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Communication problems in preschool
children
Rosemary Crossley
Every child who
has very limited intelligible speech after
the age of two should have a professional assessment by a speech
pathologist with experience in augmentative communication as well as
traditional speech therapy. For children with diagnoses
associated with a high probability of speech impairment, such as
cerebral palsiy, Down syndrome and Rett syndrome, intervention should
start earlier. The aim of therapy should be to help the child
communicate as fluently as possible, using any strategies which work
for that child.
Parents are often anxious that early use of non-speech communication will prevent a child talking. In fact, every indication is that the reverse is true. For example, in the Helsinki signing study, children with Down syndrome who started using manual sign at the age of 6 months talked significantly earlier and more fluently than children who did not use sign.
It's not easy to replace speech. Manual sign is as portable as speech (like your tongue, your hands go everywhere with you) but only people who know sign will understand you. A communication book containing lots of pictures and words will be understood by more people but is a nuisance to carry round and can't be used in the swimming pool, or to talk to a number of people at the same time. An electronic voice is great for talking to a number of people, but the batteries go flat. And so on.
Every non-speech communication strategy has pros and cons. In selecting augmentative communication strategies, account has to be taken of these, in addition to the physical and sensory skills of the users, and their communication needs. It is rare for any user's overall communication needs to be met by one device or one strategy, partly because most people with severe speech impairments also find hand-writing difficult. The need for specialist training of communication partners must also be considered.
Just to give some idea of the range of possibilities, I've listed below the options I would choose to explore if I had a child with a severe communication impairment. Because children's needs vary with age and educational situation, there are multiple lists.
Pre-school (up to age 6)
This is merely a brief tour of some of the communication options and issues which might be considered in relation to a child growing up with severe communication impairments.
For details of studies, devices, strategies or services mentioned, please contact DEAL.
Description of options
Yes/No boards - cards with YES and NO written on them for fist or eye pointing.
Multiple choice boards - white boards on which options are written or mounted quickly for fist or eye pointing.
Simple voice output devices - devices on which a limited number of utterances is recorded by a speaking person and accessed by fist or finger pointing – e.g. Cheaptalk, Voice Pal or Message Mate.
ABC boards - cards with the alphabet written on them in letters and layouts which have been chosen to suit the visual and hand function of individual users
Modified computers –
keyboards with guards to prevent two letters being hit at the same time
enlarged keyboards to cater for people who cannot see or point accurately to small targets e.g. Intellikeys
miniature keyboards for people with limited range of movement
software which speaks the text typed, e.g. Intellitalk, or which reads the screen
Indexed communication books - booklets containing words and phrases (with or without pictures) which are relevant to the user. These are arranged by topic, e.g. greetings, basic needs, feelings, school etc. to enable the user to find wanted items easily. The layout, size and number of items varies from user to user.
Parents are often anxious that early use of non-speech communication will prevent a child talking. In fact, every indication is that the reverse is true. For example, in the Helsinki signing study, children with Down syndrome who started using manual sign at the age of 6 months talked significantly earlier and more fluently than children who did not use sign.
It's not easy to replace speech. Manual sign is as portable as speech (like your tongue, your hands go everywhere with you) but only people who know sign will understand you. A communication book containing lots of pictures and words will be understood by more people but is a nuisance to carry round and can't be used in the swimming pool, or to talk to a number of people at the same time. An electronic voice is great for talking to a number of people, but the batteries go flat. And so on.
Every non-speech communication strategy has pros and cons. In selecting augmentative communication strategies, account has to be taken of these, in addition to the physical and sensory skills of the users, and their communication needs. It is rare for any user's overall communication needs to be met by one device or one strategy, partly because most people with severe speech impairments also find hand-writing difficult. The need for specialist training of communication partners must also be considered.
Just to give some idea of the range of possibilities, I've listed below the options I would choose to explore if I had a child with a severe communication impairment. Because children's needs vary with age and educational situation, there are multiple lists.
Pre-school (up to age 6)
- Speech therapy by a therapist with Prompt and Augmentative Communication training.
- Signing and gestures - hand signs can be taught to very young infants. They will also need to be taught to family members and later to kindergarten and day care staff. They will not be useable by children with severe cerebral palsy and will be difficult for children with major motor planning problems.
- PECS - Picture-elicited communication - sets of cards with pictures of common items are mounted in accessible locations. The child removes the card showing a wanted item and takes it to an adult. Alternative set-ups will be needed for children with severe motor problems.
- Symbol boards or book - collections of pictures and symbols such as Compic or Picsyms arranged according to subject which may be used to make comments and express feelings, as well as asking for things. Depending on the child these may be used by finger or fist pointing (with or without facilitation) or with eye pointing. These are more easily carried by children who use wheelchairs.
- Cheaptalk, Chatbox or similar portable voice output device - essential for singing along, talking to other children and joining in group activities. Children who have more severe physical impairments and children who are unlikely to develop intelligible speech before starting school are likely to require more sophisticated VOCAs - voice-output communication aids.
- Lots of literacy exposure. As well as regular story reading, computer-based activities using software/hardware such as Intellitalk and Intellikeys, and books on CD-ROM are valuable - especially for children who cannot hold pencils or turn pages.
- Lots of work on hand skills including index finger pointing and eye-hand co-ordination. Children whose hand skills are unlikely ever to allow them to write or use regular keyboards should be starting to use alternatives.
- Signals for yes and no - ideally these should be used without assistance, and not require any technology e.g. nod/shake, eye blinks, hand movements. Yes/no boards should be available for all children who do not have clear no-tech yes/no responses.
This is merely a brief tour of some of the communication options and issues which might be considered in relation to a child growing up with severe communication impairments.
For details of studies, devices, strategies or services mentioned, please contact DEAL.
Description of options
Yes/No boards - cards with YES and NO written on them for fist or eye pointing.
Multiple choice boards - white boards on which options are written or mounted quickly for fist or eye pointing.
Simple voice output devices - devices on which a limited number of utterances is recorded by a speaking person and accessed by fist or finger pointing – e.g. Cheaptalk, Voice Pal or Message Mate.
ABC boards - cards with the alphabet written on them in letters and layouts which have been chosen to suit the visual and hand function of individual users
Modified computers –
keyboards with guards to prevent two letters being hit at the same time
enlarged keyboards to cater for people who cannot see or point accurately to small targets e.g. Intellikeys
miniature keyboards for people with limited range of movement
software which speaks the text typed, e.g. Intellitalk, or which reads the screen
Indexed communication books - booklets containing words and phrases (with or without pictures) which are relevant to the user. These are arranged by topic, e.g. greetings, basic needs, feelings, school etc. to enable the user to find wanted items easily. The layout, size and number of items varies from user to user.
Communication Centre Inc.,
538 Dandenong Road, Caulfield, Victoria 3162, AUSTRALIA
Ph. (61-3) 9509 6324
Fax. (61-3) 9509 6321
e-mail: dealcc@deal.org.au
Autism/ASD, Cerebral Palsy, Down Syndrome, Intellectual Impairment, Learning Disability, Fragile X Syndrome, Rett Syndrome, Stroke/CVA,
Persistent/Permanent Vegetative State, Acquired Brain Damage,
Motor Neurone Disease/ALS, and Huntington's Disease.
DEAL has been able to help people with all of these diagnoses to communicate.