What You Can Do to Help a Child Communicate Better
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Replacing problem behaviors is often high on the list of priorities for people working with children. Consider these criteria and suggestions for selecting replacement responses |
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Parents, teachers, family, and friends of a child with developmental and physical disabilities must gain the skills necessary to engage the child in meaningful communication. In the new book Enhancing Everyday Communication for Children with Disabilities, you'll find evidence-based guidelines for those who routinely interact with the child during the day.
Using the Inventory of Potential Communicative Acts and Behavior Indication Assessment Scale included in Enhancing Everyday Communication, you can get a clearer picture of a child’s efforts at communication. You are then better able to decide which of a number of empirically validated procedures will best achieve the goals you are striving for. Case studies in the book illustrate the basic principles that underlie each procedure.
Consider, for example, the use of referencing. Referencing is a procedure designed to direct a child’s attention to an object and to the person he or she is interacting with—or in other words to establish joint attention. It is used when it is difficult to understand from context alone just what the child is attempting to communicate.
Using referencing, you teach the child to direct her gaze to whatever is troubling her or whatever she is interested in. This will help you better understand what she needs.
Take the case of Bill*
Bill was a 7-year-old boy with a severe intellectual disability and cerebral palsy. He attended his neighborhood school and lived with his parents and two siblings. He was not able to walk or stand, but he could sit independently. The extent of his visual ability was not known.
Assessment
Informal interviews with partners revealed that Bill mainly used prelinguistic forms of communication. For example, he appeared to seek continuation of a social interaction by reaching out and touching the adult with whom he was interacting.
At mealtimes, however, he often kept his eyes shut. Because Bill was able to interact with people at other times (e.g., social games, routines), it was decided that he needed to interact more with the person assisting him at lunchtime.
Intervention Pathway
Bill's communication partners determined that mealtime was an appropriate, natural context for promoting social interaction. For their communication objective, they decided that Bill would open his eyes and look at the person assisting him at mealtimes in response to the cue, “Bill, look at me. Do you want some lunch?”
When Bill looked at them, they responded quickly and consistently to prompt increased communication during mealtimes.
Instructional Procedures
Referencing was used by asking Bill to look, then directing him to the person assisting him with his meal and his food.
Outcomes
Bill initially opened his eyes and looked to the side as he moved his head about. He gradually focused his attention toward the person interacting with him. Finally, he stopped moving his head and looked directly at the person talking to him and assisting him with his meal.
Bill also became more responsive when others outside the classroom interacted with him. If spoken to, he would lift his head and look at the person interacting with him. As a result, more people began to take the time to talk with Bill.
He was also observed to pay more visual attention to things happening in the classroom. For example, he would follow someone moving across the room. The behavior of looking to the person interacting with him during mealtimes transferred to other activities throughout the day.
Summary
This case study illustrates how the referencing procedure was used to increase Bill’s social interaction during mealtimes. The establishment of a social connection with the person assisting him appeared to have a significant impact on Bill’s overall quality of life.
For more case studies illustrating other instructional procedures, including contingent responding, wait and signal, response chaining, and shaping, please refer to Enhancing Everyday Communication for Children with Disabilities.
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Steps for implementing referencing 1. When interacting with a child, watch carefully for occurrences of any potential communicative acts, even though these acts might not be directed toward you or something in particular. At snack time, a child prefers to drink milk rather than juice. The child reaches for the drinks but does not look at you or reach directly for the milk. 2. Attempt to make eye contact with the child and then verbally acknowledge the act. The child may need to be prompted to look at you. When the child reaches toward the drinks, establish eye contact and say, “Look at me. Okay, I see you are telling me you want a drink.” 3. After she looks at you, prompt the child to look at and reach for the item she wants and then look back to you. Look at the child again and acknowledge the joint attention. “Yes, I see that you are telling me you want the milk.” 4. After the child has established joint attention, give the child the item. Give the child the milk once she has shifted her gaze back to you. |
*Adapted from Enhancing Everyday Communication for Children with Disabilities
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