Teaching Communication Skills to Students with Severe Disabilities

June E. Downing, Amy Hanreddy, Kathryn D. Peckham-Hardin

• Publisher: Brookes Publishing
• Year: 2015
• ISBN:
  9781598575798
• Edition: 3
• Topic: Education
• Subtopic: Inclusive Education

How can educators and therapists support effective communication for students with severe and multiple disabilities? Today's best research and strategies are in the NEW third edition of this trusted textbook and teaching guide. Current and future education professionals will get up-to-date information and practical guidance on the entire process of supporting communication for students of all ages, from assessing their communication skills to involving peers and adults in intervention. An important textbook and professional reference, this comprehensive volume will help educators, paraprofessionals, SLPs, and other school staff skillfully support every student's right to communicate.

TOPICS COVERED: communication assessment * intervention strategies * identification of natural opportunities to teach skills * augmentative and alternative communication (AAC) techniques * collaborative teaming * challenging behavior * Functional Communication Training * literacy instruction * peers as communication partners * teaching a wide range of skills that go beyond simple requesting, from commenting to gaining attention

WHAT'S NEW:

• More emphasis on technology throughout the book
• Timely new contributions by experts in the field
• New chapter on the relationship between communication and challenging behavior
• New chapter on communication and literacy
• More on making AAC devices accessible and attainable
• Expanded guidance on friendship development and how peers can aid intervention
• More strategies for teaching specific communication skills, highlighted for easy reference
• New case examples to show strategies and interventions in action
• FAQs, extension activities, and study questions that highlight key ideas and trouble spots

1

The Importance of Teaching Communication Skills

June E. Downing and Mary A. Falvey

Communication is the key to learning because a great deal of what we learn depends on our interactions with others. Communication can occur every time two or more people are in proximity with one another, whether in person or through electronic means (e.g., e-mail, social media, telephone). Although all human beings communicate, some individuals may have limited communication skills due to the impact of their disabilities or limited contact with others. Individuals with significant disabilities may not have full access to or full control of the multiple means by which most individuals communicate (e.g., speech, facial expressions, body language, print). This inability to express themselves as others would does not mean that these individuals have nothing to say, nor does it diminish their need and right to communicate. Teachers and other service providers must assume that all people have the desire to communicate and, therefore, must use their expertise, experience, and commitment to facilitate the development of communication for their students. The assumption that everyone has something to say is what Donnellan referred to as the least dangerous assumption (1984). This assumption demonstrates the greatest level of respect for all people (Cardinal, 2002; Leary & Donnellan, 2012). It assumes that all people can and do desire to communicate, regardless of the impact of their disability. This chapter highlights the importance of supporting all communicative efforts of individuals who do not use their own speech as their primary mode of communication.

WHO IS THE TARGET POPULATION FOR THIS BOOK?

This book addresses the needs of children and youth whose significant disabilities make even the most basic interactions challenging. This group of learners experiences communication challenges for a number of reasons. Individuals with autism and significant developmental delays may find it difficult to effectively communicate (Trief, Cascella, & Bruce, 2013). The intricate physical movements of the oral musculature required for speech often make it difficult if not impossible for people with significant physical disabilities to develop oral communication skills (Beukelman & Mirenda, 2013). Individuals with deafblindness who do not have access to visual or hearing stimuli often experience significant communication delays (Chen, 2005). Those with significant intellectual delays often find it difficult to associate symbols with their referents. This group of learners also is likely to experience difficulty acquiring and understanding abstract means of communication, such as speech or American Sign Language (ASL) (Westling, Fox, & Carter, 2013). Many of these children use alternative forms of communication in their efforts to understand and be better understood by others (Beukelman & Mirenda, 2013).

Communication for those who have acquired some speech may be primarily focused on expressing basic needs, such as requesting a desired food or activity. Limitations in using complex language patterns hamper more abstract communication, such as discussing dreams, feelings, concerns, and/or future plans. Although these individuals may have multiple means of communicating without abstract symbols, the ability to clearly express more complex thoughts and feelings is restricted without the use of a system of representative symbols. Additional effort will need to be taken to increase the complexity and range of communication functions, including teaching students to make comments, ask questions, and engage in reciprocal conversations (see Chapter 7).

Because this is an extremely heterogeneous group of individuals, information in this book concentrates on those children and youth (ages 3–22) who receive their education in age-appropriate general education classes with the support of teachers, classmates, paraprofessionals, parents, administrators, and related services providers. General education classrooms afford both students and teachers essential opportunities for learning, particularly communication skills (Downing, 2011; Giangreco, 2011; Janney & Snell, 2006; Jorgensen, McSheehan, & Sonnenmeier, 2010). Therefore, general education settings where students with communication disabilities are provided with substantial opportunities to interact with, teach, and learn from peers without disabilities will be the premise of this text. Much of the information presented in this text, however, also has applicability to other natural environments, such as the home, the workplace, and other community settings. Communication interventions for students who need them are strongly recommended, no matter where the students are educated.

WHAT IS COMMUNICATION?

Communication is the exchange of a message between two or more people (Stremel, 2008). Communicative competence in a symbolic and abstract language system (e.g., spoken English or Spanish, manual ASL) with formalized rules of word representation, production, and use, however, is not a prerequisite for communication development. In fact, one can be quite adept with a spoken language and not communicate at all if there is no one to talk to, no one present who understands the spoken language used, or no one who is attending to or hearing the message. A request for directions in a foreign country or an interaction with a preoccupied teenager illustrates these points. Students with significant communication challenges must be educated and immersed in environments where same-age peers who are competent communicators provide frequent opportunities to use communication skills.

Just as the presence of language does not necessarily mean that communication will follow, the absence of language does not always mean that communication cannot occur. In fact, those not using language can communicate quite well at times. For example, college students putting away their papers and pens informs the professor that class has ended; rumbling stomachs and glazed eyes inform a principal that the meeting is over (or should be); and the fidgety behavior of young children who need to go to the bathroom is easily recognizable. The absence of symbolic language behavior is irrelevant for all of these situations and countless others. In fact, as much as 90% of messages exchanged between two very verbal people can be attributed to nonverbal behavior (Evans, Hearn, Uhlemann, & Ivey, 2003). In addition, many nonverbal communicative behaviors are universal, recognized, and understood despite cultural and linguistic differences (Ekman, 2003; Izard, 1994). Recognizing the power of nonsymbolic yet highly communicative behavior (e.g., facial expressions, body movements, gestures) is critical for those interested in improving and increasing the communication skill development of students who have difficulty mastering symbolic languages. Such behaviors form the foundation for enhanced communicative interactions (Cress, 2002; Dennis, 2002) because they are easier to shape and, therefore, easier to learn.

WHO NEEDS COMMUNICATION INTERVENTION?

The absence of a clear expressive communication system has led some people to assume that students with severe and multiple disabilities have little to say (Biklen & Cardinal, 1997; Jorgensen et al., 2010). Furthermore, if the student experiences cognitive delays coupled with communication challenges, then he or she may be perceived as someone who will not/cannot benefit from communication interventions. The student’s age, perceived discrepancy between cognitive and communicative ability, and absence of speech are often cited as reasons why a student with a severe intellectual and communication delay would not benefit from intervention (Snell et al., 2003). Unfortunately, these views may lead some practitioners to spend valuable time and energy determining eligibility for communication intervention services rather than determining how to meet students’ communication needs. Parents and teachers express their frustration at the inability to gain access to quality speech-language services for their children or students who do not speak.

The belief that children who experience delays in language and cognitive development are unable to benefit from language intervention has not been substantiated (Beukelman & Mirenda, 2013). In a report to the National Joint Committee for the Communication Needs of Persons with Severe Disabilities, Snell and colleagues (2003) provided a strong rebuttal to the many rationalizations used to avoid serving students with significant disabilities. These experts argued that all individuals with complex communication needs require and benefit from quality services. They must qualify for services and appropriate interventions because of their very need to communicate. The question should not be whether students with significant disabilities will benefit from communication intervention, but rather how best to provide that support and intervention.

ENVIRONMENTAL CHARACTERISTICS OF COMMUNICATION

Communication by definition requires at least two people—a sender of the message and a receiver who understands the message. Critical components of communication include form (i.e., a way to send the message), content (i.e., something to talk about), and a reason or purpose to communicate (Beukelman & Mirenda, 2013). Most of us with well-developed language and communication skills use a variety of forms to communicate, including speech, facial expressions, gestures, and vocalizations (e.g., grunts, moans). The varied experiences in our lives, along with the many different people we encounter, provide things for us to talk about (i.e., content). Finally, we are motivated to share our thoughts, ideas, emotions, and opinions with others because we typically receive positive feedback. In other words, the other people in our lives listen, understand, and value what we have to say. In summary, communication is more than a mechanical act; it is steeped in the environmental conditions that help make it flourish and grow (Downing, 2011). These environmental conditions need to be present in order to promote, encourage, and support communication in students with severe and multiple disabilities.

Disadvantages of Segregated Educational Programs

There are several disadvantages to segregated educational programs, especially when the focus is on teaching, supporting, and expanding communication and language skills. First, students in these settings tend to have extensive interactions with adults but limited interactions with other students (Carter & Hughes, 2006). Not only can this lack of social opportunity make it difficult for students with significant disabilities to learn communication skills, but it can also interfere with their ability to make friends (Falvey, 2005; Giangreco, 2011). Far too many students with significant disabilities are automatically placed in segregated special education classes and schools, often times requiring them to travel great distances to these programs, which can further inhibit friendship development (Falvey, 2005). Second, the brunt of the responsibility for being a responsive communicative partner in special education classrooms composed solely of students with a variety of communication difficulties falls to the teacher or other adults in the room. Opportunities for meaningful communication with individual students are limited because the adult must attend to a number of students who all need considerable support. Third, students with significant disabilities attending segregated classes and schools are often denied access to the core academic curriculum, including reading and writing. Because they do not read or learn about the same topics their peers without disabilities are reading and learning about, they have less in common to talk about. Furthermore, reading and writing are forms of communication, and these skills can further facilitate the development and expansion of communication skills (Downing, 2005). Finally, students in these settings typically remain in one class for the entire day with less opportunity to interact with different and novel people throughout the day (Jorgensen, Schuh, & Nesbit, 2006). All of these variables can serve to depress versus enhance communication and language skills.

Advantages of Inclusive/Integrated Educational Programs

In contrast, inclusive settings provide a more conducive environment to promote, encourage, and support communication and language skills. Social contacts increase when students with significant disabilities are educated in general education classrooms, which results in a larger social network and more durable relationships (Carter, Cushing, & Kennedy, 2009; Downing, 2005; Giangreco, 2011). Although friendships cannot be mandated in a general education classroom, at least the opportunity exists for regular and recurring interactions that could lead to the formation of friendships. Common experiences can be shared that can form the basis for more in-depth relationships. Foreman, Arthur-Kelly, Pascoe, and King (2004) compared the social-communicative interactions of students with profound and multiple disabilities in separate special classrooms with those of similarly matched students in general education classrooms. They found that the students with disabilities in general education were involved in significantly higher levels of communication interactions than were their matched pair in separate special classrooms.

When students with disabilities are full-time members of general education classrooms, the other students in the class serve as communicative partners. In fact, these students may have a better perspective than adults given the closeness in age to a classmate with significant disabilities and may, as a result, be better able to understand what their classmate is trying to say. Certainly, they serve as more age-appropriate and effective models for communication skills (Carter & Hughes, 2013). Furthermore, communicating with peers is a more direct way for a student to achieve friendships than learning communication skills first with a teacher and then having to transfer those skills to an interaction with a peer. As an added benefit, students without disabilities acquire a better understanding of diversity and learn ways to interact with those who have disabilities (Jones, 2007). Many students given access to reading and writing accommodations such as an electronic tablet (e.g., iPad) with voice output (e.g., the iPad application for “Speak It!”) have successfully increased their communication skills through supported typing or facilitated typing, often times referred to as facilitated communication (Biklen & Cardinal, 1997). Many of these same students have had the support or facilitation faded over time and are now typing independently (Cardinal, 2002).

Form of Communication

Individuals need some identifiable and understandable form of communication to effectively convey a message. Sometimes the form or forms used by the individual are very clear (e.g., spoken language, signs, universally understood gestures). Sometimes forms of communication are more difficult to discern. The form used by individuals with the most significant and complex disabilities may be more difficult to interpret (e.g., fast breathing to indicate “no;” smooth, easy breathing to express “yes”). The forms of communication used by the individual must be understood by his or her recipient or he or she fails to be communicative. Therefore, highly idiosyncratic forms of communication may require a fair degree of interpretation by the communication partner.

Professionals in the field of speech-language and communication generally recognize the multimodal nature of communication (Beukelman & Mirenda, 2013; Blackstone & Berg, 2003; Reichle, 1997). No one form of communication will suffice to meet all needs or all social expectations of a given situation. With multiple ways to convey messages, more options are available for choosing communicative alternatives that fit each individual. For example, some students with significant disabilities may not hear or understand speech because of difficulties processing auditory information. These individuals, however, may benefit from visually ...