This Small Shift in Language Makes a Huge Impact on Communication

When I’m working with children who have complex communication needs, my goal is to always strive for spontaneous language. This means a child has a novel thought or idea in their head, and they can communicate it autonomously.

In fact, it’s one of the first questions I ask parents: “What is your child communicating completely on their own?” If they’re not sure, I have them track their child’s spontaneous language throughout the week by writing down what a child said and in what context. During my consults I like to use this helpful PDF below that breaks this down even further: 

When I give the homework of tracking spontaneous language,  families often come back and report there’s not a lot of spontaneous language happening! This exercise made them realize their child is waiting for them to ask a question or model language or give them some level of prompting in order for them to communicate.  

So the big question is: How do we get kids communicating more spontaneously? I use a least-to-most prompting hierarchy, featured on my AAC Vocabulary Bundle, that prioritizes giving kids the space and time they need to start initiating more communication.

Decreasing Demands and Increasing Invitations 

I love this quote from Caroline Musselwhite. I often witness communication partners using demanding language like“What do you want?” or “Tell me with your device.”  in order to elicit communication. While this might seem helpful, this type of language often results in children feeling pressured rather than encouraged to communicate. Instead, we can make a subtle shift in our language to be more enticing. For instance, if a child wants crackers, you might naturally comment, “Mmm, crackers!” or “Yes, I love these crackers.” When you use commenting like this you’re modeling language in a way that invites communication without demanding it. 

I always start simply commenting about what’s happening FIRST to see if that’s enough to inspire communication. 

Start building awareness of the types of language you’re using to encourage communication with AAC. Aim for your interactions to sound more like natural conversations.

Here are my favorite strategies to encourage communication:

Exposure to a Specific Word Repeatedly

First we need to give a child a lot of exposure to a specific word/phrase. For example, if I’m teaching the word “OPEN,” I immerse children in that word by modeling it frequently on their AAC system during motivating activities. 

This could be opening up the refrigerator for a snack, opening up a game box or opening the door to go outside. Once I've given lots of repeated exposure to teach this word, it's time to start following the least-to-most prompting hierarchy.

Tempt and Pause

Pick a familiar routine like opening up the refrigerator. The first step is to simply tempt and pause. This might mean that you put your hand on the refrigerator door to tempt and then pause and wait a communication attempt. Make sure the device is easily accessible to your child and be sure to recognize ANY attempt at communication… even if it’s not “accurate”. 

A child doesn’t even have to select the “correct” word. The key here is that we're giving the child the space to have an idea and then independently initiate communication with us. If they use a word that doesn’t make sense we can simply attribute meaning to that word. 

Use Body Language

Let’s say the child doesn’t respond to tempting and pausing. You can use body language like a facial expression like raising your eyebrows or shrugging your shoulders as if to say “I don’t know. ”

Ask an Open-Ended Question/ Provide a Comment

If the child still doesn’t respond, then you can ask an open-ended question, such as “Now what?” or a comment like, “Hmm, I wonder what we should do next…”

Ask for a Specific Response

Still no response? You might try asking a more specific question like “What do you want?” or “Tell me with your talker.” 

Point to the Device/Word

If a child continues to need help you might give more support by pointing to their device or even pointing to the word “OPEN” on their device.  

I never venture into physical prompting because it violates bodily autonomy AND I haven’t found it to be useful in supporting independence down the line.

If I’m not getting a response it tells me either the child isn’t motivated by the activity I’ve chosen OR they haven’t had enough modeling or teaching with the specific word/phrase I’m targeting to use it on their own.  

Avoid Over-Prompting

The reality is that the more support and prompting we give, the more reliant our students will become on that high level of support. The secret art of amazing therapy is pushing kids out of the comfort zone just enough so that they are able to start learning and growing. When we give children space and time to formulate their ideas into communication we are supporting a broader vision of heling our students become as independent as possible when it comes to sharing their thoughts and connecting with those around them. 

Watch this video about How Over-Prompting Kills Spontaneous Language

The takeaway message here is that we need to be really cognizant of how often we’re asking questions to a child and demanding communication. Ultimately, if we do this too much we’re training kids to learn to only talk when someone tells them to.

Instead, we can build a strong foundation for independent, autonomous communication. That starts with giving kids the space and time to formulate and communicate their thoughts on their own.

Over to you...

Do have a child who relies heavily on prompting in order to communicate? What strategies have you've found successful? Share your story in the comments below OR reach out to me on my Instagram - I’d love to hear from you!

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Helping Children Learn Mindfulness w/ Melanie Pensak

How did you become interested in mindfulness and when did you realize it was applicable to speech-language pathology?

When I moved to Los Angeles 3 ½ years ago. I was blown away by the abundant health and wellness resources available to me in this city. I learned about the Mindful Schools and Inner Kids programs from colleagues who were teaching mindfulness practices to children, which in turn fueled the interest to deepen my own personal mindfulness meditation practice. When I learned to return to the present moment in my body instead of worrying or planning, life started to open naturally allowing me the freedom to enjoy the simplicity of life. I felt less stressed and triggered by circumstances around me as I intimately learned more about the reality and changing nature of my inner world and mind.  

Many of the children I worked with at that time were experiencing sensory and emotional regulation challenges, and some were diagnosed with attention and learning differences.

I realized that if their brain’s were more calm, concentrated, and prepared for hearing and processing the tasks I needed them to participate in to help reach their speech and language goals, their progress could possibly happen faster.

There would be less stress for everyone involved! I witnessed first hand how taking a few minutes to engage in mindful breathing or moving helped the child attend and participate more willingly in therapeutic activities.

How do you think bringing mindfulness into practice helps increase pediatric communication skills?

Mindfulness practices, such as focusing on feeling the breath, help to build attention which is essential for language development. If a child can sustain attention to their caregiver or teacher during reading time or develop a stronger awareness of the world around them, their receptive vocabulary and understanding can grow. This is shown through a child’s ability to follow longer directions, identify concepts and learn new skills. From there, expressive language areas such as vocabulary, commenting, asking questions and storytelling blooms. Mindfulness is clearly seeing what is happening in the present moment with kindness, curiosity, and acceptance.

Overall, when a child learns to be calm, explores emotions with curiosity, and develops awareness of what’s actually happening inside, they are in a better position to learn and respond to conditions and stresses from the outer world. They can learn to become more effective communicators and to be kinder and more compassionate humans.

What does a typical mindfulness session look like with a pediatric client?

I keep it simple and fun! Mindfulness sessions with pediatric clients are playful, interactive and experiential. Sessions usually last 30 minutes and have a general theme each time. For example, we may start with mindful moving, pretending to be a butterfly and feeling into the body as the child flaps their arms slowly like wings. Then we transition to a mindful game such as the body scan, where the child sits and feels different parts of their body with their eyes closed. After the meditation, I like to incorporate a book that compliments the theme or an art activity. We finish saying aloud what we are thankful from that day as we throw a ball back and forth. My sessions are appropriate for children as young as 4-5 through age 10. I love to incorporate the parents into the sessions when possible so they understand the concepts. In general, each session is a mix of movement, sound, meditation, reading, and games. For children ages 6 to 10, journaling and reflective writing are a part of the session. I love to hold sessions outside when possible.

Is there a mindfulness activity that you consistently incorporate into treatment plans?

For children of all ages, I prefer to start teaching mindfulness of the breath. We pause and learn where the child feels the breath the strongest so they can find their own anchor of breath. For younger children, I often start using visual supports like a toy boat and a play weight as an “anchor” so the child can see that an anchor holds the boat steady as the waves come and go. The child learns to feel where their own breath anchor is in the body and eventually understands the breath is there to come back to any time life feels hard or difficult feelings come up. With all children, we practice breathing slowly using breath balls (Hoberman spheres) as a physical representation of the belly expanding and contracting. It really helps children and adults to tune into their own natural rhythm of the breath.

How can mindfulness help parents and caregivers?

When parents and caregivers begin to clearly understand their own internal world and become aware of their habits of thought, feel their emotions, and return to the present moment over and over again, calm and concentration arise. It helps them learn how to handle their own stress so they can then better respond to the needs of another. Space begins to develop between a stimulus and a response, and a parent can learn to react skillfully in situations. Just something as simple as pausing to breathe before the habit of yelling at a child to pick up his shoes can create space to more skillfully communicate improving connection.

Over time when a parent learns to be more aware, kind and compassionate with themselves, they learn to be more attuned, kind and compassionate with others including their children.

Do you feel that you see a dramatic behavior shift in pediatric patients after teaching mindfulness strategies?

Children are amazing. They are naturally curious and open and often soak up the l mindfulness games easily without judgment. They further learn to integrate the concepts into their lives when the adults around them understand and model the concepts as well. Over time, I often see an increase in attention, flexibility, confidence and emotional resilience. And they will do almost anything to be able to ring the meditation bell!

How do you suggest teaching mindfulness strategies to children who are nonverbal or use devices?

In my experience, it’s best to know how your child learns and to adapt the concepts to a level that is appropriate for the child. One way to teach children is to model the behavior yourself. So as an adult or caregiver, I always recommend the adults begin to learn and use mindfulness of breath and emotions in their own lives and then talk about it aloud. A parent may be driving and could say, “I feel mad there is so much traffic. I feel mad in my throat. I am going to pause and take a deep breath. (Model a deep breath). I feel calmer in my body.” This is one way to model to the child we feel emotions in the body, emotions are okay and how to handle them.

Some children need more structure and visual supports, so when they are angry, I may hold up my hand or use a visual of a stop sign and say, “Pause and breathe” to keep language simple and concrete. I may model a big, exaggerated breath in and out. Because of mirror neurons, people tend to imitate and match moods, facial expressions, and behavior. My invitation to parents and caregivers is to use this to our advantage and help reinforce the idea of pausing and breathing by modeling breathe, body parts and feeling words on their device to help develop a child’s understanding and learning.

Are there any apps or resources that you find helpful?

Yes! I adore Susan Kaiser Greenland’s Mindful Games Activity Cards and use them for children of all ages. Her book The Mindful Child is a must-read. I also love the app Stop, Breath, & Think Kids for children ages 5-10. The parent uses it with the child, and the child chooses an emoji that aligns with the emotion they are feeling. Then a selection of short meditations or movement activities arise that are tailored to the feeling. Each activity is paired with a child-friendly animation.

What is nature-based speech therapy and what are the benefits?

Nature-based speech therapy cultivates receptive, expressive, and social language development through engaging the senses in outdoor environments. I transitioned to this type of speech-language therapy after learning more about the term “nature-deficit disorder” introduced by Richard Louv. Nature-deficit disorder is the idea that humans, especially children, are spending less time outdoors resulting in a wide range of behavioral problems. For adults, research shows that being outside lowers stress, blood pressure, and heart rate and increases physical activity and well being. The research showing the benefits of children is also growing.

Research shows that kids who grow up with greener environments are less likely to develop mental disorders in adulthood, and time in nature is suggested as an added therapy for children with ADHD and other similar conditions. Learning outside helps to build confidence, independence, empathy, health, and can improve sleep and mood by learning through experience.

By exploring and being aware of the natural world, children naturally ask questions, produce spontaneous comments, and develop an embodied understanding of their world. They are also learning to love and connect with the world which is vitally important to help protect the world in the years to come. One of my teachers often says, “We protect what we love” and by helping children get outside more frequently, we are also helping them create a stronger relationship with Earth. Through this appreciation, more children will be motivated to protect our green spaces which will continue to support life into the future.  

If you are interested in learning more about nature-deficit disorder, please consider reading Vitamin N and Last Child in the Woods by Richard Louv.

Where are your favorite places in Los Angeles to hold your nature-based speech sessions?

The South Beach Park playground in Santa Monica is a beautiful playground located right next to the beach. It is accessible and designed for children of all abilities. Many natural communication opportunities arise in this setting. Children often comment on the weather, inquire about the planes or helicopters going by, and have multiple opportunities to share, take turns with peers, and explore their world through movement and use of all the senses. Children learn experientially and come to understand a variety of verbs, descriptive words, language structures, and social language skills by engaging first-hand with the outdoor environment. We also go down to the beach to make castles, explore the seaweed, and make sand angels. The possibilities are endless!

Find out more about Melanie at melaniepensak.com OR check out her Instagram @mpensak9

Over to you

Have you thought about implementing mindfulness into your practice? I’d love to hear your thoughts in the comments below!