• Collaborative

Stimulate my child's communication when they have little or no oral language

Celine Bestoso, Claire-Marie Courbin, Oriane Graciano, Bérengère Marais, Dr Anna Maruani, Hoang-Thi Nguyen, Mathilde Petit, Sophie Ripoll,

Center of Excellence for Autism and Neurodevelopmental Disorders, Robert Debré Hospital, Paris



During this period of confinement, the speech therapy sessions are suspended and you want to continue to stimulate the communication skills of your child with social interaction difficulties.

Know that you already do a lot on a daily basis, without even realizing it.

It is primarily thanks to you that your child progresses because you are their privileged communication partner.

In this sheet, we will list the activities of daily life, and all that they allow in terms of communication: you will be aware of everything that you do naturally! The purpose of this document is to support, structure, adjust and enrich what you are already doing. There is no need to buy equipment or change your habits.

This document offers ideas for stimulating communication and language, as well as the use of alternative means of communication (PECS, Makaton for example).

You will find practical examples in the first part, then a reminder of the technical terms.

What I can do if my child uses PECS for communication

I can reinforce its use in situations that seem possible to me. If I don't do it all the time it doesn't matter. The important thing is to spend only 15 minutes according to the procedures learned with the professionals. I do not hesitate to contact them if necessary. In the absence of a session, progress in the stages of this type of means of communication will be limited, but in any case I can consolidate what I already know how to do with the tools that have been used. I can reproduce the same procedures on new reinforcers.

In case my child has just started PECS, the professional has barely begun to introduce it and I don't know how to use it at home. I can then ask them for advice in order to have more precise indications. Even if I cannot immediately set up the PECS I will be able to continue to stimulate communication in all everyday situations.

During the confinement period, I favor moments of play and I reduce my requirements in order to limit behavioral difficulties (see self-stimulation sheet) and my own fatigue!

What I can do if my child uses the Makaton

If my speech therapist introduced the use of Makaton gestures, I reinforce what has been presented. I can enrich my stock of gestures in order to support understanding. If the sessions continue by video call, I refer to my speech therapist directly for progression.

In any case, whatever their communication mode, I can help my child understand the course of the day with visual aids. There is no need to set up "rehabilitation time" to replace the missing speech therapy session. I rather consolidate the moments of interaction on routine times.

What I can do to support communication and language upon waking

Here I can use visual schedules such as sequences: (space management sheet) to support my child's verbal understanding.

It is recommended to always use the same sentences related to the activity while following the visual planning.

My child is learning here to follow morning routines: it can help limit outbursts and overflows.

Here is a morning sequence created by a parent and which I can take back and adapt. Upon awakening, at each stage I can verbally accompany my child:

What I can do to support communication and language when it is time for school activities

In order to help my child prepare for school activities, I use visual planning again. On this one, in addition to what they are asked to do, I can add a column to help them express how they feel about this activity, namely if it is easy, difficult, if they like it or not.

Here is an example of a schedule that I can set up.

What I can do to support communication and language during meals

Meal time helps stimulate my child's joint attention by, for example, placing him in front of me and putting food between us.

It allows you to increase the repertoire of verbal requests for my child (with the PECS, Makaton or other workbook) for example:

· I can help them make choices during dessert or snack: I present to them two food options and they must choose the one they want by pointing, looking in the direction of the target food, using their PECS or by responding verbally. I take more time than usual in this situation.



· I can ask them directly what they want to eat, so they can answer "I want to eat ...". In this situation, I can help my child to evoke what is missing by presenting photos of the dishes because they are not yet cooked.

· It is also the moment when I can let them express themselves on their tastes and support their oral comprehension: is it good? What do you prefer?

I don't necessarily expect my child to respond verbally, their behavior will tell me whether they enjoy the meal or not. I can then verbalize for them. In case they eat with pleasure: "Hmm, it's good!". If they reject the food: "You don't want it, you don't like it".

What I can do to support communication and language while bathing

It’s a moment of shared pleasure where I can play and chat with my child. This stimulates several prerequisites for communication such as looking, imitation, joint attention, pretend play...

As with the awakening situation, the sequences of the shower can be illustrated by a visual planning (undressing, getting into the bath, playing time, washing, rinsing, drying, putting on pajamas, brushing teeth). This sequence can be accompanied by ritualized sentences which allow my child to strengthen their oral comprehension.

Here is a sequence made by a parent, which I can adapt and use.



This is a time when I can do actions and my child can imitate me. I can also name them, which develops the semantic field of the bath and the body (the specific vocabulary).

I can physically guide my child to soap the different parts of the body or by imitation, then in a second step, they will do it alone with gestural help (I point to the target body parts while verbalizing). I accompany each step with a sentence. Sentences allow my child to associate body parts and their names.

Here is a sequence sheet for the bath which can be laminated and glued to the wall.






1: I spread the soap on my chest

2: I spread the soap on the armpits

3: I spread the soap on the left arm then the right arm etc.

Once the steps are learned, you can target verbal comprehension by modifying the steps. This can be done in the form of a game in the manner of Simon Says (Jacques a dit) said: "Simon says you have to soap your left arm!".

If I do not have time, this sheet will serve as a visual aid for my child to learn to soap themselves.

This progression in learning can be used for different activities: for example helping to set the table, putting away the laundry, making a cooking recipe.

What I can do to support communication and language at bedtime

In this situation, I can still use a visual planning as for the previous situations to enrich oral comprehension, favor transitions and anticipate everyday actions.

Here is a typical sequence:


I'm putting away the games / I'm taking my evening medicine / I'm going to read a book / I'm going to bed

· In the evening routine I can suggest a story with a book:

This allows a transition to sleep. I can leave the choice of the book to my child even if they always choose the same.

Offering a book they know well strengthens their lexical and syntactic knowledge. I then stimulate joint attention around a popular book: we look at and comment on the images together.

They can take pleasure in completing sentences or even say them themselves from memory.

I don't hesitate to add sound effects, to play on the characters' voices or to add gestures to make this moment more fun.

· I can also set up a time when we talk about everything that has been done during the day with the support of images or pictograms already used during the day. I give my child the opportunity to verbalize or repeat my sentences without requiring them to have good articulation or good syntax. What is important here is joint attention and shared pleasure.

First I can be the person who tells the story: I give a model to my child using sentences adapted to their level of language (this can range from an isolated word to a short sentence of 3-4 words) preferably using words already seen during the day to help them learn them.

Then I suggest to my child to relate with me, possibly by asking small questions.

What I can do to support communication and language during game situations

When the moment seems right, or after academic and school activities, I can offer a moment of free play. My child can play alone, with their siblings, or with me. I can offer games that my child likes and that I have at home. Games are an essential medium for communication and develop various skills.

The first games should focus on my child's interests. It is not important to follow rules. For example, if they are attracted to Uno cards, especially colors or numbers, they will be allowed to manipulate them, sort them, name them without worrying about teaching them the conventional rules.

All symbolic games such as dinner party, merchant, doctor or games with dolls are also interesting for my child's development. I can read the practical sheet “How to stimulate my child under 2 years old during confinement”.

When my child plays alone it also stimulates their creativity and imagination. To find out more about tablet and phone games, I can consult the sheet “Manage screens in confinement time”.

About the games between brothers and sisters, which are important moments for developing communication, you can refer to the sheet “Interactions in siblings”.

Lexicon

The look

The establishment of the look and eye contact is acquired from the first months of life. This is an essential point in communication, it establishes contact between the interlocutors.

A person with autism tends to look less at the other person's face, especially their eyes.

Joint attention

Joint attention is the ability to bring one's attention to a common object with an interlocutor, and to exchange, share, play, communicate around this object. It is sharing an activity with many.

An autistic child may tend to prefer to play alone, without interacting with the other.

Pointing

Pointing is the ability to show with your finger the desired object (proto-imperative pointing) or the object we are talking about (proto-declarative pointing).

It is an act of non-verbal communication, which appears before one year of age and which allows non-verbal babies and children to make requests or obtain information about a person or an object.

It requires joint attention.

Pointing is often used in people with ASD but often only to ask for something. It is not often used to set up joint attention and interaction (it is often limited to proto-imperative pointing).

Imitation

Imitation is the act of reproducing what we have heard, observed. It intervenes very early in the development of the baby. The first learnings are done through this, the child trying to imitate those around them.

Imitation is not always spontaneous or adapted in autistic children. It needs to be stimulated more specifically.

The pretend game and the symbolic game

The pretend game is the ability to play by reproducing, imitating scenes from everyday life (sound of vehicles and animal sounds, taking care of a doll, playing with food or doing housework or handiwork, etc.).

Symbolic play is the ability to divert the primary function of an object to use it as another object in the game. For example, taking a banana for a phone, a pen like a magic wand, a shoe like a boat or a space shuttle for playmobile, etc.

Children with autism tend not to use toys to pretend and imitate. For example, they will not roll a car but will align them, they will not walk a doll in a stroller but will play with the wheels of the stroller.

Taking turn

Taking turn is "everyone's turn", alternately. It integrates into game situations (ball, card games, board games, group games) but also in communication, to respect the speaking turn in conversation.

Taking turns can be difficult for your child since the consideration of his partner is not systematic.

Auditory attention

Auditory attention is the ability to take into account a heard noise / sound, to react to it, to turn around and to look for the sound source, possibly to call someone to explain this noise to us. It is also the ability to respond when we are called by our first name, to identify the beginning of a conversation, to recognize a prosody.

People with autism may not respond to the sounds around them. They tend to prefer the sounds of objects to the human voice.

For example, they sometimes have to be taught to react to the call of their first name.

Resources

· Online training for parents; https://helpisinyourhands.org

48 Boulevard Serurier, 75019  Paris France

©2020 by Dr. Benjamin Landman. Child Psychiatry, Robert Debre Hospital - Paris