|
|
        
|
Developmental Approach to Problems in Relating and Communicating in Autistic Spectrum Disorders and Related Syndromes Stanley I. Greenspan, M.D. Reconsidering Aspects of the Goals of Speech and Language Therapy Speech pathologists have been at the forefront of using dynamic, affect-based interactions to promote language and thinking. Below are a few clinical observations we have made that may contribute to the tactics that can be employed. We have found that the quicker a child can harness preverbal and verbal communication patterns in connection with strong states of affect (i.e., intent), the better. For example, repeating the word "open," while at the door trying to open it to get a favorite cookie on the other side is far more useful than simply imitating the word "Open" without the strong affect or looking at a picture and using a word to label a picture. As soon as a child can repeat the word in connection with an emotionally motivated action, we find it is especially helpful to challenge the child to think rather than just repeat, and, for example, say "Open" or "Close." If the child repeats "Open close," then we show the child the open door and the closed door and with even more emphasis, challenge him with multiple choice "Open...close." Eventually, because of his strong motivation, the child thinks it through and repeats the first rather than the second and comes to understand "open." The affect and motivation, coupled with solving a problem, appears to speed up the learning process considerably. As part of mobilizing the child's affect, we also have found that children's grammar and, more generally, pragmatic language, is mobilized quickest when we help children open and close many preverbal and verbal circles in a row. The key is long interactive dialogues using gestures and, when possible, words. For example, when the child says "Out," we would say "Do what?" If the child says, "Play outside," we would say, "What do you want to play?" If the child is stymied, we might offer a few choices "Play with swing or a chase game?" We would try to get long sequences rather than focus on full sentences. For example, rather than having the child imitate "I want to go outside," we would focus on the number of circles of communication, even if each circle only contains one or two words (or a short phrase). Similarly, even if the child confused pronouns and said "You want to go outside," when he meant he wanted to go outside, we would go after the affect (intent) rather than model the correct response to the child. For example, we might playfully, say, "OK, I'll go outside" and then ask again, "Who wants to go outside?" If the child says, "You go outside," we might say, "I am outside" and ask him if he wants to go outside, emphasizing "you" and then perhaps use his name and say, "Johnny, want to go outside?" Then we might emphasize, as he's banging on the door, that "I" am outside. While this may sound like a little bit of the old Abbott and Costello "who's on first?" routine, if done with a gleam in your eye and a light-hearted attitude, the child actually learns his pronouns more quickly and will frequently start off with "Johnny go outside" and then eventually get the idea that "I" refers to Johnny. More importantly, in this view, rather than long grammatically correct sentences, is the use of back and forth speech, motivated and initiated through connections with strong affect. In a sense, the affect creates the proper verb/noun relationships and eventually helps organize the pronouns as well. The goals of this approach are the same as the approaches that would use a little more modeling in place of this many interactions. The more you can use interaction together with some modeling to help the child pronounce the relevant words, the better. We approach a child who is echolalic, or is repeating scripts, or is repeating lists of nouns in a seemingly meaningless way using the same principles. We create opportunities for interaction based on strong affect. For example, we might hide a toy in our hand that the child really wants, and as he's grabbing for it with his gestures, help him find the word to either label the toy or say "mine," or "give it to me." The affect combined with action quickly pulls the child out of the echolalic, scriptive, or repeating word patterns and into a meaningful gestural and verbal dialogue. The action and affect combined, in a sense, provide the organizational structure, the roadway, so to speak, for the meaningful use of words. What we are doing is working at the earlier affect/gestural/action level, which is compromised in many children with developmental problems, at the same time that we are working on the verbal/symbolic level. |
|
Copyright©2006 This site designed and maintained by
VisionPoint®
|