Early communication for children with complex needs
Some children with cerebral palsy - and this includes children with hemiplegia - have complex needs and will be at a very early stage of communication. This may be irrespective of age. This information has been written jointly by HemiHelp and Scope, with childminders in mind, but may also be useful for a number of different early years settings. As a childminder you will have a great deal of experience in listening to and encouraging children's early communication. These are the same skills you will use with children with complex needs. Complex needs can refer to a mixture of any of the following:
- physical needs
- learning needs
- behavioural needs
- medical needs
- sensory needs
. It is important to use parents as an 'information centre'. They can pass on information from the child's Speech and Language Therapist and relay any questions you may have. However, some younger children may not have a Speech and Language Therapist and will benefit greatly from the right experiences.
Use what you already know
- Use consistent language
- Consider how many key words a child may understand in a sentence
- Use body language, facial expressions and so on
- Talk, talk, talk all the time
- Respond to the child's early communication - crying, laughing etc
- Remember the importance of play in the development of communication
- Make it a fun experience for both you and the child
- Consider attention span
- Work on developing eye contact
- Encourage taking turns
- Involve other children where possible, especially siblings
- Create opportunities for communication
- Children are children whatever the differences thereafter
Think about how any baby or young child develops their early communication skills. You will be using the same tools with an older child with complex needs. It is important to consider the child's age and level of understanding alongside their level of language / communication development.
One of the most important areas of development in early communication for children with complex needs is choice making. To enable a child's development through choices is very easy. It doesn't require lots of work, but more a mindset to always consider choices such as different foods, drinks, toys, videos and music tapes. This starts with asking a child which they want from two objects, held apart, that they must reach for, point to or look at. Some children may not yet understand how to make a choice or what a choice is. Always accept their first answer and give them that choice, even if a child has only fleetingly looked at it. It is important that they learn the consequence of their choice. If you offer a child the choice of two different drinks and they indicate one when you know the other is their favourite, don't give them their favourite, give them the one they chose. Choice making can progress to choosing from an increasing number of objects or pictures / photos or eventually a symbol system. When a child is ready to move on from objects you can start to introduce choosing from labels, pictures cut out of magazines or photos. Once a child becomes accustomed to choosing, try making one of the options 'something else' so that they can choose something you haven't chosen for them. Later on a Speech and Language Therapist may provide a symbol system. Helping children to make choices teaches them to take control of the world around them and to want to communicate.
Other aspects to consider
Positioning for communication
Children with complex needs will probably need serious consideration given to positioning. This may involve specialist seating. It certainly means they need to be able to lift their heads to see what / who they are looking at and that they may need to be able to use a hand to point. They need to be comfortable, so consider whether they have sunlight / lights shining in their eyes. When supportive seating is being introduced for the first time, sessions need to be kept short but fun, gradually extending over a period of time. Speak to parents, their occupational therapist can advise on this area. If there are any visual difficulties you may need to consider lighting and / or positioning. Similarly for any hearing difficulties positioning will be important.
Equipment and toys
You don't need to have lots of expensive equipment. Specialist seating usually comes with the child. Specialist toys are not necessary. An empty box can be a toy. You may need to give time to manually assist the child to play with toys that they cannot access alone. Remember to relax and have FUN, as with any child he or she will pick up on your anxiety. As for any concerns you may have, ask the advice of the child's parent / carer as they are the ones who know and understand the child the best. If they cannot help you they will probably be able to point you to a professional who has contact with the child. For ideas on toys see Play Talks produced by Scope, see details below.
Some children may be starting to use simple sign language (such as Makaton). However, it is unlikely that a child with complex needs will use this as their primary method of communication. Simple sign language is an excellent tool for teaching and reinforcing language. Parents / carers will happily show you the new signs they are introducing to their child.
Objects of reference
Some children may be introduced to objects of reference. These are to refer a child to a particular thing, for example, a spoon attached to a photo of lunch to refer to lunchtime. If a child is using objects of reference, parents / carers will explain their use to you.
It is important that the child understands the meaning of right and wrong, yes and no. It won't help a child to become part of his or her community now or in the future if this message is denied to them. Whatever their impairment, they need to understand what behaviour is acceptable and what is not. Do not make an exception because of the child's ability; this helps no one, least of all them. It is vital that the child is helped to understand the meaning of yes and no with regards to any child protection issue within any setting. Contact Mencap.