Tracey Jones SLP (C) , MRCSLT 16 th November 2010

1. Developing Communication Skills in the 21st Century Classroom for students with Additional Needs: Fetal Alcohol Spectrum Disorder (FASD) Tracey Jones SLP(C), MRCSLT 16th November 2010

2. What is a 21st Century Classroom?

3. Spot the Difference…

4. What do we know? • Learning styles • Teaching Strategies • Developmental stages • Neurological development • Biographical/Cultural/Structural impact • We can identify additional needs (?)

5. What are additional needs?

6. ‘People with disabilities become stereotyped by their disability because we have such a broad conception of disability and such a narrow perception of ability’

7. Pygmalion Effect (Rosenthal & Jacobson, ’68/92) Write down all your beliefs about teaching students with FASD, include beliefs that intellectually you know better but which emotionally still affect you. Divide your list into: • Empowering beliefs • Disempowering beliefs

8. ‘Changing Paradigms’ Sir Ken Robinson

9. Ken Robinson • You can’t meet the future by doing what you did in the past • Academic Ability is valued above ‘Vocational’ • Children are living in the most stimulating era ever known • We penalize them for being distracted in ‘boring’ situations by anaesthetizing them to conform to education • Divergent thinking the ability to see lots of different answers to a question • Most people 10-15, genius 200+ • Most great learning happens in groups • The culture of the school/institution is vital • RAISE STANDARDS

10. http://www.thersa.org/events/vision/archive/sir-ken-robinson

11. Aims Participants should have an understanding of: • The potential for students in 21stC learning environments. • The impact of fetal alcohol exposure on communication. • How communication skills influence learning. • Strategies for developing communication skills in the classroom.

12. Communication Skills and FASD

13. Why is SLP involvement important? • This population is at risk for experiencing difficulty in all areas of communication and language development. • Language deficits, in particular, are likely to contribute to the child’s poor coping strategies, which often result in negative secondary behaviours. • Numerous older students identified as affected by FASD are already in High School programmes for behavioural support. Children who do not receive effective intervention services have increased potential to develop externalizing behaviour problems.

14. SLP Involvement cont… • Impairments in expressive and receptive language for this population increase in severity over time rather than remain static. • 20% increase of language concerns being noted in a sample of children from the elementary to secondary populations (Nelson et al., 2003).

15. Brain Domains • Cognition • Memory • Attention/Activity Level • Executive Function • Adaptive Behaviour • Sensory/Motor • Communication • Academic Achievement

16. Language • Develops through specific historical, cultural and social contexts. • Follows ‘rules’ which are phonological (sound), morphological (word), syntactic (sentence), semantic (meaning), pragmatic (social). • Is acquired through the interaction of biological, cognitive, psychosocial and environmental factors.Neurodevelopment is subject to environmental and psycho-social impact - not just biological. • To use language for communication an individual needs to understand subtleties of human interaction including non-verbal cues, motivation and socio-cultural roles.

17. Primary Behaviours • Primary Behaviours are those that most clearly reflect underlying changes in brain structure and function. • There is wide variability in their frequency and magnitude, and none are exclusive to FASD.

18. Communication • Receptive language • Expressive language • Speech • Non-verbal & Social communication skills

19. Communication Common presentations include: • Generalized language impairments/language-based learning disabilities • Better expressive language than receptive • Average overall language skills but significant problems with very abstract language, figurative or ambiguous language, narrativelanguage • Difficulties understanding and using pragmatic/social behaviours • Phonologicaldisorders Research has not identified a specific pattern of deficit

20. ‘There is strong evidence that socio-emotional development in the first year of life is the foundation of language development and that socio-emotional well-being continues to affect both language and literacy as the child matures.’ (Espinosa, 2002.p. 31)

21. Alexithymia • Difficulty identifying, understanding and processing emotional information even though they experience intense feelings • Ford and Milosky (2003) • students with language impairment were able to label emotions, but had difficulty interpreting character motivations and intentions when presented with narratives. • They also confused characters’ positive and negative emotions at a significantly higher rate than did their typically developing peers.

22. Communication Breakdown Difficulties often experienced by children with FASD such as: • Understanding and using language; • reading nonlinguistic cues of emotion; • gaining insight into a speaker’s perspective and intentions; • difficulty understanding and expressing emotions. (Alexithymia) Contribute to higher levels of breakdown in social communication.

24. How are you Feeling?

25. ACTIVITY • Groups of 3 • Choose who will be A, B and C • Person B, read the instructions in your handout labelled ‘Social CommunicationActivity) • Person A, think of a subject you feel comfortable talking about • Person C, observe… When you are ready start the conversation…

26. FEEDBACK • Spend a few minutes talking in your group about how the conversation went and what you observed and felt as it progressed.

27. Social Communication-Pragmatics • Using language for different purposes; • changing language according to the needs of a listener or situation; • following rules for conversations and storytelling. A child with pragmatic difficulties may: • Say inappropriate or unrelated things during conversations; • tell stories in a disorganized way; • have little variety in language use. http://www.asha.org/public/speech/development/pragmatics.htm

28. Social Communication • Social communication is reliant upon linguistic competence including: • knowledge of sophisticated sentence construction; • word knowledge; • the ability to use this knowledge during real-time social interactions. • Students with compromised social communication lack essential resources for resolving the dynamic challenges associated with daily school activities.

29. Social Cognitive • Social cognition is concerned with how children think about their social world: • The people they observe; • the relationships between people; • the groups in which people participate. • Understand why people act in certain ways and what they are likely to do next

30. Executive Function • A socially competent communicatormust plan, integrate, and update their language and social cognitive abilities in accordance with the demands of particular situations. • Executive function deficits constrain the amount of information that children with high prenatal alcohol exposure can process when they are confronted with more complex challenges. • Executive function is the overarching component for this skill.

31. Social Cognition • Caregivers have consistently reported that children with FASD seem unable to empathize and have genuine difficulty anticipating the consequences of their actions in social situations • The ability to make inferences about what other people believe in specific situations, is regarded as an essential component of social cognition. • Research suggests that these children don’t have the language to understand or express empathic skills.

32. BTW… • Ramachandran: The neurons that shaped civilization (2009) • Rizzolatti discovered ‘Mirror Neurons’; • Mirror neurons fire when you observe someone performing an action or being touched. • Imitating a complex act requires the brain to adopt another persons’ point of view. These neurons are empathizing… http://www.ted.com/talks/lang/eng/vs_ramachandran_the_neurons_that_shaped_civilization.html

33. Ubuntu ‘…the only way for me to be human is for you to reflect my humanity back at me.’

34. Hearing • Hearing and language development are intrinsically linked. • For a child to develop speech and language skills they need to have a consistent ability to hear and process sounds.

35. Hearing cont… • Research has demonstrated behavioural responses to sound at 16 weeks gestation via ultrasound (Shahidullah and Hepper, 1992). • Reactive listening begins eight weeks before the ear is structurally complete at about 24 weeks. • Suggests that receptive hearing begins with the skin and skeletal framework, skin being a multi-receptor organ • With responsive listening proven at 16 weeks, hearing is clearly a major information channel operating for about 24 weeks before birth.

36. Hearing Loss • Children with prenatal alcohol exposures, especially those with fetal alcohol syndrome (FAS), have a high incidence of sensorineural hearing loss (damage to the sensory nerve for hearing) and middle ear disease.

37. ‘Rewiring the Brain’ Michael Merzenich

38. Merzenich ‘…it’s constructed for change. It’s all about change. It confers on us the ability to do things tomorrow that we can’t do today, things today that we couldn’t do yesterday.’ ‘…and of course it’s born stupid.’

39. Merzenich • We are individuals, our skills and abilities are shaped by everything we experience, our environment, culture and history all have a physical impact on us; these experiences change the form of our brain. • 2 great epochs of brain plasticity: • ‘Critical Period’ when the brain is ‘…setting up its basic processing machinery.’ For Example: to develop a ‘master processor’ for sound the brain need just be exposed to sound. • Adult Plasticity: the brain acts under specific attentional control, ‘…a specific function of whether a goal in a behaviour is achieved or whether the individual is rewarded for that behaviour.’

40. Summary Children affected by Fetal Alcohol Syndrome disorders can experience difficulty with all or some of the following communication abilities: • Expressive and Receptive language • Syntax(the rules of sentence construction) • Morphology (the form of words) • Semantics (meaning) • Memory: rarely universally poor –likely to see isolated deficits in working memory, auditory memory, or spatial memory. • Social Communication. • At risk for a variety of hearingdisorders. • Oral-Peripheral Mechanism: the structure and function of the oral-peripheral mechanism. Changes are mainly seen in the dentition and in the function of the tongue and larynx. • Speech and language pathologies may be due to a combination of CNS, hearing, oral-motor, and structural deficits.

41. Speech and Language Assessment

42. Research • Research tells us that high levels of prenatal alcohol exposure disrupts the development and use of language (Mattson & Riley, 1998; Streissguth et al., 1996 etc.) • Much of the evidence to support this claim has been gathered using standardized tests that focus on how well these children comprehend and/or produce the structure and content of their language. • The results have revealed an array of performance profiles, no pattern of deficit has emerged.

43. However… • We know that areas such as social communication and more abstract language skills are also commonly affected. Functional assessment focuses on: • The ability of these children to use their language effectively to achieve important communicative goals; • gathering information about underlying competence. Preliminary findings from research using FA confirms this & also suggests a common deficit in narrative skills for children with FASD.

44. Structure of Assessment • Case History: • Information gathered from parents/carers & multi-agencies e.g. • Family history; • medical history; • hearing status and history; • educational or clinical psychology evaluation; • occupational therapy; • academic history and any support given; • social services (MCFD); • any other specialist support.

45. Informal Assessment • Observation • Sampling of communication, interaction and behaviour in a variety of settings • Video/audio recording where appropriate

46. Informal Assessment Verbal Communication: • Use and understanding Language: • Follow instructions in various settings; • use a range of vocabulary, syntactic structures; • word order and use in sentences; • echolalia, perseveration; • literal interpretations, abstract, figurative, jokes, irony etc. Non-Verbal Communication: • Use and understanding of gesture, facial expression, prosodic features; • eye contact; • turn-taking, play, social interaction; • initiation of communication; • attention control.

47. Formal Assessments • Core language: CELF-P2/CELF-4, • Narrative language: Bus Story/Frog Story • Expressive language: CELF-P2/CELF-4 • Receptive language: CELF-P2/CELF-4 • Pragmatics checklist • Oro-motor skills/phonology: Goldman Fristoe/Phonological Awareness Skills Programme

48. Clinical Evaluation of Language Fundamentals - CELF (pre-school and 4) Designed to assess: • The nature of the disorder (strengths, weaknesses, affected modalities, content areas, conditions that enable the student to perform well); • the underlying clinical behaviors (working memory, automaticity of speech, phonological awareness); • how the disorder affects the student’s classroom performance (Observational Rating Scale and Pragmatics Profile).

49. What the test measures • Core Language Score: • Identify whether or not there is a language disorder • Receptive, Expressive, Language Content, Language Memory, Working memory: • Describe the nature of the disorder. • Underlying clinical behaviours (supplemental): • Working memory, Speech Fluency, Phonological awareness • Language and Communication in Context: • Pragmatics; • Attention, Motivation, Non-verbal behaviours.

50. CELF-4: Subtests • Concepts & Following Directions (Core, Receptive, Language Memory): used to evaluate the student’s ability to interpret, recall, and execute oral commands of increasing length and complexity that contain concepts of functional language. • Recalling Sentences (Core,Expressive, Language Memory): used to evaluate the student’s ability to recall and reproduce sentences of varying length and syntactic complexity. • Formulated Sentences (Core, Expressive, Language Memory): used to evaluate the ability to formulate compound and complex sentences when given grammatical (semantic and syntactic) constraints. • Word Classes 2–Total (Core, Expressive, Receptive, Language Content): used to evaluate the student’s ability to understand relationships between words that share a variety of functional and conceptual relationships.