Question
I have a 12-year-old patient with Down Syndrome. He is performing on a 2-year-old level according to the evaluation completed in November, 2004. The parent expressed concerns regarding his articulation. She wanted him to be able to tell her if "someone ev
Answer
Although we have limited information about this 12-year-old, he appears to have several potential means for communication. Picture symbols and speech were specifically identified, and one might expect that he also uses natural gestures to some degree (e.g., nodding head for yes or waiving for goodbye). In developing therapy goals and making decisions about when to terminate therapy we need to take into account short term and long term needs. In the short term, we should determine whether his current communication means allow him to participate fully in his routine daily activities and whether we have addressed the parent's concern about telling her if he has been hurt by someone. In looking at communication participation in daily activities, we want to determine if there are discrepancies in what he is able to communicate and what his peers are able to communicate in the same situation (Beukelman & Mirenda, 1998). To address any discrepancies, we could develop therapy goals to improve one of his current communication means. For example we could teach additional picture symbols, work to improve intelligibility of specific, communicatively "powerful" spoken words, or identify natural gestures which would convey the message.
The current focus of therapy is on requesting toys or activities with picture symbols. This type of communication has been called expression of wants/needs (Light, 1988), and often is an early focus for children communicating with picture symbols. Expressing a want is a powerful form of communication because the message specifies its own natural consequence (e.g., receiving a preferred toy or activity). However, Light (1988) identified four social purposes for communication. These four included the expression of needs/wants, but also information transfer, social closeness, and social etiquette. The parents concern about telling her if he has been hurt falls under the second of these purposes, information transfer. Telling about feelings might be an appropriate starting point for learning to share information. Fallon, Light, and Paige (2001) developed a vocabulary selection questionnaire for preschool children that might be adapted for use with this patient. They included a category for emotions/feelings and listed words such as afraid, happy, hurt, mad, sad, sick, and so forth. Use of words for feelings/emotions could be taught in a message such as, "I feel (emotion)," that parallels the kind of message he is learning for requesting toys/activities. Another strategy for teaching information transfer is to begin a routine of sending a message home to his parent, either in a notebook or on a communication page, that allows him to communicate something about his school day. He could select a picture symbol representing an activity he did at school, and use the symbol to complete a message such as, "Today at school I (activity)." When he gets home his parent could ask to see the message and talk about what he did.
A final part to this question is when to terminate therapy. As noted above, determining how he communicates in routine daily activities and deciding if you have done as much as you can to assure his full participation are important considerations. However, for this 12-year-old, I also think you will need to begin transition planning soon . What are the family's plans for his future when he exits the school environment? Although this change is several years away, he may need new communication skills when his daily routine changes, and it may take a few years for him to learn those skills. It will be important for his family to begin thinking about his future and for his speech-language pathologist to be a part of the planning process.
References
Beukelman, D.R., & Mirenda, P. (1988). Augmentative and alternative communication: Management of severe communication disorders in children and adults (2nd ed.). Baltimore, MD: Paul H. Brookes.
Fallon, K.A., Light, J.C., & Paige, T. K. (2001). Enhancing vocabulary selection for preschoolers who require augmentative and alternative communication (AAC). American Journal of Speech-Language Pathology, 10, 81-94.
Light, J. (1988). Interaction involving individuals using augmentative and alternative communication systems. State of the art and future directions. Augmentative and Alternative Communication, 4, 66-82.
Dr. Lauren K. Nelson began her career as a speech-language pathologist in 1978. She has been on the faculty at the University of Northern Iowa in Cedar Falls, Iowa since 1990. Dr. Nelson can be reached at lauren.nelson@uni.edu
