Routines Promote Communication and Understanding for Children with Multiple Disabilities
Learning how to communicate with others is a crucial part of any child’s life. Communication is vital for your child to be able to make his wants and needs known, to understand what is happening around him, and to have social interactions with other people. If your child has multiple disabilities, his daily routines can be an important tool for developing his interest in communicating and increasing his communication skills. Routines are activities in your child’s life in which he participates and that happen consistently the same way every time. Their basic ingredients include
- a consistent beginning, middle and ending;
- opportunities for your child to participate in the different steps of the routine; and
- a theme around which the routine is based—such as washing hands before dinner, feeding the dog, or playing a game.
Routines help your child learn many different skills. When you use routines for teaching, you and your child don’t have to learn a new activity. Because your child already knows what will happen next, it is easier for him to make the connection between the activity and the communication about it. In addition, motivation for communicating is often built into routines; for example, receiving a cookie after washing hands and then signing “cookie” or hearing a bedtime story after getting into pajamas and then saying “book.” Both the routines and the additional communication help support your child’s increased understanding of daily events and the surrounding world.
Colin’s Bus Routine
Here’s an example of how one family uses a routine to help a child with a visual impairment and other disabilities to improve his communication skills. Colin is nine years old and lives with his grandmother and two brothers. He enjoys music, cars, and playing with his brothers. Colin has low vision due to cortical visual impairment (CVI) and is limited in his body movements due to cerebral palsy. He communicates using gestures, facial expressions, 10 to 12 words that his family and teachers understand, and symbols in a communication book. At school, Colin is learning to use an alternative and augmentative communication (AAC) device to express his thoughts.
Colin’s grandmother has worked closely with the other members of Colin’s educational team to identify ways for him to increase his communication and participation in activities at home. The following table illustrates the steps in Colin’s morning routine for getting ready for the school bus to pick him up. It shows how his grandmother, with the bus driver’s help, uses the steps in the routine to encourage Colin to both understand and initiate different kinds of communication.
| Step in the Routine | Communications | Considerations |
|---|---|---|
| Colin wheels his chair to his picture schedule in the kitchen to see what activity is happening next. | Grandma says, “Breakfast is finished. What’s next?” Colin points to the symbol on the schedule for “school bus” (a photograph of Colin’s school bus) and says “bus.” | The schedule is in the kitchen where it is accessible to Colin. The pictures have high contrast, with only one object per card, which are arranged in order on a chart. |
| Colin wheels his chair to front door. | Colin signs “Help” to Grandma, who responds by handing Colin his jacket. | Colin’s jacket is red, a color he is motivated to look at. Grandma does not take his jacket down off the hook until Colin communicates that he needs help. |
| Grandma helps Colin put on his jacket. | After Grandma assists Colin in putting on the jacket, she asks if he wants it zipped. Colin responds by nodding his head “yes” or “no” or by verbalizing “yes” or “no.” | Grandma has Colin help in putting on his jacket by holding out his arms one at a time and pushing them through the openings. |
| Colin touches the front door. | After Colin touches the front door, Grandma says, “Let’s go out to meet Ms. Dot,” the bus driver. Grandma sings a short song she created to say “have a good day at school.” | Grandma does not push Colin out the door until he touches it. |
| The bus pulls up, and Ms. Dot greets Colin. | Ms. Dot says “Good morning Colin.” Colin says “Hi.” | Ms. Dot looks at Colin and waits for him to greet her before getting out to load his chair onto the bus. |
Considerations for Communication
Colin’s bus routine illustrates a number of things to think about when you are considering the opportunities for your child to communicate during one of his own daily routines. For example, consider the many different kinds of reasons people communicate, including
- requesting something,
- confirming an understanding of a situation,
- getting attention,
- sharing information,
- labeling an object or activity,
- initiating a social interaction, or
- rejecting an object or activity or saying “no.”
Building many different reasons for communicating into a routine will expand your child’s communication opportunities.
Your child, like Colin, can also use a variety of communication methods within a routine, including (but not limited to)
- gestures, such as shaking his head “yes” or “no;”
- an AAC device—perhaps a four-choice switching device;
- sign language;
- a symbol system; or
- voice—speech or other vocalization.
You may also want to think about how your child can use all his senses to increase his participation in a routine. He can use his vision, if present, touch, hearing, and even smell and taste within a routine to give him a cue about what to do next, to motivate his participation, or to reinforce when he has completed a step in the routine.
Expert Advice
To learn more about the use of routines to promote communication, read the advice of three professionals: