1. Communication it goes without saying… Marjan Vervat speech therapist
2006

2. Goals of presentation:
Provide you with knowledge about:
Normal speech and language development
Communication problems in children with multiple disabilities
.Possible solutions

3. What makes communication happen?
Exchange of information
Taking turns: two way traffic
Taking initiatives
The word “exchange” is underlined because so often it’s just us talking, demanding, leading, telling. That’s a different kind of communication, which doesn’t give the child room and opportunities to explore and develop itself.
If the child is able to give its own response, opinion, ideas you sometimes are surprised what they have to say!
Also be alert to signals of the child that it’s trying to “say” something. “Saying” can also mean: some sort of behaviour: crying, laughing, throwing things. Give the child time to take initiative to communicate.
Studies from Harris, Light and Heim tell that communication with non-speaking children often is very limited, also because of the way we, the speakers, react to them: their role often is just responsive, they get less time to understand the message and to take and hold on to their turn, we don’t always see their signals or misinterpreted them.

4. Conditions for speech / language development:
Sufficient:
Function of the muscles around the mouth
Hearing
Intelligence
Social /emotional development
oral motor function: every muscle and nerve needed for speech production, from respiratory muscles up to the larynx, lip, tongue and cheeks.
you need sufficient hearing to learn how to speak. When you cannot hear your parents you can’t imitate their speech, and you won’t learn your mother tongue..
You also need to be smart enough to understand the language system, words and sentences, cause and effect, understand that a change of grammar can involve a change of meaning.
to be able to learn language by imitating the people in your environment you need to be focussed on those people, be able to make contact, or at least don’t reject that idea.

5. Children with multiple disabilities:
Have motor problems
Often have sensory problems: bad hearing / eye sight
Often have cognitive deficits and
Often have lags in social / emotional development
The multiple disabilities often lead to communication problems. Many areas important for communication can be disturbed in different ways and on different levels.
Sometimes there’s just a slight speech problem, up to unintelligible speech or no speech at all.
Children with mental retardation will have problems understanding spoken language, the connection between words in a sentence, cause and effect.
We are not just talking about deafness or hearing loss!! There are many other causes for communication disorders.

6. what is communication ? Understanding and be understood.
Exchanging thoughts, ideas, wishes, feelings, demands, knowledge.
Without communication: isolation.
Literally the word “communication” comes from the Latin word “communicare”: which means “ shearing”, “participating”
We communicate throughout the whole day, with everybody in our surroundings. We use body language, facial expressions, language, we read and write.
Children with MD often have problems understanding our means of communication, especially the spoken and written word.
Also, when children have speech problems, their communication can be very unintelligible to us too.
For proper communication it is necessary that you understand the message the other person is sending to you, and the other person has to understand you. When I`m speaking Dutch to you and you in Russian to me wouldn’t make sense. Sometimes you can compare that to talking with a child with MD: they don’t have a clue what you are talking about, they don’t understand your message.
And also the other way around: did you ever work with a child with severe speech problems and tried to understand what it said?
Both parties can feel really bad about that, being misunderstood. No good start for a working relationship.
Children can develop behaviour problems reducible to the fact that they don’t understand what is expected from them and not being understood.

7. Speech and language development
How do children learn to speak and understand?
expresses needs through body movements, looks on the face, and crying
makes 'happy sounds'-coos and gurgles
babbles-listens to sounds and tries to imitate
says a few words
begins to put words (and ideas) together
Learning that prepares a baby for speech begins early, long before she says her first word. Speech develops out of body movement, use of the mouth and tongue in eating, and use of the senses-through interaction with people and things.
One of the early stages in a baby's development of speech is noticing and responding to different sounds. A delayed child may need extra help and stimulation.

8. What if things are not that easy?
Always talk
about what
you`re doing
To get the child used to language, explain everything you do with him. Use clear, simple words-the same ones each time. Name toys, objects, body parts. Repeat often.

9. Repeat and expand the child`s sayings
Repeat the babble of the child: have conversations with him in his language. But when he begins to say words, repeat and pronounce them clearly and correctly-do not use 'baby talk'.

10. Sing songs
Rhythm is important to language development. Sing songs, play music, and have the child imitate body movements: clap your hands, touch your toes, or beat a drum.
Imitate the sounds that baby makes and have him copy the same sounds when you make them. Then say words similar to those sounds.
Also, imitate use of the mouth: open wide, close tight, stick out tongue, blow air, push lips in and out.

11. Play games
Play question games to help him listen and learn; he can answer your questions by pointing, nodding, or shaking his head.
The child needs a lot of stimulation of all her senses to develop language. Play with her, speak to her, and sing to her often. Ask her questions and give her time to answer. Do not try to 'make her learn', but give her many learning opportunities. Ask questions that need words for answers, not just 'yes' or 'no'.
Repeat words. Make small requests. Reward successes.

12. What if a child doesn`t speak at all?
Bad control of mouth, tongue, or voice muscles
Profound deafness
Severe mental retardation
some children who hear well may never be able to speak. For example, certain children with cerebral palsy cannot control their mouth, tongue, or voice muscles. For these children, as for young deaf children, we must look for other ways to communicate

13. What is total communication? (TC)
Using every possible means to
communicate:
(increasing level of difficulty)
Body language / facial expression
Gestures and signs
Photographs / pictures / symbols
Spoken language
Written language
“Total communication” comes from the deaf society. Before 1960 deaf people where supposed to learn to speak and read lips. Using sign language was inferior and not allowed.
But of course that didn't really work: telling a deaf person to speak and listen is like telling a blind man to watch out. Gradually deaf teachers and scientists started realising that no means of communication should be rejected when communication is jeopardized. That idea started in deaf society but the past 20 years its also adopted by the caretakers of the mentally retarded.
So you can use any type or means to communicate, as long as the message is coming through, and you and your communication partner understand each other.
Spoken language is difficult to understand because it has no relation to the object you’re referring to other than we agreed that this word means something. A sign or picture is having a much clearer relation to the subject and is therefore easier to understand. Think of the little picture dictionary you can take with you abroad!
For blind MD children , tactile aids can be used: hand in hand signs, objects in stead of symbols / pictures.
Usually a speech therapist will be able to tell which means of communication or which combination of means is most suited for someone.

14. body language / facial expression
SAD!
body language / facial expression
Body language and facial expressions are the most natural ways of communicating without speech. Think of how your posture can show sadness. (gesture)

15. SAD……
sign
This Dutch sign is almost body language. It comes very close to how a sad person looks: facial expression, the tears flowing.
Sign language is a language equal to spoken language, so there are many signs that are less clear than this one. Grammar is also different from spoken language, f.e. the order of words is different.
With mentally retarded people we use the most natural signs. Its not a sign “language”, but a way to support your spoken language. Children can use it without speech.
Using gestures and signs slows down the word flow. That is a good thing: it gives the child the opportunity to understand what you are saying, and to react.

16. SAD…..
picture symbol
A picture symbol is already a little more abstract: a face with a sad mouth and a tear, children have to understand less concrete messages to understand that this means “sad”.
There are many kinds of picture symbols. In the Netherlands we often use Picture Symbol Communication (PCS) of Symbols for Windows. (a computer programme)
Of course you can also make a drawing.

17. draw a picture symbol communication card
With picture symbols you can make a communication card for different occasions

18. Ask for help from other deaf people
Local deaf persons as teachers. Even a small village usually has some persons who have been deaf a long time. Probably they will have learned to communicate through signs and gestures. If you ask some of them to become the friends and teachers of a deaf child, and advisers to the family, often they will be glad to do so. They may remember the difficulties and loneliness of their own childhood and want to help provide the understanding and learning opportunities that the deaf child needs.
Deaf persons can be especially helpful if they have learned the 'national sign language' and can communicate fully with other deaf persons. If there is no such person in your village, but there is in a neighboring town, perhaps the child can visit that person, or a group of deaf persons.
Other families with deaf children. If several families with a deaf child can come together, share experiences, and learn as a group, this can be a big help. The younger deaf children can learn from older ones, or from deaf adults. Together they can develop a form of communication so that all the children and their families can understand each other

19. If you think a child is hearing impaired
Go to a specialist for a hearing test
Use total communication
Try to get hearing aids
A few children are completely deaf; they do not hear at all. Parents often notice early that their child cannot hear, because she does not turn her head or respond, even to loud sounds.
Much more often, children are partly deaf. A child may show surprise or turn her head to a loud noise, but not to softer noises. She may respond to a low-pitched sound like thunder, a drum, or a cow's 'moo', but not to high-pitched sounds like a whistle or a rooster crowing. Or (less commonly) a child may respond to high-pitched sounds but not low ones.
Some children who are partly deaf hear a little when people speak to them. They may slowly learn to recognize and respond to some words. But many words they do not hear clearly enough to understand. They are slow to begin to speak. Often they do not speak clearly, mix up certain sounds, or seem to 'talk through their nose'. Unfortunately, sometimes parents, other children, and teachers do not realize that the child has difficulty hearing. They may treat her as if she is mentally slow, or 'dumb'. This only increases the child's problems.

20. assignment
One participant tries to explain to another, a task which she has to do . You are not allowed to speak !
The others observe what happens: does the other understand? What makes her understand her task?
 Task:
1. Tell Monique that you want to sit on her chair. She can sit on yours. You are not allowed to speak English.
2. Ask Monique to shut (open) the window because you’re cold (warm). You are not allowed to speak English.
3. Explain to her what you think of her lessons. You are not allowed to speak English.

21. assignment what do you do when someone doesn’t understand you?
say it again? Maybe use other words? Talk louder?
use body language?
draw a picture?
take the lead instead of keep on trying?
The more abstract the task, the harder to explain without spoken language. You will use other means of communication.