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A Simple "Yes" or "No" Will Do Nicely

Written by: Michael S. True, M.Ed

This article is copy protected and should only be reproduced by permission of the author. For information contact me at: .

     It is not my intention to capitalize on the frenzy of media attention that was given the legal battles involving Ms. Terri Schiavo and the question of her prolonged life support, (lasting from 1990 to 2005), but I must admit, her situation has motivated me to write the following article. It is not so much about life or death; who should live or who should die. It is about the role of communication in the matter. In Terri's case, her inability to clearly and consistently communicate her wants, needs, and desires ultimately paved the way for others to have to step in and make decisions on her behalf.

     People, usually family members or significant others, make decisions for other people, (generally minors or incapacitated adults), all of the time. However, I would venture to say that if an individual is capable of expressing his or her own individual preferences, those who are providing care, at least in some measure, would take these, into consideration. This is the essence of a Western ideal called empowerment, or self-actualization. It is about building and maintaining self-esteem and dignity. It speaks volumes about how we want others to become independent and self-sustaining. And how we would want to be able to make our own choices in the course of a lifetime, as well.

     Making choices is based on self-expression, communication. Communication is a complex human function that scientists and philosophers are still studying and interpreting to this very day. No one knows all there is to know about the subject. But there are some basic parts of the process that we can examine in order to understand it better.

     Most parents I know have at least one glowing story of a son or daughter's first word. It is such a simple yet profound act. This process of making a sound that can be given meaning. Of course, in reality, that so-called first word probably had little or no meaning other than the wonderful and undoubtedly hugely unexpected happy reaction of a very big person, to the very little person that has uttered it. A pleasant surprise, to be sure. And, logically enough, if something good were to come of making such a strange noise with one's mouth, tongue, and the wind of the lungs, most likely attempts will be made to repeat the actions and time and again relive the positive experience.

     This is the way of language between humans, cause and effect. My actions cause your reaction. Your reaction, if pleasant, causes me to want to repeat that same action again and again. Parents, friends, and relatives, spend countless hours with infants, cooing over them and getting them to imitate the sounds being made. The soft-throated sounds, "oooohs", and "aaaahs", may come first. "Maaah", "Paaah", and "Baaah" eventually get shaped to Mama, Papa, and Baby, among other early sounds and English language words. It is no small miracle that the tiniest movements of the lips, tongue, and the soft or strong exhaling of the breath can be shaped in such a way.

     For most children, the native language of the parent is quickly learned over the first two to three years of life. Survival words that call for food or drink, a hug, a warm place to feel safe, these generally come first. Names associated with special people and places are early words too. Little phrases like, "I want…" will not be far off.

     But for some children, adolescents, young adults, and senior citizens, the luxury of verbal language does not come so easily. There are a variety of reasons for this. Language delays can be both physiological and psychological. Most are due to the body's inability to follow through with all of the many physical processes that go into this extremely complex mechanical exercise.

     We know, for instance, that certain parts of the brain control our ability to understand, to imitate, to direct the motor functions, which in turn lead to the speech process. If damage occurs in these areas, language development is directly effected.

     Speech, for instance, is closely tied to hearing. If a baby cannot hear the sounds that they need to imitate, the difficulty is obvious. Hearing impairments may be caused by a breakdown in any part of the audio-sensory system, from weakened or damaged receptors in the middle, or inner ear, to neurological damage to those parts of the brain that pickup and interpret sounds and make sense of them. Parents of young children who are not speaking by the age of two generally seek out an audiologist and have the child's hearing tested.

     But having limited hearing does not necessarily stop the development of language. In reality, language is going on even before the onset of the spoken word. Smile at a six-month-old baby and you will know what I mean. In most cases, if the infant has been watching you he or she will smile back. Even the very act of watching can be considered to be an important condition of language development.

     Those parents, teachers, therapists, and care providers who are involved in the process of building, maintaining, or otherwise encouraging the process of language development should always be aware of these simple but important skills.

     Whenever you are involved in the process of determining someone's potential to communicate, one of the first things you need to consider is whether or not he or she is able to follow you or what you may be offering to them. This simple skill often referred to by clinicians as "tracking", can be done using any of the senses: sight, sound, touch, smell, or taste. Tracking is the act of demonstrating or acting upon an awareness of things outsides one's own body. But it is more than awareness; it is a desire to continue to have some kind of contact with that person, place, or thing; the stimuli that they have encountered.

     The infant's eyes may follow the face, hands, or other body parts of another person, depending on their needs or interest in that person. Their head may tilt or turn to allow continued vision of something interesting or desired. Similarly, they may tilt or turn the head to better hear or smell something pleasant. Little arms may reach towards a desired item. Attempts may be made to move the whole body towards people or things, as well. All of these may be considered tracking actions.

     We all know what we want more of, in our day-to-day routines. We naturally seek those things out. Our choices are as varied as are our individual personalities. If we are to encourage choice making in others we need to learn to read the signs of a personal reaction towards things presented or otherwise made available in their environment. And, perhaps more importantly, we need to build a foundation upon which we can consistently understand the choices being made.

     In very young children, individuals with significant developmental delays, or persons who have suffered a severe injury or illness causing the loss of communication skills, our work is cut out for us. It must be the role of the parent or care provider to present objects, food, or visual stimulation to which the person may react. That person may or may not be aware that the things being presented even exist. It is up to us to provide a wide variety to their sensory diet.

     When presenting objects, food, noises, smells, or other sensory items to an individual you will usually note three types of responses, "Positive", "Negative", or "Neutral, (little or no response)". These reactions are, in the most primitive state, reflexive. That is to say, there is a natural tendency for us to move toward or away from things based on our preferences. We reach or move toward what we want, and the opposite is true for what we don't want. We smile or frown, open or close our eyes, make happy noises or cry. Each of these reactions can be considered a "yes or no" response. If we reinforce these responses they will become more obvious and easier to read as time goes by.

     A simple example of non-verbal choice making will be seen everyday in classrooms around the world. The teacher asks, "How many want to play kickball at recess, let me see your hands." A flurry of soft chatter and excitement fills the room and twenty or so hands begin to rise up in the air. The teacher counts and then determines how to make sure all who want to play get to be involved in the game. This behavior has obviously been taught to the students. They understand their action, (hand raising); will result in their teacher's reaction, (to divide them into teams, give them the necessary equipment, etc.). This is purposeful communication.

     I'd like to sum up this article by encouraging all who are providing care or training for language delayed or even the most physically challenged person to work towards finding some system of communication and using it on a regular basis. If there is a movement, even the slightest turn of the head towards or away from things liked and disliked, always respond to it as if it is the person's clearly spoken choice. Verbally reinforce or praise any and all efforts at choice making and be sure and follow through by giving the item, (food or whatever has been presented), to the person upon acknowledging their response.

     If we are truly caring in our efforts, we will want to take into consideration the choices of others. Just remember, even if choices have not been put into writing, or are able to be spoken out loud, there are other ways to determine them. The key is to find a response that can be reasonably repeated by the individual and easily understood by the care provider.

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