviorSlide45

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.Slide46

Functional Assessment Features

Clear

description of behavior

Events, times, and situations that are predictive

Describes consequences that may maintain the behavior

Formulates a hypothesisSlide47

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)Slide48

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 communicateSlide49

Functions of Communication

Request object, activity, person

Escape demands

Escape activity

Request help

Request social interaction

Comment

Request information

Request sensory stimulation

Escape sensory stimulationSlide50

Forms of Communication

Words

Sentences

Point to a picture

Eye gaze

Pulling Adult

Crying

Biting

TantrumsSlide51

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

reinforcersSlide52

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.mpgSlide53

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)Slide54

Developing Outcomes, Goals, and Strategies for an IFSPSlide55

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

metSlide56

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…Slide57

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. Slide58

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.Slide59

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. Slide60

Developing High Quality Goals

Identify a selection of skills or behaviors that relate to the outcome and write goals for smaller steps to achieve skills or behaviors

Identify the current level of support for the behavior to occur and systematically alter the level of support provided.

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.Slide61

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 meaningfulSlide62

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)Slide63

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 activitiesSlide64

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 characterSlide65

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)Slide66

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?

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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.