School Age Groups for children with Semantic Pragmatic Difficulties

HEATHLANDS LANGUAGE UNIT

School Age Groups for children with Semantic Pragmatic Difficulties

The general aims of the groups are :-

1. TO PROVIDE A PEER GROUP for children of similar sociability who are otherwise isolated in mainstream.

2. MONITOR THEIR PROGRESS and see what specific difficulties emerge or continue as they mature.

3 PROVIDE PARENTAL SUPPORT. We see parents as co-professionals. Wherever possible we encourage them to join in the groups and share their problems with us and each other. We would expect the childrens communication strategies to be further enhanced if philosophy of the group dynamics was extended, wherever possible, to home and school.

4. EXTEND PLAY SKILLS

Particularly the concept of pretend. Most children with communication disorders understand representation but do not easily acquire 'double knowledge', that is, that people can pretend to be someone else. We try and develop this understanding through informal teasing, jokey language and planned role play based on shared knowledge. For example re-enacting a trip to a cafe or a farm or creating worlds using playpeople and small toys.

5. FILL IN GAPS IN AREAS OF PRE LANGUAGE DEVELOPMENT

We look for areas like early turntaking and shared attention skills which have not been established or have been lost. We plan therapy to establish or reinstate these early skills., Talking without shared attention or taking turns in conversation is impossible unless the child learns that his partner is an individual who moves and thinks differently. Most of the skills can be established through informal early adult/child interactive play games, musical activities and ball games.

6. MAP LANGUAGE ON TO MEANINGFUL ACTIVITIES

Activities are usually most meaningful to communication disordered children if they are self chosen.

We aim to select toys which are developmentally appropriate for them, giving them selective times during the group when we follow their lead rather than the reverse. We comment on what they are doing, reflect their needs and feelings and those of other children interacting or alongside and respond immediately to any communication intent signalled verbally or non verbally by the child.

CONFIRM THAT A MESSAGE HAS BEEN RECEIVED

Many SPD children cannot infer from adults responses that their message has been received, e.g. a child who says "look mummy a blue car" will probably go on repeating the message if the only response is 'Hmm'. A child who bangs the door and screams will not be placated if the response is 'no'or

"What do you want now?"

He is much more likely to accept carers limits if :

(a) they acknowledge the childs communication intent first , "Sam wants to play outside".

(b) Say whether they can or cannot do

"no outside"

or "I'm sorry I cannot let you play now (depending on the child's linguistic competency and age).

"outside later"

Thus avoiding meaningless questions (to them) and reinforcing time concepts.

VISUALLY REPRESENT ABSTRACT CONCEPTS

Children's understanding of situations and feelings are often enhanced if we help them represent them through colours and drawing.

At first this may involve children directing adults to draw for them, but as they gain in confidence children often choose to draw events for themselves.

7. SET BOUNDARIES

On the whole we widen boundaries to exclude meaningless sanctions. However, to help the children 'get it right', we give them a very clear idea of what these boundaries are. We often say 'the rule is.......'

When boundaries are reached, we do try to make firm and simple limits using 'stop' rather than 'no'and avoiding too much moral reasoning.. We do not encourage aggression but we do allow children to negotiate and explore physically if we feel this is developmentally appropriate. On the whole, provided unprovoked 'aggression' is nipped in the bud, verbal strategies for interaction increase at the expense of physical strategies as the child improves his communicative competence. Communication disordered children however do not recognise social status and if carers use physical punishment communication disordered children will see it as their right to use the same.

8. PROVIDE AN ENRICHED LANGUAGE ENVIRONMENT

Communication disordered children find it particularly difficult to learn language without visual props. Abstract concepts like time' words for example are difficult to learn. We select words (usually from the Anne Locke programme) and over use them in as many different situations as we can to generalise meaning.

We concentrate our input in the following areas (with examples given):-

Action run/jump/eat/drink tell/ask bring/take

Space on/under/in/infront/behind

between/above/below/across

Comparisons big/bigger/biggest loud/quiet

and Descriptions long/short slow/fast

rough/smooth clean/dirty

sour sweet

Time today/now

tomorrow/yesterday

before/after

soon/later

next/last week

Mind words know

think

guess

remember

wish

want

Feelings hungry angry

thirsty surprised

tired pleased

hurt

Moderators maybe if

perhaps when

Quantity a few/a lot each/all

more/more than both/some

empty/full

half/another

Conjunctions but/and/so

NB Concentrating on opposites

Specific Vocabulary related to chosen topic or school curriculum

Social Greetings

9. TEACH NEW CONCEPTS IN A CONCEPTUALLY ORDERED PATTERN

Most communication disordered children only see the world clearly from their own point of view. They also find it difficult to recognise new words presented at a too symbolic a level. They need to be able to point to a cup before they can show you one in a picture for example. If they are to learn new vocabulary or topics meaningfully then we suggest the following principles:-

(a) hands on experience first, followed by -

(b) role play with real and substitute props

(d) pictures and small toys next.

(e) line drawings.

(f) writing without props.

10. DEVELOP CONVERSATIONAL LANGUAGE

This involves taking turns and bringing the 'there-and-then' to the 'here-and-now'. We do this through building up shared knowledge and recording the experience and talking about it with photos etc. as above.

Conversation is dependent on the ability to:

1. Understanding word meanings. (see 8).

2. Decontextualise (then ---Ø now).

3. Infering mental states in others (reading people's minds and their feelings and intentions).

(a) which in turn means taking turns in conversation, giving enough information without boring the listener.

(b) understanding jokes and social chit-chat

(d) giving appropriate responses.

We intend to further develop conversational language through exaggeration and explicit statement of listeners feelings, motivation and intent. e.g. you want to talk abut washing machines

I want to know about .....

Encouraging the child to think about another person in the group e.g. (turntaking)

You want to say more?

Does Jim want to speak?

Ask Jim what he did on holiday

11. EXTENDING THE CHILD'S USE OF LANGUAGE

Most of the children want to be sociable but go about it in a rather idiosyncratic way. They may use echoed or learned sentences to ask repetitive questions or they may interact physically rather than use words.

By careful observation and listening we try to reflect what we think the child wanted to say. We state in short sentences (depending on the childs comprehension) the childs communication intent. A repetitive question might for example indicate a childs expression of anxiety, an attempt to express need or simply say hello. We attempt to say what the child really means.

12. PROVIDE ROLE REVERSAL OPPORTUNITIES

Contrived situations in which the childs communication intent produces the desired result and therefore has maximum meaning. Communication disordered children often give insufficient information when directing others. We aim to facilitate more specific use of language so that children learn to direct others and negotiate more successfully, eg directing a blind folded child to a packet of sweets, putting the tail on the donkey etc.

REDUCE LINGUISTIC COMPLEXITY

Most SPD children say more than they really understand and this does give a false impress of their linguistic skills. To ensure maximum understanding and confidence we aim to reduce linguistic input to short salient sentences.

13. DEVELOP LISTENING SKILLS AND COMPREHENSION

As well as formal listening activities we hope that our attempts to reflect the child's communication intent with short sentences will result in more careful listening on their part.

Following instructions is a fairly concrete task however, so we try to extend understanding through jokey language and role play. We try to help the children understand that words do not always mean what they say. So far most of the children take meaning fairly literally and need specific help with jokes, metaphors and sarcasm.

14. BUILD CONFIDENCE

Many of the children have experienced failure through not understanding situations correctly.

We try to be non judgemental avoiding 'naughty' and 'silly'. We aim to

provide activities of maximum interest but well within their achievement level.

We also suggest that wherever possible carers help children to develop any special skills they may have as much as possible. A child who is shy will be respected by the other children in his class if he is accomplished at drawing or competent on the computer.

PLAN CHANGE

The central feature of children with Semantic-Pragmatic Difficulties is their difficulty in extracting the saliency or the central meaning of what is happening around them (extracting the wood from the trees). They tend to remember everything or focus on a minute detail instead. This means that when they are in new situations, like coming to a group at Heathlands, they are initially thrown.

Most children without communication disorders cope with change by comparing the similarities they see in old situations with new situations. They can therefore predict what is likely to happen next. When you cannot predict you become anxious, withdrawn, controlling or questioning.

The aim of the group is therefore to provide a safe and predictable sequence of activities with planned changes, which do not adversely affect learning. Without any change the child would be unprepared for new events outside the clinic. With too much unpredictability the child is too anxious and unable to absorb any information and becomes withdrawn or unco-operative.

For older children we have found that by providing them with a visual diary of the mornings events at the start of the day helps to reduce anxiety and repetitive questioning. Some parents and schools have also found this strategy helpful.

PROVIDE KEY WORD SIGNING

Communication disordered children respond more quickly to language if there are visual clues like picture or gestures to hang the language on.

We have found that by signing specific key abstract words within a sentence, as these words occur during the day, helps the child to generalise their meaning more quickly and use the word appropriately themselves to signal meaning.

For very young children we use Makaton signs. Older, brighter children, however, soon 'grow out' of the Makaton system and we therefore incorporate Paget Gorman Signs as well, calling it Pageton. We try wherever possible not to conflict with alternative signs used elsewhere.

DEAL WITH INSIGHT

Most bright children with specific communication disorders have experienced some failure either academically or socially. This inevitably leads to insight : ie: I must be different, why?

We aim to address these problems individually and with parents help using a personal construct approach.

We attempt to explain why the child is attending the group, his difficulties to him -in a simple and clear way, from his perspective and using his words.

"Lots of people have difficulties, some people can't hear, some people can't see very well, some people can see if they wear glasses etc.

HELP AN UNDERSTANDING OF PEOPLE'S MINDS

One of the key problems for SPD/Asperger children is understanding that people have minds of their own and think differently. This unfortunately makes SPD children very self centred and unable to appreciate the other persons point of view or their intentions.

We try to address these problems by providing opportunities for the children to work co-operatively as a group taking responsibility for each other rather than as individuals. As well as constantly saying what goes on in their minds and other people's (by reflecting feelings and intentions) we provide games where successful strategies require an understanding of what the opposition is thinking eg hide and seek, pictionary, guess what this is ?, what will he do next, happy families, scruples.

EXPAND OBSESSIONS

Many children with SPD have obsessional interests ranging from animals and cars to maps. Generally we adopt the principle that if an obsession is useful it is probably better to expand on it and incorporate some useful knowledge rather than ignoring it. It is also important to remember that obsessions are a means of dealing with anxiety by making the world more predictable and therefore more safe. To deny them entirely would therefore cause immense distress to the child.

Many teachers particularly have used controlled access to obsessional interests during the day as a reward for good behaviour.

We have always found that positive strategies work best with these children, ie If you do such and such you can play with your .... rather than

If you don't do your work you can't have your car.

ENCOURAGING INFERRING AND PREDICTING

This really follows on from an understanding of what goes on in people's minds. As well as being able to describe what people are doing - say in a picture or after listening to a story, if you 'know' what the characters are feeling or thinking (putting yourself in their shoes) then you can predict or infer what they are likely to do next.

We attempt to address this problem by presenting unfinished stories either through the medium of acting or through pictures and encouraging the children through role play or drawing to end the story in their own way e.g. Man packs his suitcase, arrives at the station, misses the train. What will he do next?

ADDRESS, TEASING AND BULLYING

These are probably the most common problems that SPD/Asperger children encounter in school. Taking other people's comments too seriously plus an inability to sus out being set up can have disastrous consequences. While we would like to, we cannot prevent teasing and bullying altogether, but we can help children, through role play, understand other children's intentions and how to deal with these problems.

Margo Sharp

Chief Speech and Language Therapist

5.11.1993 (revised 12 11 93)

MS/sjw

Updated 10/2002: Margo Sharp is currently not based at the Heathermount School. Latest known contact information: eMail -- MARY.RICHARDS@bhamchildrens.wmids.nhs.uk * Telephone 0121 243 2000.