Guidelines for parents: How to play with my child who is nonverbal- Beginning play level

 

How do I play with my young child who is nonverbal? Expansion from where your child is at..

It is not uncommon for parents to express uncertainty about how to go about playing with young children who are not able to express themselves. These children often have a limited repertoire of toys that they are interested in. All we need for play is to identify one toy (e.g. teddy), action (e.g. jumping), or object (e.g.. car) that the child is interested in and use it as a basis for play. We want to be aware of what the child is interested in and then for us to extend what s/he does with the toy/object to expand involvement with us and the toy/object or action. 

My child is in school already, why should s/he still learn to play like this?

There is a direct link between children’s ability to play with themselves and others, and their ability to learn.  This also applies for children of school -going age. Children learn primarily through play. They make up action stories (e.g. the doggie runs in the yard, he runs fast, he sees daddy coming in the car, what does the doggie do? He runs to the car to greet daddy). In playing out a simple story like this, they learn about sequential actions and logical outcomes. If we can get a young child to play like this, s/he is  well on the way to learning. 

What toys do I use?

We need to watch carefully what toys the child spontaneously engages with. We need to observe how s/he uses the toys to develop their play skills. Allow yourself to expand play around the object of your child’s interest by adding one or two ideas that you think the child might relate to. Parents can be most intuitive in knowing what a child might enjoy – and if it doesn’t work, then you can try with another object/action/toy later on.  It is not how many times we have to try that is important, but where we are heading for!

Gaining a young child’s attention is often difficult and expanding that interest to include a slightly longer engagement with the toy can be quite difficult at first. Remember this is an activity that you and your child should enjoy together. Don’t allow a play session to change into a “teaching session”. The idea is to have fun together. Play, communication and learning can only happen when a child is interested and enjoy what they are doing with you. 

So how do I do this?

  1. Where do I start? More observation, less talking and directing: This is not about what you, the parent wants to play with, but what your child would like to play with. We can suggest certain activities, but we need to ensure that the child is in the lead here. We often times tend to be too directive in playing with our children. Rather, watch what they do and then, let’s move from there.
  2. What does your child do with the toys spontaneously? Does s/he hold the toy, throw the toy, put the toy in a box with other toys? These are important first indicators of where you can start to play with your child.
  3. How do I use these observations to play with my child?
  • Start where your child is at , e.g. If your child is holding his/her toy, that is where you start.
  • Slowly try and expand what they are doing by introducing some other ideas
  • Look, see how your child responds. If s/he loses interest, you need to try something else. Know that everything you try is positive as you get to know and understand your child’s interests better. 

An example of a play interaction : Please make sure to use whatever means of comunication your child has available. These could include manual signs, grahic symbols on a communication board or a device- or a combination of these. That you communicate during play is much more important than how you do it! Again, don’t turn this play interaction into a “teaching situation”. Rather see it as an opportunity to interact with your child in a non-pressuring, creative way.

Q:  My child only tends to hold his toy. How do I get him/her  to play with me?

One way of initiating play:

Parent: I see you like to hold Teddy? Can I hold him a bit?

Child: (gives it to you)

Parent: Teddy is a good friend. Look! Teddy is waving at you?

Child: (wants Teddy back).

Parent: You like to hold Teddy! He is your friend.  Do you think Teddy wants to play with something?

Child: (ignores utterance)…(parent puts some other toys closer – and takes the car)

Parent:  (takes the car): Hallo, Teddy, do you want a ride ? Come sit with me in the car….(Parent helps the child to place Teddy on the car) go!  See, we are going fast/slow!

Child: Takes teddy and the car and imitate the action of “go”

A short sequence of play like this, can be a major step forward for a child with severe communication difficulties. Do not under-estimate the power of these  short, but meaningful interactions.

What should I look out for?

  1. You want your children to be interested, to pay attention to you and to engage with the toys. The quality of the attention and how they play with the toys is what we want to promote.
  2. When you introduce new ideas, you have to do so slowly while watching your child’s reaction. If they lose interest and walk away – that’s ok. That is where you start. Next time, new or same toy, new play situation.
  3. It is not about how long you play together, but the quality of the joint attention that is important.
  4. Be with your child in a child-like way. What we are looking for is for you and your child to play together in a way that is joyful and meaningful to your relationship. Then we can gradually try and extend this time.

Most important: Have fun!

Standing on the Shoulders of Giants: A Personal Tribute to a Great Mentor

Landscape with blind Orion seeking the sun by Nicolas Poussin

We recently lost one of the big research giants in the field of augmentative and alternative communication: Lyle L. Lloyd. He died at the age of 86 and was a professor in Special Education and Speech and Language Pathology at Purdue University, West Lafayette, Indiana, for 34 years.

Lyle Lloyd at work
Llyle Lloyd at work

Continue reading “Standing on the Shoulders of Giants: A Personal Tribute to a Great Mentor”

Typing with Hand-over-hand Support: Is This Really Communication?

Letter board

I recently read the article “After years with no way to communicate, Newburgh teen finds her voice.” Like so many other similar stories, this heartwarming narrative gives an account of how a young women is using supported typing to “communicate.” The mother describes how this strategy has helped her teenage daughter to communicate and find her “voice.” Her daughter points to letters on a letter board while another person (the facilitator) supports the daughter’s wrist during the process of typing.

Although it is good to read positive stories like this, it is important that we alert parents and professionals to the pitfalls involved in describing “supported or assisted typing” as a communication strategy.

Continue reading “Typing with Hand-over-hand Support: Is This Really Communication?”

Augmented Input and Meaning-making

Child with iPad

Recently during a professional development session in the schools, we were observing a video of a teaching aide using augmented input by pointing on a student’s device. As we engaged in discussion, participants expressed some confusion about the assumptions underlying augmented input as seen in the video and questioned its role in promoting the student’s expressive ability using the device.

The video showed a group of children listening to a teacher telling a story. The teaching aide was pointing to some core vocabulary on the student’s device (reinforcing core concepts used by the teacher) while the teacher was narrating a story. The purpose of the augmented input by the teaching aide was presumably to enhance the student’s understanding of the narrative.

Participants’ confusion in observing this video related to the different ways in which the device was used: How is the teaching aide using augmented input on the child’s device assisting the student in understanding his role in expressing him/herself? Providing input on the child’s device by repeating concepts used by the teacher can be confusing if the child needs to learn to use his/her device for self-expression. This dilemma is not new to AAC intervention, and different solutions have been proposed over the years. Two of these solutions are discussed below. Continue reading “Augmented Input and Meaning-making”

Being with Another: The Basis for AAC intervention?

Two people together at sunset

I recently went back to South Africa to see my mom, who is 88. She is in a nursing facility with 24-hour care, unable to walk, and at times quite confused. During the past year she had a couple of ischemic attacks, which rendered her unable to speak for certain periods of time. Recently, however, she has regained some speech, although verbal expression remains difficult. In spite of all these factors, I looked forward to our visit.

The author with her mom and her brother
The author with her mom and her brother

I talk to my mom on the phone from New York on a daily basis. Even though interactions are difficult, we are able to maintain interaction for sometimes shorter and sometimes longer periods of time. My visits with her are less focused on content and more on celebrating the joy of being together.

When in Johannesburg, I visit her at the facility twice a day for about an hour each in the morning and afternoon, depending on how my mom and I seem to be doing at the time and on a specific day. Continue reading “Being with Another: The Basis for AAC intervention?”

Spontaneous Second Language Interactions: What Can We Learn for AAC Intervention?

Two Cousins

In a recent visit to South Africa I had the privilege to be a fly on the wall in observing an interaction between two young people: a little girl who is 9 years old (Afrikaans-speaking, but also fluent in English) and a young adult in her early 30s (English-speaking, but also competent in Afrikaans, although she hasn’t spoken it for some time). These two cousins had not seen each other in a couple of years and were very happy to be reacquainted. A recording was made of their interaction (embedded below). Continue reading “Spontaneous Second Language Interactions: What Can We Learn for AAC Intervention?”

How Do We Promote Engagement in Interactions with Students Who Use AAC?

I have often been surprised to discover how therapists and teachers (myself included!) become so wrapped up in daily toil and activities that we are exhausted by 10:00 in the morning. Although we often admit this is not a state of mind we necessarily are content with, changing how we do things can be really difficult. Being busy makes us feel like we are productive and engaged professionals—but are we really? How is this “being busy” really benefiting our interaction with our students? This question is even more relevant when it comes to how we support students who use AAC to become engaged with others in interaction. Continue reading “How Do We Promote Engagement in Interactions with Students Who Use AAC?”

Are We Missing the Boat in AAC Intervention?

Ferry boat leaving shore

Over the past 30 years of working in this field, I have often had sleepless nights when meeting a student in elementary, middle, or high school who has no or very limited means to communicate in spite of having access to a device or iPad with a communication app. I keep asking myself how it is possible that a student can reach middle or even high school without the ability to express themselves when we have trained teachers and therapists to provide intervention and support? Despite these resources, it still seems rather easy for students with severe communication problems to fall through the cracks.

Although the reasons for these dilemmas are complex, looking at the way in which we formulate IEP goals can be illuminating. IEP goals are often written to reflect outcomes that show the student has learned or gained (that is, variables that are easy to measure, for example, how frequently students respond correctly to certain stimuli or use language structures correctly within context), without due consideration of how what they have learned impact on their daily interactions. Continue reading “Are We Missing the Boat in AAC Intervention?”

Repeat Questions from Students
with Special Needs in the Classroom:
What to Do?

Children raising hands in classroom

A teacher recently shared that she has a student in her class who keeps repeating the same question even after she has responded to it. The student will ask the teacher, “When will we get our tests back?” To which the teacher will reply, “I will give them back tomorrow, as I have not finished making all the corrections yet.” However, 10 minutes later, the student will proceed to ask the same question.

This reminded me of a similar scenario with a student I know of who used an AAC device. This student also repeated the same question, even though the teacher had responded to the question. The student would activate his device to ask, “When do we go to the library?” To which the teacher would respond by saying, “We will go to the library after break.” However, within 10 minutes of the first question, the student proceeded to repeat the same question. Continue reading “Repeat Questions from Students
with Special Needs in the Classroom:
What to Do?”

Listening, Communication Intent, and Rabbits

Rabbit in a field of grass

What Can We Learn from Our Leporine Neighbors?

I have been watching the rabbits in our garden in the early morning hours as they nibble at the grass and momentarily stop to listen, before continuing with their nibbling. This process of nibbling, abrupt stopping and listening, nibbling and stopping and listening fascinates me. It is almost as if the rabbits realize that while they are busy nibbling grass, they can’t listen (or become aware of potential threats), hence they have to stop, albeit momentarily, to listen.

While the idea of stopping in the midst of daily activity is not new, it made me think about our communication intervention practices. I have been trained (and have also trained others for a long time) to understand that communication is an intentional, goal-oriented process of exchanging messages to achieve specific outcomes. The closer the outcomes resemble the initial intent, the more successful we deem the communication to be. But is communication with others really purposeful in that way? Is the process of developing meaning with others really that predictable? Continue reading “Listening, Communication Intent, and Rabbits”