Communication and children with neurological conditions

communicationIn the first of a new series of articles on dealing with problem behaviour in children with neurological conditions, Cerebra Sleep Practitioner Bethan Roberts gives advice on improving  communication.

There are many reasons that negative/problem behaviours occur in children with neurological conditions (and indeed with those who are neurotypically developing). Here I am going to talk about communication and the importance of Functional Communication in reducing frustration and other negative behaviours and increasing interaction and language acquisition.

Communication begins as soon as we are born, for example, a cry to indicate we are too warm, hungry or tired. As parents and carers we tend to learn pretty fast what each cry means and then act upon them, thus increasing the likelihood that this specific behaviour will happen again. This is called positive reinforcement (something to remember is that it’s only positive reinforcement if it does increase the occurrence of a behaviour).

It may seem the simplest thing in the world to be able to express a need that is not being met, for it then to be consequently met. However when this does or cannot happen it can be an incredibly frustrating place to be. Have you ever found yourself in a situation perhaps on holiday where you need something and the person who can give it to you does not speak the same language? A lot of people do not ‘naturally’ come to utilise speech, sign etc and there are many that, due to certain conditions simply cannot. So we would look at using whatever means of communication that’s available/simplest i.e sign, pecs, speech, augmentative devices, pointing, vocal sounds, written word.

As a starting point for introducing functional communication I think we need to break down what we mean. By functional, we mean the impact of that behaviour/communication. What is the purpose of  the behaviour/communication? Does the intended communication produce some change in the persons environment making it more reinforcing? For example, it’s a hot summer day, a child asks for an ice cream, they get an ice cream. This behaviour is likely to be strengthened (reinforced) by receiving an ice cream therefore making it more likely that asking for an ice cream will occur in future. The negative (and very common) alternative can sometimes look like this. It’s a hot summer day, a child wants an ice cream, the child has little/no functional communication skills so they scream and cry until someone figures out what they want, and they get the ice cream. This behaviour is likely to be strengthened (reinforced) by receiving the ice cream therefore making it more likely that screaming and crying will occur in the future. Both scenarios may have the same outcome, but the latter probably took a great deal longer and involved much more stress and upset.

So as a starting point, look at a reasonable way for your child/young person to begin communicating. Once this has been chosen, create a list of their preferred activities/toys/food/people (get creative) and find as many opportunities for asking to occur in a sitting. At first you will have to prompt quite a lot (taking their hands and creating the sign, saying the word for them to repeat, taking their hand to the correct pecs symbol etc). Break things down, if it’s a favourite movie give them 30 seconds and then pause, presenting the opportunity to request again. If it’s a tangerine, give one segment at a time. When on the swings, give two pushes then stop. Fairly soon, children and young people will begin to learn that if they ask, they very often get.  It’s important to remember that what we find reinforcing can change moment to moment, it’s tricky to teach people to ask for something they don’t particularly want, if you’re asking someone to make a big effort with a new skill, the reward (reinforcement) has to be worth it.