Latest / AAC Access All Areas / What are the reasons for communication?
Transcript
- Ruth: Hello and welcome to another episode of AAC Access All Areas. I'm Ruth Jones. Ali Battye: and I'm Ali Bhatti. And our question today is, what are the different reasons that we communicate? Ruth: Yeah, and we thought we might start today talking about ⁓ an oldie but a goodie in terms of speech and language therapy models. It's something that I came across, I think, when I trained and that is the Means, Reasons and Opportunities model. So it's usually visually created in three little circles, you know, where they all cross over and in the middle of that is like beautiful, harmonious communication moments. But in order to do that, we need... The means for communication, which is in the kind of context, the conversations we're having are AAC, but also that might be spoken language, that might be body language and facial expressions. could be gesture, could be writing, drawing loads of different means to communicate. We also need the opportunity, which is quite important with AAC as well. And particularly in that teaching phase is thinking about who we're communicating with, when we're communicating, where we're communicating. And then importantly, it's the reasons for communication. And that is something that I think there's a bit of legacy work going on within speech therapy and AAC generally, think, particularly within our autistic community to recognize. And there was a campaign, wasn't there? I can do more than request. And I think there's something about those reasons for communication and that legacy of focusing on requesting and just. Ali Battye: and Yeah. Ruth: I want something or I would like something please so and so and putting phrases together like that but actually there are so many more reasons for us to communicate than just asking for what we want. If we think about our communication there's so much more that we talk to people about in the day isn't there? Ali Battye: Yeah. Yes. Well, I often sort of like encourage people to think about what was the most meaningful interaction that you had today. And it's usually ⁓ not about requesting something. It's not about sort of like ordering your coffee or making a choice between two things to wear or, you know, ⁓ two things to watch on TV. It's usually something a bit more profound. And I think it's usually more about connection of like just sharing the moment together. and sharing that feeling of that person really got me, really understood me in that moment. So yeah, like you Ruth, I wish that we could just erase that whole legacy of AAC always starts with requesting, because we see that over and over, don't we? In schools or we hear from maybe other speech and language therapists or people that we supervise, or I see it written all over EHCPs actually. that the desired outcome is that this child will make a choice between two items or they'll request something at snack time and I just want to get a great big crayon and scribble all over it so that you can't see that anymore. Ruth: Yeah. ⁓ yeah, think it's just that's really common AAC practice isn't it that adults around a child, particularly a child who's an AAC user will be like, right, I need to ask them what they want. This is that opportunity for communication. And so the time and the place and the person that becomes the opportunity for communication is rounded around those points in the day. And then you see the means of communication, the AAC, then put away. Ali Battye: And, yeah. Ruth: when it's like, the opportunity is finished now, our communication time is finished. And I love it when I go into classrooms and I see AAC tools, whether that's communication books, boards, iPads, whatever it is, when I just see them out all over the place. And I recognise there are challenges to that with supporting complex needs children in a space like, you know, and keeping everybody's AAC together and safe is not always easy, but. Ali Battye: Mmm, yeah. Ruth: ⁓ that sort of that concept that it's communication time and the reason you want to communicate is to ask for what you want and then we'll put it away because communication time is finished and the only thing you want to communicate for is a request and I actually think so much of the joy gets taken out of it and like food is so pleasurable and you're making kids ask for it when you know it's what they want Ali Battye: Yeah. in. Yes. Yes. Yes, yes, yes and I would be absolutely furious if my husband said no you've got to ask nicely before I get a cup of tea. That would not go well. So yeah definitely. So the communication in... Ruth: We're stuck beneath! It's like when you go to a restaurant. Now, I should say, it's like when you go to a restaurant, if you order your food and then you have to wait a bit longer, you start to get a bit antsy, don't you, La? I'm kind of ready for it now. I just think there is a barrier that we create to children having pleasurable experiences, particularly around food, when if a child's quality of life is impacted by their disability. For a lot of them, food is a real pleasure and a real joy. And so kind of putting this barrier, you've got to ask for it before you can have this pleasurable, joyful experience feels... Ali Battye: Yeah, yeah. in. Yes, yes. Ruth: and just feels wrong and I think actually then you could have the ⁓ it's crunchy it's spicy it's yummy let's have some more and there's so much other language you could model in those situations and I think there's something isn't there about that legacy piece that communication is taught in a behavioral way where we as the communication partners expect a response and often a way to get that is to dangle the carrot that they Ali Battye: I know. Yes. Mm-hmm. Hmm. Yes. Yes. Ruth: the child wants. So we teach it by that kind of request and response. But actually, if we think about communication development, and we think about where children's communication starts from and grows into, it's not just about asking for the things they want. It's about seeking that connection and sharing those fun things. You know, when babies first learn to clap and they look around like, what just happened? Isn't that exciting? know, moments. Ali Battye: Thank No. Yes, yes. Yes, and I always have a sort of visceral reaction to the term functional communication because we also read that a lot in reports or EHCPs ⁓ and I just kind of think what is functional communication? If you're basing this on a typical young child Their communication is not very functional, is it? It's very non-functional for most of the time because it's, you know, it's based on having fun and spontaneity and silliness and like spontaneous protests and being like a bit, you know, disorganized, surprises coming left, right and centre. Not much of it is functional. Ruth: Yep. Ali Battye: So, yeah, that's another term that I wish we could sort of get away from and really put the fun back into communication because communication is so much more messy and silly and we don't know what a child is going to say next, we? You've got young children, Ruth. I bet you don't know what's going to come out of their mouths next. Ruth: today. No, no, the other day, my, he's four next week and he came up to me in the middle of the swimming pool. We were sat upstairs watching his big sister swimming and just came up and went, I'm a gorilla. I eat poo. And I was like, okay. You know, and, and, and I just said, wow. I said, that was a funny thing to say because actually it's just your, it's just your embarrassing for parents. Ali Battye: Yes, Ruth: full join and that's the thing isn't it and I think we place this kind of presumption that particularly for our autistic community that they don't want to talk about those kind of things and share those kinds of things and so therefore we focus on the requesting and I think there's something about you know what if autistic non-speaking children want to talk about being a gorilla and eating poo why are we not giving them access to Ali Battye: Yes. Ruth: words to do that and you know recognizing that communication development is often different for autistic children and and you know might lean into more of their special interests or particularly if they're using echolalia or engashtalts but equally that sort of thinking about communication in a much broader way over how do they tell us things are fun Ali Battye: Yeah. Very good. Mm-hmm. Ruth: And we might see it in their body language, but then that's one word, one way, whereas we could offer them lots of different language because it's that excitement or is that fun or is it hilarious or is a joke or is it like, ha ha, you know, all these different words. So while we can see in their body and their facial expressions that they're experiencing joy, what is actually the kind of words that we're giving them to communicate that? And so if we're just Ali Battye: Yeah. Yes, yes. Mm. Mm-hmm. Ruth: you know and they're the bits aren't they where I think we need to think about really the reasons for communication being broader than just a request for a thing you know a comment about you know I work with the little one who loves airplanes and loves trains and will go and watch the trains and watch the airplanes and that communication just to say like I can see it I don't want it but I can see it. Ali Battye: Yes. No. Yes. Yes. Yes. Ruth: It's in the sky, you know, like those kinds of things, that content of language that is just meaningful. He doesn't want to request them. He might have done it at home to get them to go out to watch them. But actually then it's just one thing there. There's so much to say about. Ali Battye: Yeah. Yes. Yeah. Yeah, yeah, but I just want to share a thought that's in my head. Yeah, and I remember there was a piece of research a long time ago that was saying that children who used AAC, their language was often interpreted as a request, but it wasn't necessarily a request. So if a child was to say mummy at school, it was often interpreted as, you want your mummy. But that child might just have been wanting to say, I'm thinking about mummy, or I wonder when mummy will be coming, or loads of different possible functions. of functions, reasons to communicate that weren't requesting but it was limiting children's communication to requesting. Ruth: Yeah, I think back again to another boy I worked with, this was years ago and he would have been in my, if you read the Ruth, then Spillman, reports of the era, it would have been all about functional communication and requesting and you know, because that was what I knew and what I was trained in and we were introducing him to an iPad. And I was programming it and his, he'd been really quite distressed. His teacher called and said, can you just bring the iPad up? Like, I know it's not ready yet, but can you just bring it? Cause we don't know. And he had like some vocalizations and been saying, buh-buh, buh-buh, buh-buh, like repeatedly. And they'd always, I can't quite recall the exact, whether he'd always said that. And they'd always thought he meant his bedroom and that he wanted to go back to his bedroom. And so we got the iPad and I just sat down like, Ali Battye: Mmm. Ruth: he was sat on a bean bag with his sort of teacher behind him giving lots of deep pressure and squeezes because he was kind of starting to regulate a little bit again and he navigated and he said the bus and the teacher was like ⁓ well we were meant to go on the bus this morning but we couldn't because of staffing you know blah blah blah and I said ⁓ did you know that and you could see the connection then the teacher going ⁓ my god we just presumed blah blah blah meant bedroom that he was requesting to go back that's all we presumed it meant Ali Battye: than the world. Yum. Yeah. Ruth: And actually that was one of his only vocalisations, so could have meant all sorts of things. And in that moment giving him, it wasn't the, want the bus, but it was like, what's happened to the bus? Like we were meant to go on the bus, why is the bus? Why am I in class? You know? And that moment then she was like, ⁓ my God, I should have written a social story or I should have done something to inform. And I just think they're those moments, aren't they, where we presume what an individual wants to say. Ali Battye: and Yes. Yeah. Yeah. Yeah. Hmm. Ruth: And we presume it's often a request because of this legacy stuff. And actually, if we start to challenge that and see autistic children as wanting to share comments, share their experiences, share their ideas, share jokes and humor, and be able to describe things and have conversations and play games and, you know, all of these things that I think historically that legacy stuff has kind of lent into, we just want them to be able to ask what they want. Ali Battye: Thank you. Thanks Ruth: And I get that because for children who struggle with communication, often if communication is behaviour that hurts themselves or other people, you want to know in that moment what is driving that behaviour, right? And if it's something that they want that they can't get to to show you and they don't have the language, then I can understand where it comes from about wants and needs. Ali Battye: you Hmm. Mm. Ruth: But I think sometimes we can get a bit stuck on that and actually think if we focus on connection and joy, we might find a way into understanding a little bit more of that child's experiences in the moment that it might not actually be for something that they want. It could be something internally. It could be, where's the bus? Why is that not happening? And that isn't something that that child wanted in that moment. He was really distressed, but it wasn't because he wanted to go, wanted the bus. It's cause he was wondering what the heck happened to it. And Ali Battye: Yes. Yeah. Mmm. Yes, yes, yes. And something that I ⁓ sort of think about with AAC, I've been talking to an adult AAC user a lot. We've been sort of like sharing a lot of emails and the insights that I've been getting from her have just been incredible. And she has described her AAC as sort of like being an external brain. Ruth: So I think there's that piece, isn't there? Ali Battye: So she sometimes explores her thoughts through her AAC because she doesn't have an internal voice. I think some AAC users definitely do have an internal voice, but she says that she doesn't. So she doesn't actually always know what she's thinking until she has a little fiddle around with her AAC by herself. So it's not for anybody else as such in those moments. It's just to gather Ruth: you Ali Battye: gather her thoughts or develop her thoughts. ⁓ And I see this a lot in the children that I work with that their parents will say, ⁓ yeah, sometimes they take themselves off into a little corner and I hear them just exploring and saying things to themselves. And I think that's an underused or undervalued part of AAC use that sometimes it is just for It is for exploring thoughts, exploring language, making connections between things. ⁓ And that that's really valid. Like I celebrate if a child is exploring their AAC by themselves. I think previously we might have said, we might have dismissed that a bit. Like I've certainly heard ⁓ people worry they're just... pressing buttons, saying things like that. They're just pressing buttons, they're repeat pressing, they're just saying the same thing over and over and over again. ⁓ And I think we probably have said this before on the podcast, that that is really valid exploration of the language that's on there. And if we hear that, then we're absolutely delighted. Ruth: Yeah, yeah, and I think it's interesting, isn't it, that I was actually in a class this week with a young person doing some AAC work and he'd got it and he typed ⁓ the, the, the, ⁓ And it was so interesting because they in threes and it was like ⁓ and then the and then back to ⁓ And I kind of just went, ⁓ and I just repeated what he'd said because I thought, I'm not sure this is for me. This isn't like a... Ali Battye: I'm ready. I'm good. I'm good. Ruth: hey Ruth, look at this or like look at this thing over here or I'm telling you something. And it might have been, but I just didn't get that sense, you know, in that moment when you're kind of tuned into someone. And he just looked at me and smiled and then just deleted it and went on. But I thought, how interesting, like, and I think that's that sort of thing, isn't it? Where there's communication practice and then there's communication actually happening. And when it's that kind of more intentional, I'm... Ali Battye: Mmm. Yeah. Yeah. Ruth: giving you a message that I want you to receive and understand versus those moments where you do just see a bit of exploration. And I suppose like thinking about how we differentiate between what is a reason for communication and what is more of that self-regulatory, exploratory, processing language. And a lot of that comes down to knowing the individual, doesn't it? And really tuning in. Ali Battye: Mm-hmm. Yeah. Ruth: them and I think that's quite a complex thing within therapy to know which bits to respond to and which bits to notice but maybe take a different response as a communication partner. Ali Battye: Yes. Yes! Yes, and you have to be in relationship with that child, don't you, to sort of ⁓ get to know their patterns or their preferences. I think increasingly we are allowed to talk about ⁓ sort of like our gut instincts or our intuition in speech and language therapy. think, you know, previously it's been very much we only talk Ruth: Mm-hmm. Ali Battye: about observable behaviours and I think we're moving away from that, thank goodness, that we are allowed to, you know, like deeply relate to another. human being in speech and language therapy and sort of, ⁓ you know, do all of those things that are quite intangible like, you know, reading the mood in the room or, you know, sensing where a person's energy is at in that moment. And I think that's a really interesting area that we will explore more, I think, over the next few years in speech and language therapy. But I think the point that I Ruth: Bye. Mm-hmm. Yeah. Ali Battye: trying to make that, sorry, I'm very, very going off on tangents today. The point that I was probably trying to make there was, it's really important for us to get to know AAC users well. If we are supporting them, that you can sort of make that call more confidently if you know them well, compared to if you're just meeting them for the first time, you might not be able to tell, ⁓ that actually was just for themselves, that wasn't meant for me. But over time, getting to know a child, I think you can get that sense of, know, through their body language, through their postures, through their positioning, through, you know, general signs of regulation, I think that can help us to sense whether that was for us or not. Ruth: Yeah, and I think also as you get to know them you get to know their signs of intention You know, they're like is it a little bit of a side eye or a little bit of a nudge or do they sort of move the device towards you? You know those bits where they're like, yeah, this is come on now. This is for you whatever it is that I'm saying and I think the thing isn't it is that if you don't give an individual access to enough words and enough kind of Ali Battye: Yeah, yeah, yeah. Yes, yes. Ruth: opportunities and reasons for communication, you don't get that connection because you're looking at them going, I expect something from you, I expect you to now request this thing. And when they do it, you go, ⁓ here's the thing. And then almost like the moment's gone. Like, it's very transactional. Ali Battye: Amen. Yes and you've kind of ruined the connection haven't you? As soon as we've got an agenda, as soon as we have ⁓ an expectation for what someone is going to say the whole interest in communication just evaporates doesn't it? I remember someone when my eldest daughter was was very small, if she had been caring for my daughter that day when I went to pick her up she would say to my daughter tell mummy about how we... and she'd basically tell me before Ruth: Yeah. Ali Battye: my daughter was expected to tell me. So my daughter was expected to just repeat basically what this person had said. And she wasn't interested in that at all. You could see the sort of like interest drain from her body. And I think that, you know, that would be the same in any communication situation. It's sort of like passing an exam, isn't it? If you remember back to like taking a French oral exam or German oral exam and you know that they want you to say a very predefined script and it's just not interesting. There's no joy in that interaction if you think that the person already knows what you're going to say or expects you to say something that actually wasn't your genuine thought. Ruth: Mm-hmm. Yeah, and it becomes like, can even remember my French all exam now like Bonjour, Je m'appelle Ruth, j'habite a Sheffield, you know, and then I went on to talk about how it was a green city or something, because it was just drilled in, it wasn't communication for joy, was just drilled, and it was expected. And I think that's the thing that if we focus solely on requesting, it becomes a bit of a drill and it becomes a bit of an expectation like, ⁓ here we go again, yeah, there's the symbols, can I my snack now, please? Ali Battye: Yeah. Yes. Yeah. Good. Yeah. Ruth: Whereas if we think about communication for, you know, asking questions. I was working again this week, just this week, and saying to a child who took their socks off, and they like took their socks off, and I was just like, ⁓ And I got the device, I was like, where are you gonna put those? And then they put them in their boots, and I went, in your boots! I'm not modelling there that he needed to request anything, I'm just been like, I'm modelling a question, I'm modelling a comment, of a preposition. Ali Battye: Thank you. Ruth: like there's some labeling and then he took them off and he put his feet on the floor and wriggled his toes and I went, ⁓ I like that. You know, like just that preference. And so I think even in that moment, you can model a few different reasons for communication. So I think if we're thinking about AAC, we've got to be thinking about what reasons are meaningful to communicate for and what language are we giving. Ali Battye: you you Hmm. Hmm. Ruth: an individual. So if it's paper-based, making sure you've maybe got a few pages for different reasons. If you're looking in an AAC device, that's an app, where is the meaningful vocab, not just the requested vocab? And how do we use things like in-grid, you've got messages, haven't you? You've got quick fires in TDSnap, like things that you could program that are just a moment of communication that is just grounded in something that's connecting and meaningful. Ali Battye: Good. Thank Yeah. Yes, yes. Yes and sort of family fun sayings are nice to include, aren't they? So ⁓ you know like all families have different ways of checking in with each other or you know like favourite sayings or maybe a favourite song or something and that's really nice to include in the AAC. ⁓ Or some like real silly things like if we are talking about young children, young children just like to say really silly things, things that kind of Ruth: and Ali Battye: just feel nice in their mouth to say. yeah, some of that or sound nice. ⁓ Some of that just complete almost nonsense stuff, but that is just. Ruth: Yeah. Ali Battye: fun and delightful and it does mean something to the people sharing that language because it's like, you know, how they connect and how they essentially they're sort of communicating, I see you, I hear you, we're in this together. That kind of language can be really nice to have a think about and include some of that. Ruth: Mm-hmm. Yeah, definitely. I think kind of just thinking about what are the reasons for communication? And we've talked a lot about them today, but actually if you do a quick Google search, other search engines are available, but if you do a quick search, you would be able to find the means, reasons and opportunities model. And it will give you that list of reasons ⁓ and ideas. There's also, again, if you search for the, can do more than requests, there's a really lovely. like diagram within the middle like communication and it goes off on all these different ⁓ branches with lots of their little bits coming off it of all the different reasons to communicate. So actually if I can find it I'll put that in the show notes so people can ⁓ click through to those. ⁓ So thinking a little bit about our glimmers for ⁓ this week. ⁓ Ali Battye: Hmm. Ruth: I've got a couple. Have you got one that's at the forefront of your mind or shall I jump straight in? ⁓ Ali Battye: Yes, I do. This one was a couple of days ago so it's the newest child that I'm working with. So this was session two and we've just been modelling a few bits and pieces from the iPad. This is a quite typical scenario. the first, this is a very young child, like three, three and a half. The first time children come to my therapy space, very understandably, they're often dysregulated because they don't know what's going to happen. Like they've never been here before. They often want to explore the space and see what's behind other closed doors and stuff. And sometimes that's fine. And sometimes they kind of like want to finish before the end. always, you know, pains to say to parents like, we can finish early, that is fine. Because I don't want this child to feel as though they're imprisoned, first of all, and they're being held against their will. That they have agency and that this has been a positive experience. you know, I want them to come back the second time feeling like this is a space that I can be myself and that people listen to me. So this was the child's second time, the first time that we had finished slightly early because they'd clearly communicated by going to the door and pulling the door and pulling their mum's hand that they wanted to go. So this was only the second session and we were kind of like exploring the room a bit more and pulling things out of the drawers, pulling toys out of the drawers. And this child's mum knew that he really likes colours and sorting colours. So she had found a little stick container where you put like the red stick through the red hole and the blue stick through the blue hole and this child really got into that and so I was just modelling colours, I'd gone to the colours page and was just modelling that and this child had been sort of glancing throughout the session when I'd modelled things like definitely turning his head to look when I was modelling things on on the AAC so I'd been saying to his mum ⁓ that is that's brilliant he's turning his head and looking already and then when we were doing this colour thing he just sort like turn to the iPad and notice that they had the colours on that page and just had a lovely little explore really ⁓ deliberately going through the colours and just you know you could you could feel this little ⁓ that's exciting it's going up to the sentence bar so when I press red then red appears in the sentence bar and the mum like got quite tearful over it because it was the first like insight of like what's going on in his head, like the sort of like learning and processing that he's doing and just that lovely ⁓ recognition. He's really interested in this and this is really exciting. So yeah, that was my little glimmer of the week, I would say. Ruth: love that. My glimmer is a really interesting one and it's somebody that I have connected with on Instagram who is a parent who is introducing AAC and I've had so many wonderful messages over time and I just got another one this week which is what sort of prompted it to be in my mind of how this is a parent who has got some speech therapy support, but it is very limited, has thought, I want to introduce AAC. And their child is now speaking more and like generating quite like novel, spontaneous ⁓ language. They're putting things together that she's kind of having to work out what she means, because maybe it's like using a word that's semantically as similar, but isn't quite, you know, the like... ⁓ Ali Battye: Mm-mm. Yeah. I love you. Ruth: castle but they meant the, I don't know, restaurant or something, you know, those kind of things, like using slightly different words for different things. And it's just been so lovely. And it's one thing I really love about social media is to like have this experience where it's just sharing really positive, the positive impact of AAC, but also to see a parent feeling so empowered, you know, like they might ask the odd question, or message and things, but just... Ali Battye: and Mm. and then. Ruth: and the impact that that is having for that child because somebody's kind of had that, because a parent's had that capacity to just give something a go and it's just been so joyful like the little messages coming through of like oh she said this today or oh press this or oh just and which is really lovely really lovely. Ali Battye: Yeah. Yes. Yeah. for all my life. Yes, yeah, I Ruth: Thank you so much for our ⁓ chat today, about the reasons communication. I will put those bits the show ⁓ notes ⁓ so people can go and have a look. And we will you next time for the next episode of AAC Access All Areas. Ali Battye: Thank you. Bye bye.