What Does It Mean to Be Social? Defining the Social Landscape for Children With Childhood Apraxia of Speech

 

By Nancy Tarshis, Michelle Garcia Winner, and Pamela Crooke

August, 2020

Summary by Nancy Tarshis

Often, when thinking about CAS we are deeply enmeshed in the challenges of developing speech. So much so, it is possible to forget that communication and social competencies are crucial impacted areas above and beyond aspects of motor speech. Through the lens of early social development and social competency, this clinical focus article explores how speech motor challenges can impact social development and what happens when young learners miss early opportunities to grow socially.

The article traces the development of social competency through the lens of the Social Thinking Social Competency Model (Winner and Crooke 2009) starting with the earliest relationships and traces the roots of the very human, collaborative mindsets from birth through the preschool and early elementary years. The model outlines four key aspects of social processing. At each developmental phase, social competencies are placed in relief against the communication challenges and how they impact a child’s participation in the social landscape. Knowing that communication is so much more than simply putting together sounds, words, phrases and sentences; early communication deficits impact opportunities for interaction as we know that social interaction is reciprocal and when output is lower, often those around input less.

While it is important to intervene early, clinical impression suggests that many children with CAS do not get a diagnosis or any sort of intervention until years of social learning opportunities have passed. Typically a child is not diagnosed until the very early preschool years. At that point, social knowledge deficits are already present secondary to reduced practice, overreliance on adult relationships, and years of playtime spent going to therapy appointments.

For our youngest children, intervention must account for early losses which means a focus on relationship building and on early communicative behaviors that are broader than just sound imitation. Infants are sensori-motor learners, take advantage of that! Intervention with toddlers is all about connecting! Clinicians should orchestrate play experiences so that the child with CAS has opportunities to participate and a role to play. Practicing play is crucial as often these toddlers have reduced opportunities to play and are missing key moments of learning. Choose speech targets including words, proto-words (early functional words like “mama”), and power words that are relevant to the toys to ensure the child has something to say when playing with a peer. The goal is to be sure they are having those important play experiences that enable them to observe, interpret, decision-make, and respond in ways that build their understanding of social intention and interaction, despite their communicative weaknesses.

Intervention for preschoolers is all about teaching awareness of how the social world works, leading to working on how the child functions in that world. It is at this point that a model of social competencies with core components of social development such as the ST-SCM (Winner & Crooke, 2009) is useful as a place to start guiding and directing social attention, helping preschoolers to notice their peers, and make guesses about their thoughts and feelings. The focus at this point in development is to understand that thoughts and feelings can be recognized, interpreted, and changed to meet the shifting expectations in the social landscape.

As children grow into early elementary and onward, the goal will be to monitor and intervene for social development to assure they are keeping pace with peers to the best of their ability. Children with CAS are at risk for social delays, anxiety, withdrawal and peer rejection. It is crucial that along with motor speech work, a speech pathologist is tracking social development.

https://doi.org/10.1044/2020_PERSP-19-00116

Download the PDF version of the article here.

 

By Nancy Tarshis, Michelle Garcia Winner, and Pamela Crooke

August, 2020

Summary by Nancy Tarshis

Often, when thinking about CAS we are deeply enmeshed in the challenges of developing speech. So much so, it is possible to forget that communication and social competencies are crucial impacted areas above and beyond aspects of motor speech. Through the lens of early social development and social competency, this clinical focus article explores how speech motor challenges can impact social development and what happens when young learners miss early opportunities to grow socially.

The article traces the development of social competency through the lens of the Social Thinking Social Competency Model (Winner and Crooke 2009) starting with the earliest relationships and traces the roots of the very human, collaborative mindsets from birth through the preschool and early elementary years. The model outlines four key aspects of social processing. At each developmental phase, social competencies are placed in relief against the communication challenges and how they impact a child’s participation in the social landscape. Knowing that communication is so much more than simply putting together sounds, words, phrases and sentences; early communication deficits impact opportunities for interaction as we know that social interaction is reciprocal and when output is lower, often those around input less.

While it is important to intervene early, clinical impression suggests that many children with CAS do not get a diagnosis or any sort of intervention until years of social learning opportunities have passed. Typically a child is not diagnosed until the very early preschool years. At that point, social knowledge deficits are already present secondary to reduced practice, overreliance on adult relationships, and years of playtime spent going to therapy appointments.

For our youngest children, intervention must account for early losses which means a focus on relationship building and on early communicative behaviors that are broader than just sound imitation. Infants are sensori-motor learners, take advantage of that! Intervention with toddlers is all about connecting! Clinicians should orchestrate play experiences so that the child with CAS has opportunities to participate and a role to play. Practicing play is crucial as often these toddlers have reduced opportunities to play and are missing key moments of learning. Choose speech targets including words, proto-words (early functional words like “mama”), and power words that are relevant to the toys to ensure the child has something to say when playing with a peer. The goal is to be sure they are having those important play experiences that enable them to observe, interpret, decision-make, and respond in ways that build their understanding of social intention and interaction, despite their communicative weaknesses.

Intervention for preschoolers is all about teaching awareness of how the social world works, leading to working on how the child functions in that world. It is at this point that a model of social competencies with core components of social development such as the ST-SCM (Winner & Crooke, 2009) is useful as a place to start guiding and directing social attention, helping preschoolers to notice their peers, and make guesses about their thoughts and feelings. The focus at this point in development is to understand that thoughts and feelings can be recognized, interpreted, and changed to meet the shifting expectations in the social landscape.

As children grow into early elementary and onward, the goal will be to monitor and intervene for social development to assure they are keeping pace with peers to the best of their ability. Children with CAS are at risk for social delays, anxiety, withdrawal and peer rejection. It is crucial that along with motor speech work, a speech pathologist is tracking social development.

https://doi.org/10.1044/2020_PERSP-19-00116

Download the PDF version of the article here.



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