1. Communication and Behavior
Djenne-amal N. Morris and Susan Wiley
June 2017

2. How do you define communication?

3. How do you know communication is happening?
It’s not what you say, it’s what they hear

4. Ways to Communicate Eye Gaze/Facial Expression Vocalization Speech
Gestures/Sign Language
Writing
Pointing to: object, photograph, line drawing, symbol
Speech Generating Device (SGD)
Cell phone (calling/texting)
Mobile technologies
Apple’s iOS, iPhone, iPod touch, iPad
Google’s Android
HP/Palm’s Web OS
Microsoft’s Windows 7 and 7 Mobile

5. Why do we communicate?

6. (paraphrased quote from Janice Light).
“Communication is essential to attaining quality of life, allowing humans to connect with each other, touching others’ lives, and having others touch our lives”
(paraphrased quote from Janice Light). 

7. Functions of Communication
Protest/reject (to refuse things you don’t want)
Request object/action (to get what you want)
Greet/gets attention (to engage in social interaction)
Shows objects/comments (to provide or seek information)

8. Communication Progress
Hierarchy of skill development is often necessary
When children are not making progress, looking back at some of the foundational precursors to communication is important
Joint attention
Eye contact
Requesting
Showing
Turn-taking (back and forth play)
Choice-making (objects, pictures, icons)
Understanding of routines vs words
What types of activities build these skills?
How do you work with families to gain their understanding of these activities supporting communication development?

9. Communication Matrix: Helpful for individuals with any type or degree of disability but not suitable for individuals who already use some form of language to communicate meaningfully and fluently

10. Seven levels of communication Charity Rowland, PhD
LEVEL I: PRE-INTENTIONAL BEHAVIORS
These behaviors are reflexive or reactive rather than purposeful, but they seem to be associated with specific states of well-being.
Parents interpret the behaviors as expressing certain internal states such as hunger, comfort or pain.
Do you have children on your case load who are in this category?
Describe why you think this is the case.

11. Seven levels of communication Charity Rowland, PhD
LEVEL II: INTENTIONAL BEHAVIORS ... that function as communication
These behaviors are intentional, but they are not intentionally communicative. That is, children do not realize that they can use these behaviors to control another person's behavior.
Nevertheless, some of these behaviors serve a communicative function, since parents interpret them as communicating something.
At this level, children do not establish eye contact prior to exhibiting a potentially communicative behavior, nor do they wait for a response from the adult. Instead, children operate directly on objects and people, rather than using an object to attract a person's attention or using a person to obtain a desired object.
Do you have children on your case load who are in this category?
Describe why you think this is the case.

12. Seven levels of communication
LEVEL III: UNCONVENTIONAL COMMUNICATION ... using pre-symbolic behaviors
This is a critical stage. Now children communicate intentionally, but they use unconventional ways of communicating, such as body movement, actions on people and objects, vocalizations (or switch activation for the severely orthopedically impaired).
Behaviors are called nonconventional because they do not constitute a socially acceptable means of communication in the adult world. Although these behaviors are extremely effective, they are usually replaced eventually by more conventional gestures.
Do you have children on your case load who are in this category?
Describe why you think this is the case.

13. Seven levels of communication
LEVEL IV: CONVENTIONAL COMMUNICATION ... using pre-symbolic behaviors
At this level children communicate intentionally using conventional (or socially acceptable) gestures and vocalizations. The conventional gestures will continue to be used throughout childhood and adulthood to effectively augment symbolic behavior.
The child now has "dual orientation": she or he acts on or orients toward both a person and the topic of communication at the same time. Dual orientation is frequently achieved through the combination of gestures (e.g., gazing at someone while pointing to something) Children with vision impairments may not develop these skills.
Do you have children on your case load who are in this category?
Describe why you think this is the case.

14. Seven levels of communication
LEVEL V: CONCRETE SYMBOLS ... that represent specific referents
At this level children are able to represent an environmental entity (a referent) through the use of concrete symbols such as "natural" or "depictive" gestures (gestures for mine, sit, come), pantomiming actions or objects, or the use of tangible symbols (pictures or objects used as symbols).
These concrete symbols are related to environmental entities in two ways. First, they bear a 1:1 relationship to a specific referent. Second, they bear a clear perceptual relationship to the referent: that is, they physically resemble the referent in appearance, sound, touch or motion.
Children with severe orthopedic impairments may access tangible symbols through the use of a switch or other mechanical device or by pointing, touching, eye gaze, etc.
In most children, Level V does not appear as a separate stage of communicative development. Instead, Level V behaviors tend to be interspersed with Level IV and Level VI behaviors. However, Level V may become a separate and critical stage of development for children with severe disabilities for whom concrete symbols may be the only meaningful symbols. Or, it may serve as a transitional stage for children with milder disabilities who are having difficulty acquiring abstract symbols.

15. Seven levels of communication
LEVEL VI: ABSTRACT SYMBOLS ... that represent specific referents
At this level children are able to represent environmental entities through the use of abstract symbols such as speech, manual signs, Brailled or written words, abstract graphic symbols, or three-dimensional abstract symbols (a certain shape or texture that has been arbitrarily designated as a symbol for something).
These symbols bear a purely arbitrary relationship to their referents - that is, they are not perceptually similar to them.
At this stage, the child uses abstract symbols one at a time, rather than in combinations. Children with severe orthopedic impairments may access the symbols through the use of a switch or other mechanical device or by pointing, touching, eye gaze, etc.

16. Seven levels of communication
LEVEL VII: LANGUAGE ... combining symbols
At this level children use symbols in two- or three-symbol combinations, according to grammatical rules, or syntax.
The meaning of an utterance may change if the order of the symbols is changed. Children with severe orthopedic impairments may access the symbols through the use of a switch or other mechanical device or through pointing, touch, eye gaze, etc.

17. Small Group Work (2 cases)
Have someone in the group present a child with whom they have worked that fits the category of communication
As a group, discuss what activities they would do to build skills to get to the next level with the consideration of family partnerships
Report out to the larger group, key learnings

18. What activities would you do to move a child from Level II to Level III
LEVEL II: INTENTIONAL BEHAVIORS ...
These behaviors are intentional, but they are not intentionally communicative. That is, children do not realize that they can use these behaviors to control another person's behavior.
Level III: UNCONVENTIONAL COMMUNICATION ... using pre-symbolic behaviors
Children communicate intentionally, but they use unconventional ways of communicating, such as body movement, actions on people and objects, vocalizations (or switch activation for the severely orthopedically impaired).

19. What activities would you do to move a child from Level III to Level IV
Level III: UNCONVENTIONAL COMMUNICATION ... using pre-symbolic behaviors
Children communicate intentionally, but they use unconventional ways of communicating, such as body movement, actions on people and objects, vocalizations (or switch activation for the severely orthopedically impaired).
Level IV: CONVENTIONAL COMMUNICATION... using pre-symbolic behaviors
At this level children communicate intentionally using conventional (or socially acceptable) gestures and vocalizations. The conventional gestures will continue to be used throughout childhood and adulthood to effectively augment symbolic behavior.

21. Tools Gestural Development Assessment and Progress Monitoring
Finding motivators
Routine and activities worksheet

22. Gestural Development Assessment & Progress Monitoring Stremel Thomas, Schalock, Ruder & Bashinski,
Rubric:
0 = Not yet;
1 = Emerging, but seldom seen;
2= Emerging with increased frequency;
3 = Uses each day when there are opportunities,
4 = High rate and generalizations to many different people, objects, and routines.

23. Typical Development at 9-12 months

24. Typical Development at 9-12 months

25. Typical Development at 9-12 months

26. Typical Development at 12-15 months

27. Typical Development at 15-18 months

28. Typical Development 18-24 months

29. What activities would you do to help a child move from a 9-12 month level to a 12-15 month level?
9-12 months: refuse and request via gestures (to be picked up), enjoys peek-a-boo, anticipates activities, gives and shows, waves bye-bye
12-15 months: points to objects, looks at named people

30. Assessment of Salience/Understanding
Objects
Entire object vs part of an object to represent
Photos
Photo with the child, without the child
Cartoon representations
Icons/symbols
Higher level representations
Words/Signs
Highest level of representations

31. Choice-making Between objects Between photos Between icons
preferred vs non-preferred or preferred vs preferred
Between photos
Between icons
Between signs/words

32. Assessment of Motivators
These can then be used either to reinforce preferred behavior or to establish things that a child would want to communicate about (request)
The caregiver interview which asks open-ended questions followed by comparison questions:
“What does he like to do?”, “What are his favorite foods?”, and “Where does he like to go?”
“Which does he like better, cookies or crackers?” and “What would he rather do, go for a walk or eat chips?”
Structured surveys: obtains information about potential reinforcers and ranks the potential reinforcers in order of preference. (i.e: the Reinforcement Assessment for Individuals with Severe Disabilities, Fisher et al., 1994).
Direct Observation: present items with no demands placed and record time child spends with the item (more time intensive, but likely most accurate)
Can present information in various formats, single item, paired, and multiple choices

33. Considerations of daily routines for embedding expanding communication
In pre-linguistic level communicators, routines can be a structure to embed communication
For working on higher level concepts, daily routines can provide a framework to help coach parents in working on communication

34. Embedding communication within routines

35. What routines might you consider and what activities would you embed in a routine?
Diaper changes
Feeding
Bath-time routine

36. How do you recognize atypical language development?
Can children who are D/HH have language disorders?
“Auditory Processing” (vs “language processing”)
Autism spectrum Disorder
Apraxia of Speech
Language Gaps in typically developing D/HH children
How should we define language under-performance?

37. Pre-Linguistic Communication Red Flags for Autism in Hearing Children
Barbaro, J. and Dissanayake, C. Prospective Identification of Autism Spectrum Disorders in Infancy and Toddlerhood Using Developmental Surveillance: The Social Attention and Communication Study. Journal of Developmental & Behavioral Pediatrics. 31(5): , June 2010.
Pre-Linguistic Communication Red Flags for Autism in Hearing Children
Behavior
8 months
12 months
18 months
24 months
Eye Contact X
Turning to Name Call
Imitation
Pointing
Gestures-Waving
Pretend Play
Showing Behaviors
Fail Criteria
Fail 2/2
Fail 3/4
Fail 3/5

38. Intervention for Atypical Language Development
It’s not about communication mode
Static representations vs words/signs that are here and gone
Hierarchy of communication
Functions of communication
Think through what is salient to a child
Finding what motivates a child
“Input” may need to be different than “Output”

39. Visual Schedules Is this a communication system?
What is the target behavior for visual schedules?
How can these help?
What types of considerations are needed to build one?

40. Sleep: ATN/AIR-P Toolkit

41. Picture Exchange Communication System It’s not just for autism….

42. Functions of Behavior Escape (I get to avoid something I don’t like)
Tangible (I get what I want)
Attention (I get your attention)
Automatic (Because it feels good)

43. Behavior: Considerations
Understood in the context of communication needs
Understood in the context of the child’s overall developmental levels (i.e., if a child is functioning at a 2 year level, anticipate an attention span that is commensurate with most 2 year old’s)
Recognize when there may be risks for emotional difficulties (parent-child relationship, exposure to abuse, domestic violence)
Recognize when there are neurobiological factors contributing to behavior (attention, impulsivity, hyperactivity)

44. Developmental framework
Do I understand first-then?
Re-direction (for those children who do not yet understand first-then)
Do I understand later or waiting
How long can I wait? (don’t reinforce a lot longer than that time frame, frequency of reinforcement and expanding plan)
What types of visuals will help remind me what I need to do?

45. Building Behavior Systems
Functional Behavioral Assessment
A-B-C
Motivation assessment
Building an approach for a behavior plan
Triggers of behavior
Reason for behavior
Frequency of behavior
Establishing a plan to extinguish or shape behavior
Consider frequency of reinforcement needed
Teaching replacement behavior
Teaching waiting

46. Alternative Rewards
May need to help family members (and extended family members) figure out a way to engage and interact positively (enjoyable activities) that don’t just rely on food

47. Types of systems

48. Types of Systems Social Stories Describes what the issue is
Gives the correct behavior or response that is desired
I like to hold my rabbit.
When I sit still and use quiet hands, my rabbit likes that

49. Social Stories © Carol Gray Definition:
Social Story accurately describes a context, skill, achievement, or concept according to 10 defining criteria.
These criteria guide Story research, development, and implementation to ensure an overall patient and supportive quality, and a format, “voice”, content, and learning experience that is descriptive, meaningful, and physically, socially, and emotionally safe for the child, adolescent, or adult with autism.

50. Types of statements/sentences
Descriptive sentences: are truthful and observable sentences (opinion- and assumption-free) that identify the most relevant factors in a social situation. They often answer "why" questions.
Perspective sentences: refer to or describe the internal state of other people (their knowledge/thoughts, feelings, beliefs, opinions, motivation or physical condition) so that the individual can learn how others' perceive various events.
Directive sentences: presents or suggests, in positive terms, a response or choice of responses to a situation or concept.
Affirmative sentences: enhances the meaning of statements and may express a commonly shared value or opinion. They can also stress the important points, refer to a law or rule to reassure the learner.

51. Types of statements/sentences
Affirmative sentences: enhances the meaning of statements and may express a commonly shared value or opinion. They can also stress the important points, refer to a law or rule to reassure the learner.
Control sentences: identifies personal strategies the individual will use to recall and apply information. They are written by the individual after reviewing the Social Story.
Cooperative sentences: describe what others will do to assist the individual. This helps to ensure consistent responses by a variety of people.
Partial sentences: encourages the individual to make guesses regarding the next step in a situation, the response of another individual, or his/her own response. Any of the above sentences can be written as a partial sentence with a portion of the sentence being a blank space to complete.

52. Simplified version I like to go to the park
My favorite thing to do is swing
Sometimes there are other children on the swing
I will wait my turn
I can do another activity while I wait
When they are done, I will get a turn to swing

53. Creating Safe Play Spaces
High Interest, multi-sensory materials
Anchored down
Self-initiated Exploration
Easily adaptable
Individual use or with others
Inexpensive and Easy to create
Hold Everything page 1

54. Examples

55. How would you create your space?
Think about who, what, where, when, how as you create?
Who will use this play space?
Where can you use it? High chair, car seat, pack-n-play, bath tub
What developmental domain is being addressed?
What skill is being practiced and how will you make it salient and functional?

56. Communication Style Quiz
Styles focusing on achievement, relationship, idea creation or action
Take quiz

57. Focused on Task: Doer (rapid movers)
Doers like to be in control. They like quick action and they like to see results. They like to get to the point with little formalities. They don’t care for details and love finding shortcuts. Otherwise, they get bored easily. They like autonomy, freedom and taking risks. They are self-starters, innovators and love to expend physical energy. They like public recognition, especially for putting what they most value into action and for creating results that make a difference in the world (or at least in world they see and act in every day).

58. Focused on Task: Thinkers (slower speed)
Thinkers love to gather information. They enjoy reading and presenting their findings in detail. However, they need to mentally rehearse before they present, and take time to evaluate and wind down after the show. They take their time making decisions, but stand by what they decide once they do. They don’t care to talk about personal issues, but enjoy discussing hobbies and issues. They desire clear expectations, specific goals, deadlines and structure. They live by a sense of order, methodologies and personal responsibility. Thinkers love to win, and will compete with themselves if no one is available. They will jump into the game with no coaxing if they perceive they have a fighting chance. They are proud of their good work. They like acknowledgment but won’t ask for it.

59. Focused on Relationship: Influencers
Influencers like to verbally process their thoughts so they welcome situations where they can “think out loud” with others. They like to interrupt others, especially when they are excited about the topic. They view this as conversation, not a disruption. They enjoy people, desire approval and tend to be friendly, creative and persuasive. However, they may need some help staying on track and following through on tasks. They desire social interaction, acknowledgment and chances to be creative and have fun. They often see the bright side and can be very amusing, dramatic and passionate about work. They help others get through difficult times and can build rapport and support. They genuinely like people. However, they might find themselves caught up in a lot of drama since they are quick to want to help fix things and people. Teasing is one of their favorite pastimes.

60. Focused on Relationship: Connectors
Connectors count on others to set the tone and determine direction. They are consistent and reliable once given their responsibilities. They like to work with others instead of alone but take their time trusting and allowing new people to join their established groups. They do not readily give opinions, but this does not mean they don’t have any. Because they are diligent and dependable, they often know the most about how work is getting done. They like to be asked what they know and they appreciate personal recognition (done privately, not in front of others). They desire consistency, social bonds and acknowledgment for effort as well as results. Although they may appear stubborn, they can be very flexible and adaptable if they understand why the changes are being made and how they will benefit themselves and others. They seek to reduce stress and promote harmony

61. When Communicating with a Doer
What to do
Be clear, specific, brief and to the point.
Stick to business.
Be prepared to support your ideas and work.
Factors that will create tension or dissatisfaction:
Talking about things that are not relevant to the task or issue.
Being unprepared or incomplete. Avoiding or beating around the bush.
Appearing unsure or disorganized, but not asking for help.

62. When Communicating with a Thinker
Do these things:
Prepare your “case” in advance. Be prepared for a debate.
Stick to business.
Be accurate and realistic.
Factors that will create tension or dissatisfaction:
Being giddy, casual, informal, emotional or loud.
Pushing too hard for results or being unrealistic with deadlines.
Being disorganized or messy.

63. When Communicating with an Influencer style
Do these things:
Provide a warm and friendly environment. Do little things to show your care.
Don’t deal with a lot of details (put them in writing).
Ask “feeling” questions to draw their opinions or comments.
Factors that will create tension or dissatisfaction:
Being curt or cold. Cutting them off if they have something to say.
Controlling the conversation. Not allowing them to talk and express.
Focusing on facts and figures.

64. When Communicating with a Connector Style
Do these things:
Begin with a personal comment--break the ice.
Present your case smoothly, non-threateningly.
Ask “how?” questions to draw their opinions.
Factors that will create tension or dissatisfaction:
Rushing headlong into business. Creating tension.
Being domineering or demanding.
Forcing them to respond quickly to your ideas. Demanding change.

65. Communication with Families
Our communication styles
Tasks
Relationship