Thursday, April 27, 2017

Just Talking To Myself, Don't Mind Me.

Teaching Internal Dialogue to AAC Users with Complex Needs

 We all hold ongoing conversations with ourselves. We use self-talk to:
  • Regulate our emotions (take a deep breathe, it must just be drive like a jerk day) 
  • Motivate ourselves (I got this!) 
  • Scold ourselves (Put down your phone and talk to people!) 
  • Explain things to ourselves (He probably meant that as a joke...) 
  • Help us with planning (if I leave at 3:30 I can run to the store before I pick him up at karate.) 
  • Remind ourselves (The radio just said rain tomorrow, put the umbrella by the door.) 
  • Work through fear or anxiety (Maybe my boss just wants this meeting on a Friday afternoon to be nice to me?)
  • To manage pain (I'm ok, the Advil will kick in soon and this headache will calm down.) 
  • And so much more!
Dory using positive self-talk

But what happens to our student who do no have the language skills for an internal dialog or who use AAC to communicate but have not developed the skills to use language for self-talk? Especially if those students have issues with anxiety, regulating their emotions, self-soothing or executive functions?

All too often what happens is we do not realize that part of their struggles are because they do not have the ability to hold internal dialogues and we turn towards behavioral interventions that might help in the short term but do not develop the vital skill of self-talk. We stop the problem in the moment (maybe) but don't stop future problems.

We focus on the functions of AAC in our classrooms all the time, those from Janice Light's research:

  1. Meeting wants and needs 
  2. Transferring information 
  3. Social closeness 
  4. Social etiquette 
But do we focus on the fifth, and just as vital function added by Buekleman and Miranda? Internal dialogue (aka self-talk)?

Focusing on internal dialogue and teaching it with as much  attention as we teach the other four functions is vital for AAC users. I always think about my verbal students who had Down Syndrome as my models for what self-talk looks like.

My student, Cory (now in his 30s!), taught me so much about self talk and self
regulation. When he was working at his desk he would stop and look around and then say aloud, but to himself, "back to work, Cor!" Or if he was in the hall and started to run he would say, "walk in the hall, Cor" and return to walking. He used self-talk for other things too. When he was very angry at me for insisting on things like doing work or follow rules he might say, "the Power Rangers are going to get her". Which was fair warning that he was upset and I should back off but wasn't meant for me, it was meant for himself, his internal dialogue was specific to his needs, if the Power Rangers were going to get me he was free to calm down. By the time he was 14 he didn't need to rely on the Power Rangers as often and could use other self talk like, "you can do this, Cor" or "I'm the man!" Cory had developed the vital skills of internal dialogue. But how do we do that for children and others who use AAC and have complex communication needs?

Well, we teach it the same way we do the rest of AAC use. We presume possibility and set high and meaningful expectations. We provide access to core words, salient
auxiliary words (fringe) and stored, quick phrases and sentences for times that often repeat or do not allow enough time to make a message. Basically, a robust communication system. We use aided language input/modeling to connect what we want to teach to what is happening in a natural setting and we do so intensively over long periods of time. We use structured lessons, games and activities with adapted materials for direct instruction. We provide visual supports. We use video modeling, including contextual video modeling, self video modeling and modeling by highly preferred people or even puppets as appropriate for our learner.

 At first self talk will likely be pre-programmed phrases for our complex communicators, especially those with intellectual or developmental disabilities as part of the complexities. Though some may be able to create self-talk messages in the moment, possibly with coaching.

 Choosing and Creating Self-Talk Messages

  • Observe your student closely and connect with parents and other stakeholders to determine situations when self-talk might be useful to the child. Does she have trouble at transitions? Does he get anxious when other people are too close? Knowing which situations might be relieved by the ability to self-talk while help you choose the messages needed. 
  • Consider if there is anything that is said that calms or assists the child during these times. Do you repeat, "you're ok" or "safe body"? If so, these phrases will be useful to turn into positive, self-talk statements on the child's AAC system. 
  • Watch the child and look for the cues and body language you can teach him to recognize in himself for when he needs to use self-talk. Take note of these for later. 
  • Seek the input of the child! This is vital! When he or she is calm and focused talk about what sorts of messages he or she wants to talk to himself. Offer choices based on reactions to the conversation. Allow them to select from different phrasing of the same messages when it is time to program, for example, "Do you want it to say, 'I can have a safe body', 'Look at my safe body', 'I am calm and safe' or something else? The more input you have and take into account the more successful the self-talk message may be. 
  • Chose and program the self-talk statements. Some examples: 
  • I can have safe hands I can wait I am ok I can calm down I am just so excited (or I am excited) I can take a deep breath I can count to three (or five or ten) I can have a calm body It is ok to need help I am ok when I make a mistake 
  •  Consider how immediate the needs will be for these messages. Then decide, with the child, how and where to put them in the AAC system. A child who is reminding herself to have a safe body may not be able to combine words to make a sentence or to navigate multiple levels of a communicate system to get to her self-talk messages. Some children may need, at least at first, to have some of the valuable real estate of the home/main/top page be taken up with self-talk messages. Other children may be ok with getting to quick phrases/quick fire or social pragmatic pages to use these messages. You might need to use some trial and error to decide where the messages go and how to set them up. Remember teaching self-talk doesn't eliminate the need for other interventions should challenging behaviors be problematic. It is another tool in the tool box, and likely a longer term intervention. 
 Teaching Use of Self-Talk Messages
Self-Talk in top right 

  •  Ask explained above, use all of the teaching tools you use for teaching each of the communicative functions. 
  •  Model self-talk verbally and using the child's communication system both in reference to yourself and the child - combine it with modeling self-advocacy if needed For example if you spill something you might verbally say, "it makes me upset that I spilled that. But I can stay calm. I am ok." While modeling self-talk buttons that say "I can stay calm" and "I am ok" Or you notice your student is starting to get agitated. So you verbally say, "I see you making fist and bouncing in your chair. You can tell yourself, 'I am ok' and the you can say, "I need a break". 
  •  Create social stories for situations that cause anxiety, dysregulation, etc which include the same self-talk messages that are in the child's talker. Some self-talk messages I have created social stories for in the past include, "I can wait", "I can have safe hands", "I can calm down", "I am ok when other people are upset". Read these frequently, especial during calmer times. Refer to the story as needed. If possible have the stories in a format the child can access independently, such as in the Pictello app on their leisure iPad or on their high tech eye gaze device. 
  •  Continue to refine the messages and re-teach them as needed. 
  •  Celebrate with gusto when your child uses these messages for self-talk. Use descriptive feedback while praising the child, "I heard your tell your self, 'I can wait' and then you waited! Fantastic! Here is a big hug!" 
 Pairing Self-Talk Messages with Self Advocacy Messages

  •  Once the child has used internal dialogue to attempt to regulate they need a way to self advocate. 
  •  Advocacy messages can be a bit deeper in the book or device as the hope is they are used once calm. These are messages directed towards others not the self. Hopefully, caregivers were listening when then internal dialogue messages were used and is ready to help guide the self-advocacy process. 
  •  Messages can include: 
    • Give me some space, so we can all be safe 
    • Don't talk to me like a baby 
    • Don't lecture me 
    • Don't touch me/my chair/my hands/my head/my device 
    •  Don't speak for me 
    • Please speak directly to me 
    • Too many people are here 
    • It is too loud 
    • I need a break/walk/hug/sensory input 
    •  I need to eat right now/drink right now 
    • This feels like an emergency 
    • Call my mom/dad/aide/teacher, etc 
    • It is too bright/dark 
    • I am constipated 
    •  I feel worried/scared/nervous 
    • Explain the schedule to me 
    • I need to rock/flap/stim 
    • I need my music/headphones
    • I need my calming videos
    • I need a chewy tube
    •  I need to do yoga 
    • I need to count 
    • I need my stuffed animal, blanket, calming object 
    • Leave me alone for a while 
    • Don't leave me, please 
    • Someone is missing 
    • Someone else is upset 
    • Someone was mean to me 
    • Someone was mean to someone else 
    • I can hear the lights/fans/buzzing/beeping. 
    • Make it stop. 
    • I will point I don't know how to explain 
    •  I don't know what I need

who knows what self-talk can lead to once we teach it?

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