Changing our communication style: declarative language

One of the most simple and powerful changes we can make to help our children and adults with autism improve their thinking and communication competence is to use declarative language.  My guest author for this blogpost is Linda Murphy, a Speech and Language Therapist and RDI Consultant who also has a Masters in Communication Sciences.  This article was first published on the Connections Centre web site and is reproduced here with kind permission from Linda.

Declarative language, plain and simple, is stating out loud what one knows or thinks in the form of a comment. It may be used to share an opinion (I love spaghetti!); make a prediction (I think we are going to the movies tomorrow.); announce / celebrate (We had a great time today!); observe (I notice that your friend wants a turn.); reflect on past experience (Last time this stopped working we checked the batteries.); or problem solve (We need tape to fix it.). Declarative language does not require a verbal response. Rather, it invites experience-sharing, and provides an ideal social framework for later conversational interactions.

Unfortunately, however, when people talk to children with ASD they frequently use imperative language, which is in the form of questions or commands that require a particular response. For example, "What color is that?"; "What is your name?"; "Say: block;" and "Look at me", are all imperatives. The problem with this type of language is that it does not teach children how to become authentic communication partners, because its circumscribed nature does not invite experience-sharing, which is the basis for interactive language use. Indeed, when people primarily use imperative language with a child, he or she learns, incorrectly, that communication consists of right and wrong answers and questions and directive. It also teaches that the main purpose of communication is instrumental; that is, to "get" something from another person. In truth, authentic communication is primarily about experience-sharing. We communicate with others to share memories, gather information, learn about one another and the world, seek different opinions, and share emotions. While it is true that we sometimes need to communicate in order to "get" something, if children with ASD are to learn how to socially communicate with others, they need a linguistic environment that is rooted in declarative language input.

If truth be told, children with ASD do not need language models that lead to the development of instrumental language use, for it is common knowledge that as their language progresses, it is often characterized by scripts and rote language that is instrumental, as opposed to social in nature. Furthermore, children with ASD often become "stuck" at the instrumental level and fail to reach the next (higher) level of language development which involves generating the creative, flexible, and dynamic language that comes so easily to typical language learners.

The question to ask is: What can we do to help the child with ASD generate creative language? The first step in this teaching process actually begins with the adult (which is very good news, because we are in control of what we do!). So, we need to take a step back and become aware of the type of language that we are using with the child. Are we asking the child with ASD a lot of questions (many of which we already know the answer to!)? Are we using too many commands? Is most of our language input designed to get something from the child? Or, are we generously giving information and sharing experiences so that the child can learn, over time, to do the same in return?

In contrast to the erroneous assumption that children with ASD cannot learn from this type of language input, I have found that mindful use of declarative language with children with ASD can make a huge difference in their ability to share experiences and memories; notice things; problem solve; understand perspective; and communicate on a more dynamic and creative level. That said, it is important to note that the language gains that result from ongoing exposure to declarative language take time, for the focus is not on words, per se, but rather on the use of those words for authentic communication. The challenge then is for us to make the commitment to change how we communicate with children with ASD, and to exercise the patience required to see results.

The following contains additional information on the benefits of using declarative language input with children on the autism spectrum:

Model self-narratives to help your child develop his or her own "inner voice"

A critically important by-product of language acquisition is that of developing an inner voice to problem-solve and plan. For example, imagine that you are getting ready to go to work and you can't find your keys. Your inner voice may say something like, "Now when did I last see my keys? What jacket did I have on?" Basically, your inner voice helps you think through the problem calmly and gets you started on a plan of action to solve it.

Children with ASD do not usually develop this inner voice to regulate their thoughts, actions and emotions. To help them to develop this ability, think out loud. For example, make predictions; ponder opportunities; consider possibilities; and reflect on past experiences when you are with your child or student. By so doing, you will be providing a clear language model from which the child can begin to form his or her own inner voice.

Provide a window into another person's perspective

Most of us know that children with ASD have difficulty taking perspective. Using declarative language to share your thoughts and feelings provides children with a window into the way you view the world in an inviting, nonthreatening way. In addition, if different people regularly use declarative language for this purpose, we help the child to understand that different people have different thoughts, opinions, perspectives, and emotions.

Help your child "zoom out" to see the big picture

It is well known that children with ASD tend to focus on details, but fail to put them together to understand the big picture. When we use imperative language, we inadvertently promote this focus. For example, if we tell a child to "put the toy in the toy box" or "say goodbye to Grandma", we are zooming into the details and creating a situation where there is one and only one right answer. If, on the other hand, we use declarative language to comment on what we see in the big picture, we help the child to notice the context; integrate this new information with previously stored knowledge; and subsequently form a plan of action that makes sense to them. For example, instead of using the imperative language noted above, use the following: "I see a toy on the floor" or "I notice Grandma is leaving."

Empower your child to be a problem solver rather than direction follower

When we give a directive to children with ASD, we leave little room for them to go beyond the response the directive requires. The same is true for asking questions. In contrast, when we use declarative language to share information about the environment or situation at-hand, we provide opportunities for them to expand awareness and practice problem-solving. Think of it this way. From a young age, the type of language input that has been used most often with children with ASD has been that of asking questions and giving directives. Clearly, they do not need more practice in that area! Rather, they need practice in problem solving, and identifying themselves as competent problem solvers. That said, success at this level is more likely if you have been diligent in the use of self-narratives. For example, if you have staged situations in the past where you have said on several occasions, "My pencil broke. I need to sharpen it," then when the child breaks his or her pencil, saying "I see that you broke your pencil," (and waiting expectantly) enables him or her to generate the solution. In contrast, telling the child to "Go sharpen your pencil" robs him or her of the opportunity to solve the problem on his or her own.

Give your child reasons to visually reference and read what is going on in his or her environment

We know that it can be difficult for children with ASD to tune into the social information that is going on around them. Rather than telling them exactly what to do and when to do it, use declarative language to help them to notice what is important. For example, if it is time for a transition, instead of telling your child to "go to the table for snack" or "put on your coat," direct his or her attention toward the changes in the environment: "I notice that all the kids are at the table" or "I notice that all the kids are putting on their coats." Using declarative language in these situations helps children with ASD to recognize the importance of periodically checking in on one's environment to obtain the information they need. Over time they become information seekers rather than passive recipients of information that comes to them when there is an overuse of imperative language.

Linda Murphy has been a speech and language therapist since 1999. She is also a Certified Early Intervention Specialist and an RDI® Program Certified After spending two years working with adults with Autism, she decided to pursue a Master's Degree in Communication Sciences and Disorders at Emerson College. Since then, Linda has provided services to children ranging from toddlers to young adults in a range of educational and other settings, including schools, daycares, homes, summer camps, playgrounds, her office, and university clinics. She enjoys working collaboratively with families and other members of a child's team. She has a private practice in Beverly, MA. For more information, visit her www.peer-projects.com or read more of her articles at www.examiner.com/x-39111-Boston-Autism--Parenting-Examiner.

Talking to your child about their autism diagnosis

One of my families asked me a while ago for some ideas about how to broach the subject of their child's autism diagnosis.  I put together this collection of excellent resources that had already been shared amongst my RDI colleagues as the result of a former query, and thought it might be useful to others, so am sharing it here.

With grateful thanks to Terry Frank; Barbara Avila; Lauren Wilson and Kathy Darrow.  Here goes.....

From Terry (initial query)

I am looking for suggestions and resources for parents who are wanting to help their high functioning ten year old understand his autism diagnosis. Also I'm interested in opinions from parents on the timing of this. We are feeling that he needs to understand the reasons for some of his behavior and difficulties in friendship.

From Barbara

1. Stephen Shore (adult with autism) youtube interview when Stephen is asked ‘should you tell your child about their autism diagnosis?’

2. "How do I discuss my child’s autism with him?"

 

3. Getting Started: Introducing Your Child to His or Her Diagnosis of Autism or Asperger Syndrome

4. ASD Diagnosis: What do we tell the kid?

 

 

From Lauren

It maybe important to emphasize the fluidity of an autism diagnosis. Just because it looks one way today, doesn't mean that's the only way it will look. And the child has some control over it- as we all do over certain innate differences

Carol Dweck has done some interesting research (not related to autism) about the impact of teaching kids about their brain and what they can do with it. The impact for kids of knowing that their brain is like a muscle that they can make stronger was a positive one. Some of her work on the subject is found here and here.

One family shared that to normalize the idea that everyone has differences they "work" on each member of the family shared goals they were also working on. We're all in process.

From Kathy

 

 

For my own kids, I have taken the route of letting all my kids know that they are all individuals with strengths and weakness. Mom and Dad have different strengths and weaknesses too! We all work on what we want to get better at. My son no longer asks about this ( he is 14 and really is not struggling socially in school at this point) but when he was younger he did alot of comparing himself to his older brother. I did not feel it was going to be beneficial to bring up autism with him over and over so making it more a family affair where we all see what each other is good at etc. From doing this he learned to process how everyone is unique apart from labels. Every person has weaknesses. He typically loved hearing stories when he was younger about all my weaknesses!

Thanks again to the above RDI Consultants.  One of the best things about the RDI community is that you always know that someone will be able to help with guidance and suggestions.

Hope that is useful for people.

Philip's school newsletter: 'The Nut'

I’ve got a treat in store for you all today. Philip has been writing a newsletter about what’s been going on at school and he has agreed to share it via my blog

Just to give some background – the ‘gang’ at school is called ‘The Nutters’.  Hence the newsletter’s title.  Philip (aka Philnut) is The Captain. B is ‘The Noggin’ (brains); I is The Tactician (strategist); and L (part time member – Philip’s brother) is ‘The Marine’ (covert operations). Our newest pupil, T, has yet to be inducted.

Enjoy!

The Nut

Headlines

The stones for the visitors are all set*.

We now have four permanent students at Bright Futures!

Bright Futures hits an all time high!

The heavenly strawberries in the greenhouse have grown red, yum yum!

*Except for colour blind people.

The stones

Recently, visitors have had a hard time finding our school, (as if their useless sat nav wasn’t annoying enough.) Even though we put up a sign saying ‘Bright Futures’ it is still hard to find.

So the teachers and Zog decided we should get some rocks, paint them in different colours, cover them in PVA glue, and put them outside for the visitors to see. So then they can go right into the school instead of going up the road and down the road and up and down then finally calling Zog on the phone to help them.

This should make much less hassle, and stop wasting people’s time. There is only one more small problem. People who are colour blind will still need help, but that’s not a problem for now. I’m sure when the time comes we’ll be ready.

Pupil numbers growing!

In 2011 Bright futures only had one pupil, that was Philnut. 4 months later I got a placement at the school as well. 1 month after that B started to come to the school on Tuesday, then after 3 months B’s mum and dad asked for a statutory assessment and with SR’s help (Educational Psychologist - Ed). Oldham’s local authority gave up and let B be a permanent pupil at Bright Futures.

Today we have 4 pupils at the school and 5 try to get a placement that means more money more Nutters and more friends! However B and T are not coming full time.

On the up

Bright Futures is in full bloom today! We have 4 permanent pupils at the school the rabbits feel at home and our clock business is up and running.

The Nutters have predicted that the local authority will be paying sacks of money to us so we will be able to build the treehouse! We will also become very famous across all of Britain, so we will get lots of people trying to get a place at the school so, more money! If we had a sales chart for how successful we are it would probably look like this:



Strawberry delight

Our strawberry plants in the greenhouse are red and good to eat! Our strawberries are better than any strawberry you can go and buy in the shop. Since there fresh from the plant and haven’t been driven from Canterbury in a filthy truck they are softer than a cloud and juicier than the storeys news of the world wrote before anyone knew about phone hacking.

We hope to keep on growing these gorges strawberries every spring so we can all enjoy them. There may be a few left from this spring and maybe more to come, but if you want one you better hurry because they don’t last long around other people yum yum yum yum.

Job jar

1. Someone needs to tie back leaning branch on patio.

2. Someone needs to cut the two long plants leaning in the way of the patio back.

3. Someone needs to make a list of light bulbs that don’t work.

And there you have it – a synopsis of recent developments at Bright Futures School

www.brightfuturesschool.co.uk

Thanks Philip! (from a very proud Mum)









Example of an RDI assignment: working on 'Planning for imperfection and mistakes' with a child

A fellow RDI Consultant, Libby, came up with this great idea of sharing an example of the kind of assignments we work on in RDI so that people can see how RDI is put into practice in real life family situations. Libby was kind enough to agree to share some of her assignments on my blog (big thanks Libby).

Please note that this is being shared to show how parents can become empowered through working with a highly trained consultant when take the Consultant’s guidance and apply it on their own without waiting for next therapy appointment, social skills class, etc.  

It is not recommended that parents who want to try RDI dive in with this objective as there may be many foundations that would need to be mastered before a child could work at this level as well as many objectives that parents would need to work on in order to be able to competently guide their child at this level.

For those who are interested in working directly with a consultant to create an individualized plan based on a rigorous assessment of the parent-child guiding relationship, please visit www.rdiconnect.com

Sample Parent Assignment

By Libby Majewski, RDI® Program Certified Consultant

As posted on Facebook (www.facebook/kidsahead.com) 6/3/12

Dynamic Intelligence Objective: Planning for Imperfection and Mistakes

Here is an example of an assignment I recently wrote to a parent who was working alongside and guiding her son as they planned a big lemonade sale at their church. This was a project that took several weeks of planning and preparation and the mom shared every step of the way with me (I'm very lucky). I, in turn, guided her with assignments and feedback. Below, I am guiding her to make sure she works with her son on "When Things Go Wrong" as they always do in any big project. Please note that all names and personal information have been changed - the purpose of sharing this is to give the community an idea as to how a developmental/cognitive approach can empower parents.

Please share thoughts or questions.

Hi J,

Here is your next assignment as you continue on with the lemonade sale project. I'd like to explore with D his expectations for the sale and also the theme of ‘Mistakes or When Things Go Wrong’. Although he is practicing a lot at home and is working hard and preparing, the sale, in fact, is probably going to be VERY different than the times he's been practicing. With that in mind, I'd like to work a little on planning for imperfection and having realistic expectations (that mistakes will happen, that it's going to be hectic maybe, that he may run out of certain things that he is selling, etc).

Here is some info from Dr. Gutstein's new dynamic intelligence curriculum that equates to where D is at this point:

- Constructs realistic expectations for mistakes.

- Does not routinely predict perfect performance and is not surprised or upset when he makes mistakes.

- Understands that there is no reason to get upset when you make a mistake, because everyone makes mistakes. Communicates about mistakes as a normal part of life

- Willing and able to co-participate with Guides to productively evaluate mistakes and learn from them

(by Dr. Steve Gutstein, rdiconnect.com)

Work Product: Please show me 1-2 clips of film footage where you and D are discussing (you can make a list if you want) about how the sale will be great especially because you prepared and planned so well and that D took on so much responsibility and made great decisions. In addition to all the positives, show me how you guide D through a discussion about potential things that could go wrong such as if he makes a mistake, or if things get too hectic, too confusing, etc.

Here are things you could/should cover as you discuss the upcoming sale:

Does D expect the sale to go exactly as you and he have practiced and planned? If not (you may have to lead him to the fact that it will be different), how does he predict it will be different? Try to list (just discuss or make a list) some possible differences that D anticipates (with your help).

Does D think it will be busy at the table and crowded? If so, does he think it will be crowded and busy the whole time? If he thinks it's going to be super busy, how will he (just one boy) handle it? Does he have a back-up plan to ask someone for help?

What if someone (D, you, etc.) makes a mistake? Will it be a big deal or not? Will he be surprised if someone makes a mistake? If not, why not (because we all make mistakes!)
What if he runs out of certain things that people want to buy? What will he do? These are all good questions to explore with him (you are free to dig around these questions with him as much or as little as you want – you do not have to ask all these or pose all these situations to him at once).

Keep in Mind: this can be a fluid conversation with D just sitting together or you can make it like a worksheet where you and he are thinking and answering questions together. You could each do your own sheet and give your own answers privately (not collaborating) and then compare your answers.

Due Date: next Wed

Let me know if you have any questions,

Libby

For a child to have got to this stage, two things have happened. The parent has become a competent guide – so she is using pausing, pacing, scaffolding, limit-setting, spotlighting, framing, modeling, declarative language and non-verbal communication to enable the child to reference for information and emotion-sharing, to initiate and respond to joint attention, to co-regulate and self-regulate and to increasingly productively manage uncertainty.

The child has mastered developmental foundations that will include: taking increasing responsibility for co-regulation, initiating and responding to joint attention, not automatically withdrawing from uncertainty, being motivated as an active apprentice, communicating for experience-sharing purposes, comparing reactions to the guide’s reactions, anticipating partner’s reactions (and many more).

So hopefully you can see why it’s not a good idea to jump into working on this objective without first making sure that the underpinning developmental competencies are in place. It would be setting the child up to fail – like expecting them to do calculus without first having learned to add up.For me this is the beauty of RDI and of working with a trained Consultant. 

It’s all about enabling your child to be competent and to have experiences of success, making sure (via the Consultant’s supervision and support) that everything that needs to be in place for that to happen is in place. So the Consultant ensures that parents are competent as guides and that the underpinning developmental foundations are in place for the child and then empowers parents to be as creative as they like in using RDI as an integral part of their everyday lives to promote their child’s dynamic intelligence. 

Questions and comments welcome!

'Best interest' decisions and people with autism/LD - getting the family's voice heard

A facebook friend recently asked for help regarding issues relating to her daughter's mental capacity.  I was able to refer her on for guyidance from Irwin Mitchell Solicitors.  As a result of this exchange, I discovered this new resource and thought I would share it with you:

Ambitious about Autism, Mencap and the Challenging Behaviour Foundation, in partnership with Irwin Mitchell Solicitors, have developed a new resource for parents who feel that they are not being appropriately consulted about the welfare of their loved ones to ensure families are involved in best interest decisions.

The new tool was produced after concerns were raised that many professionals are failing to appropriately consult with families, as required under the Mental Capacity Act 2005. In its latest report into deaths of people with a learning disability in NHS care, Mencap found that many health professionals are failing to abide by the Act and ignoring crucial advice from families.

The leaflet which can be downloaded here, contains two template letters which are intended to help family members who have not been involved, or are concerned that they will not be involved, in the best interests decision-making process. The letters have been written by Alex Rook from Irwin Mitchell’s Public Law Department, who specialises in cases involving the Mental Capacity Act.

Alex says: "If an individual lacks the mental capacity to make a decision for themselves that decision must then be made in their best interests in accordance with the requirements of the Mental Capacity Act 2005.

"The Act requires all professionals, including those from local authorities and the NHS, to consult with family members when an adult lacks the mental capacity to make the relevant decisions themselves. The law on this is clear. We want families to know their rights."

Template letter 1 is intended to be used when family members are concerned that they may not, in the future, be involved in best interests decisions in relation to their loved ones. It clearly sets out the legal requirement to involve them.

Template letter 2 is intended to be used when decisions have already been taken without family members’ involvement. All the text in square brackets should be replaced with individual details.

It should however be noted that this leaflet and the template letters are a general guide and do not replace the need for legal advice on a specific case.

David Congdon, Head of Campaigns and Policy at Mencap says: “We know from our campaigning work how serious the consequences can be when families of people with severe learning disabilities are not listened to. They often have invaluable knowledge about their son or daughter, for example, they understand the subtle ways in which they communicate or express that they are in pain.

“It is crucial that professionals listen to family carers and use their knowledge to inform decisions being made. This applies to all decisions – those about medical treatment and social care as well as any other decision which affects the person’s life. This is not just good practice it is the law. It is important families understand this and feel able to challenge when they are not being involved.”

You can download a copy of the leaflet here.

Reflex stimulation and inhibition, sensory integration and RDI - what goes where?

Here is the response from Claire to the questions raised recently by Debbie and Nick. I've taken Claire's response out of the comments section and added it here so that it can form part of our ongoing discussions.

Gosh – not sure where to start! Think your questions pretty much embrace motor, sensory, cognitive, social and emotional development. And, of course, they are all intimately interwoven so it is always hard to unravel them to try and make sense of them developmentally. Will try and explain the bits I understand from my perspective as someone who has trained to provide a reflex stimulation and inhibition progamme (INPP) and also as the mum of a son who is autistic who had a sensory integration programme when he was younger. Others please chip in.

As you say if you were to put SIT, a reflex programme and RDI in developmental order – you would start with reflexes then sensory therapy then RDI. Of course this is overly simplistic. Failure of primitive reflexes to be stimulated and inhibitied and postural reflexes to be established will result in sensory integration problems (as well as other stuff, like emotional problems, postural problems, behavioural difficulties, gross and fine motor issues etc). Though sensory integration problems may be caused by issues other than reflexes, eg damage to developing brain.

What I was taught at INPP was that if you use sensory integration therapies (which complement reflex programmes) before addressing problems with early primitive reflexes – moro, ATNR, TLR particularly – the child doesn’t hold on to gains made during sensory integration therapy. This was certainly my experience with my son and left me wondering what comes before sensory development as it was clear we were working in the right area for him. I think if a person has problems only with the emergence of postural reflexes (which are developmentally later) sensory integration programmes have been successful and gains do hold.

And it is actually movement that proceeds sensory development. Movement that initially occurs automatically through reflexes. If a child can’t use movement to explore its world (going right back in utero as the fetus explores its body within the womb) it can’t create an physical image of either its own body, the world it can reach out and touch, and later the world it can see beyond the reach of its hand. An early crude experiment with 2 new born kittens illustrate this point. The kittens were kept together but only 1 was allowed to move its legs, the other was not. The second kitten did not develop vision. Deprived of its ability to touch the world it was impossible for its brain to make sense of the images of light that its intact retinas passed to its brain.

RDI addresses issues further on developmentally (though you can actually see the problems from the moment a baby is born sometimes). Clearly if an infant is unable to build up an image of its own physical self (eg where my body ends and the rest of the world starts/ my hand is attached to my arm etc) he/she is not going to be able to co-regulate with an adult as he/she will not have fully grasped the concept of them being 2 separate physical entities.

Thanks to Claire and everyone who has been participating in this discussion.  I've learned loads from it and hopefully it'll also have helped others :)

Timing of sensory integration and reflex integration/inhibition

Continuing our discussions about retained reflexes and overall development, here are some observations and questions from Deb and Nick related to the work they have been doing with their son through RDI and through the BIRD programme.

Hello

Your discussions on the blog have been very interesting and have come at a time when we have been trying to assimilate our thoughts on the relationship between interventions to address retained reflexes, Sensory Integration Therapy and the RDI approach.

In October 2008 our son completed a course of sensory integration therapy. Through this we learnt how different types and amounts of movements can stimulate his different sensory systems and affect his level of functioning and behaviour in a given situation. We came to better understand what types of movement and sensation  we need to 'feed' our son 'in the moment' to help him with his sensory processing and integration to help him in terms of  his concentration / attention, posture, physical regulation, gross and fine motor skills etc. We see short lived improvements in these areas – enough to make a positive difference so that he can more fully participate or be more competent in an activity at that time - but this does not result in him being able to sustain these improvements over time without further/ regular feeding.

In April 2011 we commenced Reflexive Rehabilitation Development programme under the direction of B.I.R.D. The initial assessment concluded that our son (who was 7yrs 4 months at that time) had retained all of the primitive reflexes that they test for i.e.  babinski, asymmetrical tonic neck reflex, spinal gallant and the symmetrical tonic neck reflex. A year on, May 2012, at his latest assessment it was found that the asymmetrical tonic neck reflex and the spinal gallant reflex are now inhibited completely. The babinski reflex is residual in the left foot only, and we are commencing new exercises to work on inhibiting the symmetrical tonic neck reflex.

In January 2012 we commenced RDI programme and have just completed the initial education module.

Like Kimberley we too have considered the importance of timing, and this has led us to conclude that to get the best outcomes from an RDI approach, the work on retained reflexes has to happen first or be happening, if at all possible, doesn't it?  And what about sensory integration difficulties  - exercises to address these difficulties -  they need to be part and parcel of everyday life don't they.?

We are wondering what the relationship is between retained reflexes and sensory integration difficulties. They must be inextricably linked / interwoven. Can you possibly have one without the other? We are assuming you can't, and that work on retained reflexes and work on sensory integration difficulties have to go together.

But they are different aren't they?  Why do some therapists advocate sensory integration therapy and not do any work on retained reflexes, and other therapists lead with work on the retained reflexes and don't mention sensory integration therapy? How can this be?

Finally, for now anyhow, do you think our sons sensory integration and processing will improve and be more sustained, with the need for less 'feeding', once all his retained reflexes have been inhibited?

from Deb and Nick

The question about the difference between sensory integration and reflex integration and inhibition is one that I too have been pondering since this discussion started.  I'm hoping that Claire  and others can give us the benefit of their wisdom on that one!