One of my first roles as a professional clinician (formal title in Canada "Communicative Disorders Assistant) was to help the speech-language pathologist who I was working with complete assessments for adults with developmental delays. The individuals we were working with were adults with developmental delays (or mental retardation) who were living in group homes and day programs in the community. Some of the individuals has Down syndrome, cerebral palsy, and/or hearing loss. One of the individuals had Rett syndrome. Many of the individuals had they been children now would have had a diagnosis of Autism/PDD or Fragile X syndrome. Most of our clients were non-verbal and many were also on a Behaviour Therapists' caseload.
In my role, I collected information regarding and past assessments, interviewed caregivers and videotaped 50 spontaneous attempts that the individual made to communicate. These 50 spontaneous attempts at communication were then analyzed by the speech language pathologist in order to see just how the individual was communicating. Often getting 50 spontaneous attempts at communication took 3-4 hours of videotaping so it could be completed in a day. One of the clients, who would have probably been given a diagnosis of Autism today, took to calling me not "Sara" but "Sony" because of the camcorder I carried around on a daily basis!
What was a spontaneous attempts at communication? It was any attempt to communicate a request (e.g., reaching for an item), a rejection (e.g., pushing an item away), get someone's attention (e.g., vocalizing when a particular staff entered the room), etc. Getting these 50 attempts at communication was usually not hard. Often my most difficult challenging was encouraging staff to stay in the room to interact with the client because they didn't want to be on camera! The most I videotaped one client was for three 7 hours days straight. Oh and by the way this was videotape...yes, good old VHS tapes!
The speech language pathologist, Susan Troncho, who I worked with would then watch and analyze the videotapes, review the caregiver interviews and comb through all past reports. The reports we looked at where any past assessment and treatment reports that touched on speech, hearing, behaviour, occupational therapy, physiotherapy, neurological and developmental psychological evaluations and others. Even a physician's pharmalogical reports were examined when available. Each of these held pieces of a communication puzzle that we were trying to put together.
While few of the individuals I saw were verbal, they did communicate. They communicated what they wanted, to get attention, to direct attention, to ask for breaks, to be social or just to say no. They didn't use the words that we would use but they used sounds, eye gaze, and gestures to share their messages. Some individuals would take your hand (actions on people) to a drawer that held something they wanted while others would simply stand or sit beside (using proximity) something they wanted.
After Susan complete her analysis we would meet with all caregivers (staff, family as well as any other therapists involved) for what we called an "assessment review meeting". This was done before a formal assessment and treatment report was written to confirm the picture of what we saw and to discuss recommendations with staff. We wanted to ensure that all parties thought that any programming recommendations were practical and agreed upon by all parties before they were written up.
My job was then to work with the individual and all caregivers to ensure that the programming recommendations were understood and followed through. With the staff we created communication displays, learned sign language, wrote social stories, etc., all as a way to help the individual understand what was communicated to them and to help caregivers understand how the individual communicated.
For many of the individuals I created tangible symbols (picture or object symbols that were portable) and taught the staff how to teach the individual to use these to communicate. I was teaching the staff to (1) recognize how the individuals they worked with did communicate (using sounds and body movements) and to (2) encourage these individuals to use more recognizable forms of communication (picture symbols or sign language).
One individual we worked with was a very strong woman in her early thirties. She could be very aggressive and didn't use spoken words at all. Many of the staff and clients were afraid of her. She was also very sweet. She would often leave her program room in the day program to go to the bathroom. When staff tried to stop her, she would yell and hit. We taught her to take a tangible symbol with her, a pink doll house toilet, to let staff know she was going to the bathroom. I actually put in a order for 20 of these toilets from Fisher Price! I'll never forget the smile on her face as she trudge down the hall to the bathroom waving that pink toy toilet in the air! No one stopped her but they did cheer her on!
Sara Bingham is the founder of WeeHands and the author of The Baby Signing Book. WeeHands is the world's leading children's sign language and language development program for babies, toddlers and preschool children. Sara is currently writing her second book, "Encouraging Communication".
