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
and
- 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.
Cathy
Basterfield
Speech
Pathologist
Access
Easy English
0466
579 855
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