This account of the development of Michael's communication is taken from Rosemary Crossley's 1994 book "Facilitated Communication Training", published by Teachers College Press.
"Michael was 12 years old and in sixth grade at his neighbourhood school when he was brought to DEAL communication centre by his parents in September 1989. His parents were in their forties and had professional qualifications. Michael was the second of their three children. He has Down syndrome.
Michael’s motor development was only mildly delayed and he walked alone at 18 months. He said his first word at 18 months and his first two and three word utterances at 24 months. As a toddler, Michael’s speech varied from day to day, and this pattern continued through his primary school years. Sometimes he spoke in sentences and initiated conversations. On other occasions he seemed to have difficulty giving one word answers to questions. Michael had speech/language therapy for an hour a week for 2 years between the ages of 6 and 8, when all therapy was discontinued because of lack of progress. At age 12 years, Michael would occasionally utter a complex sentence; more commonly he would use two or three word utterances, and sometimes he wouldn't even manage that, responding to questions not at all or with gestures. While Michael had some articulation problems his speech was generally intelligible. To some extent his speech appeared to reflect his muscle tone, which was variable. On days when Michael’s body almost seemed too heavy for him to move, his speech was more limited and less clear, and he didn't initiate conversation or movement. On days when he was full of energy, his muscle tone was higher and he spoke far more. While his oral language still wasn't normal, and he still couldn't say everything he wanted to say, which frustrated him, he could speak when he was spoken to and he would spontaneously ask questions and make comments, displaying a wicked sense of humour. However, even when he was at his most vocal, his responses to complex instructions and to jokes on subjects such as politics indicated that his comprehension was well in advance of his speech production
One extra problem plagued Michael and his family. He would perseverate and say the same word again and again. 'Banana' had been the first word he'd said at kindergarten, and had been much praised Encouraged, he said it so often that it became automatic and came out at all kinds of inappropriate moments. Michael was not beyond using "banana"deliberately to stir his parents; unfortunately, every time he did so made it more likely that it would come out when not wanted.
Michael had done a modified school curriculum at the local primary school. He sat in with the class, but he wasn't expected to do everything they did. At age 12 he had writing skills at about a six or seven year old level. His writing showed motor planning and perseveration problems. He could not read aloud but he spent a lot of time turning the pages of books that were age-appropriate. His family watched him with amusement and thought that he was imitating his sisters. His mother said that he could play the piano a little as a result of long-term teaching, but had difficulty tying his shoelaces. He was independent and walked to and from school by himself.
Michael was due to start at secondary school in February, 1990. His parents and teachers were concerned as to how he would cope both socially and academically in his new school and were seeking help with his communication. At this stage, his parents were looking for augmentative strategies that could help Michael make himself understood. It had been suggested that Michael use Australasian Deaf sign. (In Victoria the Makaton sign vocabulary [Grove & Walker,1990] is probably the augmentative strategy most commonly used with people with Down Syndrome [Iacono & Parsons,1986]). However, several important considerations had been overlooked. Communication partners fluent in sign were not available in a regular secondary school. While it is possible in a primary school to teach sign to the signing student’s class and teacher this is more difficult at secondary level, where the student moves from class to class. As well, it was difficult to answer schoolwork-related questions in a restricted sign vocabulary, and the signing required certain motor skills (Klein,1982). When asked to imitate a simple hand posture, holding up both hands with the index fingers extended and the other fingers flexed, Michael was unable to do so and had to use his left hand to hold down the fingers of his right hand to achieve index finger isolation. This did not mean sign acquisition would be impossible, but it did raise significant questions about the ease with which Michael would be able to learn sign shapes.
Like most older children and adults I have seen with severe communication impairments associated with a diagnosis of intellectual impairment, Michael suffered from lack of self-confidence. When spoken to, he hung his head and "went blank" or feigned deafness. Initially he made no apparent effort to do anything I asked. He was sullen and unco-operative until offered a toy, “My Talking Computer”, which had a voice. My initial assessment was based around this toy, which can be used to ask questions that explore the student’s knowledge of concepts from picture recognition to composing sentences by selecting written words. After successfully completing all the assigned tasks Michael typed his name, and typed “I CAN READ I GET SILLY I CANT STOP SOMETIMES SCHOOL THINK I’M STUPID” on a Communicator. He had considerable difficulty isolating an index finger to hit the letters. This was remedied by having him hold a rod in his palm with his other fingers. Michael’s communication partner held the other end of the rod to compensate for his low muscle tone and endurance (and to stop him from fooling around). Testing showed reading comprehension appropriate for his age. This is not exceptional; Buckley (1985) cites a number of examples of young children with Down syndrome who had reading comprehension skills equal to or in advance of their age peers. Michael’s spelling was poor for his age but his vocabulary appeared to be above average and he used standard syntax.
Michael had a bad habit of regressing to immature behaviour whenever he felt anxious. Whether he felt anxious because he was in a new situation or because people were in fact babying him, the behaviour was unproductive. Towards the end of 1989 Michael paid a number of visits to his future secondary school. His behaviour was inappropriate. When asked to do things he laid down on the floor and refused to budge, he said"banana" a lot, and he demonstrated few skills.
Over the six weeks of the Christmas holidays Michael communicated fluently with all of his immediate family by typing on a Communicator. In that time he used the Communicator everywhere he went, with his extended family, with neighbours, and with friends. He was reported as walking taller, looking people in the face and responding, orally or on the Communicator, when spoken to. Michael attributed the change to his new means of communication. His family reported that they started to interact with him differently as he showed them unexpected capabilities and understanding through his typing.
By July, 1990 Michael’s new teacher, who had been dreading his arrival, was able to say, “Now he's just another kid.” His contact with the communication centre was limited to monthly communication groups in which he had no hesitation in expressing his opinion “i insist on academic [work] on the next session being held here am i damn well going to get it”. He no longer had a modified syllabus. In December 1990 his best examination result was 90% in German, which was a new subject for all the students. He could type short answers without any facilitation, but he tired quickly. In some classes he was accompanied by an integration aide. If she was not there and he needed someone to hold the end of the rod when he was typing longer answers, he just asked one of the other students to help. In 1991 his mother and teacher reported that Michael was speaking more and that his spoken vocabulary had increased. Clunies-Ross (1990) found that the reading skills of young children with Down Syndrome could be used to improve their understanding and use of spoken language. Michael generally introduced new words into his oral system after he had typed them, though he certainly has not said every word he has typed, and he still has problems reading aloud. A speech/language pathologist has recently suggested that he has significant oral dyspraxia.
By 1991 Michael no longer had problems with index finger isolation and his tendency to perseverate on selections had abated. Consequently it was possible to administer a Peabody Picture Vocabulary Test — Form M (Dunn and Dunn,1981) with no facilitation. To ensure scanning each of the four plates was indicated by the examiner before the question was asked, and Michael was encouraged to pause before responding. His score was above the 99th percentile, confirming the initial impression that Michael had an above-average vocabulary.
Michael’s communication training continues in 1992. He needs to become fully independent in typing, to augment both his speech and his handwriting. As well, he needs quick ways of getting across routine messages such as lunch orders on days when his speech lets him down.. Communication wallets containing words and phrases specific to different situations need to be developed. Michael also has to learn to select the appropriate communication strategy for each situation, out of speech, gesture, communication wallet and typing. The need to select the appropriate mode became obvious when Michael, in mid-adolescence, started swearing at his aides on the Communicator. As the evidence was incontrovertible, he was frequently suspended from school. If he had sworn in speech, he might have got away with it."
Crossley, R., 1994, Facilitated Communication Training, Teachers College Press, New York, $15.95
The Contents page, the Introduction and Chapter Two of the book are available on-line. I am grateful to Teachers College Press for permission to republish this material on the Web.
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