by Marge Blanc, M.A., CCC-SLP
THeXPERTS
Child-Directed Language Therapy
by Marge Blanc, M.A., CCC-SLP
THeXPERTS
Child-Directed Language
Therapy
As a speech therapist I love the philosophy of
"child-directed" language therapy, but I have heard it's not effective for
teaching kids on the autism spectrum. Can I use these methods at all
with my ASD kids, or do they simply need a more structured, ABA-type approach to
learn language?
These are great questions, and ones we often simply don’t seem to “have time” to ask ourselves. We have the accountability of IEP goals and progress to report, the pressure of limited funding on our shoulders, and a plethora of experts telling us over and over again how kids on the spectrum are so “different.” With so much going on around us, it’s easy to feel a little guilty stopping to ask if some of the “best practices” (like “intentionality” and “child-directed therapy”) in the field of Communicative Disorders even remotely apply to our ASD kids.
Two issues are involved here: (1) Do kids on the autism spectrum “learn” language, like a skill, or do they “develop” it in a natural way, as do other kids? (2) Do kids on the spectrum have internal motivations to communicate, like other kids, or do we have to motivate them to communicate? If they do have their own motivations, how can we uncover them well enough to be “child-directed” in our therapy with them?
After ten years of asking these questions every day, I have learned some things that can help us support natural language development in kids on the autism spectrum. Taking the original research of Barry Prizant, Amy Wetherby and others to heart, I looked for “gestalt language learning” patterns in my ASD children. I see them every day, and rejoice along with my kids when they move predictably along a pathway from repeating (“echoing”) large chunks (“gestalts”) of language, to using smaller chunks, to constructing original sentences very much like the rest of us. Depending on a particular child’s speech skills, we all hear various renditions of “movie talk” (sometimes the unintelligible, low roar of entire video scripts) and then, later, isolated parts said at amazingly-appropriate times (“It’s showtime!” “I can fly!!”). Still later, with support from knowing adults, we hear still-smaller parts mitigated from common sentence patterns (pulling out “It’s” or “I” from the above quotations) and, finally, we watch in amazement as our children learn to build original sentences, albeit later than their peers, but in the same way!
Is this “learning” or is it “development?” Granting that we use these terms interchangeably at times, it seems important here to acknowledge “gestalt language learning” as actually development, just as is the more commonly-understood “generative language learning.” It is not skill-based learning, like writing letters, although certainly all children are capable of “learning” certain words and “scripts” when taught. The point here, as Prizant and Wetherby demonstrated over 15 years ago, is that language develops in the ASD brain, and the pattern of development (“gestalt” or whole chunks first) is predictable. It is natural, actually common in many of us (boys, in particular), and even a part of all of our language development systems!
We, as SLP’s, educators, and parents, then, will serve our kids best if we understand how language develops in our kids and then be there to support it. If we attempt to teach certain words and language structures out of a developmental progression (e.g. the overtaught “I want ...” phrase, when a child is not developmentally ready), kids will certainly learn them. But, unfortunately, these will be the words and phrases we will hear them use forevermore! Not surprisingly, the more we have kids practice these “target” words and phrases, the “better” they will learn them; eventually they will become overlearned. At this point, the overlearned and overused words and phrases become like a “default” setting, one that kids “access” a little too easily, without real intentional thought, and actually interfere with natural language development.
So, what can we do? First of all, ask if your SLP is familiar with gestalt language development, or, if you are an SLP, go back and read more about it! Listen for versions of it in other kids...especially boys. Kids might say, “To infinity and beyond!” even when they are too young to have seen the movie referent, or to have any concept of “infinity.” As a gestalt expression, however, it doesn’t matter to its use on the playground. As adults, we might harken back to a few of the comparable expressions of our childhood, e.g. “Forward ho the wagons!” or “Yo, Rinnie!” (anybody out there as old as me?), which within the right community need not be broken down, analyzed, or literally understood to be effective as gestalt expressions meaning, “Charge!” or “Here I go!” Our list of examples grows quickly, once we are clued in!
“Gestalts” seem to be much more common as an early language strategy in “right brained” learners, often boys, who seem just a little behind the girls in “typical” language development during the early elementary grades. But all of us have some “gestalts” in our language that we never break down, or mitigate. To this day, I have no idea how many days are in January, until I mumble, “Thirty days has September...” and hope no one is listening too closely until I get to the end and figure it out.
WE,as
SLP’s,
educators, and parents,
then,
will serve our kids
best if
we understand
how
language develops
in our
kids and then be
there to
support it.
Let’s now consider the second issue, “Do kids on the spectrum have internal motivations to communicate, and can I tap into these in child-directed therapy?” All the evidence I have seen in my ten years with ASD kids points to a resounding, “Yes!!” I have seen no dearth of internal motivation to communicate; the differences from other kids seem to be in the difficulty ASD kids have demonstrating, or showing it—or, conversely our difficulty being able to see it. In other words, their challenged sensory and motor systems create such a discrepancy between this “external state” and their “internal state”, that we simply can’t rely on what they do motorically as representing the depths of their inner thoughts and abilities.
When I think about how easily the typically-developing child can command our attention with eye contact and pointing, I am not surprised that we are fooled into thinking that these are the only indicators that kids care about us or other things! We have been pretty well trained by our typical kids to regard eye contact and pointing as virtually synonymous with being interested. Sometimes, with our ASD kids, it is only in hindsight that we realize that they cared about something for a long, long time (maybe years) before they had the motor ability to show us. We often realize, with more or less degree of self-blame, that they would have liked to talk about bicycles, for example, long before they had the motor ability to point to one in the garage, get it out, much less ride it themselves.
What such a child would like to have shared with us long ago was an “intention,” to communicate, for instance a thought such as, “Can you show me how a bicycle works?” or “Would it be safe for me to ride on that with you?” or “Do you have any videos that show how people actually balance on those things?” Yes, such a complicated intention would be the kind of thought any child would have. Thinking about the typically-developing child first pointing to a bike, he probably was not trying to communicate, “I want a bike,” but something less specific like, “That bike is interesting. How does it work?”
When we respond to the typically-developing child’s finger point, we don’t know exactly what he intends to communicate. But, we assume there is something, some interest we can address. With our ASD kids, we don’t have a point to respond to. We might get a slight glance in the direction of the bike, however, or a squeal when one goes by, or a frequently-rewound segment of a video to give us a hint. In these and dozens of other “clues,” we find our kid’s intentions...and the core of our “child-directed” therapy.
Even when we have a list of possible intentions, gathered from careful observations made by families and others, what do we do with them in a play session, when the child is moving around seemingly “aimlessly?” Here is where the expertise from occupational and Physical Therapy comes into play. Setting up our therapy rooms and homes with materials used in OT/PT clinics (we all know the value of trampolines, now, don’t we?), kids can then be “set up” to “access” whatever motor skills (speech, gesture, other non-verbal behaviors) they have developed so they can actually communicate their intentions!! If we are careful observers and listeners, we will see the attempts, the near-misses, and the clues that tell us what to acknowledge, “gloss” back to kids, and make part of our “feedback loops” for helping kids get closer to their verbal and non-verbal targets.
When real intentions are at the heart of what we do with kids, we don’t have to worry about generalizing. We can truly “do life,” and do “on-the-spot” practice of the motor skills that challenge our kids. Practice, then, becomes based on what kids want to communicate, not on what we have chosen for them or limited them to, and motivation is intrinsically built into therapy. In this way, “child direction” zeros in on targets naturally and instantly, and “working” is internally-motivating, because kids know we want to help them demonstrate who they already are, inside!
References
Blanc,
Margery (1998) Language Development in Children with Autism: A
Practical Approach to
Gestalt and Echolalic Learning Styles.
Madison, WI: Wisconsin Speech-Language Hearing
Association Convention.
Blanc,
Margery (2001) Language Development in Children on the
Spectrum: A Developmental
Approach to Intentional
Communication. Green Bay, WI: Autism Society of Wisconsin
Convention.
Prizant,
Barry M. (1983) Language acquisition and
communicative behavior in autism: toward an
understanding of
the ‘whole’ of it. Journal of Speech and Hearing Disorders, 48, 296-307.
Wetherby,
Amy M. and Prizant, Barry M. (2000) Autism Spectrum
Disorders. Baltimore, MD: Paul H.
Brookes
Publishing Co.
BIO
Marge Blanc, M.A.,
CCC-SLP, is a Speech-Language Pathologist with 30 years of clinical experience, three of them as a Clinical Instructor in the Department of Communicative Disorders, University of Wisconsin- Madison. She founded and now directs the Communication Development Center, a non-profit clinic in Madison, which specializes in communication services to children on the autism continuum and others who benefit from sensory-motor supports. Contact her at the Communication Development Center, 700 Rayovac Drive, Suite 200, Madison, WI 53711; phone (608) 278-9161; email lyonblanc@aol.com
Printable Version
(Adobe Acrobat Required)
January - February 2004 AUTISM ASPERGER'S DIGEST