Functional Communication Camp: Interaction

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Functional Communication Camp Interaction
Intervention Strategies for Nonverbal Children

• Colleen F. Visconti, Ph.D., CCC-SLP
• Christie A. Needham, M.A., CCC-SLP
• ASHA Convention, Chicago, IL, November 20, 2008,
  Poster 936

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Abstract

• This poster will provide an in-depth look at the
  logistics of the set-up of an intensive group
  therapy program for children with nonverbal
  communication needs. Over the past two summers,
  22 children have participated in camp for
  functionally nonverbal children. Data will be
  presented comparing pre- and post-camp
  communication skills. The results suggest that an
  intensive speech-language therapy approach that
  incorporates peer interaction and highly
  responsive clinicians can lead to significant
  improvements in the use of functional
  communication by children who are functionally
  nonverbal. Clinical implications and future
  research directions will be discussed.

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Functional Communication Camp

• A summer program designed to provided social and
  functional language learning opportunities for
  children who were functionally non-verbal or had
  limited verbal communication skills
• Met 2 hours per day, 3 days per week for 4
  weeks

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Participants

• 2007
• 10 children (2 groups of 5 children)
• 2 student clinicians and 1 clinical supervisor
• 2008
• 12 children (2 groups of 6 children)
• 4 student clinicians and 1 clinical supervisor
• one child participated both summers

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Participants

• Ages 3 years 5 months to 15 years 8 months (mean
  age 7 years 3 months)
• 16 males and 6 females
• Children were selected for the camp on a
  first-come, first-serve basis
• Requirements were that the children were
  functionally nonverbal at the beginning of the
  camp

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Participants Diagnoses

• Primary Diagnoses

• Other Diagnoses

• Language Disorder
• Speech Delay
• Autism
• Rett Syndrome
• PDD-NOS
• Cognitive disability
• Cerebral palsy
• Angelmans syndrome
• Ring Chromosome 13
• Seizure Disorder
• Corticalvision impairment
• Periventricular leukomalacia (PVL)
• Brian Migration Defect

• Blind - 2
• Visually impaired - 2
• Wheelchair 5
• Limited ambulation - 2

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Pre-Camp Evaluation

• Individual evaluations
• 1-2 hours in length
• Student Clinicians and Clinical Supervisor
  attempted to elicit a variety of communicative
  behaviors
• Clinical Supervisor interviewed the
  parent(s)/caregiver(s) regarding the childs
  Functions of Communication

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Functions of Communication

• Gain Attention
• Greetings
• Social Answers
• Social Questions
• Closure
• Initiates Turn-Taking (Nonverbal)
• Follows Turn-Taking (Nonverbal)
• Initiates Turn-Taking (Verbal)
• Follows Turn-Taking (Verbal)
• Manners

• Answers Where and Who Questions
• Asks Where and Who Questions
• Answers Why and When Questions
• Asks Why and When Questions
• More
• No
• Yes/No Differentiation
• Answers What Questions
• Asks What Questions
• Comments

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General Evaluation Procedures

• Non-standardized, play-based assessment of
  communicative functions based on the following
• Communicative Attempts
• Communicative Mode
• Communication Success
• Communication Partner(s)

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Daily Activities

• 10-15 minutes -Arrival Time (e.g., talked to
  parents and transition time)
• 15-20 minutes Circle Time (e.g., greeting song,
  calendar, songs, and books)
• 60 minutes Play and individual work time (e.g.,
  worked on individual goals, peer related
  communication skills, utilized play and literacy
  activities)
• 15-20 minutes - Games (e.g., musical chairs, ball
  games)
• 15 minutes - Closing Circle - goodbye and snack

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Intervention Strategies

• Used variety of strategies including
• Small/large group
• Individual therapy
• Peer modeling
• Trained undergraduate clinicians to be highly
  responsive to all types of communication
• Silence!!!!!! Waiting for communication to
  happen, even in its most basic of forms.

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Intervention Strategies (Continued)

• Behavior Modification and Planning
• Super Nanny
• Individualized based on needs and abilities
• Consistency
• Clinicians
• Routine
• Parents
• Repetition of activities

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Parent Involvement

• Daily Logs sent home
• Take home activities
• Literacy Activities
• Adapted childrens books
• Trained parents on how to use the take home
  activities
• Parents established social network for support

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Student Training

• Responsiveness to communication
• AAC training by SLPs at the Cleveland Clinic
  Childrens Hospital Shaker Campus Shaker
  Heights, Ohio
• AAC programming for intervention acitivities

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Modes of Communication Utilized

• AAC devices
• PECS
• Verbal productions
• Vocalizations
• Signs
• Gestures

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Results General

• Significant differences (p gt .05) were found
  between the pre-camp and post-camp measures on
  the following
• Communicative Attempts
• Mode of Communication
• Communicative Partner
• Communicative Success

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Results Attempts Communication

• Significant improvements were found in
• Gains Attention
• Social Answer
• Social Questions
• Initiates Turning Taking (Nonverbal)
• Yes/No Differentiation
• Comments

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Results Modes of Communication

• Significant improvements were found in
• Gains Attention
• Greeting
• Social Answer
• Closure
• Initiates Turning Taking
• (Nonverbal)
• Yes/No Differentiation
• Answers What Questions
• Comments

• Follows Turn Taking (Nonverbal)
• Initiates Turn Taking (Verbal)
• Follows Turn Taking (Verbal)
• Manners
• More
• No

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Results Communicative Partner

• Significant improvements were found in
• Greeting
• Social Answers
• Manners
• More
• Yes/No Differentiation

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Results Communicative Success

• Significant improvements were noted in
• Gain Attention
• Greeting
• Social Answers
• Closure
• Initiating Turn Taking (Nonverbal)
• Initiating Turn Taking
• (Verbal)

• Following Turn Taking (Nonverbal)
• Manners
• More
• Yes/No Differentiation
• Answering What Questions
• Comments

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Discussion Attempts Communication

• Participants are attempting to communicate more
  frequently.
• They are initiating communication more
  frequently.
• Gaining the listeners attention, commenting,
  responding and questioning.

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Discussion Modes of Communication

• Prior to camp, the participants either did not
  attempt communication, stopped their activity as
  a sign of communication, or physically tried to
  indicate communication.
• After camp, they attempted more sophisticated
  forms of communication, including signs/gestures,
  verbal communication, and/or AAC.

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Discussion Communicative Partner

• Prior to camp, the participants were either not
  attempting to communicate or only occasionally
  attempted to communicate with familiar
  individuals. Rarely, if ever, did they attempt
  communication with unfamiliar partners.
• Post-camp, the participants were attempting to
  communicate more frequently with both familiar
  and unfamiliar communicative partners, especially
  when greeting, using manners, and requesting
  more.
• Commenting to familiar and unfamiliar partners
  was also approaching significance by then end of
  camp.

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Discussion Communicative Success

• Prior to camp the participants were either not
  successful in their communicative attempts or
  only sometimes successful. Rarely were they
  always successful.
• After participating in the camp, participants
  were sometimes or always successful in their
  communicative attempts. This was especially true
  for gaining attention, greeting, closure, and
  more.

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Conclusion

• Intensive group intervention for functionally
  nonverbal children lead to improvements in the
  following
• Increase in the number of communicative attempts
• Use of more sophisticated modes of communication
• Attempting communication with both familiar and
  unfamiliar partners
• Greater communicative success

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Future Research

• Currently, we are examining the effectiveness of
  this intervention approach using a weekly group
  therapy meeting time versus 3 days per week.
• Examining progress in children who continue their
  enrollment in this treatment throughout the year
  versus those who attend only one treatment cycle
  (e.g., summer camp, semester program).

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Future Research (Continued)

• Effectiveness of Literacy Activities in this
  intervention approach
• Effectiveness of the AAC Student Training Program

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Acknowledgements

• AAC devices were loaned by
• Prentke Romich Company
• Assistive Technologies
• Saltillo
• Words
• DynaVox Techologies

• AAC Training was provided by SLPs at the
  Cleveland Clinic Childrens Hospital Shaker
  Branch
• Glenna Greenwald
• Jackie Wolslager
• Lisa Leonard

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Acknowledgements

• Thank you to the Student Clinicians
• Amy Lagzdins
• Chelsea Lengal
• Crysten Skebo
• This project was funded by Baldwin-Wallace
  Colleges Center for Transformational Learning.
  These results represent the views of the authors
  and not those of Baldwin-Wallace College.

• Amanda Smith
• Cassandra Turic
• Julianne Wolf