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jhayes
5/8/2016 5:50 AM
Module1: Understanding Your Child'sCues
We are all aware that children begin to communicate their wants and needs long before they have concrete words. When we interpret the child's desires and respond to them appropriately, it promotes the continued desire to communicate with those around them. When a child has multiple disabilities the attempts made at communication may not
be easily recognized, understood, and responded to, however, it is important to recognize that indeed the child is making attempts to communicate. It is important that we recognize and respond to all the child's existing attempts at communication. This is done by taking time to observe and note how the child responds during their daily activities. Are they displaying signs of liking the activity through smiling, flapping their hands, blinking their eyes, smiling, leaning towards you, etc. or dislike by crying, turning their head, engaging in self-stimulating behaviors, stiffening, etc. Emily Dayle Quinn has also addressed this topic in her collection titled, “I've Done the Communication Matrix.....Now What Do I Do for
Intervention?”
Another topic addressed in the PLAI curriculum and addressed by Emily, is recognizing behavioral states and behavioral patterns. As Emily stated, it is helpful to find the times when the child is “typically comfortable, alert, and attentive.” It is during these times that they will be most likely be ready to learn and ready to play. It is our obligation to identify the child's behavioral states and discover the ways in which they are communicating, even at the most subtle level. The wonderful part is that all it requires to learn these cues is some careful observation an active listening to the child throughout their daily activities; recognizing the ways in which they are attempting to interact and communicate their wants, needs, feelings, etc. with those around them.
Module 2: Identifying Your Child's Preferences
As human beings we all like to be recognized and rewarded for our actions. Receiving rewards provides motivation to continue. Another motivator is having choice in participating in or partaking of our desired preferences in life. We will work harder for something we enjoy and will avoid or quickly get through those things that are less enjoyable. Children with
disabilities are no different.
The goal here is to develop a list of preferences that the child has now (they will, of course, change over time). Are there specific activities/people/objects/food that they really like or really dislike, or perhaps their preference seems to fall somewhere in the middle? As this list of preferences is established we can then utilize them for communication, for
motivation, and for choice making.
Another thing to remember at this point is to continue to be aware of the child's state of awareness as was mentioned previously. The child may respond differently to the
same activity/person/object/food presented when they are irritable verses when they are alert, or drowsy.
Another item to keep in mind is that as the child begins to understand being offered preferences and having the opportunity to choose, that initially the child may just be grabbing an item at random. disliked item. In this way they begin to understand that their choice has meaning and consequence.
Module 3: Establishing Predictable Routines
Emily Dayle Quinn defines and addresses routines in her collection titled, “I've Done the Communication Matrix.....Now What Do I Do for Intervention?”, offering examples of a variety of different types or routines, so I will not repeat that information here. However, please take time to review this material to ensure the understanding of what a routine is if you are not already familiar with this topic.
As a parent the understanding and implementation of established routines has been a lifesaver and a sanity creator. Establishing predictable daily routines allows for consistency and anticipation for the child. It allows them to be an active participant and communicator about what is happening, what just happened, and what will be happening.
What really opened the world of routines for me and my children was the realization that within a regular daily routine there are many opportunities for subroutines. The PLAI curriculum defines a subroutine as “....consistent sequences or steps that occur within a familiar activity like bath time or dressing.” These subroutines which may incorporate auditory cues, tactile cues, kinesthetic cues, olfactory cues, or visual cues (or likely a combination of several or all of them). We introduced only a few subroutine items within the routine at first, but as we could see increased understanding, communication, and anticipation we added more and more.
Let me provide an example of a routine with it's subroutines that we enjoy and have expanded over time; bath time. Bath time at our house takes place at 7:30pm, it is preceded by
a preferred activity such as going for a walk or playing together on the rug. After indicating that the preferred activity is finished we give a tactile cue/sign bath (we say it auditorily as well, however, he has now lost his hearing, so the tactile is our main cue here) and then help him to sign bath. We go to the bathroom and as we turn on the water we allow him to feel the water running. We have a subroutine for undressing within the bath routine where we first take of his shirt cueing him that we will do so by lightly tugging on his shirt sleeve and raising his arm (he now actually just begins taking his arm out by himself when we tug on the sleeve....an example of grown understanding in the evolution of communicating day after day within the same routine and subroutines). We have a similar slight tug on his pants/shorts to indicate that it's time to remove them. Next is the cue to remove his diaper. It's now time to get into the bath. We get a washcloth out of the drawer and once again, with washcloth in hand, sign bath together on him. Rather than just plunging him into the tub we allow him to feel the side of the tub. It's now time to get into the tub we cue him by squeezing under his arms to indicate that we will be lifting him up, and allow his toes to dip into the water before sitting him fully into the water. In the bath we utilize olfactory cues by allowing him to smell the shampoo and soaps before applying them. We touch his head lightly and rub gently to indicate the act of shampooing and then proceed to shampoo. We have cues to indicate him needing to lie back to rinse out his hair. We have fun just “talking” about the water and splashing. After awhile I begin to allow the water to drain and as the water gets low, and it's time to get out we sign finished together. I cue him that I will be lifting him up by once again squeezing lightly under his arms and then up he goes, landing in a towel followed by a snuggle. It's then off to put his pajamas on, but we'll stop there. As you can see there are so many different types of subroutines that you can incorporate within the routine and it can all be customized based upon the needs and preferences of the child! And oh, what a variety of cues you can incorporate to add meaning and purpose! It open the door in so many places to provide greater anticipation, understanding, and communication!
Module 4: Establishing Turn Taking
Turn taking is so much fun because it involves playing and extending interaction time. Initially it is important to establish a way of requesting “more.” This could very well be a verbal statement, or sign, however, with complex children we will likely need to think outside the traditional way of requesting. For example, if the child is eating a preferred food and
there is no longer any more they may attempt to communicate wanting more by banging their hands on the tray and vocalizing in some way. If it appears that the child is really wanting more, then say to them “Oh, you want more _______.” Give them another and allow the opportunity to request more again. When it comes to a desired food or activity, it is a great technique to give the child less than you know they typically like, setting up opportunities for them to request more.
As you establish turn taking games and they become better understood by the child, take the opportunity to generalize them across various settings; with the different people
and environments that the child interacts with.
So as a quick synopsis, here are a few bullet points to help encourage turn taking routines:
Module 5: Encouraging Communicative Initiations
Up to this point we have discussed various ways to identify the child's cues in their attempt to communicate, identified preferences (including likes and dislikes), established predictable routines and subroutines, and established turn taking games. Each piece can work as a stepping stone to our final goal of encouraging communicative interaction. Reaching this point has/will take time, patience, and consistency; however as you watch the child expand their understanding and ability to communicate more and more the rewards are quite fantastic.
The goal now is to continue to build the skills and concepts necessary for the child to continue to increase their “rate communicative initiations for the purposes of obtaining attention from significant caregivers, obtaining a desired object or pleasurable activity, and expressing rejection. The goal is to increase the child's control and initiations of those behaviors
identified in earlier modules.” In essence, we are creating active and responsive communication partners!
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One of my all time favorite resources! PLAI- so practical for blending "intervention" into natural routines. Makes it all the more sustainable! Thank you Jenn for your wonderful post!
Amy Parker - 5/12/2016
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The only way I know that he wants something is because he fusses or whines when he's unhappy or uncomfortable, and he smiles, makes noises or calms down when he's happy and comfortable. Does this statement describe your child?
She doesn't come to me to let me know what she wants, but it's easy for me to figure out, because she tries to do things for herself. She knows what she wants, and her behavior shows me what she wants. If she runs out of something to eat, she will just try to get more, rather than trying to get me to give her more.
Does this statement describe your child?
He knows how to get me to do something for him. He uses some of the kinds of behaviors below to communicate:
Does this statement describe your child?
Each question you will see is related to a certain message that your child might be able to express using a variety of behaviors. Read the question and decide whether your child is able to express the message described using any of the listed behaviors. If the answer is YES, then you must also decide whether your child has mastered the use of each behavior or whether it is still at an emerging stage. Check either the mastered or emerging box next to any behaviors your child uses to express the message. Use the following definitions to decide whether a behavior is mastered or emerging
– Does this independently most of the time when the opportunity arises
– Does this in a number of di erent contexts, and with di erent people
– Does this inconsistently
–
Only does this when prompted or encouraged to do so. Only does this in one or two contexts or with one person.
Each question you will see is related to a certain message that your child might be able to express using a variety of behaviors. Read the question and decide whether your child is able to express the message described using any of the listed behaviors. If the answer is YES, then you must also decide whether your child has mastered the use of each behavior or whether it is still at an emerging stage. Check either the mastered or emerging box next to any behaviors your child uses to express the message. Use the following definitions to decide whether a behavior is mastered or emerging
