Identifying and Validating Prelinguistic Communicative Forms and Functions in Children with Developmental Disability

<p>While children with developmental disabilities often fail to develop speech, many will nonetheless engage in a range of prelinguistic behaviours. Prelinguistic behaviours include actions such as eye gaze or eye pointing, pointing with a finger, facial expressions (e.g., smile, frown), and body movements (e.g., waving an arm, leg extension). The purpose of this research project was to evaluate procedures for (a) identifying prelinguistic forms in the repertoires of children with developmental disability, and (b) validating the communicative function, if any, of these existing prelinguistic behaviours. This was achieved through a three-phase study involving a total of 10 children with developmental disabilities and their parents. For Phase 1, the author interviewed each child’s parent(s) and teacher using a structured protocol; The Inventory of Potential Communicative Acts (IPCA; Sigafoos, Woodyatt, Keen et al., 2000). The IPCA has been used in numerous previous studies to identify prelinguistic behaviours that are interpreted as forms of communication. In Phase 2, the author used informant report to identify and replicate six situations: three in which each participant was reported to communicate a specific function and three in which he/she reportedly did not communicate. The author then compared the children’s responses during the clinical trials to the behaviours he/she was reported to use for the targeted function. In Phase 3, the parent replicated the structured trials used in Phase 2 to determine whether participant performance varied relative to communicative partner. Findings from this study provide evidence to support the validity of the IPCA as an interview protocol for identifying potential communicative acts in children with developmental disability and severe communication impairment. The comparisons made between the reported communicative behaviours used for each function revealed both similarities and differences across children. The results also provide evidence that children with severe communication impairment and developmental disability are using similar behaviours to communicate specific functions across different environments and with different communicative partners.</p>

Identifying and Validating Prelinguistic Communicative Forms and Functions in Children with Developmental Disability

<p>While children with developmental disabilities often fail to develop speech, many will nonetheless engage in a range of prelinguistic behaviours. Prelinguistic behaviours include actions such as eye gaze or eye pointing, pointing with a finger, facial expressions (e.g., smile, frown), and body movements (e.g., waving an arm, leg extension). The purpose of this research project was to evaluate procedures for (a) identifying prelinguistic forms in the repertoires of children with developmental disability, and (b) validating the communicative function, if any, of these existing prelinguistic behaviours. This was achieved through a three-phase study involving a total of 10 children with developmental disabilities and their parents. For Phase 1, the author interviewed each child’s parent(s) and teacher using a structured protocol; The Inventory of Potential Communicative Acts (IPCA; Sigafoos, Woodyatt, Keen et al., 2000). The IPCA has been used in numerous previous studies to identify prelinguistic behaviours that are interpreted as forms of communication. In Phase 2, the author used informant report to identify and replicate six situations: three in which each participant was reported to communicate a specific function and three in which he/she reportedly did not communicate. The author then compared the children’s responses during the clinical trials to the behaviours he/she was reported to use for the targeted function. In Phase 3, the parent replicated the structured trials used in Phase 2 to determine whether participant performance varied relative to communicative partner. Findings from this study provide evidence to support the validity of the IPCA as an interview protocol for identifying potential communicative acts in children with developmental disability and severe communication impairment. The comparisons made between the reported communicative behaviours used for each function revealed both similarities and differences across children. The results also provide evidence that children with severe communication impairment and developmental disability are using similar behaviours to communicate specific functions across different environments and with different communicative partners.</p>

Psychometrics of the Pragmatic Rating Scale for School-Age Children With a Range of Linguistic and Social Communication Skills

Purpose Social communication or pragmatic skills are continuously distributed in the general population. Impairment in these skills is associated with two clinical disorders, autism spectrum disorder (ASD) and social (pragmatic) communication disorder. Such impairment can impact a child's peer acceptance, school performance, and current and later mental health. Valid, reliable, examiner-rated observational measures of social communication from a semistructured language sample are needed to detect social communication impairment. We evaluated the psychometrics of an examiner-rated measure of social (pragmatic) communication, the Pragmatic Rating Scale–School Age (PRS-SA). Method The analytic sample consisted of 130 children, ages 7–12 years, from five mutually exclusive groups: ASD ( n = 25), language concern (LC; n = 5), ASD + LC ( n = 10), social communication impairment only ( n = 22), and typically developing (TD; n = 68). All children received language and autism assessments. The PRS-SA was rated separately using video-recorded communication samples from the Autism Diagnostic Observation Schedule. Assessment data were employed to evaluate the psychometrics of the PRS-SA. Analysis of covariance models were used to assess whether the PRS-SA would detect differences in social communication functioning across the five groups. Results The PRS-SA demonstrated strong internal reliability, concurrent validity, and interrater reliability. PRS-SA scores were significantly higher in all groups compared to the TD group and differed significantly in most pairwise comparisons; the ASD + LC group had the highest (more atypical) scores. Conclusions The PRS-SA shows promise as a measure of social communication skills in school-age verbally fluent children with a range of social and language abilities. More research is needed with a larger sample, including a wider age range and geographical diversity, to replicate findings. Supplemental Material https://doi.org/10.23641/asha.15138240

Basic Counseling Skills: Working With People With Aphasia and Their Families

Purpose People with aphasia (PWA) and their families experience dramatic changes to many facets of life following stroke or other brain injury. With these changes comes complex loss and grief that can lead to chronic stress and depression, and impact recovery and rehabilitation. Clinicians working with PWA are often unsure how to best address these experiences and reactions. This tutorial introduces an approach to building the therapeutic alliance and navigating challenging conversations with clients and families using basic counseling skills that can be adapted to varying situations and clinical contexts. In addition to demonstrating each skill using example scenarios (Part 1), these skills are applied to the evolving stages of crisis and recovery experienced by many clients with communication impairment and their families—from injury onset to adjustment to chronic aphasia (Part 2). Conclusions Clinicians can adapt a set of basic counseling skills to promote effective therapeutic relationships and change in the lives of their clients across the contexts of recovery and rehabilitation. Although the clinician and client may work together for a relatively limited period of time, these flexible skills can help galvanize client engagement and participation in clinical activities, yield high-quality client information for treatment planning, and motivate clients as they navigate life with aphasia.

Patient-centred communication intervention study to evaluate nurse-patient interactions in complex continuing care

Background Communication impairment is a frequent consequence of stroke. Patients who cannot articulate their needs respond with frustration and agitation, resulting in poor optimization of post-stroke functions. A key component of patient-centred care is the ability of staff to communicate in a way that allows them to understand the patient’s needs. We developed a patient-centred communication intervention targeting registered and unregulated nursing staff caring for complex continuing care patients with communication impairments post stroke. Research objectives include 1) examining the effects of the intervention on patients’ quality of life, depression, satisfaction with care, and agitation; and (2) examining the extent to which the intervention improves staff’s attitudes and knowledge in caring for patients with communication impairments. The intervention builds on a previous pilot study. Methods/design A quasi-experimental repeated measures non-equivalent control group design in a complex continuing care facility is being used. Patients with a communication impairment post-stroke admitted to the facility are eligible to participate. All staff nurses are eligible. Baseline data are collected from staff and patients. Follow-up will occur at 1 and 3 months post-intervention. Subject recruitment and data collection from 60 patients and 30 staff will take approximately 36 months. The Patient-Centred Communication Intervention consists of three components: (1) development of an individualized patient communication care plan; (2) a one-day workshop focused on communication and behavioural management strategies for nursing staff; and (3) a staff support system. The intervention takes comprehensive patient assessments into account to inform the development of communication and behavioural strategies specifically tailored to each patient. Discussion The Patient-Centred Communication Intervention will provide staff with strategies to facilitate interactions with patients and to minimize agitation associated with considerable stress. The improvement of these interactions will lead to a reduction of agitation, which has the additional significance of increasing patients’ well-being, quality of life, and satisfaction with care.

Patient-centred communication intervention study to evaluate nurse-patient interactions in complex continuing care

Background Communication impairment is a frequent consequence of stroke. Patients who cannot articulate their needs respond with frustration and agitation, resulting in poor optimization of post-stroke functions. A key component of patient-centred care is the ability of staff to communicate in a way that allows them to understand the patient’s needs. We developed a patient-centred communication intervention targeting registered and unregulated nursing staff caring for complex continuing care patients with communication impairments post stroke. Research objectives include 1) examining the effects of the intervention on patients’ quality of life, depression, satisfaction with care, and agitation; and (2) examining the extent to which the intervention improves staff’s attitudes and knowledge in caring for patients with communication impairments. The intervention builds on a previous pilot study. Methods/design A quasi-experimental repeated measures non-equivalent control group design in a complex continuing care facility is being used. Patients with a communication impairment post-stroke admitted to the facility are eligible to participate. All staff nurses are eligible. Baseline data are collected from staff and patients. Follow-up will occur at 1 and 3 months post-intervention. Subject recruitment and data collection from 60 patients and 30 staff will take approximately 36 months. The Patient-Centred Communication Intervention consists of three components: (1) development of an individualized patient communication care plan; (2) a one-day workshop focused on communication and behavioural management strategies for nursing staff; and (3) a staff support system. The intervention takes comprehensive patient assessments into account to inform the development of communication and behavioural strategies specifically tailored to each patient. Discussion The Patient-Centred Communication Intervention will provide staff with strategies to facilitate interactions with patients and to minimize agitation associated with considerable stress. The improvement of these interactions will lead to a reduction of agitation, which has the additional significance of increasing patients’ well-being, quality of life, and satisfaction with care.

Facilitating End-of-Life Interaction Between Patients With Severe Communication Impairment and Their Families

Purpose The purpose of this report is to promote conversation among medical speech-language pathologists (SLPs) about their role in facilitating family–patient interaction involving patients who acutely encounter the end-of-life (EOL) phase and have severe communication impairment. Case Report We provide self-reflections from our own clinical practice, pertinent literature review, and medical chart review of a relevant patient to serve as a catalyst for such discussion. Reflections We share a preliminary handout containing strategies that SLPs could provide family members of patients who have encountered an EOL phase and have severe communication impairment (e.g., global aphasia) and reduced alertness level. Clinical Implications SLPs can play an important role in facilitating EOL patient–family interaction and alleviate suffering even when patients have severe communication impairment.

Breakdowns in Informativeness of Naturalistic Speech Production in Primary Progressive Aphasia

“Functional communication” refers to an individual’s ability to communicate effectively in his or her everyday environment, and thus is a paramount skill to monitor and target therapeutically in people with aphasia. However, traditional controlled-paradigm assessments commonly used in both research and clinical settings often fail to adequately capture this ability. In the current study, facets of functional communication were measured from picture-elicited speech samples from 70 individuals with mild primary progressive aphasia (PPA), including the three variants, and 31 age-matched controls. Building upon methods recently used by Berube et al. (2019), we measured the informativeness of speech by quantifying the content of each patient’s description that was relevant to a picture relative to the total amount of speech they produced. Importantly, form-based errors, such as mispronunciations of words, unusual word choices, or grammatical mistakes are not penalized in this approach. We found that the relative informativeness, or efficiency, of speech was preserved in non-fluent variant PPA patients as compared with controls, whereas the logopenic and semantic variant PPA patients produced significantly less informative output. Furthermore, reduced informativeness in the semantic variant is attributable to a lower production of content units and a propensity for self-referential tangents, whereas for the logopenic variant, a lower production of content units and relatively ”empty” speech and false starts contribute to this reduction. These findings demonstrate that functional communication impairment does not uniformly affect all the PPA variants and highlight the utility of naturalistic speech analysis for measuring the breakdown of functional communication in PPA.