Our tip of the week is joint attention.
Joint attention is the capacity to focus together with another (e.g. a parent) on something in the world, like an apple or a game. For typically developing children, it starts at about 9 months of age.
Banter Speech & LanguageBanter Speech & Language is owned and managed by David Kinnane, a Hanen- and LSVT LOUD-certified speech-language pathologist with post-graduate training in the PreLit early literacy preparation program by MultiLit, the Spalding Method for literacy, the Lidcombe and Camperdown Programs for stuttering, and Voicecraft for voice disorders. David is also a Certified PESL Instructor for accent modification.
David holds a Master of Speech Language Pathology from the University of Sydney, where he was a Dean’s Scholar. David is a Practising Member of Speech Pathology Australia and a Certified Practising Speech Pathologist (CPSP). David is a part-time Associate Lecturer at the University of Technology Sydney’s Graduate School of Health. David sits on Speech Pathology Australia’s Ethics Board and Professional Standards Advisory Committee, and is a Board Member of SPELD NSW.
Communication access = communication for all: Speech Pathology Week
Wheelchair ramps. Disabled parking. Lifts at train stations. All ways that communities support people with physical disabilities to get on with their lives and to contribute to society. Things that help people with physical disabilities go places and do stuff most of us take for granted.
But what about communication access?
Huh?
Almost everyone knows what this sign means:
Source: Wikimedia Commons.
But what about this one?
Source: Scope Victoria.
It’s called the Communication Access Symbol.
Communication Access?
To live our lives well, we need to communicate with others. We need to understand what others say and write. We need to get our messages – thoughts, feelings, needs – across to others.
Some people have problems getting and giving messages (or both).
Think about people with:
- communication disorders like aphasia or developmental language disorders;
- speech sound disorders, childhood apraxia of speech or motor speech problems, like dysarthria, which make it hard for people to understand their speech;
- hearing problems;
- vision problems;
- literacy problems;
- English as their second language;
- physical/sensory issues;
- intellectual/cognitive issues, e.g. people with a life-long disability or people with an acquired brain injury; and
- neurogenic diseases or disorders, e.g. Parkinson’s Disease.
These are examples of people who might have communication support needs. They might need help to get or receive messages (or both).
Communication problems often invisible, but common
Compared to some physical disabilities, communication disabilities can be hard to spot. But consider this:
- Between 1-2% of us have a communication disability (Law et al., 2007). Speech Pathology Australia thinks that the true number might be closer to 5%, or 1 in 20.
- Up to 20% of us have some difficulties with communication compared to the majority (Law et al., 2007).
- 44% of Australians have reading problems that prevent them from reading stuff required to meet daily needs (ABS, 2012).
How do people with communication problems help themselves?
Lots of ways! Here are just a few examples:
- Speech-language or voice therapy from a speech pathologist.
- Manual signing, e.g. Key Word Sign or Auslan.
- Augmentative communication aids, including “low tech” things like picture communication boards, or higher tech things like iPad apps (e.g. Proloquo2Go).
- Visual support.
- Audio support.
- Partner/carer training and/or supported conversational partner training.
How can communities help people with communication needs?
Our aim as a community should be to help people with communication problems to communicate effectively in unfamiliar, mainstream settings and with the greatest level of independence possible (Solarsh & Johnson, 2017).
Here are just a few suggested ways we can pitch in and help:
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- Watch and learn: Check out this short video by Scope.
- Share what you’ve learned with others: I had no idea about how common communication disorders were until I started studying speech pathology. A little bit of knowledge changed my attitudes, re-set my priorities and, over time, affected my values. I now know that communication is a human right, and that each of us is responsible for improving communication access for everyone.
- Promote Communication Access Cards. Help people with communication needs to tell others how they prefer to communicate. Scope has wonderful free templates you can download via here.
- When writing for the public, use these principles of writing.
- Use Plain English. Avoid pointless, long words. Work with Plain English experts to make forms, websites, etc. more accessible.
- Use pictures and symbols to help people who can’t read well and/or are learning to read English.
- Follow the example of business, community and other organisations that have been named as Communication Accessible Places and have been awarded the Communication Access Symbol by Scope. There are now over 160 such organisations and you can access the directory here. Many of these organisations are small. Inspiring stuff!
- Advocate for better access. When you encounter a hostile receptionist, an impenetrable website, or see a terrible form, sign or other document, call it out and advocate for change. For example, I saw this sign on the Sydney Light Rail recently:
Bottom line
Communication is a human right. It’s essential for taking part in society and living a fulfilling life.
Some people need help with communication. Outstanding organisations like Scope, are working hard with businesses and community groups to help people with communication needs. But we can all do things to make it easier for people with communication needs to communicate more effectively.
Related articles:
- How to write for people with acquired language problems (an example)
- Speech Talk 5: Alan Siegal – plain English – striving for simplicity
- Want your writing to sound smarter? Get rid of long, pointless words!
- Alternative communication options for children: not a last resort
Principal source: Solarsh, B. & Johnson, H. (2017). Developing Communication Access Standards to Maximize Community Inclusion for People with Communication Support Needs. Topics in Language Disorders, 37(1), 52-66.
Other resources (highly recommended reading):
- Scope on Communication Access
- Communication Access Network (CAN) Projects
- Autism Speaks on Inclusive Learning Environments
- Communication Disabilities Access Canada
- Ontario Integrated Accessibility Standards
- Royal College of Psychiatrists Enabling Environments Standards
- Scottish Government (2011) Principles of Inclusive Communication
Image: http://tinyurl.com/ya9ve8v8
Banter Speech & LanguageBanter Speech & Language is owned and managed by David Kinnane, a Hanen- and LSVT LOUD-certified speech-language pathologist with post-graduate training in the PreLit early literacy preparation program by MultiLit, the Spalding Method for literacy, the Lidcombe and Camperdown Programs for stuttering, and Voicecraft for voice disorders. David is also a Certified PESL Instructor for accent modification.
David holds a Master of Speech Language Pathology from the University of Sydney, where he was a Dean’s Scholar. David is a Practising Member of Speech Pathology Australia and a Certified Practising Speech Pathologist (CPSP).
Early warning signs of possible autism spectrum disorder
Kids are rarely diagnosed with autism spectrum disorder (“ASD“) before three years of age. But the research tells us that the best time to start intervention is between 18 months and 4 years of age.
We know that young kids with ASD often have deficits in social communication skills. These include deficits with:
- joint attention: the shared focus of the child and another (e.g. a parent) on an object (e.g. a ball or truck);
- shared affect: the social use of emotional expressions in response to others (e.g. smiling);
- eye contact;
- gestures; and
- functional and symbolic play.
We also know that speech and language development alone can’t be used to differentiate children with ASD from children with developmental disabilities or language delays because speech and language delays are common to all developmental delays.
Wetherby (2007) identifies 5 core deficits that are “red flags” or warning signs of possible ASD in early years:
- no or limited gaze shifting (looking from a person to an object or other person and back to the first person);
- not looking at where someone is pointing;
- limited or no joint attention;
- slow rate of communication (typically developing 12 month olds communicate about 2.5 times a minute, increasing to about 7.5 times a minute by 24 months of age); and
- few early gestures (e.g. pointing, “feeding” self from an empty spoon; hands to mouth to indicate wanting to eat).
In 2001, Robins and colleagues identified 6 red flags for ASD in children aged between 18 and 30 months of age, namely:
- limited interest in other children;
- limited pointing for interest;
- limited imitation of a parent or other caregiver;
- limited showing of objects to indicate interest;
- limited response to their name; and
- not looking at where someone else is pointing.
In 2012, Vaness and colleagues published a study looking at three groups of Australian children – typically developing, language-impaired and children with ASD. They found that:
- reduced use of early gestures at both 12 and 24 months most clearly differentiated children with ASD from comparison groups, although they were unable to identify specific gestures distinguishing kids with ASD from others. Instead, the difference appeared to be in the pattern of early gestures used as a whole;
- responding to name, waving, pointing and giving gestures, requesting attention and help, and sharing an interest did not safely discriminate kids with ASD from typically developing children at 12 or 24 months;
- joint attention at 12 months, and gaze-point following and the showing gesture at 24 months, may discriminate between children with ASD and children with a pure language impairment or delay; and
- parents of children with ASD are likely to be aware of the slowing development of their child during the second year.
What do these red flags look like in the real world?
Some of the potential warning signs listed above can be hard to visualise – especially if you haven’t met many children with ASD. Autism Speaks, one of the world’s leading ASD research and advocacy groups, hosts a fantastic video glossary resource, including several valuable video examples of red flags for ASD. To access the videos, you first have to register (it’s free). But it’s well worth the effort – especially if you want to see some great video examples directly comparing behaviours of children with ASD to those of typically developing children.
You can access the video glossary here.
Bottom Line
Trust your instincts. If you are concerned that your toddler is not developing typically and might be displaying some of the red flags for ASD, consult with your child’s pediatrician. But don’t panic. “Red flags” like the ones listed here – though useful – are just early warning signs of possible ASD. Only a paediatrician can diagnose your child with ASD, and only then after a thorough assessment, usually including input from speech pathologists, psychologists and other health professionals.
Principal source: Vaness, C., Prior, M., Bavin, E., Eadie,P., Cini, E. & Reilly, S. (2012). Early indicators of autism spectrum disorders at 12 and 24 months of age: prospective, longitudinal comparative study. Autism, 16(2), 163-177.
Banter Speech & LanguageBanter Speech & Language is owned and managed by David Kinnane, a Hanen- and LSVT LOUD-certified speech-language pathologist with post-graduate training in the Spalding Method for literacy, the Lidcombe and Camperdown Programs for stuttering, and Voicecraft for voice disorders. David is also a Certified PESL Instructor for accent modification.
David holds a Master of Speech Language Pathology from the University of Sydney, where he was a Dean’s Scholar. David is a Practising Member of Speech Pathology Australia and a Certified Practising Speech Pathologist (CPSP).
Alternative communication options for children: not a last resort
Like most professions, we speech pathologists love jargon. And one of the terms we bandy about – often assuming people know what we’re talking about – is “alternative and augmentative communication” or “AAC”.
Researchers have forged careers debating, defining and re-defining AAC; and the field is technical and (with good reason) politically charged. For our purposes, AAC is simply a therapy approach that seeks to increase a person’s ability to communicate and participate in his or her preferred activities, often using more than one way of communicating (Glennan, 2000). These abilities may include:
- any existing speech or vocalisations;
- gestures;
- manual signs (like AUSLAN or Key Word Signing);
- communication boards using popular software like Boardmaker;
- pictures, e.g. PECS; and
- speech-output communication devices, e.g. (i) iPads with apps such as Sono Flex and Proloquo2go; and (ii) other devices running proprietary programs such as Minspeak.
Many parents – understandably – resist AAC in the early stages of treatment, preferring speech pathologists to focus on improving their child’s speech. But it doesn’t need to be an “either/or” decision. And research suggests there’s no reason to be concerned about the effect of AAC on speech development. Here’s what the research tells us:
- For children, AAC (including manual signing and devices) does not slow or stop speech development, but may in fact speed up the development of speech (Cress, 2003; Romski, Sevcik & Hyatt, 2003).
- Speech devices can benefit children with speech delays or disorders, regardless of whether they also have cognitive impairments. This used to be a bigger issue in the days before iPads, when devices tended to be both expensive and complicated to use. Now there are some terrific apps including Board Builder and TapSpeak that can assist children with severe intellectual impairments.
- AAC can benefit children of all ages, including infants, toddlers and pre-schoolers.
Related articles:
- FAQ: In what order and at what age should my child have learned his/her speech sound consonants?
- 10 common speech error patterns seen in children of 3-5 years of age – and when you should be concerned
- Which words should I teach first?
- Principles we follow when assessing a toddler’s language
- What can we do to prepare pre-schoolers to read?
- Expressive language – syntax and past tense
- Do kids learn to string sentences together by listening to baby talk?
Key source: Romski & Sevcik. (2005). Augmentative Communication and Early Intervention: Myths and Realities. Infants & Young Children, 18(3), 174–185.
Image: http://tinyurl.com/mfvehon
Banter Speech & LanguageBanter Speech & Language is owned and managed by David Kinnane, a Hanen- and LSVT LOUD-certified speech-language pathologist with post-graduate training in the Spalding Method for literacy, the Lidcombe and Camperdown Programs for stuttering, and Voicecraft for voice disorders. David is also a Certified PESL Instructor for accent modification.
David holds a Master of Speech Language Pathology from the University of Sydney, where he was a Dean’s Scholar. David is a Practising Member of Speech Pathology Australia and a Certified Practising Speech Pathologist (CPSP).