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Communicating with non-verbal children 

Background

The Royal College of Speech and Language Therapists 1 reported that 1 in 10 children (an estimated 1.2 million children across the UK) have a communication disability. This means that thousands of families may have to learn additional ways of communicating with their children, whether through symbolic behaviour, gestures, sign language, or by undertaking specific training to learn how to communicate through pictures or digital devices.

Learning disability (LD) is defined as a significantly subaverage intellectual functioning, ranging from ‘mild’ to ‘profound’, and can be assessed by a standardised Intelligence Quotient (IQ) test. Children with mild LD can perform basic tasks and communicate in simple terms, whereas children with profound LD require full-time care and tend not to interact with others socially. Their vocabulary may reach 300-400 words when they are adults while, in contrast, children without LD are able to hold a vocabulary of 100 to 200 words at 18-24 months. 2

The majority of children with profound LD are not able to use spoken language and, therefore, have alternative ways of communicating, such as through gestures, muscle tensions, a wink or a blink. 6 Children with severe and profound LD have a very limited range of communication skills. These gestures may be interpreted in different ways, and their reactions to various situations are likely to differ from the norm. Parents and carers find great difficulty in identifying appropriate ways to communicate with nonverbal children with LD, and the children become frustrated as most of them have a tremendous desire to interact and socialise with others.

The only way some children with LD can demonstrate their preferences, likes and dislikes is by reacting physically to what is presented to them. For example, if offered food, they may move it away with their hands, or spit it out. These reactive communicative behaviours are often interpreted as challenging 6, and often misunderstood by the communication partner and observers. Clearly, there is a real need for the d evelopment of communication systems to assist all concerned.

Effective communication techniques

Many methods have been developed for communicating with children and young people who do not use speech, for example:

  • Picture Exchange Communication System (PECS)
  • Voice Output Communication Aids (VOCA)
  • Intensive Interaction (II), and
  • Total Communication Approach (TCA)
  • Makaton.

The main aim of these communication techniques is to develop the child’s communication skills to the highest possible extent, and, consequently, to increase the child’s participation in everyday life. They also allow a child who does not use speech to use every possible opportunity to communicate, whether it is an unassisted form of communication, such as natural body language, gestures and sign language, or an assisted form of communication, such as a Voice Output Communication Aid, where external support will be required. 5

The Picture Exchange Communication System and other graphic symbols

The Picture Exchange Communication System (PECS) involves using a collection of pictures that help nonverbal children to make requests, to communicate with sentences, and to respond to questions. 3 The set of pictures is usually laid out in front of a child so that s/he could make a choice of a favourite food, toy, or activity. When s/he wants to receive some item such as food or to play with a particular toy, s/he can give the picture of that item to the communication partner in exchange for the actual thing. In this way, children with LD learn to communicate in sentences using the pictures, and to make requests and respond to questions.

The advantage of PECS is that it does not require an individual to make eye contact before the beginning of communication training or to have developed motor and verbal imitation skills. It can be suitable for children with other additional physical difficulties. Also, PECS is reasonably simple to use in comparison to other options, and is relatively cheap to purchase.8 It is an effective system for communicating with brain-injured children, which can be easily learned by communication partners, who may have little, if any, prior experience with these types of communication techniques. 3, 8

Voice Output Communication Aids

A Voice Output Communication Aid (VOCA) is a computerised switch device that can ‘speak’ for the child. By pressing one of the buttons, a child can pre-record his or her messages so that it can be played later 9, or s/he can press on the screen pictures and the digital voice will be activated. VOCAs can be used in many ways, for example: to make a choice, to make a request, to deliver a message, to express emotions, to make greetings, and even to participate in a short conversation. 18 The device is controlled by either a hand touch on the screen or by a person’s eye gaze/blink in order to activate a pre-programmed word or message i.e. the device ‘speaks’ for them.

Other benefits of this valuable and useful gadget include:

  • the listener does not require any training
  • it motivates the user to communicate further (because it is rewarding for a child with LD to listen to his/her own messages and ideas)
  • it is much faster than writing messages down or building sentences out of pictures
  • it empowers the user to lead the conversation, and
  • it is accessible (as a VOCA may be used by people who do not have the ability to turn pages, write, or speak). 9

Intensive Interaction

Intensive Interaction (II) is a specific way of working with children and adults with severe LD who find it extremely difficult to socialise and often demonstrate challenging behaviours. This approach is based on the infant-caregiver principle: interaction between the carer and the person with LD takes the form of well-known interactive games such as ‘peek-a-boo’, which provide joyful and pleasurable methods of learning to communicate. For example, when interacting with a child, the caregiver can use repetitions, i.e. repeating what the child’s sounds, gestures or actions, or changing the tone of voice and body language, whilst watching the child’s reaction. 11 II is a very effective approach to communication with brain-injured children 12, especially those who can be described as ‘passive’, ‘disinterested’ and ‘unsociable’. However, this approach requires a specialised training, and can be very time-consuming.

Total Communication Approach

Waltz (1999) states that the Total Communication Approach (TCA) is ‘the best approach’ for communicating with nonverbal individuals. In the same way that people use a variety of approaches to interact with each other (for example, pointing at a picture while talking about it), TCA employs a variety of approaches, including sounds, words, gestures, sign language, and a visual communication system, such as pictures 13,14 In other words, whereas one child may use sounds, a few words, and some gestures, another one may rely mainly on PECS and Makaton sign language 15, depending on which communication techniques the child prefers to use.

The downside of TCA is that individualisation is a focal point of the approach, which means that communication with more than one child at a time, for example, in school, makes it impossible for teachers to use in such situations.  15

Makaton

Makaton is a language programme using signs and symbols to help communication. It supports spoken language, and signs and symbols are always used with speech in spoken word order.

Children and adults can communicate immediately using Makaton. Many people then naturally drop signs or symbols at their own pace, as speech develops.

Makaton is extremely flexible and can be personalised to the person’s own needs and level of understanding. Makaton can build on self esteem and confidence for anyone who experiences the frustration of being able to communicate effectively or meaningfully. Children and adults with learning disabilities or communication difficulties can struggle to understand others and to make themsleves understood. This can lead to isolation, intense frustration and challenging behaviours, and can also become a barrier to education and personal achievement.

Parents and carers can also feel similar frustrations and isolation, wondering how they will ‘ever get through’ . 19 Makaton eases that frustration and enables connection and communication, and so opens up many opportunities and possibilities. Today over 100,000 children and adults use Makaton symbols and signs, as either a way to support speech or as their main form of communication. 19

Shona Chambers is Cerebra’s North East Regional Parent Support Officer and also a licensed Makaton Regional Tutor. As part of Cerebra’s services, Shona offers Makaton training to parents, carers and professionals in the North East.

Other important factors

The role of touch

Touch is a very important aspect of interaction. When typical children are observed in their play, a wide range of touching can be seen, from holding each others’ hands to play-fighting and hugging. 16 Children with LD typically do not experience as much physical touch as do children without disabilities, for a variety of reasons, for example, they may have physically restricted movements. 16

The role of touch is very important to the child’s development. Touch has been studied in parent-infant interaction and psychologists recognise it as a necessity for the healthy development of humans and animals. 16, 17 Often, people feel that touching without a clear reason is not appropriate and could be misunderstood by others. Children with LD experience less physical touch because they are often strapped into wheelchairs, or restricted by other aids that can form a physical barrier between them and others. Also, they may be perceived as being too fragile and delicate to be hugged.

‘When’ and ‘what’ to tell the child?

Children with LD often have difficulty understanding the concept of time. The timing of the information given (when) can be equally as important as the information that is actually communicated (what). With some intellectually disabled children, it is better not to give too much information in advance - for example, telling your child that you would take them swimming as a treat after school. The child may have difficulty controlling their emotions, and their excitement and/or anxiety may cause problems for them and for their caregivers throughout the day. Parents of these children have to carefully plan when the child should be informed of upcoming events. They also have to carefully consider the content of the information that is given. It is important to be clear about why the child needs to be given each piece of information, simply because the information will lose its meaning if it is outside his or her capacity of understanding. 12

Conclusion

There is no doubt that communication is an essential part of human living, and that helping parents and careers of nonverbal children to develop ways to communicate with their children, can bring great benefits. Currently, many communication aids have been developed and used successfully in homes, schools and care homes. However, these aids can be more suitable for some individuals than for others. Factors, such as the severity of the intellectual and/or physical disorder, age and gender, may influence their suitability. Some children may greatly benefit from using VOCAs for communication, whereas others may rely on PECS and basic sign language. Additionally, psychological approaches such as Intensive Interaction, or using frequent touch with disabled children and adults, may enhance their self-esteem and their desire to learn to interact with others.

Advice for parents

The practical advice to the parents would be read about all the available communication techniques in books, booklets (such as this), online (e.g. Cerebra’s website), and if you find something new, seek advice from your medical practitioner or speech and language therapist. Sometimes additional help or training might be needed, but most of this help (and especially information on this subject) is available. Do not be afraid to try something new and do not get despondent if it does not work. You will find the method that suits you and your child - it is only a matter of time.

Useful organisations

Afasic
A parent run organisation for children with speech and language difficulties. Afasic works to promote inclusion, whilst providing support for families.
Tel: 020 7490 9410 Helpline: 0845 355  Website: www.afasic.org.uk

British Stammering Association
National organisation for children and adults that stammer.
Tel: 0208 983 1003  Website: www.stammering.org

Connect
Information and support for those with communication difficulties.
Tel: 0207 7367 0840  Website - www.ukconnect.org

I CAN
A national charity that helps children with speech and language difficulties. I CAN offer specialist therapy, teaching and care for children, information for families, and training for teachers and professionals.
Website: www.ican.org.uk or  www.talkingpoint.org.uk

Royal College of Speech and Language Therapists
The professional body for Speech and Language Therapy (SLT) in the UK. Provides a range of information on SLT and how to find a therapist.
Tel: 020 7378 1200  Website: www.rcslt.org

Speak Ability
A national charity that provides information and support to those suffering aphasia (problems speaking, reading, writing or understanding language).
Helpline: 080 8808 9572  Website - www.speakability.org.uk

Talking point
Provide a range of information on children’s communication.
Tel: 0845 225 4071

Website - www.ican.org.uk/talkingpoint

The Makaton Charity
A charity providing information, training, advice as well as a range of other services relating to the provision of Makaton, a speech and gestural communication programme.
Tel: 01276 606 760  Website: www.makaton.org.

Cerebra Makaton Training
Cerebra is a unique national charity that aims to improve the lives of children and young people with neurological conditions, through research, education and direct, on-going support.
Cerebra are launching a new Makaton training service for families of children aged 0-16 with brain related conditions, as well as professionals, across the north east of England. The training will be provided by Shona Chambers, Cerebra’s Regional Officer for the area, who is a qualified Makaton Regional Tutor. Makaton uses signs and symbols to teach communication, language and literacy skills to people with communication and learning difficulties. Training for families who fit the Cerebra charity criteria will be FREE - although there will be a cost for necessary Makaton resources such as module guides and handbooks. Professionals will be asked to make a payment towards Shona’s time either as individual delegates or by engaging her to provide courses to a group for a daily charge.

If you would like to find out more, please contact Shona Chambers on: shonac@cerebra.org.uk or 07827 848 611.

Disclaimer: Cerebra is not responsible for the content of external websites and any referral does not necessarily indicate Cerebra’s endorsement of the website content.

References

1 Harulow, S. (2007). Communication chief and welcome review of speech, language and communication provision. Retrieved October 13, 2009, from the Royal College of Speech and Language Therapists Web site: http://www.rcslt.org/news/press_releases/jointwelcomeonbercowreview

2 Fenson, L., Dale, P. S., Reznick, J. S., Bates, E., Thal, D. J., & Pethick, S. J. (1994). Variability in early communicative development. Monographs of the Society for Research in Child Development, 59(5)

3 Stoner, J. B., Beck, A. R., Bock, S. J., Hickey, K., Kosuwan, K., & Thompson, J. R. (2006). The effectiveness of the Picture Exchange Communication System with nonspeaking adults. Remedial and Special Education, 27(3), 154-165

4 Liddell, S.K. (2003). Grammar, gesture, and meaning in American Sign Language. Cambridge, UK: Cambridge University Press.

5 Wilder, J. (2008). Proximal processes of children with profound multiple disabilities. Unpublished doctoral dissertation, Stockholm University – Sweden.

6 Thurman, S., Jones, J., & Tarleton, B. (2005). Without words – meaningful information for people with high individual communication needs. British Journal of Learning Disabilities, 33, 83-89

7 Charlop-Christy, M. H., Carpenter, M., Le, L., LeBlanc, I. A., & Kellet, K. (2002). Using the picture exchange communication system (PECS) with children with autism: Assessment of PECS acquisition, speech, social-communicative behaviour, and problem behaviour. Journal of Applied Behaviour Analysis, 35, 213-233

8 Schwartz, I. S., & Garfinkle, A. N. (1998). The Picture Exchange Communication System: Communicative outcomes for young children with disabilities. Topics in Early Childhood Education, 18(3), 144

9 National Health Service. (2010). Voice output communication aid (VOCA). Retrieved March 4, 2010, from the South Downs Health, NHS Trust Web site: http://www.southdowns.nhs.uk/index.cfm?request=c2007983

10 The Linguistics of Sign Language. Retrieved February 22, 2010, from the Signed Language Web site: http://www.signedlanguage.co.uk/the-linguistics-of-sign-language.html

11 National Health Service – Learning Disabilities. (2003). Intensive Interaction. Retrieved 26 January, 2011, from the National Health Service Web site: http://www.library.nhs.uk/learningdisabilities/ViewResource.aspx?resID=28863

12 Nind, M., & Hewett, D. (1998). Interaction in action: reflections on the use of intensive interaction. London: David Fulton

13 Waltz, M. (1999). Pervasive developmental disorders: Diagnosis, options, and answers. Arlington, TX: Future Horizons

14 Biffin, J. (n.a.). Communication – a total experience. Learning Links, 31. Retrieved March 25, 2010, from the Learning Links Web site: http://www.learninglinks.org.au/pdf/infosheets/LLIS%2031_Communication.pdf

15 Hawkins, L., & Brawner, J. (1997). What is meant by the Total Communication Approach? A site for parents of hard of hearing and deaf children (EC Digest E559). Retrieved July 12, 2010, from http://helpkidshear.org/resources/education/comm/total.htm

16 Hewett, D. (2007). Do touch: Physical contact and people who have severe, profound and multiple learning difficulties. Support for Learning, 22(3), 116-123

17 Harlow, H., & Zimmerman, R. R. (1958). The development of affectional responses in infant monkeys. Proceedings of the American Philosophical Society, 102, 51-59

18 50 Ways to use Voice Output Devices. Bartow, FL : Polk County Public School. Retrieved 30 January, 2011, from http://www.polk-fl.net/staff/resources/ese/documents/atr/miscvoiceoutputdevices.pdf

This information is not meant to replace the advice of any physician or qualified health professional. The information provided by Cerebra is for information purposes only and is not a substitute for medical advice or treatment for any medical condition. You should promptly seek professional medical assistance if you have concerns regarding any health issue.

Page last updated: 31/01/2012 13:07 
 
 
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