Its in the Interaction! P.R. Mitchell, Ph.D.

It’s in the interaction!
Pamela R. Mitchell, Ph.D.
Kent State University
Speech Pathology

October 2009

Song: More Than Words by Extreme, c. A&M Records,
1990

Tuesday, October 27, 2009 1

Overview

Intentional Communication

Assessment

Intervention Approaches


Intentional Communication
Deﬁned

intentional communication:

gesture, vocalization, verbalization
or combination

directed toward someone

serves a communicative purpose

Wetherby & Prizant, 1993


Importance of IC
High frequency communicators used more sophisticated signals and broader range of
communicative functions than low frequency (Cirrin & Rowland, 1985)

Distal gesturers had increased rates of communicative acts, initiation, repairs and word-like
vocalizations compared to “contact” gesturers (McClean, et al. 1991)

Relationship shown between rate of intentional communication and increased
communication “sophistication” (Ogletree &Wetherby, 1992)]

Children with higher rates of intentional communication demonstrated earlier language
development than those with lower rates (Smith &Von Tetzchner, 1986; Mundy, et al., 1995;
Yoder & Warren, 1999b)

Frequent production of intentional communicative acts preceded the emergence of symbolic
communication (Warren & Yoder, 1998)

Individuals who demonstrated intentionality were more likely to acquire a greater number of
graphic symbols than those who did not (Stephenson & Linfoot, 1996)

Intentional communication more likely to be detected and reciprocated by communicative
partners (Carter & Iacono, 2002, Yoder & Warren, 1997a)


Importance, cont.
Intentional communicative acts may elicit language-facilitating maternal
responses (Yoder & Warren, 1993)

Intentional communication correlated with maternal responsivity which is
associated with later language abilities in children with disabilities (Yoder &
Warren, 1998)

Frequency of prelinguistic intentional communication predicts expressive and
receptive language levels in children with disabilities a year or more later (Yoder
& Warren, 1999; Mundy et al, 1995; Smith & von Tetzchner, 1986)

Child intentional communication predicted maternal responsivity 6 months later,
(Yoder & Warren, 1999)

Intentional communication delayed or doesn’t occur in many special needs
children, which inhibits development of symbolic communication (Yoder et al,
2001)


Communication Matrix
www.communicationmatrix.org


Entering data


Intervention
Approaches
Intensive Interaction

Lilliworks Active Learning

Greenspan, DIR

Gutstein, RDI


Fundamentals of Communication:
Intensive Interaction (Nind, 1999)
The fundamentals of communication can be characterized as
things like: (Nind, 1999)

• Learning to give brief attention to another person.
• To share attention with another person.
• Learning to extend those attentions, learning to concentrate on
another person.
• Developing shared attention into 'activities'.
• Taking turns in exchanges of behavior.
• To have fun, to play.
• Using and understanding eye contacts.
• Using and understanding of facial expressions.
• Using and understanding of non-verbal communication such as
gesture and body language.
• Learning use and understanding of physical contacts.
• Leaning use and understanding of vocalizations, having those
vocalizations become more varied and extensive, then gradually
more precise and meaningful.
Song: Please be patient with me, Wilco, c. Nonesuch Records, 2007


INTENSIVE
INTERACTION VIDEO


Aims of Intensive
Interaction
Develop:

sociability

fundamental communication abilities

cognitive abilities

emotional well-being


Rules of Thumb, Intensive
Interaction

take your time

be relaxed and playful

be available

establish “sequences”


Lilliworks Principles
http://www.lilliworks.com

1. Every One Can Learn

“Unless impacted by survival, every child and older learner can learn. It is
up to the parent, therapist or educator to keep ﬁnding the right
situation/environment with enough support, responsiveness and interest to
engage the learner.”


Lilliworks, cont

2. Active Learning is Hands Off

Challenged learners often act passive and are treated as passive
(everything is done for them). Active Learning involves creating supportive
and responsive environments that are tuned to entice a learner to become
active. When Lilli realized that blind and disabled learners often resisted
any “guided hands” approach, she set about to create environments and
situations that would increase a learner’s inclination to explore on their
own. This means the “teacher” must disengage and not talk nor prompt
until the activity is concluded. Kids learn through repetition (see #8)-
don’t interrupt them.


Lilliworks, cont

3. Auditory and Tactile Primacy

Learners with vision impairments and neurological deﬁcits rely upon
hearing as a primary sense. Vision tends to be secondary, owing to
control and processing difﬁculties. Tactile sense is also a prominent sense.


Lilliworks, cont

4. Responsive Environment, Short Sessions

The environment should provide excellent auditory and tactile feedback
(not just stimulation). Use of the Resonance Board provides key vibratory
input. The Essef Board provides optimal reaction to leg movements. The
Little Room provides a warm inviting echo and exploration chamber. As Lilli
says, “if the child cannot go to the room, the room must come to the
child.” Many short sessions are better than one long one, especially when
ﬁrst using an environment.


Lilliworks, cont

5. Mix Variety and Constancy, Provide Comparisons

As anyone does, a learner beneﬁts from moderated variety. That is, don’t
change everything every time, but provide enough variation so that the
environment has interest. Also, provide "alike but different" objects to
invite comparison. Cycling through a large inventory of objects/toys
allows for a rich, constantly interesting environment. Change some of the
objects whenever the learner shows habituation to the objects available.


Lilliworks, cont

6. Work up to Weight Bearing

Given the discomfort of bearing weight, provide support until the learner
has some control, and slowing increase the weight load. The Support
Bench and HOPSA Dress are used to control weight on the legs. Start
with no weight, toes barely touching.


Lilliworks, cont

7. Emotional Development Involves Mastery

It’s that smile of accomplishing something, doing something to their
environment, rather than the environment doing it to them that fosters a
critical step in emotional development. Related to the Active vs. Passive
learning, that “ see what I can do” smile is a crucial goal.


Lilliworks, cont

8. Learning is by Repetition - Allow to fail

Kids learn by repetition. They must do something over and over to invoke
memory and get the variations to make sense. Therefore, allowing them to
have negative results without intervention (e.g. without moving an object
into their hand as they miss on a reach) is as important as not
interrupting with any cheerleading.


Lilliworks, cont
9. Talk and Reward at the End of Play

At the end of play is the time for the adult input, the language and
commentary to describe what the learner was doing, and to positively
reinforce their activity. Point at and jiggle the objects and talk about
what they did. Ask questions and use short sentences. When a learner is
ready and can engage in turn-taking games, then a new level has been
achieved.


Lilliworks, cont
10. Limit Input, Wait for Response

As a general principle, remember that neurologically impacted learners
usually need more time to take in, process and assemble a response. If
you ask a question, remain quiet as long as possible before asking
something again, and try not to supply their answer without some sign.
This is always subject to judgment, as after a while the question may be
forgotten. Repeat using the exact same words, so additional processing to
understand new input is not needed.


DIR, Greenspan

http://www.circlestretch.blogspot.com/

http://www.playworks.cc/DIRmodel.html


Relationship Development Intervention (RDI), Gutstein
http://www.rdiconnect.com/

What are the core deficits in Autism? Researchers in the field of autism agree that autism is a
neurological information processing disorder. Specifically, autism impacts understanding, organizing
and analyzing meaning within change. RDI targets at least five specific core deficit areas of
autism including:

Emotional Referencing: Checking with someone else (or yourself) when you are not sure what to do
Social Co-Regulation: Individuals making mutual adjustments to each other
Declarative Communication: Communication for the purpose of sharing and interacting
Episodic Memory and Executive Function: Development of self and higher level thinking ability
Dynamic Thinking: Flexible thinking and Relative information processing

How is RDI implemented?

RDI is a parent-based model. The parents are the primary therapists, and the Consultant provides the
parents with tools, guidance and support.
Typically, parents will bring their child for the Relationship Development Assessment (RDA), and follow up
with an RDI Consultant. The therapy is primarily implemented in the home. Direct therapy (“lab time”) is
recommended for approximately 5-7 hours/week. Additionally, RDI encourages “lifestyle” changes. Parents
are encouraged to video tape their therapy with the child and review and analyze tapes to determine if
the child is improving.
Follow up with a RDI Consultant is usually every other week or monthly and is very often done via video
tape. The consultant analyzes the video and provides feedback to the coaches.


Patiently Contingent
Empathically Engaged
Attentively Expectant
Consistently Strategic
Effective
Song: If you want to sing out, Cat Stevens, c. UMG
Recordings, 1984


Its in the Interaction! P.R. Mitchell, Ph.D.

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