Tuesday, March 17, 2009

Some Minutia about Our Language Program

We are wrapping up our current objective in which Pamela takes responsibility for keeping me on track with joint attention. I found the coolest graphic illustrating the kind of joint attention Pamela learned: like the person with no hat, she is gazing at me (the purple-hat person) to make sure I am looking in the right direction.



We focused on Pamela using more elaborate language to redirect my attention. While she writes or types in complete sentences when narrating books, real-time interactions flow so quickly that Pamela either relies on vague language ("Over there" or "Wrong way") or nonverbals. RDI emphasizes nonverbal communication in early stages because nearly all autistic children missed the opportunity to learn it early in their development (or lost that ability). Teaching a child to talk without learning to read facial expressions and body language leads to awkward interactions. They end up ensnaring people in long monologues about their favorite topics without knowing whether they are enchanting their communication partner or boring them to tears. An autism remediation post listed you-tube clips breaking down nonverbals: introduction, body (emblems, illustrators, affect displays, regulators, adaptors), face, eyes, touch (positive touch, controlling touch, playful touch, ritualistic touch, task-related touch, touch avoidance), space (territoriality), artifacts (space decoration, appearances, clothing, color, adornment, scent), and silence.

Pamela has both autism and a severe language disorder. We never had her formally diagnosed but two SLPs who know Pamela very well (my husband Steve's sister and our RDI consultant) agree that Pamela has some form of aphasia. Five years ago, Pamela's challenges with language fit the description of syntactic aphasia perfectly (I put other definitions at the end of the post),
Difficulties in using words in the correct order and/or forms for effective communication. Certain classes of words such as prepositions, conjunctions and articles may be omitted. Example, "Car man hit" for "the man hit the car." (Teaching Language Deficient Children)
RDI is not necessarily doing special activities beyond your normal day. I have been hanging laundry since last fall because our clothes smell fresher perfumed by the great outdoors and it is easier on the pocketbook. One key to framing an activity with an objective mind is how you assign roles. All week long, Pamela has been the talker and I have been the doer, as she directs my attention to line up with hers. I find these activities work for teens and are not at all babyish, even though the objective reflects the development of a two-year-old child:
  • Laundry (hanging, pull off the rack, folding, putting away)
  • Car navigator (telling me directions)
  • Shopping (making a list, getting items, putting away)
  • Cooking (getting out recipe, following recipe, cleaning up)


In the clip, I try to give Pamela many opportunities to speak specifically about where to hang the laundry in several locations (the rack, bricks, railing, and rocking chairs). We focus on prepositions and nouns in this activity. I throw in lots of variations, which does not frustrate Pamela. What we did here worked on many kinds of words and phrases dynamically and contigently without static repetitions or rote memory.


Other Forms of Aphasia
Nominal aphasia - The inability to know the appropriate names of things or to find categorical terms. For example: 1) "We went to that place (library) to check out books." 2) "Please do the door" for "open" or "close the door."

Semantic aphasia - Difficulty with word meanings. Example pen for pencil.

Pragmatic aphasia - Syntax and semantic ability may be present, but they may be used inappropriately. Example: "Your birthday is Mary 1, 1921" repeated frequently and inappropriately in time and place. Neologism are substituted for meaningful words. Example: "That man is clipping the krepies."

Expressive aphasia/Expressive language disorder - The individual is limited in the ability to express ideas through spoken words or written symbols.

Receptive aphasia/Receptive language disorder - The individual has difficulty comprehending language through spoken or written symbols.

Expressive-receptive aphasia - Difficulties with both types of language skills, comprehending and expressing ideas.

Global aphasia - All language forms are seriously affected to the degree that it is impossible to use one of the preceding categories. There may be an automatic expression or two which may not be meaningful. Example: "The puthee the puthigh" as a response to any comment or question.

9 comments:

Mrs. C said...

((hugs))

You do so well working all this into your regular day. I know that even though you make it look easy that sometimes it sure isn't. :]

Laughing Stars said...

I never really knew what syntactic aphasia is, and your explanation crystallized it perfectly. You have a gift for communicating complicated concepts clearly and sharing your experiences in a way that is easy to "get." You are a gift to the rest of us in the "special needs" community!

The Glasers said...

Laughing Stars, all the credit for the definitions go to the writers of Teaching Language-Deficient Children (N. Etoile Dubard and Maureen Martin) . . .

Jennie said...

Mrs. Glaser- My daughter who is 3.5 years old but developmentally a 2 year old seems to have this aphasia...Do you think it could possibly be due to a natural developmental progression that our kiddos with autism get "stuck" in for a while and they eventually grow out of or do you think this is something that needs therapeutic intervention?

-Jennie

The Glasers said...

Jennie, which form of aphasia? When Pamela was your daughter's age, she had full-blown global aphasia!

The first stage of language development is the pre-verbal stage. Does your daughter communicate nonverbally? Does she read and use facial expressions and body language? Does she point, nod, shake her head, and use other natural gestures? Does she have back and forth interactions with you, recognizing when it is her turn versus yours? How does she do with change and variations? How is her receptive language (her understanding of what you say)?

If I could rewind the clock and start over, I would focus on the preverbal stage first.

Jennie said...

Mrs. Glaser-

About the type of aphasia my daughter has, she seems to have that syntactic aphasia. She is very verbal and gets better about it as she gets more healthy. Our doctor said she is going through her two's developmentally because she is making up for the time she lost while she was in her "autism coma" (I don't know a better way to say that).

I guess I was wondering if I should get some speech therapy for her or should I wait it out to see if she just gets better. A lot of things have gotten better on as we have been helping her immune system recalibrate.

I remember you saying in your earlier posts that Pamela was going through her "terrible twos" and I was hypothesizing that what if she was in the "2" stage with some of her language issues...

I really appreciate your opinion :) Thank you for taking the time to write about this!

-Jennie

The Glasers said...

Here is some food for thought: I'm not an SLP, nor do I play one on television! That being said, I would consider the following:

* Look at the whole picture of broadband communication. Is she able to use and understand multiple channels of communication (both the verbal and nonverbal)?

* Is she able to communicate her thoughts and feelings to friends and family without being frustrated?

* Is her language development on track with her developmental age? If so, then I would worry less as long as she makes steady strides in her overall development, with her language keeping pace? If your daughter is developmentally two-years-old, you would not expect great syntax.

What I would probably do is work on speech in the natural environment. One tip is to match plus one. If she says, "want milk." You could say, "Want some milk?"

Another thing I would do is see if she enjoys being read to. If her eyes follow along with the words, she might pick up sight reading. Sometimes, seeing and hearing words read aloud help fill in some gaps. I think she is way too young for something like the association method because it involves writing, which is not developmentally appropriate.

Jennie said...

Thank you! Those are great suggestions.

My daughter has a real problem with her emotional regulation, and again, it gets better if she feels better physically. She sometimes the way my other kids act when they are sick. She gets angry and indulges in her upset feelings.

That being said, I do know about some RDI techniques, like social referencing, which I do try to do, but my daughter still gets upset when she's looking at me.
Then she looks away. Oh this is tiring!

And my daughter loves to read, I have found that to be helpful with her syntax but she hasn't been generalizing that yet. Although she is 3 years old she has a 3rd grade reading level (I think she would qualify as hyperlexic)

Is that too much info? Sorry!
Thanks again for your great suggestions!!!
-Jennie

The Glasers said...

Jennie,

My daughter has a real problem with her emotional regulation, and again, it gets better if she feels better physically. She sometimes the way my other kids act when they are sick. She gets angry and
indulges in her upset feelings.

You are right about emotional regulation! It is hard for any of us to face challenges when we are dysregulated for whatever reasons. In RDI, they teach the concept of RCR: regulation, challenge, recovery. First, you make sure the child is well-regulated. Then, you throw in a tiny challenge. As long as the child stays regulated, you keep trying small variations to the norm. If the child starts to become frustrated, you stop the variations and help them recover. Then, you stick with the routine until they are regulated again.

"My daughter still gets upset when she's looking at me. Then she looks away."

She may need you to regulate for her and, when she sees you as a source of comfort, you might reference you better. When Pamela was younger, I learned to read her body language. When she started to get upset, I would pull her out of the situation and spin her because the vestibular helped her relax. When she said she needed to leave, I respected that even when it made no sense to me.

On the social referencing, there needs to be other things in place like paying attention to you, tracking where you go, following your eye gaze, etc. You might work on referencing that is easier for her like referencing for information, referencing for permission, referencing to solve a problem, referencing when uncertain about safety, etc.

"Although she is 3 years old she has a 3rd grade reading level (I think she would qualify as hyperlexic)."

That is a wonderful skill to capitalize on down the road!!! Does she like letters? Does she enjoy spelling things with letters? I wouldn't force it on a child that young, BUT if she likes it, GREAT. How are her fine motor skills? Any interest in drawing yet?

Tammy