How can we best teach social communication skills to children in natural settings?
Children with deficits in spoken language and social communication can learn many valuable lessons in the therapy room, but if we fail to provide intensive training for caregivers and properly support families, these new skills may not materialize in the child’s everyday life. The time and effort spent in therapy will have failed to accomplish actual gains.
Over the past ten years, I have worked with many children who are nonverbal or had limited verbal skills. Some of them used alternative and augmentative communication (AAC) systems. AAC systems include speech generating devices like TouchChat or Dynavox, or picture communication systems such as PECS. Other children relied on gestures, single words or short phrases. As part of my work in schools and private practice settings, I have made an effort to train teachers and parents to help my clients use AAC, in addition to practicing speech sound production and implementing visual supports as tools to enhance the development of language skills.
An Educational Experience
Several years ago, I was working as a speech therapist at a school for children with special needs. I was assigned to a classroom of high school students with moderate to severe disabilities, including many children on the autism spectrum. Many of the students were nonverbal or had very limited verbal skills.
I was excited to work with this group and devoted considerable effort into the process of making communication supports and systems. My team and I were eager to provide these kids with the everyday living skills they would need to function in the community.
One of my ideas was to teach the students how to order food at a fast food restaurant. They all loved McDonalds, and I wanted to set up an expedition to the restaurant where students would order food at the counter. I set up a replica of the restaurant in the classroom. I found a small cash register, wore a McDonald’s uniform and made laminated copies of the McDonald’s menu. Students lined up and practiced ordering. It went very well! I was excited to take them out into the community.
When we arrived at McDonalds, nothing went to plan. The students scattered in all directions when we entered the restaurant. When they got up to the counter, they had no idea how to order food or respond to questions. Some students became overstimulated, and we needed to take them aside to calm down. By the time our excursion had ended, I was discouraged and exhausted.
This was an eye-opening experience for me. The multitude of stimuli present in our everyday lives powerfully impacts our ability to learn new skills. It’s impossible to perfectly simulate real-world experiences in the therapy room.
Generalizing Social Communication Skills
For many years, I’ve been working with students who are struggling with social communication. I implement social skills curricula (e.g. Michelle Garcia Winner’s Social Thinking), write social stories, and use books, worksheets and videos to teach children conversational skills and how to understand what others are thinking and feeling. We role play different social scenarios and practice navigating difficult situations, such as dealing with teasing.
However, while the work done in the therapy room is essential, it should be paired with caregiver and parent training and practiced in real-world settings.
Parent Training
For parents, providing support for social skills development can seem overwhelming. I find it helpful to pick one or two specific skills (e.g. maintaining eye contact, refraining from interruption, staying on topic during conversation). Then I help them practice how to appropriately prompt the child to use the skill when the need arises, while providing clear direction and staying positive. We might set a goal to practice the skill at least 4-5 times per week. We check in at the end of the week and discuss progress.
We learn life skills by participating in life, and there’s no substitute for real world experience. Since I’ve prioritized supporting students in the most natural setting and providing parent training in my practice, my students have flourished.