Let's Talk About Talk! Moving Beyond A Flawed Assumption to Meaningful Communication

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Let's Talk About Talk!
Moving Beyond A Flawed Assumption to Meaningful Communication
Marion Blank, Ph.D. Mary Beth Cull Columbia University
Research now shows that between 75-95% of children who receive intensive behavioral intervention will speak by the age of five”
(Dawson, 2008)
Parent commenting on an incident:
“I thought that all I wanted was for him to talk. Now he's doing that, but it's all wrong."
A teacher relaying an incident:
been teaching him language for years. And he can’t even understand simple, basic language that could save his life.”
Why Are These Occurring?
• First child: learned what was taught (not what has been intended to be taught) • Second child: did not learn what was not taught (“holes” in the curriculum) (“failure to generalize”)
“Unintended consequences”
• Pervasive and often ignored • Medicine: iatrogenic disease • Education: “edugenic disability”
How Did We Get “Here”?
• Alarming power of the “absence of speech” • Awareness of critical periods • The stumbling block—“What can we get children to say when they have little or no speech?”
Into the Void
• Nouns and some adjectives • Occasionally a few verbs—often taught as if they were nouns (“point to drinking”)
Into the Void
• Unnoticed—cannot comprehend others when language base is limited to nouns • Unnoticed—cannot produce meaningful utterances when language base is limited to nouns
And Totally Unnoticed
• The teaching often violates the social context in which the language is used • Example: What is your name?
Into the Void
“Encouraging” “Demanding” “Requiring”
Request language (“I want…”)
Into the Void
• Unnoticed—failure to generalize beyond this “form” of language • Understanding the failure of generalization  the role of initiator  request language makes minimal demands re: understanding the speech partner  all other initiations require significant understanding of the speech partner
This amazing array of forces owes its existence to one key idea:
Moving On
What will be the replacement?
Taking a New Path
• Cognitive precursors of language • Key structural components of language • Distinction between language and communication • Bridge between language of school and home
Cognitive Precursors of Language
• Developmental psychology—powerful role of cognition prior to language (preverbal cognition) • Preverbal cognition is a prerequisite for verbal cognition (language) • But which of the many skills are central? (critical for effective intervention)
Temporal Sequencing
Pervasive and central to all of language
• Phonemes—the sounds of language (“fast forward”) • Babbling (“crib talk”) • Deficiencies in this realm pervasive in ASD • Extent of deficiencies can easily be overlooked
Structuring the Teaching for Temporal Sequencing
• Initially avoid the auditory realm!!!! • Use the visual modality to mirror characteristics of auditory modality
Criteria for Selection
• The input is composed of several elements • The particular elements that are selected follow a set order • The order in which the elements are presented is the order that the child must process and reproduce
A Sample Activity
More Examples
The adult performs and the child reproduces: • a series of actions on objects rather than symbols (e.g., turning over one object, putting another in a container, tapping another object, etc.) • a sequence of actions on one’s body (e.g., touching the nose, a shoulder and a knee) • reproducing sets of visual objects (e.g., sets of colored blocks that are shown and then hidden from view)
The Structures of Language
• Language & communication are not equivalent • Language is a system combining nouns and verbs to create meaning • A central, but overlooked, component resides in the “little words”
The Power of the “Little Words”
• The boy was here. • The boy is here. • This is a dog. • This is not a dog. • The boy wants a dog. • The boy wants that dog.
The Little Words: Central to Noun/Verb Categories
• Certain words attach to nouns (e.g., the, these, a, that, etc.) • Certain words attach to verbs (e.g., is, are, were, did, have, etc.) • Awareness and use of these words is critical to mastery of nouns and verbs & to understanding what other people are expressing
The “Little Words” and the Representation of Time
• Present – is, are, have… • Past – was, were, had, did… • Future – is going to, will…
ASD and the “Little Words”
• This realm represents one of the problematic areas for the children • Much teaching reinforces their weaknesses by avoiding these words
Some Consequences for the Child with ASD
When child is confined to the one word level, then the following represent the same utterance “What is the boy doing?” “Where is the boy?” “What does the boy want?” “What was the boy doing?” “Who is with the boy?”
• • • • •
Structuring the Teaching for Language Mastery
• Content focused on complete sentences containing linked nouns and verbs birds fly, kids run, bugs crawl, fish swim • Length just at & beyond child’s level • Method is based on sentence imitation • Resulting sentences might include: Here are some birds; they are flying. This kid can run. He is running.
If Spoken Language Production Not Feasible
• Literacy (written language) provides an alternate route • When reading and writing structured to reflect spoken language, the same processes are put into operation
Language & Communication
“The trouble with her is that she lacks the power of conversation but not the power of speech.”
George Bernard Shaw, Irish Nobel Laureate
Language & Communication
• Linked but separate domains • Pre-verbal communication exists in absence of language • Verbal communication uses pre-verbal communication and language to send and receive messages
The Two Worlds of Verbal Communication
Language Verbal Communication
• Clear recognition of the deficits in ASD • Minimal analysis of complexities of communication in intervention • Pre-verbal (averbal) communication – a skill that may not be “teachable”
A Sample Exchange
• Child: (pointing to a box on the table) Mommy, what’s that? • Mother: That’s chocolate pudding mix. I thought we’d make some for some for supper tonight. • Child: Can I mix and help you? • Mother: Sure you can.
Blank & Franklin, 1980, p. 139
Communication: Two or More Persons
• Two central roles: initiator & responder • Initiation: a role that cannot be taught • Appropriate initiation: far more complex than appropriate responding • Responder: clear path set by initiator; responder need only follow the path
Structuring the Teaching for Verbal Communication
• Creating situations accepting absence or paucity of pre-verbal communication • Focusing on the responder role • Recognizing the limitations facing the initiator
commands statements questions
In “Typical” Development: Pathways for Questions
• Social intuition (pre-verbal communication): sensing the intent of the speaker
“Could you pass the salt?” “Do you know the time?”
• Present in young child (2 year old)
Mother: “Can I fix your bed?” Child: Removes toys
In “Typical” Development: Pathways for Questions
• “Verbal links”: perceiving the unexpressed links between questions & answers What is the boy doing? (The boy is) swimming.
Using the Links as a Therapeutic Bridge
• • • • • • • • Q: A: Q: A: Q: A: Q: A: Who are these? These are boys. Where is the cat? Here is the cat What are they doing? They are running. What were the birds doing? The birds were resting.
A Beginning Topic: Intermixing Command, Statements, Questions
• Who is this? • This man has something. What does he have? • The window is broken. Point to the broken window. • He is going to use the glass to fix the window. What is he going to do?
A Beginning Topic: Continued
• Point to the window that was broken • Is the window broken now? • Who fixed the window?
Language at School and at Home: Bridging the Gap
• Can the intervention be brought into the home?
Language at School and at Home: Bridging the Gap
• The complexities of natural language
Language at School and at Home: Bridging the Gap
• Revisiting the pragmatics of statements vs. questions • Because statements do not require a response, they are ideal for lessening the demands of coping with natural exchange • Statements (comments) are fine • Questions should be reduced or eliminated to the degree possible
And Now : The “Invisible” 800 Pound Gorilla
Problematic Behavior
The “Behavior” We Are Not Talking About
• Overtly aggressive actions • Self-injurious actions • Destructive actions
The “Behavior” We Are Talking About
• New situations—ignoring adults & gravitating to objects (“oh, he’s just curious”) • Feigning ignorance • Subtle “stims” that absorb child • Needing “rewards” (“bribes”) for most “imposed” activities
A Parent’s Comments
“I thought we were doing a great job…I thought we nipped the weird behaviors in the bud…but the stim behavior never went away.” • Advice to others “If it was more out there, if we knew about it, maybe we could address the problems sooner.”
Why Do These Behaviors Occur?
• “Typical” adult-child interaction is based on an unbelievably complex, subtle “give and take” (of body language, tone of voice, facial expressions, etc.) • This system is “incomprehensible” to children with ASD
• Leaves parents bereft of the “signals” they need to understand the child & to respond effectively to him/her • Parents often attempt to fill the vacuum by “pleasing” the child—granting the child what s/he wants • The “I want…” strategy is often reinforced by intervention programs
Reinforcing “I Want…”: A Potential Recipe for Disaster
• It creates an unspoken but potentially destructive “social contract” • This “contract” that has a high likelihood of producing devastating effects—particularly as the child moves into adolescence
Another Complication of the Failure in “Give and Take”
• Apart from “stims” & highly desired activities (e.g., swimming, elevators, etc.) children rarely initiate • To fill the void, children kept occupied by intensive hours of programming • A common consequence: the children cannot tolerate “nothingness”
What Can Be Done?
• The good news: a lot • The bad news:
 it takes work that is demanding – not in terms of physical effort but steady awareness of minute behaviors  it requires techniques that run counter to our habits & intuitions  it is best established before 6 years of age
Why Do It?
• It gives the child a future that offers a better quality of life • It creates the interpersonal matrix that is needed to be a life long learner • It permits efficient learning • It counters the deterioration that sets in when continued learning does not occur
Goal: Step 1
• INHIBITION!!!! • Presence of an adult signifies that quiet, attentive, controlled behavior is required
The Key Demands: For the Adult
• Effective management of all basic routines (eating, sleeping, TV, dressing, etc.) • Simplifying the world—eliminating all unnecessary demands • When demands are made—imposing only those that adult can ensure will be carried out • Eliminating all “acting out” behavior—when with others • Being totally aware of what you are saying & ensuring that any direction be carried out correctly & in a suitable manner • Endless patience
The Key Demands: For the Child
• COMPLIANCE • Learning to tolerate “nothingness” • Learning to respond in a calm, focused, deliberate manner
Goal: Step 2
• “Activation”—via simple commands for action that child can easily execute • Teaching child to tolerate the “uncertain”
The Next Step
“Now vee may perhaps to begin. Yes?"
Portnoy’s Complaint by Philip Roth