Supporting Early Communication Skills in the Home and Classroom Settings

Jillian Baldwin, M.Sc., RSLP, S-LP(C)

October 27, 2017

Presentation Goals

∗ Understand what it takes to communicate effectively

∗ Make changes in how WE communicate with and respond to our children/students

∗ Support our children/students to express themselves clearly

�Define communication

�Common skill profile

�Opportunities to hone skills

�Strategies to support:

�Comprehension

�Expression

�Questions

�Resources

Outline

∗ How people communicate∗ Spoken words, sounds∗ Voice∗ Facial expressions∗ Body language∗ Gestures∗ Pictures∗ Sign language∗ Writing

∗ Why people communicate∗ Meeting needs (getting/refusing things), safety∗ Exchange information∗ Social interaction∗ Build/maintain relationships

“Communication”

Stages of UnderstandingGet your message IN

1. Understands that peoples’ actions and sounds have meaning

2. Understands single words

3. Understands phrases

4. Understands sentences / follows 1 step directions

5. Follows longer directions

6. Can answer questions

7. Can participate in conversation meaningfully

Stages of ExpressingGet their message OUT

1. No intentional communication

2. Beginning to intentionally send messages

3. Uses conventional gestures

4. Uses single ‘words’

5. Combines ‘words’

6. Uses sentences

7. Conversation and stories

Child Factors in Communication Development

• All the things within a child that contributes to how they learn and interact with their environment

• What the child “brings” to the learning task

Health Issues

∗ Congenital heart defects (30-60%)

∗ Obstructive sleep apnea (50-80%)

∗ Diabetes

∗ Hypothyroidism (20% children, 15-50% adults)

∗ GI tract anomalies (50%)

∗ Epilepsy (22% children)

∗ Mental health issues

Health Supervision in DS

American Academy of Pediatricshttp://www.ndss.org/Global/Health_Care_Information_for_Families_of_Children_with_Down_Syndrome%20(1).pdf

Canadian: Surrey Place Centrehttp://www.surreyplace.on.ca/documents/Primary%20Care/Down%20Syndrome.pdf

Vision (60%)

Hearing (65-80%)

Perceptual/Sensory Factors

Touch (49%)

Cognitive Factors

∗ Auditory/language processing

∗ Memory

∗ Abstract thinking

∗ Theory of mind

∗ Social understanding

∗ Generalization

∗ Executive functioning

� Attention

� Initiation

� Impulse control

� Reasoning

� Problem solving

� Sequencing, organizing, planning Kumin, 2012

Social thinking

Stein, 2015

= Communication Challenges

∗ Speech sound production / general intelligibility

∗ Stuttering

∗ Voice

∗ Expressive language

∗ Social communicationTalking

is tough!

Strengths related to language learning

∗ Visual learning

∗ Socially motivated

∗ Musical / dance ability

∗ Gesture use

∗ Visual learning

∗ Receptive language, particularly vocabulary

∗ Certain aspects of literacy development

Draw on strengths to address challenges

Receptive Language (understanding)

Expressive Language (speaking)

Vocabulary(especially for things)

Grammar(putting words together in sentences)

Concrete words Abstract concepts

Repetitive language Novel sentences

Social motivation Social skills

Strengths vs. Challenges

Auditory memoryVisual learning

How can you use one of these strengths to target things that are challenging?

Create a rich language learning environment

Child factors

+

Environment

+

Experience

=

Development

EVERY DAY!

∗ Routines

∗ Play

∗ Reading

∗ Singing

WHEN

When: Routines

∗ Interaction can be a part of daily routines

∗ Make routines predictable (same every time)

∗ Say repetitive phrases and emphasize key words

∗ Create some child-centered routines like singing and reading

Target words/phrases

cooking: cleaning:

_______________ _______________

_______________ _______________

_______________ _______________

What does your child like to play?

When: Play

Why is play so important?

∗ Hands-on: learn while doing

∗ Language concepts are exhibited naturally in context (action words, location words, etc.)

∗ Language concepts can be varied, functional, and fun!

∗ Joint play and pretend play are often mediated through language

∗ Learn pre-reading skills

∗ Hear sounds, words, combinations

with visual support

∗ Describe pictures

∗ Discuss events

When: Reading

How can you simplify this

book?

Reading: Practicing Phrases

1 word

2 words

3 words

More stories with propsUse the toys to identify and to act

out

Check out www.kizclub.com for free printables

Reading: Stories with Props

∗ Familiar, repetitive

∗ Incorporate actions/movement

∗ Practice speech sounds, vocabulary, phrases, and prosody while engaged

∗ Also great for releasing excess energy!

∗ Leave off the final word to fill in

When: Singing

♬

♫♪

♩

♬♫♪

♫

Highlight Your Language: The 4 S’s- Comprehension -

www.hanen.org

Signs your child understood you

∗ Follows directions accurately

∗ Responds meaningfully

∗ Responds consistently to similar directions/ requests

Signs your child may not have understood you

∗ Bored and fidgeting

∗ Starts doing self-directed things

Signs that don’t necessarily mean your child understood you

∗ Smile

∗ Say ‘yes’, ‘ok’, or ‘no’!

∗ Pick the last choice you gave

∗ Say the last word you said

The Value of Time: OWL- Expression -

www.hanen.org

∗ Being responsive means acknowledging and paying attention to a child’s attempts to communicate.

� Respond immediately to communication attempts (as able)

∗ Reinforce the behaviours you want to see

� Positive reinforcement (responding) = the child will try more

� No reinforcement (ignoring) = the child will try less

Responsiveness- Expression -

Ways to be responsive:

∗ Show interest

∗ Join in what your child is doing

∗ Be a sports commentator (describe what’s happening)

∗ Try to interpret your child’s attempts to communicate

∗ Follow through on requests

∗ Reward effort vs. accuracy

∗ Keep talking!

What to do if you don’t understand your child’s speech

∗ Understand it can be frustrating!∗ Stay relaxed∗ Show that you’re interested and trying to understand

∗ Ask your child to: Say it againSay it slowlySign itShow me

∗ Ask questions:Choices: “Do you mean X or Y?”Yes/no: to narrow it down – “Is it on TV?”

∗ Ask if they want to try again later

∗ WHAT: Imitate actions, use of toys -> faces -> sounds -> words -> conversation

∗ WHY: Model things to try + Early building blocks of

conversational turns

∗ HOW: Get face-to-face� Imitate your child � Use a mirror together� Play with toys that you use 1 at a time

Turn-Taking- Expression-

Teach a variety of words

Car

Crashhhh!

YellowGo!

Up

Vroooom

My turn!

Again

Fast

from www.hanen.org

Teach Helpful Phrases

Worms!

Eat big worms

Eat wormsWorms eat

Don’t eat worms

Teach Helpful Phrases

Facilitates…

∗ Communication: models word for your child to repeat

� Supports working memory

∗ Participation: Leads to empowerment and motivation

Give Choices- Expression -

What do you want for breakfast?

Do you want oatmeal or toast?

Give Choices- Expression -

Give Choices- Expression -

The environment is structured so your child has to use spontaneous communication with another person.

(Prizant & Wetherby, 1985)

Communication Temptations- Expression -

Can be used in any environment in which your child shows a need to communicate.

Hold off and allow your child to attempt to communicate his/her needs. Model what they could say.

Follow through and reinforce communication attempts that you want to see immediately, as able

Communication Temptations- Expression -

Communication Temptations: Examples

1. Put a desired food item in clear tupperware.

2. Activate a wind-up toy, let it deactivate, and hand it to your child.

3. Open a jar of bubbles, blow some, then close the jar tightly. Hand the closed jar to your child.

4. Put a desired item within view, out of reach.

The Art of Friendly Sabotage

Use Your Questions Wisely

Harder

(abstract)

Easier(concrete)

∗ Tell, don’t test

∗ Give the words your children would use if they could

∗ What? Don’t just say it, show it!

∗ How? Anything you can see that is meaningful and supports understanding

∗ Why? Capitalize on relative strength of visual processing skills to support weaker auditory and verbal memory

Visuals- Comprehension & Expression -

Visuals: Demonstrations

Visuals: Objects

Visuals: Photos

Visuals: Picture Systems

Visual Schedules

= know what to expect

Visuals: Social Story

= explain exactly what to do from

child’s perspective

Visuals: First/Then boards

No need to be fancy! Keep it simple, clear, consistent

√ Motivation

√ Transitions

Photos or picture symbols

Visuals: Choice Boards

Visual supports can be simple

Have paper or a whiteboard

handy to make visuals on the go

Photos vs. SymbolsConsider your child’s ability to understand

abstract symbols

Photos:

Drawings/Symbols:

Size

Consider attention and

visual processing skills

Communication Binder:

helps to organize many pictures

Storage

Some examples:

∗ Sign language

∗ Picture symbols

∗ Portable books

∗ Notebooks or photo albums

∗ iPad language apps

∗ Electronic communication devices (AAC)

∗ Total communication

Kumin, 2012

Transitional Communication Systems

Transitional Communication Systems

Allow children to communicate more effectively before they are ready to speak (clearly)

∗ Currently: reduces frustration

∗ For the future: continues progress in language and concept development

∗ Model speech and sign together

∗ Research has proven that this assists with speech development (visual support, tactile input)

∗ As speech develops and children learn new spoken words, speech overtakes sign

Sign Language- Comprehension & Expression -

www.signingsavvy.com

www.babysignlanguage.com

Sign Language- Resources -

Total Communication

∗ Most common augmentative

communication system for DS

∗ Signs, gestures, and visuals WITH speech

Functional Communication First!

Give your student a way they can communicate that works for them right now!

Make sure the most essential communication strategies are:

∗ Easy

∗ Fast

∗ Effective

∗ Always available

(not hidden in the backpack)

1.

2.

3.

4.

5.

Jillian Baldwin, M.Sc., RSLPSpeech Language Pathologist

Down Syndrome Research Foundation1409 Sperling Avenue, Burnaby BC, V5B 4J8Phone: 604-444-3773 ext 115Email: jillian@dsrf.org

Questions?

Resources: Who can help?

∗ Speech-Language Pathologist

∗ Audiologist

∗ ENT

∗ Doctor

∗ Dentist

∗ Optometrist

∗ Physical therapist

∗ Occupational therapist

∗ Dietician/nutritionist

∗ Psychologist

∗ Behaviour interventionist

Resources: Language Development

∗ Early Communication Skills for Children with Down Syndrome(Libby Kumin, 2012)

∗ Helping Children with Down Syndrome Communicate Better (Libby Kumin, 2008)

∗ Teach Me to Talk!: The Therapy Manual (Laura Mize, 2011)

∗ Building Verbal Imitation in Toddlers (Laura Mize, 2012)

∗ It Takes Two to Talk: A Practical Guide for Parents of Children With Language Delays (Hanen: Jan Pepper and Elaine Weitzman, 2004)

Resources: New Parents

∗ Parent’s infant development journal available for free at: http://www.ncb.org.uk/media/528564/developmental_journal_for_babies_and_children_with_down_syndrome.pdf

∗ Road Map to Holland: How I Found My Way Through My Son's First Two Years With Down Syndrome (Jennifer Graf Groneberg, 2008)

∗ Gifts (Kathryn Lynard Soper, 2007)

∗ Babies with Down Syndrome (Susan Skallerup, 2008)

∗ (DVD) Down Syndrome: The First 18 Months (Blueberry Shoes Productions, Will Schermerhorn, 2004)

Resources: Alternative Communication

∗ Boardmaker Achieve website

� www.boardmakeronline.com

∗ Sign language

� www.signingsavvy.org (free videos)

� www.babysignlanguage.com

∗ AAC RERC (Rehabilitation Engineering Research Centre) website

� http://aac-rerc.psu.edu/index.php/pages/show/id/44

∗ Touch Chat app: web resources, manuals, and training videos

� https://touchchatapp.com/

�“Language is part of daily

living and is best practiced

during real life.”

(Libby Kumin)

�Work on communication skills at home, school, and in the community naturally throughout the day

Please Remember…

∗ Remember, you have all the tools you need

∗ Capitalize on strengths to target challenging areas

∗ Pick a strategy from our Key Points to try each week

∗ Contact an SLP for individualized recommendations

and strategies

THANK YOU!

Bruni, M., Cameron, D., Dua, S., & Noy, S. (2010). Reported sensory processing of children with Down syndrome. Physical and Occupational Therapy in Pediatrics, 30, 280-293.

First years. (2011). Developmental milestones, Birth to 8 years. Available online at: http://firstyears.org/miles/chart.htm

Kumin, L (2012). Early communication skills in children with Down syndrome: A guide for parents and professionals (3rd.). Bethesda, MD. Woodbine House.

Kumin, L. (2008). Helping children with Down syndrome communicate better. Bethesda, MD. Woodbine House.

Lanza, J.R. & Flahive, L.K. (2009). Linguisystems guide to: Communication Milestones. East Moline, IL. LinguiSystems, Inc.

Mize, L. (2012). Building Verbal Imitation in Toddlers.

Mize, L. (2011). Teach Me to Talk! The Therapy Manual.

Paul, R. & Norbury, C.F. (2012). Language disorders from infancy through adolescence: Listening, speaking, reading, writing, and communicating. 4th. St. Louis, MI. Elsevier.

Stray-Gundersen, K (ed.). (1995). Babies with Down Syndrome: A new parents' guide. Bethesda, MD. Woodbine House, Inc.

References