Children with Moderate and
Severe Disabilities:
Incorporating communication
across the life span
KSHA Convention: Topeka, KS
October 1, 2010
Terre Graham, PhD, CCC-SLP
Why Am I Here?
My Challenge for You
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Make sure that EVERY child on your caseload
has a way to communicate regardless of the
severity of their speech and language
abilities.
 Setting
▪ School
▪ Home
▪ Job
▪ Individually
▪ Group
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Appropriate for
the situation
Readily available
Replacement or
back-up ready
Group Activity
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In your group – make a list of communication
strategies you implement individually or in
the classroom/clinic with your
students/clients who have moderate and
severe disabilities.
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We should perceive
all children,
regardless of the
severity of the
disability, as
individuals who have
something to say but
who have extreme
difficulty making
their thoughts heard
and understood by
others.
The Early Years
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Where do we
begin?
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An identifiable form of communication to
effectively convey a message.
Need to identify multiple ways for child to
communicate both receptively and
expressively.
Something to talk
about.
 Provide support to
help remember how
to convey something
or what to convey.
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Photo albums,
Objects
Parts of objects
Pictures
Asking questions
Topics
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Needing to communicate is motivation.
Having needs met is the reinforcement.
Develop social closeness and friendship.
Act on naturally occurring communicative
opportunities as well as creating them.
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Offers control over the environment
Provides a door to literacy and learning
A means of emotional catharsis
Way to make friends
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Communication should be accessible to
EVERYONE regardless of severity of the
disability!!!
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Control over physical and social environment.
Encourages self-determination, self-worth
and self-esteem.
Encourage many opportunities for choicemaking……we all like to make our own
choices.
Need a socially
acceptable way to
deal with anger.
 Limited control over
environment.
 Highly controlled by
others.
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Difficult to maintain interactions.
Communication is fundamental to
participating and interacting with others.
How can friendships be developed?
Limited opportunities for interaction.
Friendship development is a lifelong skill.
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Greetings and
Farewells
Asking for
attention/getting
help
Comments of
approval/rejection
Social closeness
 What does it mean to
be directive?
 Do you think you are
overly directive as an
SLP?
 What happens when
you are overly
directive - what
influence does that
have on the child?
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Write down five choices you have made
between now and the time you got up this
morning.
How many choices do our students typically
make during the day?
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Offer choices instead of making decisions for them.
Choices should be easy for student.
Connection between choice and reward are easier for
them to make at first.
Increase the number of choices so that they truly do
have a choice to make.
Find out what motivates student in making choices food, activity, etc.
Individualize choice ability to each student.
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Aggression
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Passivity
 React in a physical
 Learned helplessness:
manner
 May be most effective
means of
communicating
 Evaluate reason behind
aggression - don’t just
punish the behavior
can do something but
choose not to as
situation is perceived out
of their control.
 Be careful not to
“control” the
environment.
As much as 90% of any messages exchanged
between two very verbal people can be attributed to
nonverbal behavior.
 Many nonverbal communicative behaviors are
universal and recognized.
 We must recognize the power of nonsymbolic
communicative behaviors and build on them:
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 Facial expressions, body movements, gestures.
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Used to make needs known.
Highly individualized.
Can be used with symbols or in
isolation.
Eye movements
 Shutting eyes
 Looking away
 Eye contact with person communicating
 Eye gaze from person to desired
item/location.
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Facial Expressions
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Touch
 Smile
 Touches partner
 Frown
 Pulls partner
 Grimace
 Manipulates partner
 Surprise
 Displays emotion to
 Anger
partner
 Point/touches
item/person
 Points
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Extremity Movements
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Increased mvmnt.
Pauses mvmnt.
Changes in tone
Change in posture
Moves away
Swaying
Leaning closer
Fidgets
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Object Movement
 Touching or
manipulating objects
 Acting on objects
 Stop activity of objects
 Displaying emotion to
objects
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May have to accept nontypical ways of communicating even if it doesn’t meet social conventions. Examples?
Important to teach new behaviors but must be as
effective and as efficient.
Pay attention to minimal or vague attempts at
communication.
Recognize value of nonsymbolic communication.
Important: Provide wait time.
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Learning to communicate should be
motivating for the student.
Student should clearly be able to see the
benefit.
Natural contexts and naturally occurring
times.
Occur at home, at school, in the community,
etc.
Middle School and High School
Years
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Domains
 Community Living Domains
 Functional Academic Skills
 Embedded Social, Communication, and Motor
Skills
Community Living Domain
Self Management/Home Living
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SelfManagement/Home
Living
 Eating and food prep
 Grooming and dressing
 Hygiene and toileting
 Safety and health
 Assisting and taking care
of others
 Budgeting and
planning/scheduling
Vocational Domain
Classroom/school job
and community-based
work experiences
 Neighborhood jobs
 Community jobs
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Recreation/Leisure
School and extracurriculuar
 Activities to do alone
and with family and
friends: at home and in
the neighborhood
 Activities to do with
family and friends in
the community
 Physical fitness
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General Community Functioning
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Travel
Community safety
General shopping
Grocery shopping
Eating out
Using services
Functional Academic Skills
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Reading and writing
Money handling
Time management
Science
Social and Communication Skills
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Initiating and joining
conversations
Self-regulation
Following rules,
guidelines and routines
of activities
Providing positive and
negative feedback
Obtain and respond to
relevant situational
cues
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Provide
information/offer
assistance to others
Requests/accepts
assistance
Indicates
preference/make
choice
Cope with negatives
Terminates or
withdraws from an
interaction and/or
Ideas for Increasing
Communication Opportunities
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Lunch Conversations
 Carrying a conversation
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during lunch
Remembering to use
appropriate manners
Wiping mouth, eating
with mouth closed
When to talk
How not to dominate
conversation
Dances/Social Activities
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What to expect
What to wear
Preparing for the dance
Dance protocol
Refreshment table
Appropriate behavior
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Storms
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Emergency
 Listening for storm
 How to dial 911
watches and warnings
 Preparing ahead for a
storm
 What to do if a siren is
heard
 First Aid and First Aid kit
 When to call for help
Going to a Home Game
Expected manners
Cheers
Talking with my
buddies
 Concessions
 Is it OK to Boo?
 When to say “No”
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On the Job Site
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Resume and
application
Interview process
Dress for success
Listening to directions
The Boss
Taking a break
Working with your coworkers
Other Ideas???
High School Teacher Quote
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“The one goal I always emphasize in my
classroom is that our students continue to be
in our classrooms to learn and move toward
being as independent as possible. The
students are not placed in this classroom to
remain in a holding pattern until they are 21.”