Communication and Behavior
Djenne-amal N. Morris and Susan Wiley
June 2017
[email protected]
How do you define communication?
How do you know communication is
happening?
• It’s not what you say,
it’s what they hear
Ways to Communicate
• Eye Gaze/Facial
Expression
• Vocalization
• Speech
• Gestures/Sign
Language
• Writing
• Pointing to: object,
photograph, line
drawing, symbol
• Speech Generating
Device (SGD)
• Cell phone (calling/texting)
• Mobile technologies
– Apple’s iOS, iPhone, iPod
touch, iPad
– Google’s Android
– HP/Palm’s Web OS
– Microsoft’s Windows 7
and 7 Mobile
Why do we communicate?
“Communication is essential to attaining quality of life,
allowing humans to connect with each other, touching
others’ lives, and having others touch our lives”
(paraphrased quote from Janice Light).
Functions of Communication
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Protest/reject (to refuse things you don’t want)
Request object/action (to get what you want)
Greet/gets attention (to engage in social interaction)
Shows objects/comments (to provide or seek information)
Communication Progress
• Hierarchy of skill development is often necessary
• When children are not making progress, looking back at some
of the foundational precursors to communication is important
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Joint attention
Eye contact
Requesting
Showing
Turn-taking (back and forth play)
Choice-making (objects, pictures, icons)
Understanding of routines vs words
What types of activities build these skills?
How do you work with families to gain their understanding of these
activities supporting communication development?
Communication Matrix:
Helpful for individuals with any type or degree of disability but not suitable for
individuals who already use some form of language to communicate
meaningfully and fluently
Seven levels of communication
Charity Rowland, PhD
• LEVEL I: PRE-INTENTIONAL BEHAVIORS
• These behaviors are reflexive or reactive rather than
purposeful, but they seem to be associated with specific
states of well-being.
• Parents interpret the behaviors as expressing certain
internal states such as hunger, comfort or pain.
Do you have children on your case load who are in this category?
Describe why you think this is the case.
Seven levels of communication
Charity Rowland, PhD
• LEVEL II: INTENTIONAL BEHAVIORS ... that function as
communication
• These behaviors are intentional, but they are not intentionally
communicative. That is, children do not realize that they can use
these behaviors to control another person's behavior.
• Nevertheless, some of these behaviors serve a communicative
function, since parents interpret them as communicating something.
• At this level, children do not establish eye contact prior to exhibiting
a potentially communicative behavior, nor do they wait for a
response from the adult. Instead, children operate directly on objects
and people, rather than using an object to attract a person's
attention or using a person to obtain a desired object.
Do you have children on your case load who are in this category?
Describe why you think this is the case.
Seven levels of communication
• LEVEL III: UNCONVENTIONAL COMMUNICATION ... using
pre-symbolic behaviors
• This is a critical stage. Now children communicate
intentionally, but they use unconventional ways of
communicating, such as body movement, actions on people
and objects, vocalizations (or switch activation for the
severely orthopedically impaired).
• Behaviors are called nonconventional because they do not
constitute a socially acceptable means of communication in
the adult world. Although these behaviors are extremely
effective, they are usually replaced eventually by more
conventional gestures.
Do you have children on your case load who are in this category?
Describe why you think this is the case.
Seven levels of communication
• LEVEL IV: CONVENTIONAL COMMUNICATION ... using presymbolic behaviors
• At this level children communicate intentionally using conventional
(or socially acceptable) gestures and vocalizations. The conventional
gestures will continue to be used throughout childhood and
adulthood to effectively augment symbolic behavior.
• The child now has "dual orientation": she or he acts on or orients
toward both a person and the topic of communication at the same
time. Dual orientation is frequently achieved through the combination
of gestures (e.g., gazing at someone while pointing to something)
Children with vision impairments may not develop these skills.
Do you have children on your case load who are in this category?
Describe why you think this is the case.
Seven levels of communication
• LEVEL V: CONCRETE SYMBOLS ... that represent specific referents
• At this level children are able to represent an environmental entity (a referent)
through the use of concrete symbols such as "natural" or "depictive" gestures
(gestures for mine, sit, come), pantomiming actions or objects, or the use of tangible
symbols (pictures or objects used as symbols).
• These concrete symbols are related to environmental entities in two ways. First,
they bear a 1:1 relationship to a specific referent. Second, they bear a clear
perceptual relationship to the referent: that is, they physically resemble the referent
in appearance, sound, touch or motion.
• Children with severe orthopedic impairments may access tangible symbols through
the use of a switch or other mechanical device or by pointing, touching, eye gaze,
etc.
• In most children, Level V does not appear as a separate stage of communicative
development. Instead, Level V behaviors tend to be interspersed with Level IV and
Level VI behaviors. However, Level V may become a separate and critical stage of
development for children with severe disabilities for whom concrete symbols may be
the only meaningful symbols. Or, it may serve as a transitional stage for children
with milder disabilities who are having difficulty acquiring abstract symbols.
Seven levels of communication
• LEVEL VI: ABSTRACT SYMBOLS ... that represent specific
referents
• At this level children are able to represent environmental entities
through the use of abstract symbols such as speech, manual signs,
Brailled or written words, abstract graphic symbols, or threedimensional abstract symbols (a certain shape or texture that has
been arbitrarily designated as a symbol for something).
• These symbols bear a purely arbitrary relationship to their referents that is, they are not perceptually similar to them.
• At this stage, the child uses abstract symbols one at a time, rather
than in combinations. Children with severe orthopedic impairments
may access the symbols through the use of a switch or other
mechanical device or by pointing, touching, eye gaze, etc.
Seven levels of communication
• LEVEL VII: LANGUAGE ... combining symbols
• At this level children use symbols in two- or three-symbol
combinations, according to grammatical rules, or syntax.
• The meaning of an utterance may change if the order of
the symbols is changed. Children with severe orthopedic
impairments may access the symbols through the use of
a switch or other mechanical device or through pointing,
touch, eye gaze, etc.
Small Group Work (2 cases)
• Have someone in the group present a child with whom they
have worked that fits the category of communication
• As a group, discuss what activities they would do to build
skills to get to the next level with the consideration of family
partnerships
• Report out to the larger group, key learnings
What activities would you do to move a
child from Level II to Level III
• LEVEL II: INTENTIONAL BEHAVIORS ...
– These behaviors are intentional, but they are not intentionally communicative.
That is, children do not realize that they can use these behaviors to control
another person's behavior.
• Level III: UNCONVENTIONAL COMMUNICATION ... using pre-symbolic
behaviors
– Children communicate intentionally, but they use unconventional ways of
communicating, such as body movement, actions on people and objects,
vocalizations (or switch activation for the severely orthopedically impaired).
What activities would you do to move a
child from Level III to Level IV
• Level III: UNCONVENTIONAL COMMUNICATION ... using pre-symbolic
behaviors
– Children communicate intentionally, but they use unconventional ways of
communicating, such as body movement, actions on people and objects,
vocalizations (or switch activation for the severely orthopedically impaired).
• Level IV: CONVENTIONAL COMMUNICATION... using pre-symbolic
behaviors
– At this level children communicate intentionally using conventional (or socially
acceptable) gestures and vocalizations. The conventional gestures will continue
to be used throughout childhood and adulthood to effectively augment symbolic
behavior.
Tools
• Gestural Development Assessment and Progress
Monitoring
• Finding motivators
• Routine and activities worksheet
Gestural Development Assessment &
Progress Monitoring Stremel Thomas, Schalock, Ruder & Bashinski,
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Rubric:
0 = Not yet;
1 = Emerging, but seldom seen;
2= Emerging with increased frequency;
3 = Uses each day when there are opportunities,
4 = High rate and generalizations to many different people,
objects, and routines.
Typical Development at 9-12 months
Months
Behavior regulation
9-12 Months
Protest:
Child uses body to signal refusal/protest (e.g., arching body away when held in adult’s arms
Child pushes away an object with hand(s)
Requests objects:
Child reaches for an object as communication
Child makes contact with an adult’s hand to gain object
Request actions:
Child reaches to be picked up
Child does an action to get it to happen again (e.g., bounces up and down for “horsie”)
Typical Development at 9-12 months
Social Interaction
9-12 Months
Seek attention:
Child bangs objects to get attention
Child uses consistent body movement to get attention (e.g., flapping arms, kicking legs)
Child grabs an adult’s hand to gain attention
Social games:
Child shows interest/anticipation in social games (e.g., moves body in anticipation, holds up hands for adult to manipulate)
Child participates by imitating an adult (e.g., begins to clap)
Child initiates social games (e.g., puts blanket over head to initiate peekaboo)
Representational gestures:
Child waves “bye bye”
Child imitates others clapping
Typical Development at 9-12 months
Joint attention
9-12 months
Comment:
Child shows objects
Child gives objects
Request actions:
Child reaches while opening and closing hands (e.g., being picked up, wants windup toy wound)
Child gives an object to an adult to get help (e.g., have it opened, fixed)
Request objects:
Child looks at object, then adult, and then object again (or vice versa)
Child points to obtain an object
Typical Development at 12-15 months
Social interaction
12-15 months
Joint attention
12-15 months
Representational gestures:
Child shows functions of objects (e.g., brush hair with brush)
Child hugs objects
Child claps for excitement/accomplishment (e.g., claps after putting blocks in bucket)
Child “dances” to music (e.g. bounces in seat from side to side wit arms bent like dancing)
Comment:
Child points to object/event
Typical Development at 15-18 months
Behavior regulation
15-18 months
Social interaction
15-18 months
Joint attention
15-18 months
Protest:
Child shakes head “no”
Request objects:
Child reaches while opening and closing hand to get an object
Request actions:
Child points to get someone to do something (e.g., open a door, carry them to another room)
Child takes the hand of an adult to guide his or her hand or body to do something (e.g., takes hand of adult and brings it tow
Child takes parent’s finger to point
Representational gestures:
Child smacks lips like eating
Comment:
Child points to an object in response to an adult’s request, such as “Show me the apple” or “Where’s the doggie?”
Request information:
Child points to object or event to gain information (e.g., child points to pictures in book for adult to name it)
Typical Development 18-24 months
Social interaction
18-24 months
Joint attention
18-24 months
Seeks attention:
Child shows off (e.g., sticks out tongue, makes a funny face to get a laugh)
Representational gestures:
Child shrugs shoulders or puts hands face-up for “All gone” or “Where did it go?
Child blows kisses to others
Child signals “shh” with fingers to lips
Child nods “yes”
Child pretends to sleep with hands together by head
Child uses conventional gesture of excitement (e.g., “high five” or “touchdown”)
Comment:
Child uses gesture as clarification of word/word approximation (e.g., child says “pane” and then points to airplane wh
What activities would you do to help a child
move from a 9-12 month level to a 12-15
month level?
• 9-12 months: refuse and request via gestures (to be
picked up), enjoys peek-a-boo, anticipates activities, gives
and shows, waves bye-bye
• 12-15 months: points to objects, looks at named people
Assessment of Salience/Understanding
• Objects
– Entire object vs part of an object to represent
• Photos
– Photo with the child, without the child
• Cartoon representations
• Icons/symbols
– Higher level representations
• Words/Signs
– Highest level of representations
Choice-making
• Between objects
– preferred vs non-preferred or preferred vs preferred
• Between photos
• Between icons
• Between signs/words
Assessment of Motivators
• These can then be used either to reinforce preferred behavior or to establish things
that a child would want to communicate about (request)
• The caregiver interview which asks open-ended questions followed by comparison
questions:
– “What does he like to do?”, “What are his favorite foods?”, and “Where does he like to
go?”
– “Which does he like better, cookies or crackers?” and “What would he rather do, go for a
walk or eat chips?”
• Structured surveys: obtains information about potential reinforcers and ranks the
potential reinforcers in order of preference. (i.e: the Reinforcement Assessment for
Individuals with Severe Disabilities, Fisher et al., 1994).
• Direct Observation: present items with no demands placed and record time child
spends with the item (more time intensive, but likely most accurate)
– Can present information in various formats, single item, paired, and multiple choices
Considerations of daily routines for
embedding expanding communication
• In pre-linguistic level communicators, routines can be a
structure to embed communication
• For working on higher level concepts, daily routines can
provide a framework to help coach parents in working on
communication
Embedding communication within routines
:
KidsDBCI Routine/Activities Worksheet
Developing Routines: A Worksheet
Name: ___________________________ Date:_______________________
Routine:__________________________ Major Purpose:_______________
Major Intervention Strategies:_____________________________________________________________________
Vocabulary Used in Routine:______________________________________________________________________
What is Important to the Parents?_________________________________________________________________
R
E M DL Cog Support
What you do!
Targeted Outcomes for the Child
Consequences &
Commun
& AT
Expansions/Recasts
What routines might you consider and what
activities would you embed in a routine?
• Diaper changes
• Feeding
• Bath-time routine
How do you recognize atypical language
development?
• Can children who are D/HH have language disorders?
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“Auditory Processing” (vs “language processing”)
Autism spectrum Disorder
Apraxia of Speech
Language Gaps in typically developing D/HH children
How should we define language under-performance?
Pre-Linguistic Communication
Red Flags for Autism in Hearing
Children
Behavior
Barbaro, J. and Dissanayake, C. Prospective
Identification of Autism Spectrum Disorders in
Infancy and Toddlerhood Using Developmental
Surveillance: The Social Attention and
Communication Study. Journal of Developmental
& Behavioral Pediatrics. 31(5):376-385, June
2010.
8 months
12
months
18 months
Eye Contact
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X
Turning to Name
Call
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Imitation
24 months
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Pointing
X
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X
Gestures-Waving
X
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X
Pretend Play
Showing Behaviors
Fail Criteria
X
Fail 2/2 Fail 3/4
Fail 3/4
Fail 3/5
Intervention for Atypical Language
Development
• It’s not about communication mode
• Static representations vs words/signs that are here
and gone
• Hierarchy of communication
• Functions of communication
• Think through what is salient to a child
• Finding what motivates a child
• “Input” may need to be different than “Output”
Visual Schedules
• Is this a communication system?
• What is the target behavior for
visual schedules?
• How can these help?
• What types of considerations are
needed to build one?
Sleep: ATN/AIR-P Toolkit
http://www.airpnetwork.org/site/c.7oJGLPPsFiJYG/b.9151551/k.8682/AIRP_Tool_Ki
ts.htm
Picture Exchange Communication System
It’s not just for autism….
Functions of Behavior
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Escape (I get to avoid something I don’t like)
Tangible (I get what I want)
Attention (I get your attention)
Automatic (Because it feels good)
Behavior: Considerations
– Understood in the context of communication needs
– Understood in the context of the child’s overall developmental
levels (i.e., if a child is functioning at a 2 year level, anticipate
an attention span that is commensurate with most 2 year old’s)
– Recognize when there may be risks for emotional difficulties
(parent-child relationship, exposure to abuse, domestic
violence)
– Recognize when there are neurobiological factors contributing
to behavior (attention, impulsivity, hyperactivity)
Developmental framework
• Do I understand first-then?
– Re-direction (for those children who do not yet understand first-then)
• Do I understand later or waiting
– How long can I wait? (don’t reinforce a lot longer than that time
frame, frequency of reinforcement and expanding plan)
• What types of visuals will help remind me what I need to do?
Building Behavior Systems
• Functional Behavioral Assessment
– A-B-C
• Motivation assessment
• Building an approach for a behavior plan
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Triggers of behavior
Reason for behavior
Frequency of behavior
Establishing a plan to extinguish or shape behavior
Consider frequency of reinforcement needed
• Teaching replacement behavior
• Teaching waiting
Alternative Rewards
• May need to help family members (and extended family members) figure
out a way to engage and interact positively (enjoyable activities) that don’t
just rely on food
Types of systems
Types of Systems
• Social Stories
– Describes what the issue is
– Gives the correct behavior or
response that is desired
I like to hold my rabbit.
When I sit still and use quiet
hands, my rabbit likes that
Social Stories © Carol Gray Definition:
• Social Story accurately describes a context, skill,
achievement, or concept according to 10 defining criteria.
• These criteria guide Story research, development, and
implementation to ensure an overall patient and supportive
quality, and a format, “voice”, content, and learning
experience that is descriptive, meaningful, and physically,
socially, and emotionally safe for the child, adolescent, or
adult with autism.
http://carolgraysocialstories.com/social-stories/
Types of statements/sentences
• Descriptive sentences: are truthful and observable sentences (opinionand assumption-free) that identify the most relevant factors in a social
situation. They often answer "why" questions.
• Perspective sentences: refer to or describe the internal state of other
people (their knowledge/thoughts, feelings, beliefs, opinions, motivation
or physical condition) so that the individual can learn how others'
perceive various events.
• Directive sentences: presents or suggests, in positive terms, a
response or choice of responses to a situation or concept.
• Affirmative sentences: enhances the meaning of statements and may
express a commonly shared value or opinion. They can also stress the
important points, refer to a law or rule to reassure the learner.
http://carolgraysocialstories.com/social-stories/
Types of statements/sentences
• Affirmative sentences: enhances the meaning of statements and may
express a commonly shared value or opinion. They can also stress the
important points, refer to a law or rule to reassure the learner.
• Control sentences: identifies personal strategies the individual will use to
recall and apply information. They are written by the individual after reviewing
the Social Story.
• Cooperative sentences: describe what others will do to assist the individual.
This helps to ensure consistent responses by a variety of people.
• Partial sentences: encourages the individual to make guesses regarding the
next step in a situation, the response of another individual, or his/her own
response. Any of the above sentences can be written as a partial sentence
with a portion of the sentence being a blank space to complete.
http://carolgraysocialstories.com/social-stories/
Simplified version
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I like to go to the park
My favorite thing to do is swing
Sometimes there are other children on the swing
I will wait my turn
I can do another activity while I wait
When they are done, I will get a turn to swing
Creating Safe Play Spaces
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High Interest, multi-sensory materials
Anchored down
Self-initiated Exploration
Easily adaptable
Individual use or with others
Inexpensive and Easy to create
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Examples
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How would you create your space?
• Think about who, what, where, when, how as you create?
• Who will use this play space?
• Where can you use it? High chair, car seat, pack-n-play, bath tub
• What developmental domain is being addressed?
• What skill is being practiced and how will you make it salient and
functional?
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Communication Style Quiz
• Styles focusing on achievement, relationship,
idea creation or action
• Take quiz
Focused on Task: Doer (rapid movers)
• Doers like to be in control. They like quick action and they like
to see results. They like to get to the point with little
formalities. They don’t care for details and love finding
shortcuts. Otherwise, they get bored easily. They like
autonomy, freedom and taking risks. They are self-starters,
innovators and love to expend physical energy. They like
public recognition, especially for putting what they most value
into action and for creating results that make a difference in
the world (or at least in world they see and act in every day).
Focused on Task: Thinkers (slower speed)
• Thinkers love to gather information. They enjoy reading and
presenting their findings in detail. However, they need to
mentally rehearse before they present, and take time to evaluate
and wind down after the show. They take their time making
decisions, but stand by what they decide once they do. They
don’t care to talk about personal issues, but enjoy discussing
hobbies and issues. They desire clear expectations, specific
goals, deadlines and structure. They live by a sense of order,
methodologies and personal responsibility. Thinkers love to win,
and will compete with themselves if no one is available. They will
jump into the game with no coaxing if they perceive they have a
fighting chance. They are proud of their good work. They like
acknowledgment but won’t ask for it.
Focused on Relationship: Influencers
• Influencers like to verbally process their thoughts so they welcome
situations where they can “think out loud” with others. They like to
interrupt others, especially when they are excited about the topic.
They view this as conversation, not a disruption. They enjoy people,
desire approval and tend to be friendly, creative and persuasive.
However, they may need some help staying on track and following
through on tasks. They desire social interaction, acknowledgment
and chances to be creative and have fun. They often see the bright
side and can be very amusing, dramatic and passionate about work.
They help others get through difficult times and can build rapport and
support. They genuinely like people. However, they might find
themselves caught up in a lot of drama since they are quick to want
to help fix things and people. Teasing is one of their favorite
pastimes.
Focused on Relationship: Connectors
• Connectors count on others to set the tone and determine direction.
They are consistent and reliable once given their responsibilities.
They like to work with others instead of alone but take their time
trusting and allowing new people to join their established groups.
They do not readily give opinions, but this does not mean they don’t
have any. Because they are diligent and dependable, they often
know the most about how work is getting done. They like to be
asked what they know and they appreciate personal recognition
(done privately, not in front of others). They desire consistency,
social bonds and acknowledgment for effort as well as results.
Although they may appear stubborn, they can be very flexible and
adaptable if they understand why the changes are being made and
how they will benefit themselves and others. They seek to reduce
stress and promote harmony
When Communicating with a Doer
What to do
• Be clear, specific, brief and to the point.
• Stick to business.
• Be prepared to support your ideas and work.
Factors that will create tension or dissatisfaction:
• Talking about things that are not relevant to the task or issue.
• Being unprepared or incomplete. Avoiding or beating around the bush.
• Appearing unsure or disorganized, but not asking for help.
When Communicating with a Thinker
Do these things:
• Prepare your “case” in advance. Be prepared for a debate.
• Stick to business.
• Be accurate and realistic.
Factors that will create tension or dissatisfaction:
• Being giddy, casual, informal, emotional or loud.
• Pushing too hard for results or being unrealistic with deadlines.
• Being disorganized or messy.
When Communicating with an Influencer style
Do these things:
• Provide a warm and friendly environment. Do little things to show your
care.
• Don’t deal with a lot of details (put them in writing).
• Ask “feeling” questions to draw their opinions or comments.
Factors that will create tension or dissatisfaction:
• Being curt or cold. Cutting them off if they have something to say.
• Controlling the conversation. Not allowing them to talk and express.
• Focusing on facts and figures.
When Communicating with a Connector Style
Do these things:
• Begin with a personal comment--break the ice.
• Present your case smoothly, non-threateningly.
• Ask “how?” questions to draw their opinions.
Factors that will create tension or dissatisfaction:
• Rushing headlong into business. Creating tension.
• Being domineering or demanding.
• Forcing them to respond quickly to your ideas. Demanding change.
Communication with Families
• Our communication styles
– Tasks
– Relationship