Speech, language and communication needs: Childrens views and participation

Dr Rosalind Merrick, University College London Institute of Education

Childrens views can and should occupy a central position in our work. With the new Special Educational Needs (SEN) and Disability Code of Practice this is now mandatory. Yet ascertaining and interpreting the views of children who have speech, language and communication needs poses a particular challenge. Merricks (2014) research has led to recommendations, materials and a theory of discourse that can support meaningful dialogue with children about their communication, their needs and the assistance they receive.

The place for childrens views Childrens motivation and co-operation is likely to be greater when their views have been heard and when they have participated in decisions. This can be a primary reason for practitioners involving children in their education and their therapy. However, participation can be understood more deeply, not simply as a pragmatic step, but as childrens right. It is part of the respect that children are entitled to. Perhaps deeper still is the understanding that children can teach us things that we do not know about their own lives, and about our work with them.

The United Nations Convention on the Rights of the Child (1989) is the most rapidly ratified and widely endorsed international human rights treaty in history. The Convention changed the way children are viewed and treated as human beings with a distinct set of rights instead of as passive objects of care and charity. Regarding childrens right to express their views and have these taken into account, there are qualifying clauses. In the case of children with speech, language and communication needs, it is up to us to determine what the child who is capable and in accordance with the age and maturity can mean:

Article 12 1. State Parties shall assure to the child who is capable of forming his or her own views the

right to express those views freely in all matters affecting the child, the views of the child being given due weight in accordance with the age and maturity of the child.

Article 13 1. The child shall have the right to freedom of expression; this right shall include freedom

to seek, receive and impart information and ideas of all kinds, regardless of frontiers, either orally, in writing or in print, in the form of art, or through any other media of the childs choice.

United Convention on the Rights of the Child (1989)

Hart (1992) in his ladder of participation made the distinction between participation and non-participation, the latter including tokenism and manipulation. For example, as adults we lift childrens views out of context and use these to evidence our own arguments. The new Code of Practice aims to put children at the heart of the services they receive. Yet, ironically this obligation

presents a danger of tokenism and manipulation that is greater than ever. Harts observation of more than two decades ago remains poignant:

Children are undoubtedly the most photographed and the least listened to members of society (Hart, 1992, p. 8)

Lansdown (2001) identified three meaningful approaches to childrens participation, all of which have a place in our work with children with speech, language and communication needs. The first is consultative processes. The practitioner chooses a salient moment to consult with the child, for example at an initial assessment or review. The second is participative initiatives, where democratic principles operate as part of our regular work. An example of this could be the way a circle time is conducted, or each therapy session comprises an element of open dialogue. The third is promoting self advocacy. Assessment for learning, work on metalinguistic awareness and elements of personal and social education can all fall within this approach.

The SEN and Disability Code of Practice (2014) is underpinned by the principle of due regard for the views, wishes and feelings of the child, and for the importance of the child participating as fully as possible in decisions. Children must be provided with the information and support necessary to enable participation in those decisions, as well as be supported in their development. I would argue that the onus is now upon practitioners not to limit what possible means with regard to childrens participation.

How do children know what they need? One could also ask, how do we know what children need? Childrens perspectives can shape the provision they receive in positive ways, for example regarding the deployment and practice of teaching assistants, or regarding goals which go beyond academic targets and curriculum access to address social aspirations.

The Education and Health Care Plan begins with a section collating the views, interests and aspirations of the child or young person and their parents. A one-page profile can act as a positive starting point in gathering person centred information about the pupils needs and desires for this and other SEN planning (Cheminais, 2015; Sanderson, 2013). It is relevant to consider the audience for the document, as the purpose and relationship context are likely to matter to the child. Merrick (2014) used a scrapbook as the basis for conversational interviews with children with speech, language and communication needs. Like the one-page profile, this embeds the information about speech, language and communication needs in a context of the childs strengths, relationships and interests. The child has ownership of it, however, and it is shared on their terms within their trusted relationships.

Ascertaining childrens views Given that it is mandatory to have due regard for childrens views, involving children who have little or no speech presents an obvious difficulty. Clearly, it can be hard to know these childrens perspectives, and one must keep checking ones assumptions (Porter, Ouvry, Morgan, & Downs, 2001; Thurman, Jones, & Tarleton, 2005). Those who are closest to the child are likely to have insight into the childs means of communication, but also to be most influenced by their own subjective values (Ware, 2004). Talking Mats has proved an excellent way of mapping out clear questions in a person-centred way for people with intellectual disabilities (Murphy & Boa, 2012; Murphy & Cameron, 2008).

A Likert scale with happy and sad faces is commonly used with children of all abilities to frame answers to questions. However, responses on a scale function as openers to further conversation. Answers to generic questions (e.g. Do you like reading?) often depend on contextual and contradictory factors, rendering a single answer rather meaningless. We cannot equate simple liking with approval, or dislike with having a negative view. To use Wares (2004) example, having a negative reaction to the dentists drill is not incompatible with the wish to go to the dentist again. Moreover, many children with speech, language and communication needs find it easiest to begin with a description, rather than a summative evaluation.

Merrick and Roulstone (2011) used in-depth interviews as an alternative method of exploring the views of children of communication. This led to the development of picture materials and guidance for interviewing schoolchildren with speech, language and communication needs (Merrick, 2014). Below are six precepts:

Be informative: Help children to understand who you are, what you are wanting to know and why.

Be aware of the setting: There are obvious power differences between adults and children. The room and the materials available all send signals about the meaning of the interaction and what is acceptable to say.

Have an open mind: Children can surprise and inform us, and our expectations and wishes should not impair our ability to hear their perspectives.

Use pictures: Pictures aid intelligibility for both parties. Specially designed composite pictures (Merrick, 2014) function like a visual questionnaire to allow children to bring their own perspectives and vocabulary to scenarios at school and at home. Merrick also discusses how childrens drawings can be used in interviews.

Ask questions: Merrick gives attention to the art of questioning and the way to elicit a valid account.

Respect autonomy: Ethical issues are discussed among other things around childrens right to silence.

When seeking to talk about communication, children and practitioners may use language in different ways. As a speech and language therapist, I might speak about my work in terms of speech, language and understanding. Yet for children, these words have connotations with microphones, foreign languages and sympathy/agreement respectively, far from the associations I would intend. Words that children have used to talk specifically about speech and language impairment include the more generic sounding know, talk and forget. Thus, we must be aware of the connotations of the words we are using as well as the assumptions we are making.

Interpreting childrens views Merrick (2014) found that when children spoke about their experience of language impairment, they were focusing on the demands of the environment. This could be interpreted within the social (as opposed to the medical) model of disability. Science was Emmas worst subject, listening to a story was boring for Callum and class was not peaceful for Sophie.

My best subject is art, worst subject is science. [...] The words we have to say like solids, opaque and stuff like that, cos I cant remember all of them. EMMA

All the time we have to... boring bit, boring bit. Have to listen. Cos you dont do nothing really, you just got to be quiet. CALLUM

I like quiet. Peace. In class not peace. SOPHIE

McCormack, McLeod, McAllister & Harrison (2010) explored childrens experiences of speech disorder and found that they attributed the problem either to their speech, to their listener or to the frustration of communication breakdown. Acknowledgment of the negative feelings was clearly an important aspect.

Merrick (2014) found that childrens accounts of communication fell into three types of discourse. These are summarised in Table 1. Discourse here refers to clusters of themes, ideas and images which are shared through use of particular language. The discourse of impairment was about individual skills and abilities, in particular difficulties and deficits. It referred to whether you use speech and language properly or not, and what that means for your identity (and social inclusion). There featured comparison to others and to what is considered normal. The discourse of learning was about communication as a skill to master. You make slips/errors, forget/remember in the process of learning its something you work at. You are shown and taught how to say things and how to solve problems. The discourse of behaviour is about communication choices. There is an extent to which you are in control of the way in which you communicate, with whom and about what. You choose what to cooperate with, and when to be good, and appreciate having the freedom to act autonomously.

The significance of this analysis of discourse is that practitioners may enter into more meaningful dialogue with children if they are able to recognise the discourse in use by either party. In the example below, Declan is using the discourse of behaviour, and is rejecting of the discourse of impairment.

Declan: I dont need any manners. [...] Its just manners! Brother: Declan, its the way you speak. Its just the way you speak. Declan: [defensively] Yeah, what about it?

This could also have implications too for our dialogue with parents, particularly those early conversations where concerns are raised with the object of discussing needs and provision. Each discourse has its advantages and disadvantages for social identify and for therapy.

To summarise, if we are able to enter into a dialogue with children with speech, language and communication needs regarding their strengths and their relationships as well as their needs and wishes, then we take an important step towards facilitating their participation in decisions about the way they are taught and provided for. This paper has presented some ideas and materials that have proved useful in achieving this. Children shape as well as reflect the world they live and communicate within, and we serve them best when we recognise the value that their participation has.

Table 1: Types of discourse in childrens accounts of communication.

Talk is a matter of...

Difficulty is attributed to...

Competence is attributed to...

Help consists of...

The discourse of impairment

Identity Impairment Strengths Relationships

The discourse of learning

Skill Making mistakes Making an effort Being taught

The discourse of behaviour

Choice Dissent Being good Rules and freedom

References Cheminais, R. (2015). Rita Cheminais' Handbook for SENCOs. London: Sage. Hart, R. A. (1992). Children's Participation: From Tokenism to Citizenship. Florence: UNICEF. Lansdown, G. (2001). Promoting Children's Participation in Decision-Making. Florence: UNICEF. McCormack, J., McLeod, S., McAllister, L., & Harrison, L. J. (2010). My speech problem, your listening

problem and my frustration: the experience of living with childhood speech impairment. Language, Speech and Hearing Services in Schools, 41, 379-392.

Merrick, R. (2014). Picture Me: Children's Views of Speech, Language and Communication Needs. Guildford: J&R Press.

Merrick, R., & Roulstone, S. (2011). Children's views of communication and speech-language pathology. International journal of Speech-Language Pathology, 13(4), 281-290.

Murphy, J., & Boa, S. (2012). Using the WHO-ICF with Talking Mats to Enable Adults with Long-term Communication Difficulties to Participate in Goal Setting. Augmentative and Alternative Communication, 28(1), 52-60.

Murphy, J., & Cameron, L. (2008). The effectiveness of Talking Mats with people with intellectual disability. British Journal of Learning Disabilities, 36(4), 232-241.

Porter, J., Ouvry, C., Morgan, M., & Downs, C. (2001). Interpreting the communication of people with profound and multiple learning difficulties. British Journal of Learning Disabilities, 29(1), 12-16.

Sanderson, H. (2013). Personalisation: three steps to transform practice. Learning Disability Practice, 16(5), 34-37.

Thurman, S., Jones, J., & Tarleton, B. (2005). Without words meaningful information for people with high individual communication needs. British Journal of Learning Disabilities, 33(2), 83-89.

Ware, J. (2004). Ascertaining the views of people with profound and multiple learning disabilities. British Journal of Learning Disabilities, 32(4), 175-179.