STRATEGIES FOR ENHANCING NON-VERBAL COMMUNICATION Provincial Integration Support Program

Communication Skills Social Interactions Educational Performance Behaviour Social Interactions: Leads to student’s improved self-concept & self-esteem, Increases active participation in activities & routines.Changes attitudes about a student’s potential. Educational Performance: Pivotal to learning, because so much of what we learn depends on interaction with others Helps make learning active, rather than passive Behaviour: Reduces frustration

What is Communication Anyway? Activity: Have participants work together and come up with definitions of communication. Write definitions on board and discuss Alternate activity: hand out different sample of alternative ways of communicating and have participants work in pairs to get message across

What is Communication? Interactive: Involves at least 2 people Efficient Has a purpose or reason Gives independence & control Interactive: Any time that one person gives/receives information from another. Efficient: Most efficient method for transmitting information. For many that’s speaking & writing. We all use a combination of ways: vocalizations; gestures; facial expressions; pictures Communication partners need to be sensitive to & respond to a variety of signals. A person will stop trying to communicate if their signals aren’t being recognized & responded to. Purpose: Needs, wants, perceptions, knowledge, emotions, exchange information, make requests, socialize May not always be intentional: true for all communicators. Communication isn’t just speech. According to Linda Hogdon in her book, “Visual Strategies for Improving Communication”, communication is: 55% visual - things we see, like gestures, facial expressions, body movements, object in the environment 37% vocal - intonation patterns, rate, & intensity/volume 7% verbal

Communication Involves Establishing or shifting attention Taking in information Processing information Storing information Retrieving information Sending information Establishing and Shifting Attention: You need to be able to attend to the person who is talking to you and shift your attention among people involved in having a conversation Taking in Information: You need to be able to hear or see or feel information being communicated to you. Processing information: The information you received needs to be interpreted by the brain. Storing Information: You need to remember, so you can respond. Retrieving information: You need to formulate what you want to communicate back Sending information: You need to be able to move the muscles of your body to speak or gesture or to gaze or activate a switch, or write, or type, etc.

Baby smiles and coos Parent imitates Baby repeats For the normally developing child, communication is a process involving reception of language, processing of language, and expression of language - at first spoken, then thru reading & writing. With infants, parents first imitate their motor movements & vocalizations, which in turn leads the baby to produce + movement/vocalization, resulting in a reciprocal interaction. Eventually the baby becomes the initiator in the exchanges. As he matures, he no longer waits to be spoken to, but spontaneously names objects, asks questions, & eventually expresses needs, wants, ideas.

Child With a Disability Baby with disability may smile or coo Parent Imitates Baby doesn’t imitate Parent decreases speech output Parent anticipates child’s needs Child doesn’t have opportunity Child becomes passive For children with multiple disabilities this learning is disturbed. Reception or processing of language may or may not be intact, but inability to imitate or express themselves sets off a pattern of actions that have an adverse affect not only on communication development, but also on social, emotional, & intellectual development, including organizing, ideas & thoughts. When a child has difficulty responding vocally to parents’ speech, the parents in turn decrease their speech output to the child. They also tend to anticipate and meet child’s needs before a request of any kind is initiated. This in turn decreases number of opportunities for communication. Communication development takes a downward spiral. Eventually child learns to be passive & helpless. People will communicate by whatever means are the quickest & easiest for them (e.g., vocalizations, gestures, symbol systems) Whenever a student is able to successfully communicate a message by whatever means, probably using a combination of means, then it is naturally reinforcing and will likely be repeated.

Our Challenge Help students communicate as best as they can to : have some control in their environment be able to have social relationships prevent loneliness and isolation learn Students with severe-profound disabilities may not have full access or control of all the ways that most students communicate, but that doesn’t mean that they have nothing to say, nor does it diminish their need and right to communicate.

“Every person, regardless of the severity of their disabilities, has the right and the ability to communicate with others, express every day preferences and exercise at least some control over his or her daily life. Each student, therefore, should be given the chance, training, technology, respect, and encouragement to do so.” (B. Williams) Handout: Communication Bill of Rights

What is Non-Verbal Communication ? Have participants brain storm to come up with a list of ways we communicate non-verbally.

Non-Verbal Communication • Body Movement, Posture and Tone Facial Expression and Eyes Gestures Signs and Signals Tangible Symbols Picture Boards and Systems that use Pictures such as PECS and PODD Technical/Voice Output Vocalizations Check to see if there are any non-verbal ways the group forgot about or different ways the group came up with that are not on this list

Non-Verbal Communication? How Do We Enhance Non-Verbal Communication?

Some Guiding Principles When enhancing non-verbal communication, including both comprehension and expression, we should consider the following guiding principles.

Creating a Communication Goal Build upon a student’s existing communication skills With different people In different contexts More consistency Greater frequency

Common Communication Objectives Attending to communication partner Initiating communication Requesting and choice making Greetings Responding to initiations from others Turn taking Asking and answering questions Also: developing breakdown and repair strategies (including persistence and repetition) Handout: Possible Communication IEP Objectives for…

What are the Motivators? Observe the student Talk with others who know the student well Look at what the student may be communicating informally for clues about what they may be interested in For some students, a goal may be to facilitate the development of interests Students will learn best how to improve their communication when they are motivated to communicate

Integrating Communication Objectives Ask yourself, “Does the student have a reason to communicate in this situation?”

Use routines Predictable Reliable Create anticipation Provide opportunities for choices Examples: 1. Model waving ‘hi’ or ‘bye’ at appropriate times rather than having the student imitate actions out of context 2. Rather than asking student to point to pictures on request, hide objects, then encourage labeling using the pictures as they are ‘discovered’ 3. Have student put items ‘in’ or ‘on’ things as part of the activity (e.g. cooking - put flour in bowl; put cookies on sheet)

Prompts Pause Environmental cue Expectant delay Gesture/point Model Indirect Verbal Verbal feedback Partial Physical Full Physical Use prompts to help students develop communicative signaling within the context of a familiar routine. The prompts should be faded as soon as the student can complete a step independently. With verbal prompts, try to avoid direct models, such as “Tell me “I want juice.’ Instead use an indirect model which doesn’t involve direction imitation (e.g., Do you want to read a book or listen to music?); If you need help, let me know; Tell Joey you want some more) Say something that gives the student a general idea of what can be requested (“I have something special in my bag.” “This book looks funny.”)

Frequently Occurring Problems Amount of time Restricted message set Difficulty initiating communication Lack of Partner Training Takes a long time for student to create a message. Ave rate of Eng. Speech ranges between 100-200 words/minute. Ave rate for non-vocal communicators is 5 words per minute using a letter board and 1 word per minute using a scanning device. Communication partner loses interest; interrupts; or changes topic Need to formulate a message as quickly as possible means that polite forms and grammatically correct forms may be omitted Often what’s on a communication board determines what is asked and what the student says. Student needs a way to let others know that they have something to communicate (e.g., physical movement; eye contact; vocalization; call alarm)

Strategies Patience! Respond to all communication attempts Maximize use of already used communication modes Use motivating natural contexts that have opportunities for interaction Teach vocabulary that will have an effect on the student’s environment. **** Treat random actions and sounds as intentional communication. Your responses to his actions and sounds will help your student understand that those sound and actions have an effect on others. Handout: Role of the communication partner Maximize modes of communication that the student is already using to make messages easier to understand (e.g., pointing - fast, good for indicating needs); head- shaking - good for yes/no Students learn best when they are actively involved and motivated by the activity. They are most likely to learn new words and concepts when they are presented in the context of their own interests and concerns. Teach functional vocabulary in naturally occurring contexts that the student will need to use it.

Comprehension Skills Understanding the communication of others Interpreting cues and signals in the environment Handling changes and transitions **** We often focus on increasing expressive skills and pay relatively little attention to receptive skills) - above can all be areas of difficulty

What Does the Student Understand? • Gestures Cues from the environment Object cues Signs, logos, pictures Manual signs Printed material Speech Environmental cues: example coat to signal it’s time to get ready to go home.

Sensory Challenges Visual Auditory Cortical Visual Impairment Hearing loss Difficulty filtering background noise from foreground auditory information Sensory challenges often make it difficult to shift attention and re-engage attention

Specific Comprehension Skills Follow directions Object Labels Matching Sorting Functions of objects Answering yes-no questions Formal assessment tools not usually appropriate. Informal assessment includes observing the student with a variety of people and in a variety of environments, & interviewing people who know the student well. Handout: Language Comprehension Checklist

Strategies to Facilitate Receptive Communication Provide Visual/Auditory Supports Ask student to “show you” or “look at” Ask “what”, “who”, “where” questions Associate objects with functions Teach attributes in context Learning in functional situations facilitates generalization Anything that has intrinsic motivation for the student is more likely to be practices in different settings & used by the student (Burkhart) Motivation is governed by the amount of control & connection the student feels in the communicative interaction (Burkhart)

Schedules Use some type of symbol (object, picture, auditory cue) to represent each activity Present the symbol to the student just prior to the beginning of each activity Eventually student may learn to use the symbol to initiate a request for the activity **** Learning to know what is coming up next is another way to improve a student’s “comprehension”. Handout: Visual Schedules (Calendar Systems/Tangible Symbols/ObjectCues)

Here a picture cue is being presented to indicate that that it is time to stop an activity

Strategies to Develop Expressive Communication Stepping Stones to Developing Communication Skills Stepping Stones handout is a general framework for selecting expressive skills to work on with the student. All the skills are functional in that we all use them, only in more sophisticated ways (e.g., we all communicate that we are aware of others by looking at them or speaking to them).

How Does Your Student Presently Communicate? Personal Dictionary - Why does your student communicate? - How does your student communicate? Start with compiling a Personal Dictionary; students with multiple disabilities have unique ways of communicating. A Personal Dictionary is a composite of the different reasons for why they communicate (functions or purpose), & different ways that they use to communicate (means/modes)

Common Communicative Functions Seeking attention Requesting objects/activities Protesting Greetings Asking and answering questions Labeling Commenting

Common Communication Modes Vocalizations Gestures Facial expressions Pointing Sign language Pictures Speech **** Handouts: Creating the Personal Dictionary; Blank form; Sample form, How do we communicate? Why do we communicate?

Have participants think about their student and start to create a personal dictionary.

This is an example of a personal dictionary that a class of elementary students made for their special student. The class was making self-portraits and made one for their special classmate. They also wrote down how the student communicates non-verbal and what those communicative actions meant.

Choice Making Important in developing personal autonomy Gives power and control Our job: create opportunities for choice making; coach others to do the same Beginning choice makers: pair preferred object with non-preferred object and switch the position Choices define who we are and what we value as individual

Sample Choice Making Opportunities Food (snacks, lunch) Music Musical Instruments Position (w/c; stander; bean bag, etc.) People (who to sit next to, push chair) Art (materials, colour, texture) Books Computer programs **** A study by Houghton, Bronicki, and Guess (1987) found that classroom staff typically responded at extremely low rates to student’s expressions of choice or preference ~15% of the time during structured activities, and 7% of the time during unstructured activities. However, when the students were asked to express a preference or choice, they did so about 99% of the time. We must all be intentional about giving the opportunity to make choices Handouts: Choice Making Questionnaire; Choice Making List; Choice Making Data Sheet

Physical Considerations Positioning Eye-hand coordination Crossing Mid-Line Role of posture and influence of head & arm movements need to be considered Eye-hand coordination for picture or object choosing can be very difficult Crossing mid-line can be difficult Stabilization helps - need input from OT/PT

Examples of Ways to Make Choices Have participants think of ways their student currently makes choices. Talk about it as a group, so that participants can share ideas.

Augmentative and Alternative Communication (AAC) Augments what a student is already using to communicate Adds other ways of communicating to help a person be better understood or able to give more information Students learn to use AAC more effectively if it’s integrated into all aspects of their day (Burkhart) Technology & AAC systems can be very powerful, but are useless in enabling children to realize their potential without appropriate training & supportive environment Experiencing receptive use of augmentative systems is important AAC is effectively taught in an environment comparable to foreign language immersion

Sign Language Considerations Hand shape (finger position/isolation) Movement (active ROM, sequential bilateral/unilateral) Motor planning (affects speed & accuracy of sign production) Consider the physical demands of using signs

Easier Signs Movement toward body Performed at, or toward, but not across, body Within signer’s visual field Performed with the forearm in neutral or pronated position If using sign language, need to consider the physical demands of using signs; hand shape (position/isolation of fingers); location; movement (active range of movement; bilateral or unilateral; motor planning (affects speed and accuracy of sign production); sequential motor movements); orientation; relationship of sign to body (toward or away, face, body, midline)

Yes…No…Maybe So? Questions serve many different functions Acceptance/rejection: in the here & now Confirmation/denial: in the past Avoid rhetorical questions If you do ask a question, show that you expect a response Answering yes/no questions are deceptive in their apparent simplicity Many developing children confuse the meaning of yes and no into their fourth year and have difficulty reliably answering yes/no questions before 30 mos. By about 18 mos, they recognize a y/n question & respond, but usually in the affirmative because that’s what’s expected as a response. Typical developing child first hears ‘no’ in terms of prohibiting his action. Children with severe disabilities hear the word ‘no’ much less. When asked a y/n question, typical kids give some kind of feedback about whether or not they’ve understood the question. Comm partners of kids with mult dis frequently have to gues whether or not the question was understood “….yes and no are very important vocabulary that all of us use often. However, it may be difficult for children with severe disabilities to learn these responses at the beginning stages of communication. Alternative symbols and signals that indicate a desired or an undesired object or event may be easier to learn.” taken from ASHA website @ http://www.asha.org/NJC/faqs-comm-dev.htm#3

Using Picture Communication Systems Your student might point to pictures on boards Your student might use systems like Picture Communication Exchange (PECS) (PODD) Link for a demonstration of PECS Phase I and ll is..http:/www.youtube.com//watch?v=ZP481xnNdHM&feature=related PODD is Pragmatic Organizational Dynamic Display. Follow the link to see demonstrations of how this system works. http://www.setbc.org/setbc/communication/using_podd.html

Vocabulary Not necessarily the same as for typically developing children Needs to be functional Needs: bathroom, food/bevs, TV, bed, go Feelings: sick, tired People: family, friends Pets Concepts: up/down, day/night, cold/hot

Mini-boards may also be useful to give opportunities for a student to meaningfully comment or request during the course of an interaction.

Voice Output Opens door to: Participation Inclusion Independence Fun Activity: Demonstrate any devices you might have, such as BIGmack, Step-by-Step Communicator, Voice Pal Plus, Partner 4, etc. Demonstrate how to put a knock knock joke on the Step-by-Step. Or look them up on the internet and read all about them.

Here a student is using a Voice Output device to interact with his classmates and teachers on the playground.

Voice Output Ideas Greeting classmates, staff, visitors Respond to attendance call List day’s activities or schedule Asking for a turn Giving an announcement - PA system Giving steps of a recipe Assign weekly or daily classroom jobs

More Voice Output Ideas Sharing a joke or riddle of the day Asking for a song during circle time Talking about item brought from home Cheering classmates during sports Complimenting others Asking for more of something enjoyed Commenting while reading a book •••• Commenting while reading a book (turn the page; read it again; I can’t see) Handouts: Let the Switch Do the Talking: Elementary/Secondary

A photo of a student giving information that the office staff need.

Arrival Time Greeting peers and staff Make a choice who the student helper will be for the day using photos to choose between Use Voice Output to request removal of outdoor clothes; removal of items from back pack “Forget” to do something that’s routine Ways a student could potentially incorporate his/her goals during daily functional routines.

Reading Activity Choosing between books Choosing a classmate to read with Requesting a page to be turned Requesting “more” Repeating a line using Voice Output Answering questions Making comments (picture board) Comments: That’s scary. That’s funny. Read it again.

Social Studies Use Voice Output to call on peers to answer questions (Example: Identify capital cities) Use switch activated spinner to ask questions Use voice output to direct peers to move from location to location on a map

Math Use switch activated spinner to select numerals to create math calculation problems for peers to compute

Circle or Sharing Time Attach souvenir to top of Voice Output device that has a message about it to share with rest of class Use Voice Output or picture communication board so that student can ask peers questions, or comment on topic

Cooking Use Voice Output or picture communication board to direct peers in multiple step recipe Ask student to get one of the needed items, but have it in the wrong place (Example: Ask student to get the wooden spoon, but have it in a different drawer)

Science Use Voice Output or picture communication board to give directions for a science experiment Present objects that are unexpected Use a puzzle that relates to topic. Have some of the pieces missing so student needs to request them Play a trivia game with spinner & switch Example of unexpected item: If science lesson is on marine life, suddenly present an octopus or have it appear from concealed or unexpected places (have it descend suddenly from a string on the ceiling).

Lunch Use a place mat with picture symbols to make comments or requests “Forget” to give student part of lunch Give student a carton of juice instead of juice in a cup Give part of lunch in a container that is tightly sealed so that student needs to request help

Recess Choice making between recess activities (swing, slide, etc.) Have photo board to make choices of peers to hang out with Use picture board to make comments Indoor games (e.g., Simon Says) Choices of where to go outside Perform unexpected actions Use picture boards, wristbands, pictures/digital photos on key ring Present unexpected actions in order to elicit a response. For example, if it’s an indoor recess day, play with battery powered cars, and ‘accidentally’ drive a car off the table. Or say, ‘make the car go’, but the batteries are missing.

This student is activating a spinner for his classmates so they can play a game.

Art Withhold one of the needed materials, such as a brush, in order to elicit a response

A student is making choices during and art activity.

P.E. Engage student in turn taking activity such as a bean bag toss. Wait for the student to communicate ‘my turn’

Dismissal Use voice output to relay a message about events of the school day to the home setting

Personal Care Violate object function or manipulation (Example: Pretend to brush teeth with comb; put shoe on hand), with goal of eliciting a protest

When could you incorporate one of your student’s communication objectives into his/her school day? • What are your student’s objectives? • When could they be incorporated into the school day? Have participants think of ways they could be addressing their student’s communication objectives in the context of their student’s daily routines at school.

Communication Development Improves self-concept & self-esteem Reduces frustration and behaviour problems Increases active participation Changes expectations about the student’s potential to learn Conclusion.