Danny, sixteen, sits in his wheelchair struggling to tell me something important. Since an accident that caused brain injury many years ago, he cannot walk or speak. He can, however, articulate a few initial letter sounds, so I know the word he’s trying to say starts with B.
I go through a list.
“Is it about Brian?” He shakes his head no. “Benjy?” Another shake. “Birthday? Balloon? Bicycle?” No. Is there a symbol for it on his communication board? No. Frustrated, he moans, then clenches a fist and pounds it on his knee.
It’s 1983, and Eileen has suffered a stroke. She is in a rehabilitation wing at a hospital near where I live, and I visit her on a snowy evening. She lies in bed, straining to talk. Only unfamiliar sounds come out, and she looks at me in confusion. After several minutes of effort, I still don’t understand her, and she bursts into tears.
Doug is telling me how grateful he is to have a driver’s license, is about to graduate from high school, and plans to go on a mission soon. He speaks in a slight monotone—one of the few remaining symptoms of a learning disability—as he tells me how he felt when he was small and could barely communicate at all. “It was confusing,” he says. “I felt very alone.”
Danny is my brother, Eileen is my great-aunt, and Doug is the son of family friends. All three have experienced serious problems communicating. Eileen and Doug have improved considerably, but Danny has severe, lifelong disabilities.
Each of us knows people like these. We may struggle to communicate with them, sometimes succeeding and sometimes failing. Or we may avoid them entirely, feeling embarrassed and afraid to breach the awkwardness.
Communication is essential to the full human experience. We use language to express our ideas and opinions, which in turn invites interaction that helps us mature and grow. We use words to think through decisions and to tell our family and friends how we feel and what we need.
Those who can’t speak clearly or use language effectively find obstacles at every turn. They might find it embarrassing, unrewarding, or too frustrating to participate in a class discussion, which in turn impedes their learning. It might be difficult for them to get or keep a job. Other people may be afraid to talk to them, leaving them isolated and lonely.
The seriousness of these consequences can vary greatly, depending on the severity of the disorder, access to professional help, and the reaction of family and friends. For those in leadership positions, it is especially important to be sensitive to the needs of all ward members for acceptance and for opportunities to learn, participate, and serve.
Learning more about communication problems can allay our fears and give us the courage to interact more comfortably and lovingly with those who have disabilities.
Several years ago, Linda Coleman, a Primary teacher in a midwestern ward, had a six-year-old boy in her class who had great difficulty speaking. Born with no nerve endings in his mouth, Steven (the name has been changed) could make only indiscriminate sounds.
“He was withdrawn and felt he didn’t belong,” says Sister Coleman. “He felt so different—the other kids were all talking, and he couldn’t.”
Initially Steven didn’t want to be in the classroom, so Sister Coleman set a chair just outside the door, gave him a book, and invited him to listen through the open door. Since he knew some sign language, Sister Coleman brushed up on her signing and began teaching her lessons with the accompanying signs. She also taught the other children enough signs so they could communicate with him.
“He became more and more interested and gradually moved himself back into the classroom,” Sister Coleman says. Eventually, a loving relationship developed.
Often in ward settings, members avoid children like Steven rather than trying to understand them, accept them, and adjust to their needs. Many are afraid of mishandling the situation, but we should fight these inhibiting fears. “Often we quit talking to the child and ask his parents to translate for us,” says Dr. Bonnie Brinton, an associate scientist at the University of Kansas’s Bureau of Child Research, Parsons Research Center. “Don’t do that. Just try. You can always keep your conversations simple and say things like ‘How are you?’ or ‘It’s good to see you today.’”
Almost all children with any kind of disability have problems communicating, including those who have learning disabilities, mental retardation, hearing loss, or autism. Usually these children have problems with language (the ability to understand and use words to communicate ideas or feelings) and speech (the ability to say words intelligibly). Some children may have speech problems alone, such as stuttering or hoarse or nasal voices.
Since more children have learning disabilities (a catchall term for a wide range of learning problems) than any other type of handicap, nearly everyone who teaches Primary for any length of time will come upon at least one child with communication problems. For example, a teacher might have a seven-year-old boy in her class who has trouble following directions. His attention wanders, he can’t answer questions, his speech is hard to understand, and he talks in short sentences with grammatical errors. He may talk very little, or he may be hyperactive and talk all the time.
“Chances are he has no idea how to interact because he doesn’t know how to manage a conversation,” says Dr. Brinton. “He doesn’t know he needs to answer your questions on the same topic you asked. He doesn’t understand about taking turns, what to talk about when, how long to talk about it, how to ask for feedback. Most kids develop all those skills quickly and effortlessly, and we take them for granted. But developing them is a very complex process.”
If you encounter a child with any type of communication problem, the first thing you should do, says Dr. Brinton, is tactfully and sensitively ask his parents for information about his disorder. (You might also get information from his teacher at school and his speech-language pathologist.) Second, ask them what they have found helpful in communicating with him. Third, spend time outside the classroom getting to know the child and helping him to feel comfortable with you. Fourth, adapt your lessons to his needs.
Your in-class goal should be to give the child a successful experience, no matter what his speech or language limitations might be. Success may mean something different for each child. For a boy or girl who stutters, contributing to the discussion or joining class members as they read aloud together might be considered success. For a mentally retarded child, success might mean comprehending a simple story or managing a one-word answer to a question.
According to Dr. Ron W. Channell, assistant professor of educational psychology at Brigham Young University, teachers can use a few simple principles to adapt their lessons. “Use shorter sentences that are still grammatically correct,” he says. “Talk about the here and now, not so much removed in time and space. Slowing down the speed of talking can be helpful, too, but you don’t want to deal with an older child as though he’s a two-year-old. In most ways he’s like you and me.” (For additional ideas, see “Tips for Teaching Children with Communication Problems,” this page.)
As children with milder communication problems grow up, they may improve considerably but aren’t usually “cured.” They learn to speak better and might graduate from high school and get a job that doesn’t require much communication skill.
“The problems change shape, but they’re still there,” says Dr. Brinton. “Kids with milder problems do improve, but they don’t grow out of them without intervention.”
In social situations, adults with continuing but less-obvious problems might be perceived as standoffish and unenthusiastic about Church callings.
“The truth is, sometimes they’re scared to death,” says Dr. Brinton. “They might still have a lot of trouble expressing themselves or understanding.” Ward members, she said, should not jump to conclusions about people who might appear to isolate themselves.
For adults with more severe communication problems, particularly those of normal intelligence, the challenges can be great. For example, a man with severe cerebral palsy might have so much trouble articulating that conversation is very difficult. Most people would probably avoid interacting with him beyond perfunctory greetings. Those who make more of an effort might speak to him in a childlike, condescending manner. What he needs is people who will not act embarrassed by his speech but who will talk with him as a peer and listen to him, even if he has to repeat his thoughts several times.
Several years ago, Robert awoke from sleep and discovered that he couldn’t move his right arm or leg. He woke up his wife and tried to tell her what was happening, but found he could utter only unintelligible cries of dismay. Robert had suffered a stroke. He remains partially paralyzed and suffers from aphasia, a communication disorder that includes problems of language, speech, and comprehension.
In Robert’s case, the aphasia appears to be permanent, though he has made gradual improvement. Before his stroke, he had been an ardent student of the scriptures, committing many favorite verses to memory. As his speech-language pathologist and others worked with him, he was eventually able to recite these memorized scriptures with some clarity. After several months, he was able to read an assigned scriptural passage in his Gospel Doctrine and priesthood classes. Each week his high priests group instructor reviewed with him the next Sunday’s lesson and helped him rehearse simple responses to a few chosen questions.
Strokes and brain injuries cause a wide range of disabilities, depending on what part of the brain is damaged and how severely. Often, both speech and language are impaired.
One of the most important things to remember when trying to talk with anyone whose communication skills are impaired because of brain injury is that the person is probably very frustrated. Unable to communicate, he may feel locked inside himself and cut off from the world. He may respond with emotional outbursts he cannot control.
Reassuring contact with family and friends, then, becomes very important. The old, familiar ways of communicating, however, must be supplemented with new ways, often discovered through trial and error. Talking about familiar subjects in simple sentences is usually helpful. Since comprehension is usually affected along with language, don’t assume a brain-injured person understands but just can’t talk; it may not be so.
Some people with communication limitations are reluctant to speak in public, while others are eager to be asked. Some might appreciate an offer to give a short talk in sacrament meeting; others might do better making a presentation or commenting in a classroom situation.
Dr. Gordon Low, a retired professor of communication disorders at BYU, suggests that teachers give individual assignments well in advance so students with communication limitations can prepare. Teachers might even rehearse with them beforehand to reduce anxiety.
Ward leaders can help such members participate more if they are open to nontraditional, innovative ways of allowing them to express themselves. For example, someone with severe speech limitations could contribute by displaying a classroom presentation on an overhead projector.
“The bottom line,” says Dr. Low, “is that we should be including them in ways that don’t embarrass but that help them interact and have some success.”
People with communication problems long—as we all do—for acceptance and the connection that verbal skills make possible. Because conversation is a two-way street, their success in communicating with us depends to a large degree on our willingness to work at bridging the communication gap. That might mean simply spending time with them, or it might take more—learning sign language, the quirks of an individual’s speech, or the symbols on his communication board.
“If you have the impulse to help, you must follow through. Don’t just make overtures,” says Dr. Brinton. “Promises unkept can be very damaging to a person’s faith.”
Once you do make that effort to reach out, don’t give up if you don’t see immediate results. It isn’t easy, says Dr. Brinton, and it isn’t always fun, but it is rewarding.
“If you really want to communicate with someone,” she says, “you can figure out a way to do it, but you have to want to, you have to be persistent, and you have to do it on an ongoing basis.”
Use support materials, such as pictures and objects, carefully. Some children need as many senses as possible stimulated to reinforce learning. Others are easily distracted and need stimuli pared down so that they can pay attention to your main points.
Repeat main points several times by rephrasing.
Summarize points already made.
Make your sentences simple, short, and to the point.
Talk more slowly than usual, but not too slowly.
Talk about things in the here and now.
Talk with added intonation and stress, but without sounding unnatural or condescending.
Structure the class so that everyone has an opportunity to participate.
Find out what the child can do best and set up situations in which he can succeed.
For those with speech disorders (difficulty producing words in a way that people can understand):
Realize that someone with a speech disorder has no problem understanding or thinking; his difficulty is in speaking.
Privately ask those with speech disorders how they would prefer to participate. For example, some may not want to be called on spontaneously but only when they raise their hands.
Be patient as they try to communicate. Avoid supplying words or finishing sentences for them.
Concentrate on what they are saying, not on how they are saying it.
Avoid telling those with speech disorders to “slow down” or “start over.” These instructions tend to make the problem worse.
For those with language disorders (difficulty in assembling words logically into meaningful sentences):
Don’t be afraid to tell them you didn’t understand what they said. Sit down, say something like “I didn’t get that,” and let them know you can take time to make sure you understand.
Slow down your speech a little—but not so much that it sounds unnatural.
Don’t give too much information at once, and don’t be afraid to repeat what you have said.
Use gestures or “environmental backup” as you can, such as pointing to things.
Use familiar language on familiar subjects, such as eating, places visited in the past, or family members.
Don’t assume that a yes or no answer to a question is what the person really means. Give him a couple of chances to confirm an answer.
For additional information, contact the American Speech-Language-Hearing Association, 10801 Rockville Pike, Rockville, Maryland 20852. (Call toll free: 1-800-638-8255.)