Strategies – Promoting expressive communication

Introduction

A helpful framework when considering the nature of communication is the Means – Opportunities – Reasons model. According to this model, in order to communicate expressively, everyone needs

  • the means to communicate
  • opportunities to communicate
  • reasons to communicate.

Therefore, when planning the promotion of expressive communication, practitioners need to ensure that they

It is often the means of communication that receives the most attention. Yet, unless the young person also has opportunities and reasons to communicate, providing the means is pointless.

For more details concerning means, opportunities and reasons, see Bell (2013b).

Being an effective functional communicator also requires a crucial skill not directly addressed by the Means – Opportunities – Reasons model: the ability to initiate.

The final key element of promoting expressive communication addressed here is the need for practitioners to provide a responsive environment.

Providing the young person with the means to communicate

As noted in the introduction, a helpful framework is the Means – Opportunities – Reasons model. When promoting the expressive communication of young people with visual impairment and autism, practitioners need to ensure that they provide all three. This section focuses on providing the young person with the means to communicate.

Because many young people in this group do not use spoken language effectively, they require support to use one or more alternative means. In effect, practitioners should adopt Total Communication, which is described in the following sub-section.

Total communication

Total Communication is a communication philosophy. It is not a communication method, nor a teaching method. It is an approach to creating successful and equal communication between people with different communication skills. Using Total Communication amounts to the use of all appropriate means of communication in order to understand the young person and to support the young person to understand you.

Practitioners who adopt the Total Communication approach use Alternative and Augmentative Communication (AAC). There are two main aspects to this

  • supporting the young person's receptive communication by augmenting spoken language
  • supporting the young person's expressive communication by responding appropriately to all his / her expressive communication, no matter what means of communication he / she uses and by enabling the young person to use one or more alternatives to spoken language, as appropriate.

It is important to note that any one young person will actually use several means of communication. This includes young people who use spoken language. The vast majority of people use a wide variety of communicative means: we

  • gesture
  • make and break eye contact
  • eye point
  • smile
  • frown
  • purse our lips
  • colour the words we produce with variations in pitch, volume and speed
  • use body language and proximity
  • etc, etc.

Most of these communicative means are used naturally alongside spoken language. Very often, they support the words we produce. But, at times, they contradict what we say (e.g. when we say we feel fine, but our facial expression, body language and tone of voice indicates the opposite). Young people with visual impairment and autism also communicate in a variety of ways, whether intentionally, or not.

Practitioners need to become expert at "reading" each individual young person. This theme is developed below in discussing provide a responsive environment and also in monitoring the young person’s behaviour and moods and responding appropriately.

There are several alternatives to spoken language which practitioners can enable a young person to use. They are discussed in turn below, following the next section.

Responding to the young person's questions in a positive manner

It is particularly important that practitioners respond truthfully and consistently to the questions of a young person with visual impairment and autism. This is because it will help to them to become predictable for the young person and will contribute to building the young person's trust.

Responding in a positive manner to questions also requires practitioners to take account of the individual's receptive communication skills by adjusting the language used. Key elements of this are

Repetitive questioning is quite common amongst verbal young people with visual impairment and autism, but facilitating more functional skills in these individuals can be very difficult. In addition, repetitive questioning can be very irritating for the practitioners involved, and for the young person's peers; they may hear the same question or set of questions very many times over the course of each day. Identifying the reason(s) a young person asks questions over and over again can be very difficult. Yet this may be an important first step in reducing, or even eliminating, this behavior.

For a more detailed discussion of repetitive questioning, see Kehoe (2012).

Archie has a history of repeatedly asking staff questions about the next activity. This infuriates his peers who constantly tell him to be quiet. The practitioners who support Archie believe his repetitive questioning is related to anxieties about what will happen next. To reduce Archie's anxiety about forthcoming events, he now has a tactile timetable, a component of the TEACCH approach. This seems to have resulted in a reduction in Archie's repetitive questioning.

In addition, staff only respond to Archie’s first question about the next activity. They do so by physically prompting him gently towards his timetable whilst saying "Check timetable". The member of staff provides as little physical prompting as possible and says "Check timetable" quietly. The intention is to fade these prompts completely in time, to avoid prompt dependency, and to promote independence. In addition, staff make a particular point of giving Archie positive attention when he initiates a conversation about other topics: they respond conversationally to him and attempt to maintain the conversation.