This past Saturday was the Northwest Augmentative Communication Society's (NWACS) annual Fall Conference. Every year, NWACS invites a speaker to come present on a topic relevant to working with children (and adults) with complex communication needs. Dr. Cress spoke at last year's conference and returned again this year.
Topic: Practical Intervention Strategies for Early Communicators with Autism and Other Disabilities
It is really hard to take photos inconspicuously during conferences!Speaker: Cynthia Cress, Ph.D., CCC-SLP - Dr. Cynthia Cress is an associate professor at University of Nebraska-Lincoln, specializing in language, AAC and early intervention.
The target population her talk focused on was children and adults who are not yet intentional communicators, meaning that they rely on communication partners to interpret their behaviors and gestures. Communication is only intentional if the child sends a message deliberately to a communication partner (and that message is received). Keep in mind - just because we can read a child's behavior ("know" what they want/need) doesn't mean that s/he meant to send the message to us. These are individuals who are not intentionally directing messages to communication partners and do not understand (or plan for) how their behavior is interpreted by communication partners. This can be an extremely tricky population with whom to target communication skills. Often we struggle to figure out where/how to start.
Pre-intentional communicators communicate via partner-perceived communication, which includes:
- spontaneous reflexive behaviors (result from internal factors such as hunger, pain, tiredness)
- spontaneous reactive behaviors (a reaction to some event outside of the child's body, which include actions like looking, facial expressions, leaning away)
- intentional behaviors where the child acts directly on an object or person around them but is not "telling us" their message (like reaching for a toy s/he wants)
In all of these conditions, the communication partner is not part of the interaction - they are just another "object" in the environment. We, as the communication partners, need to "read" or interpret the behaviors and make smart guesses. To have intentional communication, the child needs to learn how to deliberately make things happen (they need to know that they are telling us).
A big intervention strategy in early intervention (whether with children or adults) is modeling. We create an opportunity and need to communicate, then we show the child the target behavior/gesture/word needed in that situation and encourage them to produce it, and then give them meaningful and immediate feedback. Which in many instances is a wonderful intervention strategy. Except when it doesn't work. What do we do when the child does not have the "radar" to benefit from modeling? If a child does not understand that his/her behavior is meaningful to us, why would they get that our behavior is meaningful to them? Not to mention that it requires attention and the ability to remember/process modelling and to then imitate it.
Don't tell kids what not to do; tell them what they should do.
That is when we need to fall back to "responsivity" - tempt, trigger, and touch. Create the opportunity and need to communicate/interact, trigger whatever natural response the child has to that opportunity/situation, and then provide meaningful and immediate (touch) response to that behavior (respond as if it was an intentional gesture). What does this do? Research shows that responsivity is a reliable method to increase intentionality - which is a stepping stone to more sophisticated communication. It helps children start to understand that their behavior has meaning to others. Responsivity helps the child learn to be an active participant and have an active role - to learn what behavior we are interpreting to mean ___.
One hard thing at a time.
When the child is ready, "Tempt-Trigger" intervention builds on responsivity by incorporating another step to begin shaping the child's natural/current behavior to develop new communication behaviors. Tempt, trigger, transfer, touch. Create the opportunity and need to communicate/interact, trigger whatever natural response the child has to that opportunity/situation, help the child produce a new behavior immediately after their current trigger behavior (no work for child), and then provide meaningful and immediate (touch) response to that behavior. Think baby steps.
Make it visual, make it predictable, make it social. Make it kinesthetic, make it vestibular, make it tactile.
While Dr. Cress covered much, much more, she ended the day talking about what she calls the "3 Windows of Communication Intervention":
- Social/Communication Interventions: everything she covered above; learn language/communication through using it
- Language/Cognitive Interventions: this includes most traditional therapy interventions; learn the concepts and language behind the skill first
- Behavior/Speech Interventions: "verbal behavior"/behavioral approach to learning; produce the word first and learn it's meaning/how to use it functionally later [Side note: speech is often confused for language in behavioral approaches to communication. Speech (being able to produce a word) is not the same as language (content/meaning).]
All interventions fall into one of these three categories. We need all three "windows"; no one approach will lead to fully functional communication. Each has benefits and limitations; we need to know when to use each...and which to switch to when one is not working. Each approach window has different priorities and goals. #2 and #3 are adult (communication partner) directed, whereas #1 is child directed. We cannot disregard the Social/Communication window - you cannot have functional communication without intentionality - but we also cannot stop there because it is inherently limited.
I always forget how exhausting it really is to sit and learn all day. :) Especially after a full work-week. But I always find the NWACS Fall Conferences worth it. I really enjoyed Dr. Cress - if you have the opportunity to hear her speak, I encourage you to go!
Were you there, too? What key bits of information did you take away from the day?