Communication Level, Style

Describe here the means in which the IP communicates. Describe the means in which the IP understands communication (receptive communication) as well as how she uses communication to express herself to others (expressive communication). It is important to assess communication levels to determine if they are adequate to meet the needs of tasks and environmental situations (most importantly, social interaction). If they are not, communication skills and deficits are remarkable.  If the IP’s deficits in communication have a likely functional relationship to the behaviors under assessment, they should be mentioned here as, well as in the Antecedent Setting Conditions section.

The Differences between Communication, Language, and Speech

Communication

Communication is the totality of means/strategies that one uses to understand and convey meaning. It can include speech and language, but it also includes non-verbal forms that are always present. With the exception of written communication, language and speech are almost always accompanied by emotional and other forms of gestural communication.

Behavior is communication: It is axiomatic in the field of Functional Analysis of Behavior that behavior is communication. In this regard, communication is either intentional or unintentional.

Language

A language represents agreement among a community of speakers that certain sounds, words, and combinations of sounds, words, and sometimes gestures have common meaning. For instance, in the community of English language speakers, the sound string “b-o-y” means a young male. Spanish or Japanese speakers are not in the community of people that agree that “boy” is the symbol for a young male – they have their own words for a young male.

The symbols of one language are different that other languages. Language has the following characteristics:

  • A language is a system of communication. The system has rules that govern its use.
  • Languages use symbols to convey meaning. Symbols can be spoken words, manual signs, gestures, and in most modern languages: written and/or pictorial forms.
  • Language is specific. Language is judged by the precision in which it is used.Spoken or written words can be nonsense. Spouting off words or symbols is not necessarily language use. There has to be some intent to convey a specific meaning to a recipient.

Speech

Speech is the oral-motor aspect of communication, usually in the form of words, but is also can be in the forms of vocal-play, or babbling.

Vocal Play

Vocal play is the long strings of consonant-vowel syllables produced in self-imitation, such as ba-ba-ba-ba. Vocal play consists of nonsense sounds the Student makes. In neurotypical development, vocal play is prominent in the latter part of the first year of infancy. It is a genetically driven behavior, required in order for the brain to develop coordination of the oro-muscular [oral- or vocal-motor] apparatus.
Think of vocal-play as speech-linguistic exploration behavior.

Babbling

This refers to the repetition of phonemes, such as ba, ba, ba, da, da, etc. These are beginning to sound like speech.

Jargon

Strings of unintelligible speech sounds with the intonational pattern of adult speech.

Jargoning tends to sound like real conversation; only the real words are missing. It typically carries the prosodic[18] elements of speech, and is often accompanied by active joint-attention behaviors. When you see a Student who is truly jargoning, you get the feeling the Student knows exactly what she is saying; only she’s using a made-up language.

Five Stages of Prelinguistic Vocalizations

Crying: Reflexive vocalization that occurs automatically whenever an infant is overly aroused.

Cooing: Sounds consisting largely of vowel sounds that express pleasure and contentment.

Vocal play
: Sounds which vary greatly in pitch and loudness, including occasional simple syllables.

Canonical babbling: Vocalizations consisting of strings of syllables that sound increasingly like speech.

Conversational babbling or jargon: Infants begin to use adult-like stress and intonation. Jargon sounds like conversation. Sound production begins to change to match the phonemes of the native language. By 10-12 months most children begin the transition to true speech.

Protowords: Vocalizations that seem to have consistent meanings for an IP and are used in attempts to communicate, but do not closely resemble real words.

Communication Level has to do with the types of representation the IP uses, going from non-symbolic, to pre-symbolic, to symbolic forms.

Non-Symbolic Forms

Non-symbolic forms do not make use of joint attention. Generally, there is a single function that they have – to indicate distress of some sort. Non-symbolic forms of communication have the function of (first) emotional release, and then (and not necessarily in tandem) to intentionally elicit caregiving help (a “requesting” function).

Crying

Crying can be differentiated among several different forms. In neurotypical development, crying goes from undifferentiated or amorphous forms to differentiated forms where other people can get a good idea from the sound of the cry what is wrong.

Undifferentiated/Amorphous Crying

This is typical of children functioning developmentally in Sensorimotor [Cognitive and Linguistic] Substage I or II. In children toddler-age and above – this very likely represents profound levels of mental retardation.

Differentiated/Specific

Within a few months after birth in neurotypical development, mothers (especially) can tell whether their baby is hungry, tired, bored, or otherwise distressed simply from the sound of their cries.

Even though the sound of the cry may be a good indicator of what is going on, the question of the IP’s intention can be in doubt. While the IP does not have an idea of a specific idea that is to be created in the hearer’s mind (as in joint attention/Theory of Mind) – which is the essence of symbolic communication, the non-symbolic IP can still assist the caregiver by continuing to cry or even crying more intensely if the caregiver is somehow misattuned.[19]

Performance

‘Performance’ in this respect is not intentional communication. It does however carry the message of “This is what is going on with me…”

In line with the axiom that “behavior is communication,” there is a message to others that comes from what a person does. For instance, when we see a child climbing onto the countertop and reaching for the cookie jar, we get the message that he wants a cookie.

In behavior analysis, it is often necessary and important to assess the difference between what someone says and what he does. The analysis of congruence between verbal communication and behavior can be the most important thing to know about the referral concern. Since children with autism are often taught word labels for feelings in an artificial and too-abstract manner, they will often report feelings that have nothing to do with their actual emotion. In such cases, it is crucial to analyze and remark about the performance-to-actual meaning congruence relationship.

In another common occurrence among children with ASDs, a Student will stand in front of the door when he wants to go outside, or stand in front of a cabinet when he wants something from the inside – without looking back at, or doing anything further to manage the attention of or increase the understanding of the caregiver. This too is performance communication.

Acting-Out Behavior

“Acting Out Behavior” is a term traditionally used by psychologists to describe behaviors that carry the message of the emotional state of the individual. For instance, a person might steal things they don’t need or even want from people they have relationships with. In such a case, anger is usually the emotional state, and stealing is the acting out behavior.

AOB is frequently confused with violent behavior. While AOB can indeed be violent and serve a function of emotional release for the individual, acting out does not necessarily involve violence.

Pre-symbolic Forms of Communication

Associative Forms

The use of symbols is somewhat random at first, but by trial and error the user learns that certain symbols are associated with environmental events. There is a difference between using a symbol – and conveying specific meaning.

For instance:

A 3-year-old has been taught through direct teaching and reinforcement, 10 manual signs. When asked “What do you want?” she goes through her entire list until her communication partner figures out what she wants. Over time, she learns to make more precise associations, but she doesn’t really understand what the symbols mean to the other person. She doesn’t understand that words are referents for other things – symbols. She just knows that a certain word produces a specific result.

A pet parrot does the same thing. The parrot speaks when it wants attention, but will say anything and nothing in particular. The parrot is aware of the reactions he gets from people for various things, but speech is a gimmick for the parrot, not real language. He’ll go through his entire vocabulary (including uncanny imitations of the telephone ringing, the garbage-truck backing up, people’s laughter, etc.), until he can get someone to enter the room and interact with him. However, most of the time, the parrot doesn’t speak when people are already paying attention to him. That is when he resorts to his innate and species-specific squawks and calls.

Joint Attention

Joint attention behaviors have to do with the Student’s efforts to direct other people’s attention, especially for the purpose of sharing experience (see Primary Deficit: Experience Sharing, p.15). They are very important in differentiating between Autism Spectrum disorders and language disorders and mental retardation (without autism).[20] These behaviors/skills develop before language, and they involve the coordination of two people’s attention to something else – a “joint reference.”[21]

Joint attention acts can be further divided into acts that involve the Student’s following an adult’s focus of gaze and those that involve initiating joint attention bids. There is substantial experimental evidence for impairments in both the production and comprehension of joint attention behaviors in children with autism. Children with autism tend to display fewer joint attention gestures than requesting gestures. They may be able to use gestures to request objects and engage in social action routines, but they tend not to use gestural acts to indicate or share awareness of objects or their properties

23-month-old Renee does something cool with a toy. She looks up to see if anyone else saw it too. If no one did, she makes an effort to do it again so someone will see it. She actively searches other people’s faces and eyes for signs that they’ve noticed. When they smile—she smiles back.

An important separation is made between imperative triadic exchanges, in which the Student’s behavior has an instrumental function, and declarative triadic exchanges, in which the Student’s behavior serves to share awareness, or the experience, of an object or event.

Be sure to remark about a lack of joint attention behaviors if you feel it is related to the behavior. If you’re performing a Developmental Assessment, then you must describe the forms joint attention take if they are present, or the way a Student communicates without them if the majority of their communications are instrumental.

Joint attention can be observed in the following behaviors, each of which is remarkable:

Gaze-shifting

The IP’s eyes shift back and forth from the reference object to the communication partner’s face and eyes.

Gaze-monitoring

The IP observes the communication partner’s face and eyes to make sure the partner

Emotional referencing

The IP attends to the emotional gestures (i.e. facial expressions, body-language) of others in order to regulate their own communication or co-regulate communication along with their partner.

Theoretical Types of Joint-Attention

Non-visual Joint Attention Behaviors

Joint attention can be coordinated over the telephone, or the referent can be something outside of the “here-and-now.”

Joint attention can come into play when statements are preferenced with e.g., “You know when…?” “Have you noticed that…?” In order for communication to include joint attention, the speaker needs to pay attention to the response, taking into account the attention and “mind” of the partner.

Here’s an example of a case where joint attention is not observed:

Two 5-year-olds:

P1: “I got a new bike at home.
P2: “My mom’s coming to get me soon.”

P1: “It’s red and it has chrome handlebars.”

Here’s a conversation that includes a non-visual form joint attention:

Telephone conversation:

P1: “You know how Monica likes to climb on things…?
P2: “Oh yeah – she’s always climbing on things…”

Symbolic Forms of Communication

Symbolic forms of communication range from concrete to abstract.

  • A ‘concretion’ is tangible. It can be experienced through the physical senses (it can be seen directly, touched, smelled, heard, etc.). Concretions are easily agreed upon by the communication partners(e.g., two observers would readily agree that what they see before them is a “dog,” whereas they might disagree about whether the dog is a “small” one or a “big” one).
  • An abstraction is intangible (e.g., “fair,” “big,” “snack” [Is an entire pizza a snack for one person? – two persons might disagree on that]). An abstraction is a value that is culturally and personally defined.
Table of Levels of Symbolic Communication

Most Concrete

Non-Symbolic Means

Differentiated Crying Only when intentional – uses crying to communicate a message – with knowledge of the typical reactions/consequences specific cries have.

Pre-symbolic Means

Gestures: Includes pointing, making specific sounds, emotional/affective expressions, etc.

Object Communication: Uses the presentation of objects to convey simple messages – usually requests: (e.g. brings bottle to Teacher to obtain more milk); recognizes the meaning of actions and objects (e.g., when Dad takes his keys off the hook – it means he’s leaving).

(Representations)

Simple/Direct: These include parts of objects (e.g., a bottle represents a bottle of milk; a doll represents a real person; a toy truck represents a real truck, etc.).

Picture Symbols: A picture or drawing represents reality. Photographs of objects are the most concrete, and inexact line drawings would be less concrete.

Complex/Abstract: These include objects that can only be understood with some imagination (e.g. Student cups his hand and pretends to drink; uses a broom to represent riding a horse).

Words, Manual Signs: These are not as universal as imaginative representations (above), because they must be agreed upon by a community of speakers (see Language, p.35). Words and manual signs often make reference to objects, actions, or ideas that are separated by time and place.[22]

Concrete References: These include words or signs that refer to tangible objects and observable actions. There is a high likelihood of inter-observer agreement with these referents.

Abstract References: These include words or signs that refer to intangible concepts (i.e. categories based on rule-based inclusion/exclusion criteria such as a fruit must grow from a plant and contain seeds, etc.), ideas, opinions, and other subjectively defined references.

Rebus: These include picture symbols strung together sequentially to represent a sequence of ideas, a sentence, or a story. Think of the old game show “Concentration.”

 Written Means

Simple Decoding: Simple decoding is the first thing learned in reading. It starts with mapping sounds to symbols (e.g., the sound ‘k’ can be ‘mapped’ to the letters k, c, cc, ch).  Reading decoding progresses to the deciphering of words as strings of sounds (not necessarily deciphering meaning).

Comprehension: This includes reading for meaning. The person can go beyond deciphering words to real understanding of written material.

Most Abstract

More About Concretions vs. Abstractions

Think of concrete v. abstract as a continuum rather than separate categories. A symbol can at different times be concrete (e.g. jump meaning leaping up [physically], “Go ‘jump’ on the trampoline…” or it can be abstract, “That assumption is quite a ‘jump’ from your last one.”

A concrete level word usually describes something you can experience through the senses (i.e. you can see it, hear it, smell it, taste it, touch it, etc…).

Concretions

These are singular and tangible items such as a cup, TV, Mommy, banana.

Lower Level Abstractions/Concepts

Abstract words go from simple to complex. The simpler abstractions include words that describe “classes” of things with common attributes, such as “red,” “vegetable,” etc. (things you can still see or touch, etc., but that include more than 1 particular item). They include things that have common attributes such as color, shape, function, class, etc, i.e. red things, big things, square [shaped things]; animals, etc.

A banana is a concretion whereas fruit is a concept.

A penny is a concretion whereas money is a concept.

Level II Abstractions

At a lightly more abstract level, you have words that require the knowledge of two concepts at once, such as relative terms like “big” (“big” is only big when you compare the big thing to something else), ordinal terms (“second” is only second when it’s between first and third), etc. Other comparative and “ connective” terms might include good/bad, directions such as up/down; prepositions (“on top” – on top of what?), etc.

Level II abstractions can also include feelings, as long as they are among the basic emotions of happy, sad, angry, afraid, etc.

A bed is a concretion, bedtime is a concept, and sleepy is a LLA.

A bowl of cereal is a concretion, breakfast is a concept, and delicious is a LLA.

Level III Abstractions

At a lightly more abstract level than above, you have words that require the understanding of changing relationships and context. Pronouns are at this level, because in a conversation, words like, “his/her,” “he/she,” I/me/you,” etc., require you to switch back and forth according to changing relationships. In other words, when you give me something that is “yours,” it is now “mine.”  When I refer to “you,” you are supposed to understand that it is yourself or “me.”  Typically developing children still have trouble with this into their 3rd and 4th years.

Level III abstractions can also include slightly more complex feelings, such as frustrated, disappointed, silly, etc. They do not include [highly] blended emotions such as guilt, embarrassed, joy, etc.

Functions of Communication

Include all functions associated with Sensorimotor Substage III and above, but comment on the presence or absence in the IP’s behavior for each one. Remember, absence of a skill is referred to as “does not yet” rather than cannot or does not

Functions of communication are purposes in which communication is used.[23] They can be non-linguistic/performance, pre-linguistic/pre-symbolic, or they can be linguistic/symbolic (be sure to note which). Children who are acquiring language often use combinations of non-symbolic/performance, pre-symbolic and symbolic forms to satisfy language functions.

Typical functions of communication (non-exhaustive list)

Regulatory Functions: for basic regulation of self or other’s actions.  The IP is just trying to get a need met. It does not matter who meets it.  The relating is instrumental – not for the purpose of sharing experience or social interaction.

Protesting, Refusing
Says, “No;” shakes head, “No;” turns head away; pushes object away; throws object; cries, whines, or tantrums, etc.CessationAsks to stop; “All done,” “No more” “Don’t want…,” etc.

Requesting Objects
Brings diaper to request change (object presentation); points to object; says, “Please,” “Mine,” or “Me,” etc; asks for object by name using a single word (“juice”); asks for object with a sentence or statement “[I] want juice” etc.

Requesting Services
Asks for “help;” says, “Go;” refers to actions needed, e.g., “Open please” “Go to park,” etc.

Greetings (Instrumental)
Uses conventional greetings and salutations as taught by social instruction.Co-regulatoryRefers to matters of degree, e.g., “faster/slower” “bigger” or subjective references such as “too much” “that’s good,” etc.

Temporal
Indicates when by referring to sequence (“after dinner”), duration (“in a minute”), or temporal placement (“…on Friday” “Tonight/Tomorrow/ Today…”); ordinal: first, next, second, last, etc.; uses abstract references such as “soon” or “later,” etc.

Requesting Information
Asks questions; uses or repeats a label e.g., “Daddy, Daddy” to ask where Daddy is), etc.

Giving Information
Answers questions; uses more than single words or rote phrases to convey information and meaning – gives details and directs [joint] attention through words and gestures; instructs, gives directions, etc.

Social  or Co-regulatory Functions: for regulation of social interaction – EXPERIENCE SHARING/SOCIAL DISCOURSE functions

Describing, Labeling
Uses words or gestures, e.g., “ball” “Mommy go.” “That’s a fish.” “I bought a fishing rod the other day for $50.” etc, usually accompanied by a joint attention gesture such as pointing; indicating “finished;” naming objects depicted in pictures and books; using people’s, pet’s, or character’s  names, etc., telling stories, describing episodes of experience

Requesting Interaction, Social Engagement
Initiates social interaction with some sort of communicative bid (i.e., words, gestures)

Maintaining Interaction
Makes gestures or uses words that share one’s experience; responds to other’s similar communication bids. Communication is reciprocal and involves mutual turn-taking of expressing and listening

Co-regulating
Uses gestures or words for communicative repair in case of communication breakdown: clarification; emphasizing; re-wording; repeating; focusing and re-focusing partner’s attention…  (Co-regulatory language is often instrumental: when partner’s are engaged in a mutual task, e.g., “Go a  little faster” “Wait a minute” “Not that one – that one.”)

Terminating
Uses words or gestures to close or end an interaction or make a transition

Time Travel
Uses word “tense” to indicate past, present or future context of the words; relates events from past or to anticipate future events

Speech-Motor Disorders

As mentioned, speech is an oral motor form of communication – essentially a motor act, but a very specialized and extremely complicated form of motor movement. Complex human speech is without question, the most complicated motor act in the animal kingdom. Speech occurs “downstream” from other parts of the brain that are responsible for the thoughts and intentions of oral communication, but it is not the end of the line. People hear their own speech and use that feedback to monitor the volume and quality of their speech production.

Apraxia

Apraxia is a motor disorder in which the ability to select and sequence movements is impaired. Apraxia is often associated with oral-motor movement (i.e. speech; as well as swallowing, oral gesticulation, etc.). Apraxia can be present from birth (as it usually is with children with pervasive developmental disorders), or it can be acquired as a result of brain injury, seizure, or stroke.

In terms of behavior assessment, relative ability to formulate ideas and a normal desire for communication can result in both acute and chronic levels of frustration. These children are commonly misunderstood when they try to speak, or they are corrected when they really just want to get their message across. The constant bottleneck of ideas to speech

Oral apraxia

This affects the ability to move the muscles of the mouth for non-speech purposes. Someone with oral apraxia would have trouble coughing, swallowing, wiggling the tongue, blowing, etc.

Verbal apraxia

This refers to apraxia of speech, which represents impairment in the sequencing of speech sounds. Errors in apraxic speech are unpredictable. Apraxic speakers “grope” for the correct word; they may make several attempts at a word before they get it right.

Developmental Apraxia

Developmental apraxia of speech (DAS) is a disorder that occurs in children and is present from birth. Apraxic children do not develop speech normally and are unable to produce consonant sounds. Some children with DAS have generalized problems with coordination.

Dysarthria

Dysarthria is a speech disorder that is due to a weakness or dyscoordination of the speech muscles. Speech is slow, weak, imprecise or uncoordinated.

Dysarthria involves muscle weakness whereas apraxia does not. Therefore, the errors heard in dysarthric speech are usually consistent and predictable, while they are not with apraxia.

The act of speech involves the delicate coordination of a number of perceptual and motor subsystems. Dyscoordination or weakness in any one of the systems can result in Dysarthria.[25]