Navigating the Complexities of Meaningful and Functional Communication

Bureau of Supports for Autism and Special PopulationsJanuary 2020

Amy Alford, M.Ed., BCBASenior Clinical Consultant

Krista Lewis, M.S.Ed.Deaf and Nontraditional Communication Professional

Why is it important to prioritize someone’s communication?

It is how you engage with people and the environment

Can make or break someone’s social inclusion

Can impact lifestyle circumstances and life transitions

Can build trust and a positive relationship with another person

Communication is individualized

Many modalities used

Everyday Lives

My Life, My Way-Communication

I am listened to and understood; my input is valued. My family, supporters, and community listen to me and communicate in ways that work for me.Everyday Lives: Values in Action, 2016. Pennsylvania Department of Human Services

Never assume that a person is not able to communicate just

because they don’t use spoken language, and never assume that a person is able to communicate

just because they speak.

Historically Speaking…

1950s• Chomsky’s Innate Theory of Language

Acquisition- “Universal Grammar”

1957• Skinner’s Verbal Behavior Operants and

Behaviorism

1978• Bloom and Lahey Components of Language

(applied using principles of Bloom’s Taxonomy)

1985• Carr and Durand’s Functional Communication

Training

“Maslow” before “Bloom”- Context before content

Evaluation

Synthesis

Analysis

Application

Comprehension

Knowledge

Esteem- self-esteem, confidence, achievement, respect of others

Love/Belonging- friends, family, intimacy

Safety- security of body, employment, resources, morality, family, health, property

Physiological- food, water, breathing, proper bodily functioning, sleep

Maslo

w’s Hier

arch

y of N

eeds

Bloom’s Taxonom

y

Self-A

ctuali

zatio

n * M

orali

ty * C

reat

ivity

* Spo

ntan

eity *

Pro

blem S

olving

Pushing Boundaries- Educational Consulting

What is Communication?

Communicationis…

A basic human need and right

Fundamental and fluid

Impacted by experiences, lifestyle,

circumstances, and trauma

Not the same for everyone

Disclaimers

Language ≠ Communication

Behavior is Communication

com·mu·ni·ca·tion • a process by which information is exchanged between individuals through a common system of symbols, signs, or behavior

• personal rapport

• a verbal or written message

Defining the Terms

Language• a conventional,

formal system for communication

Speech• communication

by talking

Communication

• the successful exchange of ideas, feelings, and information between individuals

More Specifically

Languages

English

Swahili

American Sign Language

Spanish

Korean

Russian

Arabic

Modes of Communication

Verbal or Signed Language

Speech Generating Devices (ie. Tablets with a Speech Generating App)

Picture Boards

Visual Gestural Communication (VGC)

Tactile Cues

Picture Exchange Communication System (PECS)

Behavior- what happens when effective communication is not accessible

Example: Boredom, Annoyance

Language: English

“I can’t believe we spent 3 hours in a meeting that could

have been an email.”

Communication:Body language, facial expression

Expressing the same idea or feeling through different modes

A Simple Model

Expressive Receptive

• Receptive– Understanding when others

communicate– Often by the receiver– Listening and understanding– Can be understood or

misinterpreted

A Note about Expressive and Receptive Communication

• Expressive– Communication is understood

by others– Often through the sender using

various/multiple modes of communications (sometimes more than 1 at the same time)

– Can be intentional or unintentional

• Be concrete, speak slowly, check for understanding, repeat as needed– “Say less and stress, go slow and show” (Sussman 1999)

• Refrain from jargon, slang, or abstract (use key words)• When asking a question, give ample time to process

(pause)• Keep gestures or visuals natural when used as

prompts/cues• Use the person’s name to grasp attention • Ask or say one thing at a time; multiple directions may

not be helpful• Explain/show WHY• When giving a request, alternate preferred and non-

preferred… give choices• Keep your reactions neutral

Expressive Communicator: Strategies for the Sender

Receptive Communicator: Strategies for the Receiver

• Must understand the need for a communication partner (receiver of communication)

• Must establish trust- rapport is critical– Earliest communication (although not yet intentional) is

often done in the arms of a caregiver– As communication is attempted later, it is likely done in

the presence or safety of a trusted caregiver– Distrust can break the relationship or build resistance

• Whole body listening• Hearing does not equal comprehension

A Comprehensive Model

*Impacts of internal and external factors vary for both the sender and receiver

• Sensory and environmental• Smells• Sounds• Lighting• Clutter• Crowds

Internal Factors

• Culture, Experiences• Health and physical barriers• Nonverbal communication

• Emotions and tone of the communication

External Factors

- Mikaela Sheldt

Communication Goal: Meaningful and Functional

• Add Value– Understanding the relationship between behavior and its impact on the environment

• An effective two-way street– Does it matter that you are there?– Think ping pong not darts

• Relevant and Accurate?– Communicates a message

• Clear and Organized?– Was the intended message the one that was received?

• Individualized– Active participants in their daily life

• Wants, Needs, Thoughts, and Feelings are welcomed• One person shouldn’t always be the sender or the receiver

Tools, Resources, and Strategiesfor identifying someone’s communication modalities and engaging with someone in a meaningful, functional way

• Autism, Anxiety• Nonverbal• Rocks, claps, bites wrist, throws items, grabs others• Real life pictures to support her communication• Attends a day program, receives supports in

community and home• Likes:

– Coffee– Quieter environments

• Dislikes:– Crowds

Meet Carolyn

Video

Shown with permission from Lancaster County Behavioral Health and Developmental Services

• Determine the communication through an assessment– Multifaceted– Considers both expressive and receptive– Encompasses all modalities– Ongoing– Accommodates the individual

• Ask questions

Be Curious

• Communication Assessment Report (CAR)-specialized tool

• Other communication assessments• Functional Behavioral Assessment (FBA)• Communication Planning Tool

Strategies to Be Curious

• Discuss psychiatric assessment• Update FBA to reflect current needs• Carolyn’s Communication Planning Tool

What does this look like to support Carolyn?

• Follow the lead of the individual• Joint attention• Explore preferences and interests to build

communication• Determine strengths and skill deficits

Be an Observer

• Collect data• Look for what happens right before and right after• Respond to communication attempts consistently

and reliably• Consider body language and current communication

Strategies to Be an Observer

• Carolyn’s data sheet– Observe across locations/people

• Think of behavior as communication attempts and determine their functions– Biting– Grabbing– Clapping

What does this look like to support Carolyn?

Be Intentional

• Shared experiences impact communication• Active listening

– Model communication– Imitate

• Creates a sense of reciprocity– Expand

• Develop a plan

Strategies to Be Intentional

Active Listening

Be attentive

Observe body

language

Ask open ended

questions

Provide feedback

Paraphrase

Defer judgement

Respond appropriately

Reflect

• Use Carolyn’s name• Respond with nonverbals to both mom and Carolyn

– Body positioning turned towards Carolyn• Value mom for her role

What does this look like to support Carolyn?

Be Resourceful

• Stay relevant• Tap into other resources

– LifeCourse• Connect the dots• Collaborate with teams

– Internal– External

• Attend conferences and trainings• Engage with colleagues, inside and outside of your

field/area of expertise• Think outside the box when utilizing tools

Strategies to Be Resourceful

Strategies to Be Resourceful

What does this look like to support Carolyn?

https://www.lifecoursetools.com/examples/using-lifecourse-tools-to-weather-the-storm-shay/

• Be present- tune in• Anticipate over/under stimulation• Mutual respect to strengthen rapport• Meet each person where they’re at

– High but realistic expectations

Be Intuitive

• Be ready to wait– Give the person time to communicate

• Provide breaks, when necessary• Modify communication, when necessary

Strategies to Be Intuitive

• Build skills in less stimulating environments• Provide her time to respond during the conversation• Rephrase questions asks to ensure they’re

understood

What does this look like to support Carolyn?

• Share about their communication• Be an example• Set high expectations for the individuals and staff

Be an Advocate

• Talk about it as a team- some will know aspects you don’t know

• Identify what they like and dislike• Inform others of what they need• Be flexible

– Preferences and communication change over time• Ensure individuals have a ”voice”

Strategies to Be an Advocate

• Involve Carolyn in the conversation

• Share about her preferences

• Assign meaning to communicative attempts

What does this look like to support Carolyn?

Communication is Everyone’s Job!

Be Intentional

Be Curious

Be Observant

Be Resourceful

Be Intuitive

Be an Advocate

Why is it important to prioritize someone’s communication?

It is how you engage with people and the environment

Can make or break someone’s social inclusion

Can impact lifestyle circumstances and life transitions

Can build trust and a positive relationship with another person

Communication is individualized

Many modalities used

Thank you!

Questions?