Compilation of tips, ideas and approaches suggested and utilized by a group of speech and language professionals.
Treatment of communicative problems is the primary responsibility of the speech-language pathologist. However, this responsibility does not belong exclusively to one profession. It encompasses the cooperation and assistance of a number of disciplines such as medicine, dentistry, psychology education, special education, and audiology. Treatment is an interdisciplinary team undertaking captained by the speech-language pathologist. Prevention of communicative disorders involves the same team concept and members. It would be inexpedient to attempt to prevent or treat a communicative disorder by oneself. Since communication is so pervasive and complex, it overlaps many boundaries. These communicative boundaries are occupied by a number of professionals and nonprofessionals who, because of their interaction with children, can provide valuable assistance if encouraged to do so.
In this chapter we have included 101 practical suggestions for helping children talk better. They can be used by all members of the team. Special emphasis is placed on parental activities during early childhood when communicative development begins. There are numerous approaches being used by the professional world. However, the common denominator appears to encompass motivation of the client and sincere belief in the worth, value, and effectiveness of the approach by the clinician and client. Many treatment approaches seem to work if the clinician believes in them. Most approaches do include a systematic hierarchy of sequential steps as follows:
Step l: Explain to the child and parents what the specific problem is and why it may be present, when possible.
Step ll: Obtain a commitment or contract from them regarding their cooperation and involvement in the treatment process.
Step lll: Obtain a baseline of where the child is functioning - which sound he or she can and cannot make and the percentage thereof. Record keeping should continue throughout the treatment program.
Step lV: Begin treatment by identifying the sounds to be worked on, comparing correct productions with incorrect productions, and learning to make them correctly in isolation or nonsense syllables, emphasizing the various sensory modalities.
Step V: Learn to make the sounds in words of varying length, difficulty, and in initial, medial, and final positions.
Step Vl: Learn to use the sounds in structured phrases, sentences, and conversation in the clinic.
Step Vll: Habitually use the sounds in all environments. This final step must ensure habituation, also called carry-over, transfer, or maintenance. If the child is not using the sounds subconsciously in all settings, then treatment should probably continue.
All approaches attempt to begin treatment at the appropriate level - at the level where the child is functioning - and then progress systematically to higher levels of communication following a normal developmental order. Depending on the approach used, treatment might include play or doing various activities while talking about them; discovering missing rules of language and then stimulating their usage; modeling correct linguistic utterances; and emphasizing the acquisition of meanings through concept formation and development in which the child learns to use language by thinking and comprehending the underlying concepts of language. All approaches have reported success as might be expected. Whatever approach is considered, it should be systematic, meaningful for the child, reinforcing, and probably intensive. Treatment should also be interactive, which implies group rather than individual treatment. It should also be realistic in its approach. For example, when asking a child how he or she feels, do not expect the child to say I am very well, thank you, but rather accept fine because that is how we talk. Since there are so man aspects of language, the clinician must be aware of the possible range of language problems that could exist in one child. The decision to attempt to treat all of them at once or one at a time will vary with the child and the clinicians philosophy. Efficiency and effectiveness should be the bywords. Many communication disorder can be prevented if adults will become more knowledgeable in ways to teach communication and then take the time to provide appropriate stimulation for all children, not just those children who display a communicative delay or disorder. The following suggestions are intended to provide ways of stimulating good speech and language and preventing communicative problems.
The great many suggestions may seem overwhelming and some have been alluded to previously. It is not our intent that all of these suggestions be tried with all children, but rather that a few of them be tried and used only insofar as they are needed and effective. Some ideas may be especially helpful with a speech-handicapped child. Others may be most effective with a hard-of-hearing child or a child who stutters. Select the suggestions that work best for you and for the particular child you are teaching. The suggestions are not listed in any order of importance, so peruse the entire list before you begin to teach. If you have a question about how any of the suggestions should be carried out, ask a speech-language pathologist to interpret or explain them to you. It is far better not to have tried them at all than to have tried them incorrectly and failed. Hopefully, they have been explained clearly enough not to need additional clarification.
1. Spend more time with the child who is not talking or who is talking very little. Merely increasing the amount of time spent with the child may encourage talking, but remember to increase the quality of the relationship, that is, the meaningfulness of the play activity, the degree of pleasure provided by the activity, the appropriateness of the words spoken, and the kind of praise and reinforcement used when the child says or attempts to say a word. Supportive persons can restructure situations to provide more time for the taciturn child.
2. Be a good model. This has to be one of the most important factors in teaching communication: it also is one that is too frequently over-looked. Everyone will agree that children are great imitators; these imitative characteristics can be used effectively in learning normal communicative skills. Unfortunately, many adults are guilty of being poor communicative models. They may talk too fast, too slow, too soft, or too loud. they may slur their words, run syllables or words together, talk in a monotone, with inappropriate inflections, with a pipe or cigarette between their lips. They may talk with poor eye contact or while facing the opposite direction of the listener. A good model, however, makes a special effort to talk clearly, with appropriate inflections, and short, easy-to-understand words and sentences and remembers that good talking involves good listening, good eye contact, good facial and bodily gestures; and also remembers that talking to, with, or in the presence of a child implies caution in the number of words, the kinds of words, and the arrangement of the words spoken. A good model is are that communication is learned primarily through the sense of hearing and listening and that a child speaks what has been heard whether it be god or bad communication. (For all types of communicative problems).
3. Make certain that speech and language learning are fun. Most of us learn faster and remember what we learned longer when the learning experience is fun. Remember, it is easier to play with a child than to work with a child. the use of games and other enjoyable activities can be very helpful, especially at first. Eventually, you may be able to use other, less time-consuming activities or techniques to teach good communication. In the beginning it is especially important to motivate the child, to gain cooperation, to provide an incentive for carrying out talking activities; this can best be accomplished if the activities are pleasurable. (For all types of communicative problems.)
4. Make certain that the communicative activities are rewarding. Intrinsic satisfaction from knowing that the speech is better is generally not sufficiently rewarding to a young child. Activities should incorporate fun games that can be used as rewards for hard work or good speech. Other rewards can also be used, such as a token for each good sound or correctly used word, a sugarless food reward for each verbal response called for, or a word of praise such as good or good talking after each correct response or after a certain number of correct responses. An effort should be made to decrease the frequency of the reward and to move from tangible food reinforcers to verbal reinforcers as therapy progresses, but use whatever reward is needed to keep the child interested and working on communication. (For all typesof communicative problems.)
5. Make certain that the communicative activities are appropriate. We cannot overstress the importance of having some knowledge of normal communicative development, which will provide you with guidelines for appropriate stimulation. For example, you would not each a 3-year-old child to say r correctly because this phoneme is not normally leaned until age 6 years; neither would you teach s if p or b has not been learned because s is a later sound that is more difficult to teach. Do not concentrate on speech with a child who has very little language. First work on increasing the vocabulary. Start a little below where the child is. When there is a basic vocabulary, start teaching speech according to the sequence of normal development. (For all types of communicative problems).
6. Make certain that the communicative activities are meaningful. Not only should the activities be appropriate, rewarding, and pleasurable, but they should also be meaningful. Even if the word dog is part of the early, basic comprehensive vocabulary, the child may not have a dog, be interested in a dog, or need to know the word at this time. So teaching the word dog may not be meaningful until later. Teach words that are most important to a child. The selection of words will vary with the child and the situation-with the needs of the child at that particular period of life. For example, if the word eat has not yet been learned, it might have considerable value and should be taught. It can be used with meaning or with a purpose frequently during early childhood. Well-meaning persons sometimes teach the names of favorite relatives, animals at the zoo, colors, or counting when the child does not have a useful, basic, expressive vocabulary. (For all types of communicative problems).
7. Provide the child with many experiences in listening. There is a cliche that goes, We have two ears but only one mouth; therefore we should listen twice as much as we talk. This may still be good advice for all of us, but especially for the child who has faulty speech or delayed language development. Listening is extremely important in leaning to talk and in the feedback-and-forth process of communication. It is not the same as hearing. We are born with hearing, but our listening is developed through practice. A child can and should be taught to be a better listener by listening to different fun sounds, interesting sounds, and sound pairs that are the same or nearly the same. Listening can also include practice at increasing memory, such as listening and remembering the sequence of digits, nonsense syllable, or words. Records are available that stress listening, such as stories that instruct the child to turn the page when you hear the bell. Activities may include carrying out commands or instructions, and if done correctly, will terminate in the child's receiving a reward such as, If you will go to the kitchen, and open the lid to the cookie jar, you will see some cookies that mommy just baked. You may take one. Theses listening activities will improve the child's discrimination, ability to recognize similarities and differences, memory, and hopefully ability to listen to others more carefully. This, in turn, should help to improve self-monitoring, to appreciate the importance of effective listening, and to make the child a better communicator. (For all types of communicative problems).
8. Verbally bombard the child. Most children are reared in a sufficiently verbal atmosphere, but there may be times when you could take better advantage of situations in which verbal bombardment might be very effective. When a child is carefully watching or listening to you, take advantage of the attentiveness by selecting words to use. Use them repetitiously. Few people learn a word after having heard or used it only once. Fill the air with appropriate, well-chosen, and well-timed words that are pertinent for the particular occasion. After the child is verbally bombarded with a particular word, allow ample time for a response. Verbal bombardment is important in preventing communicative disorders or in helping a child with limited communicative development, but it should not be provided indiscriminately or without sufficient repetition. There are good times and bad times for practicing verbal bombardment. (Primarily for language problems).
9. Discourage others from talking for the child. Nothing is more frustrating than to have someone talk for you. Stutterers can attest to that fact. The young child who is searching to find the right word to say or who is struggling to pronounce a particular word must feel the same frustrations when someone else says the words or relates the experience. A child deprived of the opportunity to communicate will not have had the necessary experience to develop normal communication. This lack of experience could be detrimental to all parameters of communication-articulation, language, rhythm, voice, hearing, and listening. Inform others of the child's need for expression, even if the speech is awkward and disfluent or less clear than the speech of other children. Provide the child with as much time as needed to express thoughts. Do not help by saying the word for the child or by otherwise interrupting communication. All children desperately need to practice talking. Practice of this learned behavior should be regarded no differently than practice of any other learned behavior. After all, we would not expect walking skills to improve if the child were carried all the time. Brothers, sisters, parents, grandparents, and other children are typically most likely to interrupt the child's talking. (Primarily for articulation, fluency, and language problems).
10. Provide a need to talk. Some children may not talk because they have not need to talk. They are not born with this lack of desire; it is learned through negative reinforcement, and in some instances, through actual punishment. Other children may not talk because brothers and sisters have always talked for them. Still others may not talk because talking is difficult for them or because it does not provide them sufficient pleasure. Whatever the reason, all children should have a need to talk. You can provide a need and then a reward for making an effort to talk. For example, ,you can place a dish of ice cream before the child but out of reach while saying eat or ice cream several times. Any attempt by the child at communicating should be rewarded with the prize. Later you would expect better articulation. Also take advantage of the opportunity by repeating the key word over and over while the child is eating. Talking must be fun; it must be well received by the listener; it must be appreciated; it must serve a purpose; and it must fulfill a need at that particular time. By providing the right situations, you can provide a need for the child to talk. (Primarily for articulation and language problems).
COMING NEXT ISSUE: MORE TIPS AND TECHNIQUES TO PROMOTE SPEECH
This article first appeared in issue #7 of Down Syndrome Amongst Us