Eina! Ouch! Eish! Professionals’ Perceptions of How Children with CerebralPalsy Communicate About Pain in South African School Settings: Implications forthe use of AAC
Johnson E Nilsson S, Adolfsson M in Augment Altern Commun. 2015 Sep 15:1-11.
This article outlines some interesting thoughts about how professionals in a school environment interpreted pain in the children they worked with. In the first instance the professionals used,
- knowing the child well,
- interpreting the child's body language and facial expression and
- looking at different levels of engagement in a known activity or interaction.
Interestingly to note, that many children did appear to accept situations that were painful. The researchers reflecting that, maybe the non verbals cues and behaviour changes had not previously been acknowledged. Consequently the children would stop trying o communicate nonverbally their pain.
The research does talk about how those children with access to symbols, other low tech communication devices, technology devices (VOCA) and speech do use these systems, but the more informal communication including behaviours and nonverbal cues are as important in communication about pain. Mmm think about how you communicate pain?
The research also mentions reflecting on the language a typically developing child of the same age uses, so a younger child the word “ sore,” or “ouch" might be used, but "pain" and “where is the pain?” was used with older children.
Irrespective of the age of a child, pain was rarely if ever interpreted according to a 1-10 or 1-5 pain scale. But then this was only available to children in one of the environments studied. The feedback from professionals being, a pain scale "was too abstract". But how do you know, if it is not considered as a being available or communicative need. Instead, staff based their interpretation of level of pain on knowing the child well and the informal communication.
So how does this help us in communicating with children with little or no speech? How does this give us insight into the selection of vocabulary?
Pain and emotions have an abstract base and understanding. Always consider the nonverbal cues and behaviour changes a person is using. You may be able give this non verbal cue or behaviour change a label (or name). But the child is already communicating they are in pain or have a different or changed emotion (sad, frustrated etc). Therefore, accept what they are doing, and model the more formal language alongside it. If we don't accept what the child is doing with informal communication, behaviour and nonverbal cues, either they will do a more extreme version, or stop communicating this need.
Select vocabulary useful to the child’s needs, and model its use in context. For example,
- a child screws up their face to refuse a particular drink,
- acknowledge the child is telling you they do not like the drink
- model a more formal means of this same message, using your speech and also point to a symbol, (object, word, picture, or spell it out depending on the skills of the child and their AAC system) and use natural gesture/Key Word Sign.
Select vocabulary appropriate to the child’s age, and what typically developing children may use in that space. How do you do that? Listen into some conversations!
Talk to me out vocabulary selection and developing communication boards for your child, or adult in your family or community.
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