Friday, March 4, 2011

Verbal Faux-Interaction or Verbal Interaction? There is a difference.

The Among Friends blog features a post called "19 Ways to increase verbal interaction with your child" that I want to comment on, to add to. If you right click on the link to the Among Friends blog post and open it in another tab, you can see the list without closing this post.

In the blog post, speech-language pathologist Ruth HaberkornHalm gives parents a list of 19 actions to take in interactions with their children aimed at increasing verbal interactions with children who are in some sort of speech therapy. It's a great list, particularly when used for the right reasons (and I'm not convinced she's using them for the right reasons, based upon some of her descriptions), and I see uses for the list way beyond what she suggests.

HaberkornHalm writes, "In the treatment room, the speech pathologist teaches the child the skills needed to attain receptive and expressive language skills appropriate for their age or the highest level the child can reach." (I have a problem with part of this statement. Keep reading.)

She lists 19 ways, idea-starters that parents can use to create opportunities and situations for the kids to ask for something. She says, "They are designed to help the child use/increase requesting, verbal interaction and naming as well as improve speech intelligibility, expand utterances and build associations." I want to add the idea that the list of 19 is also designed to create opportunities for the child to wonder what is in Mom's mind, to wonder why she paused, why she left something out; to perspective take; to discover a problem or breakdown together and to repair it together.

If you look at that list, you can look at it two ways. In one way, it is a list designed to help parents to create opportunities for manding (requesting, or what I sometimes refer to as DEmanding), which is a term from behavioral psychology. If you look at it from another angle, it is a list of ways to build or grow interdependence, to create a situation where your child needs YOU for something, which may or may NOT involve "words" and "talk" and more importantly, is developmental and relational. I want, using Mom as a means to an end is drastically different from I need YOU to help me WITH something; let's do it together.

Interdependence is an important concept that is sometimes (often) missed in kids w/ developmental delays. A lot of kids with developmental delays and/or special needs don't know they NEED others; don't experience the benefits and importance of relationships with others.

HaberkornHalm sort of hints at this in the text, but does not go into detail: "They may have a hard time knowing what their child wants because he/she may not request, may not engage, their language is limited or intelligibility is compromised."

If your child fits the description of the first part of her list, they probably have no developmental business being made or expected in increase verbal interaction. If your child fits this descrption "They may have a hard time knowing what their child wants because he/she may not request, may not engage" then you may want to skip opportunities for your child to mand or request and instead use this list with a different goal in mind. (Hint: it's not "verbal interaction". Take some developmental steps back, please.)

Here's what I didn't understand, what no one explained to me when my child was two.

Giving children situations where they need to mand does not = relationship building.

There is a difference between creating opportunities for a child to mand as a means to an end VS creating opportunities to need you, to experience an "us", a "we", a "between you and me"that add up to relationships. If you seek engagement, relationship, "we", "us", "between you and me" experiences, please know this: Creating opportunities to mand won't get you where you want to go. Developmentally, you can't get there from here. Creating opportunities to practice and experience competent interdependence, opportunities to interact with reciprocity at non-verbal levels will get you there, and if you understand that developmental concept, you can use this sweet list on your trip.

Engagement at non-verbal levels comes first in development. Dr Gutstein taught me that words and talk are the last enhancement to an already complex system of engagement and interaction that add up to communication. If you are parenting a child who does not engage, give him experience in engagement at non-verbal levels and save pushing for verbal exchanges for the time when the non-verbal engagement, interaction, interdependence are in place.

The list is a great list, and can and SHOULD be used for other opportunities, particularly pre-speech, non-verbal foundations of relationships, for creating situations that you can do with your child.

I wish HaberkornHalm had established some sort of developmental criteria, some sort of developmental checklist for parents to help them know when using a list like hers for "verbal interaction" is developmentally appropriate.

Why is that so important to me? Because we were given lists like these to use for "verbal interaction" when my child did not have the non-verbal foundations of interaction and joint attention in place, first. The professionals guiding us understood behavior, but did not understand development. With hearts of gold and good intentions, we created more weirdness using a list like this one outside of a developmental framework.

"Verbal interaction" is not a developmentally appropriate goal for children who don't yet engage at non-verbal levels. If your child doesn't naturally need you, is not interdependent, if you have to create situations for your child to need your assistance, you may need to back up and give her some experience and practice at pre-verbal levels. If your child does not naturally need you, watch you, monitor you visually, and I'm talking referencing for meaning, not meaningless eye contact here; if you're not having rich non-verbal back-and-forth exchanges with your child, using this list to increase verbal interaction is probably developmentally inappropriate, no matter the age of the child. However, you can use this list to help your child experience pre-verbal foundations that lead to the verbal stuff.

So, first of all, in my laymom opinion, throw out the idea that goal is for the child to be "appropriate for their age". Throw out, "Modify the activity according to your child’s age and interests.", too. Let's try "developmentally appropriate" instead, and go from there.

Here's one good thing about the list for me: We parents can fall into a lifestyle of creating a lot of learned helplessness by doing too much for our kids, and a lot of HaberkornHalm's suggestions, in my opinion, are good reminders that we as parents should not do too much for our kids. Here's an example: HaberkornHalm suggests reminding your child to brush her teeth while hiding the toothpaste. When we give the child a toothbrush loaded with toothpaste, they get the message that they don't have to be engaged and active in self-care, that mom or dad will do most of the work for them. (See the labels section in my blog left-hand side bar for more thoughts on learned helplessness.)

Here's what I see differently from HaberkornHalm: The list of "19 ways", for me, though, isn't as much about verbal interaction as it is about stages of relationship development and joint attention. Her goal is "verbal interaction" and it differs from mine. My goal is relationship building. You can get "verbal interaction" and completely miss J/A and relationship building, or you can focus on relationship building and get J/A and interaction naturally along with it.

Parents of kids with developmental delays, or "special needs" or on the autism spectrum are often taught to miss the mark of joint attention by misguided professionals, as though joint attention automatically comes with the verbal interaction. But it's not the kind of interaction that parents crave, at least it wasn't for us. I'd call it verbal faux-interaction instead of something real.

I can tell you from experience that you can create a very verbal child who has little-to-no experience with interaction. Using HaberkornHalm's list almost as a 'recipe book' of sorts, you can 'get' your child to 'talk', 'request', 'mand', 'demand'. But all of those things can occur outside of real reciprocity, outside of the non-verbal dance of turn-taking, outside of true interaction. How do I know that, you wonder? I know that because it happened at my house.

Be careful with lists of "19 ways".

Before I learned about developmental foundations through folks like the ones from Relationship Development Intervention or Communicating Partners, I would have used that list for more one-sided manding, not for reciprocity and interaction.

"But Penny," you may be wondering, the author mentions specific non-verbal actions, why are you picking on this? After all, HaberkornHalm writes, "Make sure the child wants or needs the item (looks at, reaches for, points to, tries to get it) or the action."

Looking at, reaching for, pointing to, trying to get it can ALL be one-sided mands and not functions of interaction and reciprocity. Using the ABLLS, we taught all of those actions as mands and checked them off the list. Many years later, as I studied the development of joint attention, I realized that looking at, reaching for, pointing to, trying to get are much, much more than mere mands, they're early non-verbal pre-cursers (Dr Gutstein calls them "prototypes") of joint attention. We severely limited our child by giving her the experience that they are only mands. I am still upset over the way we merrily checked them off the ABLLS checklist as though we'd captured the full developmental meaning behind them when we'd taught them only as a mand.

Looking back at our journey, I see red flags all over these recommendations for increasing verbal interactions for families who are in the same shoes that I was in a few years ago. My kid could request, verbally and non-verbally, but she could not interact. For us, "talk" and lists of ways to increase verbal interaction had REPLACED the underdeveloped joint attention and underdeveloped non-verbal foundations of speech. That list would not have helped me give my girl the things I really wanted her to have without an understanding of how joint attention develops via interaction with a parent, something both RDI(r) and CP have taught me.

Our experience, like many others, is that focusing on non-verbal foundations of communication/joint attention/theory of mind has increased verbal interaction as a by-product. I never imagined that giving up a focus on "talk" and "increasing verbal interaction" and instead focusing on pre-speech foundations would actually INCREASE speech and receptive language. But it did!!! Another by-product that we saw happen without directly targeting it as a behavior to change was the eloping and bolting behavior decreased the more she was non-verbally "with" us in terms of joint attention. (I called our then-consultant from a department store one afternoon and asked, "What is happening? She is staying with me without my hanging on to her wrist with all my might." He chuckled and told me that he was hearing that a lot from his families.)

So, if you have a child who is verbal and mostly (all) one-sided, like I did, here's a suggestion for you. Use the list to give your child practice and experience in non-verbal referencing, in non-verbal turn-taking and interaction with you, and let go of the need to "get" more words and talk and instead give them experience in the benefits of a relationship with mom or dad.

Here's an example:

When you take a different action that you usually do, for example, handing the child an empty toothbrush instead of one loaded with toothpaste, you give the child an opportunity to reference you both physically, with a glance or look (not "eye contact", but referencing for meaning, and those two things are very different!) and to reference you mentally, wondering what is in your mind. For a child on the autism spectrum, who has little experience with the idea that there could be something different in YOUR mind than their is in HIS mind, this is a preliminary step in giving him experience with that kind of joint attention. Allow him processing time to take his own glance at you to see what you're up to, be quiet and wait, and when he notices, don't try to "get" something else (a verbal request) from him; you don't have wait for him to mand for the toothpaste. Be silly and answer, "I forgot the toothpaste!" Use it as an opportunity to squirt the toothpaste together.

Honestly, my kid who could mand for toothpaste could not reference and interact. Her expressive communication far outweighed her interactive world. If your kid sounds like that, you need to approach a list like this one aimed at "verbal interaction" with caution.

HaberkornHalm's list is a good one, but I'd like to qualify that it is for children who have non-verbal foundations of speech firmly in place, and for many kids with developmental delays, "special needs", autism, etc., the list needs another title. I'd rename it, "19 Ways to Create Opportunities for Your Child to Practice and Experience Referencing You For Meaning And Joining You in Interactions As Part Experience With You in Early Stages of Joint Attention".


Dani G said...

What a great post!! I'm in complete agreement- it's ALL about the relationship building, the relating, and the communication both verbal and non-verbal.
Early on, the bird's speech therapists were so focused on just getting her to talk and she finally did but it was very robotic and really just labeling without true communication. Of course, we're still working on all this now, and will continue to do so, but nothing has made such a difference in her development as true relationship building.

Side note: When the bird was 18 months old, we did a sign language class with Ruth. While she never worked with the bird at speech, I know a lot of kids she has worked with. She's truly one of the best therapists at the fancy she clinic in which she works :)

Penny said...

Thanks, Dani!

I hate how I was taught to use a list like that in a developmentally inappropriate way. :(

I'd never heard of Ruth until I saw that article. I'm not familiar with her at all.

The line about using this list with children who may not engage is a big red flag for me. I would want a parent of a child who does not or may not engage to make sure non-verbal foundations of engagement are in place before pushing for artificual "verbal interaction". I wish she'd have said that in her post.

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