Our Commitment to Current Best Practice
Why choose group therapy?
Research has documented that three out of four children with a learning disability have inadequate social interactions with their peers (Evans, Axelrod, & Sapia, 2000). Children with disabilities often experience negative social relationships and are commonly rejected by or isolated from their peers (Clarke & Kirton, 2003). These children spend more time interacting with their teacher than with their peers, thus further reducing opportunities to develop age appropriate social and communication skills. It has been suggested that proximity is important in developing and maintaining friendships, such that children who are withdrawn or seated away from classmates are less likely to make friends (Goldstein & Morgan, 2002). For this reason, The centre utilizes group therapy as a means of enhancing and facilitating children's social interactions with their peers.
But my child won't participate in group activities!
Beukelman and Mirenda (1998) argued that the first step to increasing communication, and therefore socialization, is to increase meaningful participation in natural contexts. "Participation is the only prerequisite to communication. Without participation, there is no one to talk to, nothing to talk about and no reason to communicate" (p. 269). The participation patterns of typically developing peers in relevant environments need to be assessed and compared with those of the child. Interventions are then designed to increase the participation levels of the child with difficulties, to match peer levels more closely.
Can parents be involved in the intervention process?
Parents are encouraged to be involved as much as possible through the intervention process. Working effectively with parents means that they are supported and assisted in coping via an individualized approach (Berry, 1987). It is well documented that parental styles of interaction are linked with communication skill development in children (Siller & Sigman, 2002). Social interactions begin with infants synchronizing their behaviour with their caregiver, and intentional communication and social interaction skills develop through the use of social games (Light et al., 2002). This social closeness is crucial for the development of later social skills, with research documenting the importance of developing caregiver skills in this area (Warren, Yoder, & Leew, 2002). Warren et al. (2002) have also pointed to the importance of developing the skills of caregivers to increase adult responsivity and provide an optimal environment for highly responsive caregiver-child interactions through the use of specific teaching techniques. These techniques include arranging the environment, giving communicative temptations, close face-to-face contact, following the child's attentional lead, and contingent motor and vocal imitation. This highlights the importance of parent training to ensure optimal parent-child interactions. The centre provides tailored parent training programs to suit every family and child's unique and changing needs.
What do therapists focus on and why?
The centre focuses on developing functional communication skills, with the main focus on the four functions fulfilled within communicative interactions (Light, 1989):
- expression of needs/wants (e.g. requests)
- information transfer (e.g. comments)
- social closeness (e.g. social routines, social games)
- social etiquette (e.g. greetings and farewells)
It is important that social skills intervention includes skill development in all four areas from an early age. Traditional intervention strategies have often been directed towards expression of needs/wants and social etiquette, whereas social closeness is now emerging as the glue that holds it all together (Light, Parsons & Drager, 2002). The centre views all four functions as inextricably linked and facilitates development of all four communicative functions to ensure holistic communication development.
The centre also focuses on achieving successful interactions. A number of individual and environmental factors account for the success or failure of a social interaction. For example, studies have shown that the level of communicative behaviours in children with autism varies significantly across speaking partners (Rydell & Prizant, 1995). There appears to be a tendency to attribute problems solely to the child's cognitive differences; however this would be a naive assumption. According to Quill (1995) social interactions can also fail due to a lack of congruence between the child's abilities, unique personality traits, the demands of the situation and social partners - factors which are often overlooked. The centre takes all these factors into consideration and utilizes them to enhance both adult-child interactions and child-child interactions.
But my child won't interact with people!
Current literature in the area of early communication is suggesting that the development of social interactions in presymbolic or preintentional communicators is best achieved through social games (Aud Sonders, 2003; Nind & Hewett, 1994, 2001). The interaction needs to be of interest to the beginning communicator, involve reciprocal turn taking by both participants, be sustainable over multiple exchanges and allow the beginning communicator to participate in multiple ways by using gross rather than discrete behaviours. The interaction needs to have a clear, repetitive structure that can be repeated over time. Of utmost importance, caregivers need to be provided with support in interpreting the beginning communicator's behaviours consistently and responding appropriately. The centre successfully incorporates these factors to achieve current best practice methodologies in the area of enhancing social interactions.
Will the skills my child learns generalize to everyday interactions?
Brown and Conroy (2002) identified three fundamental strategies for planning generalization and maintenance of young children's social interactions:
- Taking advantage of natural communities of reinforcement - this relies on the presence of responsive peers and adults.
- Training diversely - this includes training across multiple exemplars (e.g. training multiple peers and adults), training loosely (e.g. embedding interventions within routine activities) and using indiscriminable contingencies (e.g. fading prompts, delaying reinforcement and sequential modification of environments). It also utilizes retraining techniques.
- Incorporating functional mediators - that is, common stimuli or verbal behaviour that are presented in nontraining contexts. This can be as simple as the presence of an adult associated with a previous history of reinforcement.
These strategies are successfully implemented within the the program to promote effective generalization.
But my child won't play with others!
The primary business of young children is play. Play skills contribute to social and emotional development, and improved performance in language, reading and writing (Hendler Lederer, 2002). Increasing participation in play activities automatically increases the quality and quantity of communication opportunities (Beukelman & Mirenda, 1998). Research indicates that children with social-skills difficulties are less likely to initiate play, more frequently engage in isolated and toy-directed behaviours (and less in social-interactive play), are more dependent on concrete toys for play and play with a smaller variety of toys (Westby, 1988). Observations of children's play can provide therapists with information regarding the child's social knowledge and cognitive skills in a naturalistic setting (Westby, 1988). Research has shown that the availability of certain types of materials influences young children's interactions more than others. Brown and Conroy (2002) found that limiting the amount of space available promoted interactions when combined with other strategies. Other factors such as toys and materials, physical room arrangements, therapist-implemented structure for play activities and the presence of socially sophisticated and responsive peers have been found to promote peer interactions among preschool children. The centre implements these strategies successfully to develop children's interactive play skills.
My child has no friends
Friendships are the foundation for children's social development and are a significant part of a child's life (Westby, 1988). Children with social skills difficulties have difficulty forming friendships. However, it does not follow that teaching appropriate social skills will automatically enable the child to develop friendships. Children also need to be taught specific relationship and friendship skills (Brown & Conroy, 2002). Children need to feel that they belong to the community of the classroom for friendships to develop. According to Goldstein and Morgan (2002), withdrawing children from class for individual therapy does not foster this. This is another reason why group therapy really is the key to improving social and friendship skills.
Goldstein and Morgan identified three factors that may serve as determinants of friendship: ability, proximity and similarity. For preschool children with limited experience, similarity usually refers to physical characteristics (e.g. age, sex, ethnicity) and interventions need to emphasize similarities among children to foster friendships. Goldstein and Morgan also referred to a study in which sharing, suggesting a play activity, affection, assistance and rough-and-tumble play had a high probability of evoking a positive response from a peer in a preschool environment. Children who use these social interaction skills are more likely to be accepted by their peers. The centre employs these findings to assist children in creating and maintaining friendships.
References
Aud Sonders, S. (2003). Giggle time: Establishing the social connection. London: Jessica Kingsley.
Berry, J. O. (1987). Strategies for involving parents in programs for young children using augmentative and alternative communication. Augmentative and Alternative Communication, 3, 90-93.
Beukelman, D. R., & Mirenda, P. (1998). Augmentative and alternative communication: Management of severe communication disorders in children and adults. Baltimore: Paul H. Brookes.
Brown, W. & Conroy, M. (2002). Promoting peer-related social-communicative competence in preschool children. In H. Goldstein, L. Kaczmarek & K. English. (Eds.), Promoting social communication: Children with development disabilities from birth to adolescence (pp. 173-210). Baltimore: Paul H. Brookes.
Clarke, M., & Kirton, A. (2003). Patterns of interaction between children with physical disabilities using augmentative and alternative communication systems and their peers. Child Language Teaching and Therapy, 19(2), 131-151.
DET (2001). Pathways to health and well-being in schools. Perth, WA: Department of Education and Training.
DET (2003). Pathways to social and emotional development. Perth, WA: Department of Education and Training.
English, K., Goldstein, H., Shafer, K., & Kaczmarek, L. (1997). Promoting interactions among preschoolers with and without disabilities: effects of a buddy skills-training program. Exceptional Children, 63(2), 229-244. Proceedings of the 2006 Speech Pathology Australia National Conference 21
Evans, S. Axelrod, J. L., & Sapia, J. (2000). Effective school-based mental health interventions: Advancing the social skills training paradigm. Journal of School Health, 70(5), 191-195.
Goldstein, H., & Morgan, L. (2002). Social interaction and models of friendship development. In H. Goldstein, L.A. Kaczmarek & K. M. English (Eds.), Promoting social competence: Children with developmental disabilities from birth to adolescence (pp. 5-26). Baltimore: Paul H. Brookes.
Hendler Lederer, S. (2002). Collaborative pretend play: From theory to therapy. Child Language Teaching and Therapy, 18(3), 233-255.
Lewis, A., Ng, J., & Wakefield, C. (2000). Forging friendships: A social skills manual for children with autism spectrum disorders and other social skills deficits. Perth: Therapy Focus.
Light, J. (1989). Toward a definition of communicative competence for individuals using augmentative and alternative communication systems. Augmentative and Alternative Communication, 5, 137-144.
Light, J., Binger, C., Agate, T., & Ramsey, K. (1999). Teaching partner-focused questions to individuals who use augmentative and alternative communication to enhance their communicative competence. Journal of Speech, Language and Hearing Research, 42, 241-255.
Light, J., Parsons, A., & Drager, K (2002). "There's more to life than cookies": Developing interaction for social closeness for beginning communicator who use AAC. In J. Reichle, D. Beukelman & J. Light (Eds.), Exemplary practices for beginning communicators (pp. 187-218). Baltimore: Paul H. Brookes.
Nind, M., & Hewett, D. (1994). Access to communication: Developing the basics of communication with people with severe learning difficulties through intensive interaction. London: David Fulton.
Nind, M., & Hewett, D. (2001). A practical guide to intensive interaction. Kidderminster: BILD Publications.
Quill, K. A. (1995). Enhancing children's social-communicative interactions. In K. Quill (Ed.), Teaching children with autism: Strategies to enhance communication and socialisation (pp. 163-192). Albany, NY: Delmar.
Rafferty, Y., Piscitelli, V., & Boettcher, C. (2003). The impact of inclusion on language development and social competence among preschoolers with disabilities. Exceptional Children, 69, 467-479.
Reid, S. (2004). Joining in: A program designed to assist children and adolescents to be included in social and community activities. Perth: Therapy Focus.
Rydell, P. J., & Prizant, B. M. (1995). Assessment and intervention strategies for children who use echolalia. In K. Quill (Ed.), Teaching children with autism: Strategies to enhance communication and socialisation (pp. 105- 132). Albany, NY: Delmar.
Siller, M., & Sigman, M. (2002). The behaviours of parents of children with autism predict the subsequent development of their child's communication. Journal of Autism and Developmental Disorders, 32, 77-89.
Staub, D. (1998). Delicate threads: Friendships between children with and without special needs in inclusive settings. Bethesda: Woodbine House.
Sussman, F. (1999). More than words: Helping parents promote communication and social skills in children with autism spectrum disorders. Toronto, ONT: The Hanen Centre.
Taylor, R., & Iacono, T. (2003). AAC and scripting activities to facilitate communication and play. Advances in Speech-Language Pathology, 5, 79-93.
Tollerfield, I. (2003). The process of collaboration within a special school setting: An exploration of the ways in which skills and knowledge are shared and barriers overcome when a teacher and a speech and language therapist collaborate. Child Language Teaching and Therapy, 19, 67-84.
Warren, S., Yoder, P., & Leew, S. (2002). Promoting social-communicative development in infants and toddlers.
In H. Goldstein, L. Kaczmarek & K. English (Eds.), Promoting social communication: Children with development disabilities from birth to adolescence (pp. 121-150). Baltimore: Paul H. Brookes.
Westby, C. (1988). Children's play: Reflections of social competence. Seminars in Speech and Language, 9, 1-12.