CommunicationDevelopmentandCharacteristics
ByMarjorieGoodban,Ph.D.,CCCͲSLP
ThisisthecomprehensiveoutlineofDr.Goodban'spresentationattheArizonaConnections
meetingonJune24,2000.
DevelopmentofCommunication[1]
x Overalldevelopmentofcommunicationskillsisdelayedforapproximately96%ofthe
individualswithCdLS.
x Basedonmy1993study,53%ofthechildrenwhowerefouryearsoroldercombined
2 or more words into sentences; 33% had no words or only 1Ͳ2 words; 4% had
languageskillswithinnormaltolowͲnormallimits
SpeechDevelopment(Articulation)/OralMotorSkills
x Manyofthechildrenexhibiterrorsinarticulation(pronunciation).
o Manyconsonants(e.g.,"k,t,s")areomitted,distorted,orotherconsonants
aresubstitutedforthem
o Earlier developingconsonants,suchas"k"and "t"arefrequentlyomitted in
theinitialand/orfinalpositionsinwords,e.g.,"ca_"for"cat"
o "Front"sounds(speechsoundsmadeinthefrontpartofthemouth),suchas
"t"and"d,"areoftensubstitutedfor"backsounds,"(soundsmadeintheback
part of themouth), e.g. "tat" for "cat," or more commonly, "ta_" for "cat, "
whichisacombinationofomissionandsubstitution
x Factorsrelatedtoarticulationerrors
o Oralmotorapraxia(difficultyimitatingorproducingvoluntarymovementsof
the mouth, in the absence of paralysis or weakness); evidenced by the
majorityoftheindividualswithCdLS[2]
o RetroͲmicrognathia(thelowerjawisretrudedandsmall)
ƒ Retrusion of the lower jaw makes the tongue movements necessary
forpronunciationmoredifficulttomake
ƒ It also may create misalignment of the teeth, which can affect
pronunciation
o Overalldevelopmentaldelay
o Hearingloss
LanguageDevelopment
x By the age of four years, approximately half of the children are combining two or
morewordsintosentences
x Asynchronous Development (uneven development of skills). Many aspects of the
languagedevelopmentaremarkedbydiscrepanciesbetweenskills:
o Receptivelanguage,cognition,andexpressivelanguage
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Receptive language skills (what the child understands) are typically
muchhigherthanthechild'sexpressivelanguageskills(whatthechild
says)
ƒ Receptivelanguageskillsappeartobecommensuratewiththechild's
cognitive developmental level (often synonymous with IQ or mental
age)
ƒ Typically, expressive language skills are much lower than the child's
cognitivedevelopmentallevelandthechild'sreceptivelanguageskills
o Nonverbal cognitive abilities (what the child is able to understand by
watching)appeartobemuchhigherthanexpressivelanguageabilities
o Vocabulary skills (the number of words the child says) and utterance length
(average or typical number of words in the child's sentences): Given the
number of words the child can say, sentence length is shorter than that
expectedforthenormallydevelopingchild
o Utterancelengthandsyntacticskills(syntaxorgrammar):Thechild'sabilityto
use standard grammatical forms is below that expected, given the typical
numberofwordsthechildcanuseinasentence;thisincludestheabilityto
transformwordsintothestandardquestionform
o Recent research on children with specific genetic syndromes reveals
performance not accounted for by their general cognitive abilities. For
example, similar to my 1993 findings in CdLS, in the Down syndrome
population, children evidence deficits in language production in comparison
to language comprehension and nonverbal cognitive skills, as well as better
developmentinvocabularyskillsthaninsyntacticskills.Asimilarcomparison
isseeninthefragileXsyndrome.Incontrast,childrenwithTurnersyndrome
appear to have better language communication skills than would be
suggestedbytheirgeneralcognitiveskills.
VocalQualityandVocalics(volumeorloudness,pitch,intonation,phrasing)
x Mostofthechildrenexhibitanunusualvocalqualitythatisgutturalandlowinpitch
x Overallrangeofvocalinflectiontendstobelimited
x Although some children have a vocal quality that is more guttural and hoarse than
otherchildren,theredoesnotseemtobearelationshipbetweenvocalqualityand
thedevelopmentofexpressivelanguageabilities
x GERD(gastroesophagealrefluxdisease)andhearinglossmaycontributetosomeof
thevocalqualitydifferences
Resonance(thevibrationofsound)
x Hypernasality (excessive resonance or sound vibration in the nose or nasal cavity)
maybepresentifthechildhasacleftpalate
x Hyponasality(notenoughresonanceorsoundvibrationinthenoseornasalcavity)
mayoccurifthenasalcavityisunusuallysmall
x Voice may sound muffled and not very loud as a result of deficiencies in oral
resonance(notenoughresonanceorvibrationofsoundinthemouthororalcavity);
theretroͲmicrognathiamaycausethetonguetobeplacedfartherbackinthemouth
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thanusual,affectingresonance;also,theoralcavitywillbeslightlysmallerasaresult
oftheretrudedlowerjaw
FacialExpression/Gesture/NonverbalBehavior
x Facestendtolacktherangeofexpressiontypicalofnormallydevelopingchildren
x Gestures and nonverbal behaviors appear to be limited but may be commensurate
withexpressivelanguageskills
x Moreinformationisneededintheseareas
Pragmatics(appropriateuseoflanguageinsocialsettings;includesturntaking,interactions
inconversation)
x Most of the children talk very little, even when they have highly developed
vocabularies
x Somechildrenexhibitdifficultyintheirrelationshipswithpeers
x ThesocialbehaviorofsomeofthechildrenwithCdLSissimilartothatofautism
Hearing
x Manychildrenhaveconductivehearinglosses(reductioninhearingsensitivity;otitis
media; often caused by fluid in the middleearcavity), often correctable with time,
antibioticsandtubes)
x Hearing aids may be recommended, although parents often report their children
seemtohearaswellwithouttheaids
x A number of children have sensorineural hearing losses (nerve damage), which are
moreserious;hearingaidsareoftenrecommended
x UnusualResultsofHearingTests
o Numerousreportsfromparentsindicatethatchildrenareoftendiagnosedas
deaf or profoundly hearing impaired immediately after birth, moderately
hearing impaired at about l2 months, and mildly hearing impaired or with
normalhearingat18Ͳ24months
o Iknowofnootherpopulationwherethehearinggetsbetterinsteadofworse.
These unusual findings may berelated to audiologic testing procedures, the
tinystructuresoftheseinfants,orsomeotherunknownfactor
o Parents must be made aware that an initial diagnosis of deafness or severe
hearinglossmaybeincorrect
o Itisimportantthatparentstalktotheirinfantsasthoughtheycanhear
o Moreinformationisneededaboutwhytheunusualhearingtestsoccur
FeedingBehavior
x Feedingproblemsseemtobeverycommon
x Dr.Carricowilltalktoyouaboutthisarea.
UnusualFindings
x UnexpectedUtterances
o Clinical observations and reports from parents indicate that some children
withCdLSclearlyutterawordorphraseonceortwiceandthenneveruseit
again
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This utterance is often many levels above the current level of performance,
e.g., a child who is still struggling with simple, singleͲsyllable words may
unexpectedlyproduceamultiͲsyllabicutterancewithperfectarticulation
o This behavior is also observed in adults with apraxia and in children with
autism
PrognosticFactors
x Childrenwhodonottalkatallorwhoareseverelydelayedintalkingtendtohaveat
leastoneofthefollowingcharacteristics:
o Birthweightunder5lbs.(probablytheleastimportantfactor)
o ModerateͲtoͲseverehearingimpairment
o UpperͲlimbmalformations
o Severemotordelay:sittingupafter25monthsorwalkingafter35months
o Deficits in social relatedness: autisticͲlike behaviors, eye contact, overall
abilitytorelatetopeople
OTHERCOMMENTS
CommunicationBetweenAbleͲbodiedPersonsandPersonswithDisabilities
x OneofmyotherareasofspecializationisInterculturalCommunication
x ThecultureoftheableͲbodiedisdifferentfromthecultureofthedisabled
x BecausetheableͲbodiedtendtofeeluncomfortableanduncertainarounddisabled
persons,theyoftenreactinpredictablewaystothedisabledandsometimestothe
parentsofthedisabled
o WhiletheableͲbodiedmaycommunicateverbalacceptancetothedisabled,
theirnonverbalbehaviormaycommunicaterejectionandavoidance
ƒ Theymaystandatagreaterdistancethanusual
ƒ Theymayavoideyecontact
ƒ Theymaycuttheconversationshort
ƒ They may speak to the parent as though the disabled child is not
present
o Parents report friends and relatives may react differently to the birth of a
disabledchild
ƒ Theymaynotsendabirthpresentoracardforthedisabledchild
ƒ They may exclude the disabled child's name when sending greeting
cards
ƒ They may not ask about the disabled child as they would the ableͲ
bodiedchild
o TheableͲbodiedoftenneedtobeeducatedonhowtocommunicatewiththe
disabled:
ƒ Treat persons with disabilities as persons first, recognizing that they
are not dealing with a disabled person but with a person who has a
disability
o
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ƒ
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Don'tavoidcommunicationwithpersonswhohavedisabilitiessimply
becauseofdiscomfortoruncertainty
Don't assume that persons with disabilities cannot speak for
themselvesordothingsforthemselves
TREATMENT
GroupingsBasedonObservedCharacteristics[3]
x GroupI:"Talkers"
o Approximately3Ͳ4%ofthepopulationIhaveseen
o Developmental milestones such as sitting and walking close to normal; may
walk as late as 18 months; abilitiesin all areasare at lowͲnormal to normal
levels; no upperͲlimb malformations; normal ability to relate socially; minor
hearingproblemsifany
o Communicationdevelopmentisclosetonormalormaybealittlelate;these
children usually begin talking on their own but will probably benefit from
speechtherapyandotherinterventions
o Educational placement may be in normal classroom with resource help for
reading,math.etc.
o Intervention will probably be necessary for some speech sounds, standard
grammatical forms, increase in loudness, and optimal social interaction.
Resourcehelpmaybenecessary
x GroupII:"LateTalkers"
o Approximately35Ͳ40%ofthechildrenIhaveseen
o The children in this group will communicate verbally but these skills will
developlaterthanfortheGroupIchildrenandmaynotdeveloptothesame
extent; typically exhibit relatively good ability to imitate words they hear,
althoughpronunciationmaynotbeprecise
o Thechildreninthisgrouptypicallysitatorby18monthsandwalkatorby30
months;noupperͲlimbmalformations;normalhearing,exceptforapossible
mildconductivelossinoneorbothearsoramoderateconductivelossinone
ear; moderateͲtoͲgood skills in social relatedness; birth weight at or greater
than 5 pounds (although birth weight is probably not as important as the
otherfactors)
o First"real"wordssuchasmama/dadamayemergeasearlyas12Ͳ18months
butoftennotuntil24Ͳ30months;additionalwordswillslowlyemerge;twoͲ
word utterances at approximately 30Ͳ40 months; short sentences at
approximately 40 monthsͲsix years; sentence length may never exceed fiveͲ
seven words and will probably average threeͲfive words per utterance; may
be persistent problems with the formation of the standard question form;
consistent omissions of substitutions of some consonants may persist;
tendencytobeveryshyabouttalkingexceptaroundfamilymembers
x GroupIII:"Limited"Talkers
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Approximately20Ͳ25%ofthechildrenIhaveseen
Thechildreninthisgroupwillcommunicateverballybuttheseskillswillnot
developasearlyortothesameextentasfoundintheGroupIIchildren
o FirstrealwordsmayoccuraslateasfourͲsevenyearsofage;additionalwords
maydevelopaslateas10Ͳ11yearsofage
o Developmentalmilestones,suchassittingandwalking,areachievedatalater
age than described for Group II children; typically no upperͲlimb
malformations; skills in social relatedness may not be as good as for the
GroupIIkiddiesbutwouldnotbedescribedasautisticͲlike
x GroupIV:"GuardedTalkers"
o Approximately25Ͳ30%ofthechildrenIhaveseen
o The children in this group may not develop verbal communication skills, or
mayneverhavemorethanoneͲthreewords
o One or more of the following is almost always present: UpperͲlimb
malformations; moderate to severe hearing loss; autism or autisticͲlike
behaviors; very late attainment of developmental milestones, e.g., may not
walkuntilafterfourͲfiveyearsofage
TreatmentProcedures
x AugmentativeandAlternativeCommunication(AAC)
o AACistraditionallydefinedasstrategiesthatincludeacommunicationboard;
Ameslansignlanguage;AmericanIndianHandTalkorAmerͲIndgesturalcode;
Blissymbolics; Total Communication; Pantomime; a manual alphabet; eyeͲ
blinkingencoding;orelectroniccommunicationaids.Forchildrenwithsevere
upperͲlimb malformations there are gesturalͲassisted and neuroͲassisted
strategiesavailable
o Unfortunately,almostallaugmentativecommunicationstrategiesaredifficult
tolearnforchildrenwhohavedifficultyunderstandingnonverbalorgestural
communication. As we know, many children with CdLS have impairments
involving vocal/verbal skills, hand skills and processing skills (sensory, e.g.,
hearingandtactile;cognition;attention)
ƒ Before considering the use of augmentative or alternative
communication, a number of factors regarding the child need to be
considered.
ƒ Thelevelofcognition
ƒ Motorabilities
ƒ Receptivelanguageabilities
ƒ Themotivationtocommunicate
ƒ Before deciding on a program, the speechͲlanguage pathologist may
want to consult as appropriate with professionals such as physical
therapists, occupational therapist, physicians, psychologists,
engineers, social workers, vocational counselors, wheelͲchair seating
specialists,nurses,andteachers
o
o
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Signlanguageoragesturesystemseemstobetheeasiestnonverbal
system for many young children with CdLS. In general, gestures
facilitatethelearningoforallanguage
o Important to know that many children with disabilities are likely to become
passiveandgiveuponallcommunicationattemptsbecausethefewattempts
theydomakearenotnoticedoraremisunderstood
o These impairments disrupt the familiar communication routines found in
most interactions between young children and their parents. Children with
CdLSarelesslikelytoinitiateandtoimitatebehaviors
o Itiscriticalthatchildrenlearnthattheirbehaviorsaremeaningfultoatleast
oneotherperson
o Becausetherearemanychildrenwhowillnotbeabletousethetraditional
AACprocedures,andbecausewedonotwanttolosetimeuntilatraditional
procedure is established, I am introducing the definition of AAC as anything
thathelpschildrenoradultscommunicatewhentraditionalstrategiesarenot
sufficienttoaccomplishacommunicationgoal(C.J.Cress,ASHA,1999).Inthis
definition, AAC refers to reacting to the child's behaviors, e.g., posture and
bodyshifts;vocalbehaviors.
o Example:Withaveryyoungchild,watchwhatbehaviorsoccurwhenthechild
wants to be picked up. If the shoulders are raised, touch the shoulders and
say,"Iseeyouareraisingyourshoulders.Doyouwantup?"Thenpickupthe
child.Communicationhasoccurredanditwassuccessful.Whenthebehavior
becomes purposeful, it becomes augmentative and alternative
communication.
o UsefulforGroupsIͲIV
o AlsoseeBuddyundertheCaseStudiessectionofthishandout
TypicalTherapyProceduresforGroupsIIandIII
x Assumesthenecessaryprognosticfactorsforsuccesswithverballanguage:physical
ability to produce speech sounds; sufficient level of cognition; adequate vision;
sufficient attention span; ability to imitate sounds and words; adequate hearing;
prepubescent; lack of autisticͲlike behaviors; and absence of upperͲlimb
malformations.
x Therapy moves from gross motor imitation, to vocal imitation, to sound and word
imitation.
x TheearliersessionsaremarkedbyplayfulactivitiesinvolvingoralͲmotorplayanduse
of noiseͲmaking objects. Sessions are designed to provide maximum visual and
auditorystimulationandtoincreaseattendingbehavior.
x Averysuccessfulstimulationapproachforelicitingvocalimitationconsistedofsaying
"ba" or some other sound, word or phrase into a plastic ring and encouraging the
childtoimitatethisutterance,whileholdingaringnearhis/hermouth.
x All sessions must include therapy specifically designed for oralͲmotor apraxia; this
therapyapproachconsistsof:
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Prolongedandhighlyinflectedsimplewordsandutterances(likemotherese);
numerous repetitions of these utterances, accompanied by holding the
stimulus item or fingers near the parent's/therapist's mouth; slightly louder
thannormalloudness
o Thisexaggeratedinflectionisprobablymoresuccessfulbecauseitintensifies
auditoryandvisualstimulation;allowsforgreaterauditoryprocessingtime;is
closer in form to the motherese appropriate for children at a younger
languageage;andis"musical"andmorelikelytoevokearesponse
o Speakingthiswaycanberemarkablydifficultforsomepeopletolearn;Iknow
becauseofthetimeittakesformystudenttherapiststolearnit!
o Use of gestures, movements, tapping with blocks, or clapping to mark the
rhythmofeachsyllableorword
o Reinforcementofsuccessiveapproximationsbythechild.
x For the most part, therapy should follow the lead of the child. Be prepared with
many interesting toys/items so that the child maintains interest and is frequently
surprised.Theseitemsalsoserveasmotivators
x Activities are designed to approximate those of normal daily routines, such as
pretend grocery shopping, meal time, playing with doll houses, using a vacuum
cleaner
x Try to find something the child will work hard to obtain. Food, toys, or fascinating
itemsoftenwork
x Tactile(touch)stimulationisoftenavoidedbecauseofthedisturbingeffectthishas
onmanychildrenwithCdLS
x The use of sign language or gestures frequently facilitates the development of oral
language.Mostofusgesturedbeforewetalked,andmanyofusstillrelyongestures
tocommunicateorfacilitateourrecallofwords
x Forthechildwhohasdevelopedsomeexpressivevocabulary,drillandrepetitionare
usefulinmaintainanddevelopinglongerutterances.The"WhͲ"questionformoften
requiresmuchpractice.
TherapyProceduresforGroupsIIIandIV
x Communication Board: If your child is completely nonverbal and unable to
communicate wants and needs, this procedure is useful in helping your child
communicate.Atthesametime,youwillbeteachingyourchildthebasicnatureof
communication.
o Provide twoͲtoͲfour actual objects, imitation objects, or large, very clear
picturesorphotographsofobjects,percontext.BycontextImean,mealtime,
playtime,selectionoftoys,etc.
o For example, at meal or snack time, you may have a communication board
with four different pictures of food, or these pictures may be on the
refrigeratordoor.Whenyourchildindicatesadesiretoeat,pairthetouching
ofthepicture(firstbytheparentasanexample;laterbythechild)withthe
presentation of that particular food or drink. This provides a method of
o
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communication for the nonverbal child who has no other method of
communication.
o There are a number of variations on the above approach. One is to have
laminatedpicturesofobjectsonalarge,circularkeyring.Thismethodisvery
portableandcanbeusedbyindividualsotherthantheparents.
x PictureExchangeCommunicationSystem(PECS):Thissystemisoftenusedinschools
forchildreninGroupIV.PECSisusuallyestablishedbyaspeechͲlanguagepathologist
andusedbythetherapistaswellasbytheteacherand/oranaide.Thebasicideaof
PECS is that the child learns to exchange a picture, and gradually a more
sophisticatedformofcommunication,forthedesiredoutcome.
x Therapy for Children with Autism Spectrum Disorders: Some children exhibit
behaviors that are very similar to those seen in children who are diagnosed with
autism.Accordingtoreportsfromparents,suchchildrenhavequalifiedfortreatment
programsforchildrenwithautism.
GeneralInterventionRecommendations
x All children should receive a communication assessment as early as possible. PreͲ
verbalandverbalassessmentcanbeobtainedfrominterviewsofcaregivers,formal
testadministration,informalobservations,andmedicalandeducationalreports.
x Communication intervention should be initiated as early as possible. Above all, the
parentsshouldtalktotheirchildasthoughtheyexpectaresponseandcontinueto
expectaverbalresponseforaslongasappropriate.
x Hearingabilityisacriticalfactorinthedevelopmentofspeechandlanguage.
o Earlyandfrequenttestsarenecessary,particularlywiththechildwhohasa
suspectedhearingloss.
o Babies with CdLS have very tiny structures and testing may be difficult. It is
advisable to consult an audiologist and/or otolaryngologist who is familiar
withCdLSorwhoisexperiencedinworkingwithinfants.
o Tubes may be useful for middleͲear drainage but again it is necessary to
consultwithaphysicianexperiencedinworkingwithsmallinfants.
x Ifahearinglossissuspected,headsetsandhearingaidsmaybeprescribedforinfants
andchildren.Evenamildhearinglosscanresultinaspeechandlanguagedelay.
o SmalleraidsareavailablesoitisnotnecessaryoradvisabletouseanadultͲ
sizedaid.
o If the child will not leave on the aid, an audiologist or behavioral therapist
maybehelpful.
o Appropriateaudiologicalmanagementshouldincludeselectionandfittingof
suitableamplificationforalllisteningenvironments.
o Whilethechild'spersonalhearingaidmaybesufficientsomeofthetime,the
useofFMamplificationmaybenecessaryintheschoolsetting.
x Cleftlipandpalateshouldbeclosedasearlyaspossible.Thisimprovestheabilityto
eat, enhances the normal speaking process, and reduces the likelihood of ear
infections leading to hearing loss. Evaluation and treatment for cleft lip and/or
palate, insufficient velopharyngeal closure, and submucous cleft requires a team
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x
x
x
x
x
x
approach, usually comprised of at a speechͲlanguage pathologist, surgeon and
dentist.
Forchildrenwithesophagealreflux,theparentsareadvisedtoseekearlytreatment
or surgery to help reduce pain and discomfort, thus improving behavior. This
treatmentmayalsoavoidirritationoftheoralͲpharyngealͲlaryngealareasaswellas
theeustachiantubeandhelppromotebettervocalqualityandhearing.
TheproceduresofselfͲtalk(describingtothechildwhatyouaredoing);paralleltalk
(describing to the child what the child is doing); and expectant waiting (using an
expectantmannerwhilewaitingforthechildtorespond)arerecommendedforthe
parents and the therapists. Gestures and sign language are also encouraged as
methods to facilitate and motivate oral communication. All babies gesture before
theyuseworksandeveryoneusesgesturestofacilitatecommunication.
ChildrenwithCdLSfrombilingualfamiliesseemtodoequallywellinbothlanguages
(ornotdoequallywellinbothlanguagesasthecasemaybe).Idonotrecommend
thatinterventionbelimitedtoonlyonelanguage.
If the child has a gastric tube, feeding therapy may be indicated so the oral
mechanism functions as normally as possible. However, it is not necessary for the
childtohaveeatennormallyinorderfortalkingtooccur.
Work with the child and other therapists as necessary to reduce deficits in social
relatedness.FortheolderchildwhohasautisticͲlikebehaviorsandconstantlyplays
withorholdsthesametoy,strivetohavethatobjectbeanageappropriateobject
AlsoseemyPreͲspeechandSpeechInterventionProcedureshandout.
CASESTUDIES
BuddyThefollowingcasestudyillustratesachildwhobenefitedfromnonͲvocalstrategies.
ThedescriptionofBuddybyBuzolich(1987)demonstratesthesuccessfuluseofBlissymbols
with a 12ͲyearͲold ambulatory nonverbal boy with Cornelia de Lange Syndrome. Buddy
receivedhisfirstnonͲoralcommunicationevaluationattheageof12yearsuponadmittance
toaprivateschoolforseverelybehaviorallyandeducationallyhandicappedchildren.Atthe
same time, he was placed in a group home due to the death of his foster parent. He was
describedashavingnosymboliccommunicationsystemonadmittancetothisprivateschool
anditwasdeterminedhehadasevereoralͲmotor,verbal,andmotorapraxia.Inadditionhe
had an attentionͲdeficit disorder, and he exhibited both impulsive and compulsive
behaviors.
Buddy'seyegaze,facialexpressions,gestures,andvocalizationswerehisprimarymeansof
communication. He reportedly had mastered 60 signs although they were idiosyncratic
versions of standard signs. Expressive verbal language was below the oneͲyear level and
receptivelanguagefunctioningwasatapproximatelythefourͲyearlevel.Hisstrengthwasin
his visual modality; he could readily recognize letters of the alphabet and some common
words. After 8 months of training he was easily trained to express himself with 100
Blissymbols and was able to combine these symbols into more complex expressions. After
outgrowinghiscommunicationbookofsymbols,BuddywastrainedtousetheWolfVoiceͲ
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OutputCommunicationDevice(citedinBuzolich,1987)andachievedanimprovedlevelof
functionalcommunication.Throughanappropriateassessment,educationalandtherapeutic
program,Buddywasabletolearnandcompensateforhishandicappingcondition.
SammyThefollowingcasestudyillustratestheuseoffacilitativecommunication.
Accordingtotheparent,Sammy,asixͲyearͲoldgirlwithCdLS,hasbenefitedgreatlyfromthe
useoffacilitativecommunication(AsktheDoctor,1993).Boththetherapistandtheparent
believethisapproachhasenhancedthischild'sabilitytocommunicate.
Facilitativecommunicationisaprocedureinvolvingatherapistora"facilitator"whoassists
an individual with physical and communication disabilities to point to desired objects,
pictures,printedlettersandwords,ortoakeyboard.Thescientificvalidityandreliabilityof
this treatment technique has not been established (American SpeechͲLanguageͲHearing
Association,1995).Assuch,thisprocedureshouldnotbeusedwithouttheinformedconsent
of the individual and family. The critics of this technique claim the facilitator and not the
childistheonecommunicating.Proponentsclaimthereareinstancesinwhichtheyhadno
priorknowledgeoftheinformationthatultimatelyunfolded.
[1]
Goodban,M.T.(1993)Surveyofspeechandlanguageskillswithprognosticindicatorsin
116patientswithCdLS.AmJMedGenet47:1059Ͳ2063.
[2]
Nine doctors present research update at Arizona convention. (1994) Reaching Out: The
NewsletteroftheCdLSFoundation.XIII:4,p.11.
[3]
©M.M.Goodban,June,2000.
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