"Yes," "no," maybe so...

Communication is a BIG topic on several Rett parent lists I participate in. Parents often ask for information as they think about getting their 18-24 month old girls started with communication. One of the questions that comes up very often is "How do we go about teaching 'yes' and 'no?'" It's such a great question; these are abstract, intangible ideas that typically-speaking kids latch onto without being directly taught, so how do we go about teaching them directly? Perhaps it might be helpful to talk about that now.

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I think it is critical to look at typical chronological development with kids this young. At 18-24 months of age, our kids with Rett haven't had time to fall very far behind, and their emotional status is often right on par with their typical peers. We can use these facts to our advantage in teaching communication skills, particularly the less concrete concepts of NO and, later, YES. 

I’m not a speech pathologist but a special ed teacher with lots of training on language development. What I share may not be what every speech pathologist would do but it worked for my daughter and for many other kids with Rett or similar issues. You will also see that everything I do with expressive and receptive communication works towards developing literacy skills, because I fully expect any of our girls to learn to read in time.

Eighteen to 24 months is a time in chronological development when kids with Rett can develop communication skills right alongside their peers. The timeline may be a bit different for kids with other severe disabilities, depending on their early experiences and health issues, but the process is the same. Think about what you hear from verbal kids as they are turning two years old..."NO, NO, NO!" and "MINE!" It's an age when kids want control and to assert themselves, most often negatively. Ah, toddlers! You gotta love 'em! So in teaching yes/no, start with NO. Offer your child something you know she isn’t fond of and have the picture symbol for NO at the ready. When she refuses the object, whether by turning her head or pushing it away or however she rejects things, hold up the NO card and say “No, you don’t want ___.” Encourage her to look at or point to the card. Certainly don’t make her have the item! Just do this one time (no kill and drill!!!! We have to instill the trust with our kids that we believe what they say the first time!!!), but repeat the process often throughout the day: as you see she’s getting full at a meal, when an errand is an option (use her coat as the object), if there is a book or toy she’s not particularly interested in…. The whole purpose of this is to give voice to what the NO card means. When she is first learning, don’t offer NO in a non-negotiable situation, because it adds too much confusion about control. After all, smart parents don’t ask any two year olds if they “want” to nap when it is obvious a nap is needed; they simply announce that it is time, no discussion.

Once your child is effectively using the NO card, begin to present it to her at the same time as you present the undesired object. Something to keep in mind is that you want to present the NO card in the same hand every time. The goal here is consistency that will allow the child to develop something we call "motor automaticity." This is a fancy term for memorizing where something is going to be in space, such as we do with the brake pedal or turn signal in our cars. Motor automaticity speeds up communication by reducing the need to visually scan among choices, especially when the child is using many symbols at once. At our house, I hold NO in my left hand, and I’ll get into the reason why later. Now at the end of her meal, you would ask “Do you want more broccoli (holding up the spoonful) or no?”

Some speech therapists suggest offering a fist for no and an open palm for yes. While I love this idea, I will confess my daughter refuses to use these signs. I wish she would, and believe me, we have tried to teach it. Perhaps if you do this from the very beginning, it would work.

While a child is learning no, she is also learning to label objects. Whether she will prefer photo representations of objects or line drawings is a very personal thing to be tailored TO HER (for more discussion on the kinds of symbols to use, see this post on selecting materials). Always LABEL the card, because this way you are 1) laying a foundation for literacy and 2) insuring that all people using the cards with her are assigning the same meaning to her cards. Be sure to start with items that are highly meaningful and motivating to her: favorite foods, people, toys and books, pets. Also include verbs with this…two year olds use verbs!!...for activities she enjoys: a bath, swinging, eating, drinking, etc. I suggest starting with favorite objects and activities, just because that is highly motivating and will help direct her interest. But once the connection is made that objects can be represented with symbols (or pictures), you can add in others that are neutral or non-preferred.

Now that she has a nice little symbol vocabulary and NO, you can start pairing choices. If you want to make sure she is rewarded regardless of what she chooses, offer cards of two preferred items. However, keep in mind that this can create internal conflict in ANY two year old, because most kids that age want BOTH at times and will get upset that they can only have one! So some kids do better emotionally by offering a favorite paired with a neutral item. You can also pair a card with NO.

As far as which hand to hold cards in or, if you prefer to use a Velcro strip or board, the cards should be placed from HER LEFT TO RIGHT in the same order as you offer them. This develops a left-to-right orientation necessary for reading later. This is also true for yes/no down the road…we tend to say “yes or no?” so hold them with YES in your right hand and NO in your left; we are mirror image to our communication partner.

On to YES! I personally would wait until a child's had plenty of opportunities to practice the other things because they are more concrete. Ideally, she would have NO down really well before you introduce YES, because the concept of YES can be interpreted as “not-no” in the mind of a toddler. That's mighty abstract! Now you are going to offer a favorite along with the YES symbol, and the NO symbol. She won’t want to pick NO, because she wants the item, so she’ll look to the item and you can point enthusiastically to YES say “Yes! You do want a cookie!” Just as you did with no, take her response at face value and give her the cookie. Again, do it one time and repeat many, many times in the day. What you are trying to teach now is that YES can be acceptance of any offer. You’ll be able to cut back to just YES (no accompanying object symbol) and NO before long.

Other abstract word pairs that I find extremely helpful are more/all done, stay/go, now/in a minute/later, great/okay/gross.

At some point as a child's development expands, she will want some word or phrase to stand for the gray area between yes and no. It should be whatever feels comfortable to you and her: “something else,” “neither,” “something different,” etc. This becomes particularly important when choices are not cut and dried, but deserve further conversation. A case in point was once when a boy asked my daughter to the 6th grade dance. She was only offered YES/NO, so she told him “no.” Perhaps she truly didn’t want to go with him. BUT maybe she meant she didn’t know if she could attend the dance at all, or if she needed to ask her parents first, or she’d rather go with a group of kids and not just him alone. Obviously, she needed an option of “something else” to keep the conversation going with that one!

I'm really encouraged by how far we've come in the last 10 years in our attitude about presenting young kids with communication technology. While we may have room to grow, "we've come a long way, Baby!!!"

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P.S.--My apologies for the goofy formating. :0( I'm just learning Blogger, and what you see in on your design page isn't always what you get when it's published! Thanks for bearing with me...and if you have any tips on how to get formatting consistent, I'm all ears!!!

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