Speech Therapy -> Pragmatics / Social Skills / Life Skills

Pragmatics / Social Skills / Life Skills

The rules associated with the use of language in conversation and broader social situations.

Minor focus areas

Skilled interventions

  • Behavioral Support Services/Modifications

    A behavior is defined as ‘anything an individual does involving action and response to stimulation’. In individuals with communication delays/disorders, behaviors are often a meaningful form of communication. During behavioral support/modification, the SLP provides environmental structuring, modified activities, and semantic prompting to reduce negative behaviors and increase positive performance (MacDonald, et al, 1974).

  • Child-Led Play

    Child-led play encourages the adult to allow the child to take the lead, which creates more meaningful and relevant learning opportunities for the child, and an environment where the child is naturally and intrinsically motivated to communicate. Children learn best through play and learning cannot occur without the child’s attention and motivation. Cari Eberts (speech-language pathologist) discusses the power of play in her Power of Play-Based Learning seminar.

  • Declarative Language (Pragmatic)

    Declarative language is an ideal communication style for neurodivergent children. It is the opposite of imperative language. Whereas imperative language (such as commands and questions) requires a response from the child, declarative language (such as comments) does not. An example of an imperative statement would be “clean up” and an example of a declarative statement would be “it looks like everyone is starting to clean up.” Imperative language can lead to anxiety and dysregulation in children (often seen in a fight/flight/freeze response). Declarative language allows children the opportunity to engage critical thinking, problem solving, and perspective taking. For example, when saying “it looks like everyone is cleaning up,” you are indirectly cueing the child to check in with their environment and determine what they should do next. If you say “clean up,” you are simply telling the child what to do, but not why they might want to do it. Linda K. Murphy MS, CCC-SLP developed declarative language and more information can be found in her book, The Declarative Language Handbook.

  • Environmental Manipulation Strategies

    Environmental manipulation strategies are used by the SLP to target prelinguistic communication skills of attention so that communicative behaviors can be taught. This is highly researched for children with autism but can used with other specific language impairments that show deficits with joint attention.

    Techniques for environmental manipulation are placing objects close to the child or sabotage, such as placing a desired item in a tightly closed jar so that the child would have to request assistance to get the item. Addressing features of attention in categories such as orienting, sustaining, and shifting can lead to joint attention.

    1. Orienting attention is the initial physical adjustment toward a stimulus. This is an eye gaze shift or head turn toward a stimulus. Orienting deficits of children with autism directly affect intervention because if stimuli used in speech and language interventions fail to gain the attention of children with autism, they cannot have the desired teaching impact.
    2. Sustaining attention is the ability to maintain attention to a stimulus. Children with autism can remain fixated on a particular stimulus while ignoring others and can be “over focused”. This may be related to the child having difficulty with shifting attention.
    3. Shifting attention requires the child to disengage from one stimulus and then shift and reorient to a new stimulus. Children with autism seem to have more difficulty with disengaging then with reorientation. SLP may address this feature during activity transitions by hiding the toys that are no longer needed and quickly placing toys for a new activity in the child’s visual field. All of this information is important as it relates to joint attention, which refers to shared attention between two individuals and an object or another individual. Once joint attention is gained the SLP can target functional communication such as sign, gestures, AAC or words for the child to communicate their wants/needs (Patten & Watson, 2011; Yoder & Stone, 2006; Kasari et al., 2006).

  • Motivational Interviewing (MI)

    Long description: Motivational Interviewing (MI) is a “collaborative conversation style for strengthening a person’s own motivation and commitment to change” (Miller & Rollnick, 2012) which is used by SLPs to support clients leveraging their own intrinsic motivation for change and collaborating to form meaningful goals (MacFarlane, 2012). 

    Motivational Interviewing is evidenced-based, can be performed in a short time, and does not require specialized training (Miller & Rose, 2009). A review by Rubak et al. (2005) found that motivational interviewing outperformed the traditional medical model of advice-giving in approximately 80% of studies reviewed. Through MI, the SLP guides a patient through decision-making rather than directing the patient. This approach is in contrast to the traditional medical model where the clinician gives the patient a plan to follow without collaborating with the patient. Motivational Interviewing is appropriate for many areas of an SLP’s clinical practice, including social/pragmatic language, fluency, voice (Behrman, 2006), dysphagia (Smith & Robinson, 2013), aphasia (Hersh et al., 2018), and TBI (Medley & Powell, 2010).

    Key Principles of Motivational Interviewing 
    Express Empathy: By reflective listening, the SLP can help the patient feel “heard.” The principle is important through the whole process. 
    Develop Discrepancy: The SLP guides the patient to see a discrepancy between goals and current behavior. This helps lead the patient on the path to deciding about why and how to change. 
    Roll With Resistance: If the SLP hears resistance from the patient, avoid falling into a persuasive style of talking. Instead, understand that this is a necessary part of the process. Listen carefully and use empathetic statements to lead the patient to supportive problem-solving.
    Support Self-Efficacy: This means that the SLP and the patient both believe the patient has the ability to change and follow-through with the plan.

    Motivational Interviewing uses the following interaction styles (selectively) to focus the conversation upon change and help lead the patient down that road. I’ve created example statements using the techniques, for different parts of the clinical process. 
    ✧ Open Questions: By phrasing a question / statement in an open-ended manner, you allow the client to take the response in the direction that is important to them. 
    ✧ Affirmations: This technique allows you to recognize the client’s skills or appreciate them in a genuine way - you are highlighting strengths and facts in a way that differs from a compliment.
    ✧ Reflections: Studies have shown that we need to do more of these as speech-pathologists! These statements are important in letting a client know that you are really listening. These statements can be as simple as rephrasing what the client said, or more complex by adding meaning while rephrasing what the client said. As you start with this skill, use 1 reflection for each question you ask, and as you get better, use 2 reflections for each question you ask. 
    ✧ Summaries: This technique involves consolidating a discussion. The point of summarizing what you’ve discussed is to highlight change talk, promote strengths, consolidate info and move the discussion forward.

  • Prelinguistic Milieu Teaching (PMT)

    This is an intervention for children with language delays who have a very limited or nonexistent lexical inventory and may be having significant difficulties in their production of nonlinguistic communicative acts. In PMT the SLP teaches other modalities for communication including specific gestures, vocalizations, and coordinated eye gaze behavior (Fey, et al., 2006).

  • Relationship-Based Learning

    The therapist prioritizes joyful connection, attunement, co-regulation, and child-led play over compliance-based intervention. Before a child can learn, they must first be regulated and trust the adult who is teaching them. Cari Eberts (speech-language pathologist) discusses the importance of relationship-based learning in her work, and specifically in The Learning to Learn Program.

  • Responsivity Education/Prelinguistic Milieu Teaching (RE/PMT)

    This is an intervention for children with language delays who have a very limited or nonexistent lexical inventory and may be having significant difficulties in their production of nonlinguistic communicative acts. In PMT steps are taken directly to teach specific gestures, vocalizations, and coordinated eye gaze behavior. The Responsivity education component of RE/PMT targets parents’ compliance to and recoding of children’s verbal and nonverbal acts (Fey, et al., 2006).

  • Script Therapy

    A language intervention procedure in which events and routines known to the child or made familiar by the clinician are used to teach advanced language skills including narrative and pragmatic skills. SLP uses mental schemes a child may have about common experiences such as eating in a restaurant, grocery shopping, or personal interactions/conversations.

  • Social Communication Skills Training

    This training enhances the ability to use language appropriately in social contexts. Activities include role-playing social scenarios, understanding non-verbal cues, and practicing conversational turn-taking to improve social communication and interaction.

  • Social Scripts Technique

    Social Scripts technique is a language intervention technique that improves patient’s linguistic and social cognitive skills using role play of social interactions and a checklist to elicit the patient’s statements about other’s perspectives and strategies for completing the social script. It is a way of rehearing new skills of social problem-solving (Timler, et al 2005).

Reference links

  • Parents' Experiences of Professionals' Involvement For Children With Extreme Demand Avoidance 0
    pubmed.ncbi.nlm.nih.gov     Author: Emma Gore Langton 1, Norah Frederickson 1 - Parents felt positive about practitioners who had listened to their experiences, made efforts to understand the child, and provided or arranged for help. Parents found involvement most helpful when it resulted in comprehensive assessment, appropriate intervention, practical advice and management strategies, and a focus on the well-being of all family members. The overall ratings of helpfulness are encouraging, and the specific feedback about what is most helpful could be of value in shaping services.
  • Multilingual, Multicultural, Bilingual Resource Link For SLPs 1
    www.asha.org     Author: ASHA - Link includes ASHA resources and information related to evaluation and treatment of clients from linguistically and culturally diverse backgrounds. Link includes ASHA resources to: Accent Modification Bilingual Service Delivery Collaborating With Interpreters, Transliterators, and Translators Cultural Competence Voice and Communication Services for Transgender and Gender Diverse Populations Dynamic Assessment Micro Course Cultural Competence Self Assessment Phonemic Inventories and Cultural and Linguistic Information Across Languages Collaboration With Interpreters: Securing Positive Outcomes Practical Assessment and Treatment Strategies for English Language Learners with Language Impairments Serving Clients From Diverse Backgrounds: Speech-Language Difference vs. Disorder Langu Continuing the Dialogue on Dialect: Positive Steps Toward Less Biased Assessments of Children Who Speak African American Englishage and Identity--Shifting Away from a Deficit Perspective on African American English Información en español
  • Evaluation of Bilingual Children- Considerations 1
    leader.pubs.asha.org     Author: Alejandro E. Brice and Roanne G. Brice - An overview of considerations when evaluating bilingual (Spanish/English) children
  • Bilingual Language Development Video 1
    www.youtube.com     Author: Kathy Kohnert - YouTube Video on Bilingual Language Development by Kathy Kohnert
  • Pathological Demand Avoidance: Exploring the Behavioral Profile 0
    pubmed.ncbi.nlm.nih.gov     Author: Elizabeth O'Nions 1, Essi Viding 2, Corina U Greven 3, Angelica Ronald 4, Francesca Happé 5 - This study is the first to use standardized measures to explore the behavioral profile of children receiving the increasingly used label PDA. It represents the first clear evidence that children fitting the PDA description display severe impairments across multiple domains. Comparisons between behavior in PDA and two putatively overlapping groups, ASD and CP/CU, revealed levels of peer problems and autistic-like traits in PDA comparable to ASD.
  • Bilingual (English/Spanish) Therapy Materials By Bilinguistics 1
    bilinguistics.com     Author: Bilinguistics - Downloads and resources for providing bilingual therapy (Spanish/English)
  • Nurturing Care For Early Childhood Development 1
    cdn.who.int     Author: World Health Organization - Your loving care as a parent is what a child needs to be healthy, wellnourished and safe. • Communicate early and often, starting even before your baby is born. It will help you build a warm and loving relationship. • Make time to play with your child and engage them in your daily chores. You will help your child to learn, be happy and thrive. • Remember that feeding times are periods of learning and love – talk to your child while feeding and make eye to eye contact. • If you feel sad and unable to respond joyfully to your child, seek help from your health care provider.
  • The Functional External Memory Aid Tool Version 2.0: A How-To Clinical Guide 0
    pubmed.ncbi.nlm.nih.gov     Author: Alyssa M Lanzi 1 2, Anna K Saylor 1, Robert F Dedrick 3, Michelle S Bourgeois 4, Matthew L Cohen 1 2 5 - This clinical-focus article describes new resources available to help clinicians administer and interpret Version 2.0 of the FEMAT when serving adults with cognitive-communication disorders.
  • Bilingual Service Delivery 1
    www.asha.org     Author: ASHA - Information and resources regarding bilingual service delivery by SLPs (from ASHA)
  • Learning Two Languages: Bilingualism 1
    www.asha.org     Author: ASHA - Information and resources for SLPs and parents of bilingual children
  • Pathological Demand Avoidance: Symptoms but Not a Syndrome 0
    pubmed.ncbi.nlm.nih.gov     Author: Jonathan Green 1, Michael Absoud 2, Victoria Grahame 3, Osman Malik 4, Emily Simonoff 5, Ann Le Couteur 6, Gillian Baird 4 - In our Viewpoint, we reviewed the current literature and conclude that the evidence does not support the validity of pathological demand avoidance as an independent syndrome. Nevertheless, the use of the term highlights an important known range of co-occurring difficulties for many children with autism spectrum disorder that can substantially affect families. We explore how these difficulties can best be understood through an understanding social, sensory, and cognitive sensitivity in autism spectrum disorder, identification of frequently occurring comorbid conditions, and assessment of how these problems interact within the child's social environment. Pathological demand avoidance (PDA) is a profile that describes those whose main characteristic is to avoid everyday demands and expectations to an extreme extent.
  • Autism Spectrum Disorder and Other Development Disorder 1
    www.who.int     Author: World Health Organization - Psychosocial interventions that are effective in reducing core symptoms and improving adaptive skills and functioning are available, but they are very resource intensive. Increased evidence on affordable service delivery models and effective and scalable capacity-building approaches are required. Interventions mediated by parents and other non-specialist providers have the potential to significantly increase access to care.
  • Language Difference vs Language Disorder: Assessing English Learners 1
    digitalcommons.odu.edu     Author: Carol Westby and Kimberly Murphy - Video available Language Difference vs Language Disorder: Assessing English Learners Carol Westby, Bilingual and Multicultural Services, Albuquerque, NM Kimberly Murphy (Host), Old Dominion UniversityFollow Document Type Presentation Publication Date 5-20-2020 Abstract To a large extent, determining whether an English learner has a language/learning disability is a process of elimination. There are no tests that can definitely tell us whether the student has a language/learning disability. Inappropriately identifying an EL student as having a language/learning disability can result in stigmatization or reduced access to academic content, but waiting too long to identify a student who truly has a language/learning disability can be the beginning or the extension of a cycle of communicative, academic, and/or social failure. Assessment of EL learners requires collaboration between classroom teachers and speech/language pathologists. This session will cover (1) factors that complicate the assessment of English learners; (2) multi-tiered systems of support (MTSS) and performance-based assessment; (3) process assessments, and (4) dynamic narrative assessment. Comments This professional development webinar was presented by Dr. Carol Westby for speech-language pathologists in Virginia. It was funded by the Virginia Department of Education and hosted by Dr. Kimberly Murphy, Old Dominion University.
  • Scope of Occupational Therapy Services For Individuals With Autism Spectrum Disorder Across the Life Course 1
    research.aota.org     Author: Copyright © 2015 By the American Occupational Therapy Association, Inc. The American Journal of Occupational Therapy, 2015, Vol. 69(Supplement_3), 6913410054p1–6913410054p12. - Occupational Therapy practitioners work collaboratively with individuals on the autism spectrum, their families, OTHER PROFESSIONALS, organizations, and community members in multiple contexts to advocate for and provide a range of needed resources and services that support individuals' ability to participate fully in life (Case-Smith & Ambersman, 2008; Kuhaneck, Madonna, Novak, & Pearson, 2015; Tanner Hand, O'Toole, & Lane, 2015; Watling & Hauer, 2015a; Weaver, 2015). According to a study conducted by the Interactive Autism Network (2011), occupational therapy ranks second to speech-language pathology as the most frequently provided service for individuals with autism throughout the United States.
  • Leveling Up Regulatory Support Through Community Collaboration 1
    pubs.asha.org     Author: Amy C. Laurenta and Jacquelyn Fede - While behavioral intervention methodologies and societal expectations for masking remain prevalent, in recent years, there has been a greater emphasis placed on understanding the underlying factors contributing to problematic and challenging behaviors. Furthermore, there has been greater recognition of the need to address those underlying factors as the primary areas to target for effective intervention that can actually help autistic individuals navigate their environments in school and as they transition out of school and into the real world (Prizant et al., 2006a). To provide this type of ethical, efficient, and sustainable support, it is imperative for clinicians to understand emotional or energy regulation as a developmental construct and then to understand its relationship to challenging behaviors.
  • Red Flags For Speech-Language Impairment In Bilingual Children 1
    leader.pubs.asha.org     Author: Scott Prath On ASHA Wire - Red Flags for Speech-Language Impairment in Bilingual Children Differentiate disability from disorder by understanding common developmental milestones.
  • Bilingual (Spanish/English) Evaluation Resources 1
    bilinguistics.com     Author: Bilinguistics - Dozens of speech, language, fluency, and other evaluation resources for bilingual evaluations
  • Language In Brief 1
    www.asha.org     Author: The American Speech-Language-Hearing Association - Language is a rule-governed behavior. It is defined as the comprehension and/or use of a spoken (i.e., listening and speaking), written (i.e., reading and writing), and/or other communication symbol system (e.g., American Sign Language).

Activity List(s)

Visual Schedule Cards

Related Disorder(s)

  • Social communication disorders - Social communication disorder (SCD) is a condition that makes it hard to talk with other people. It's not a problem with speech or with the mechanics of language, like using grammar. But it does impact other areas of language. People with SCD have trouble communicating in ways that are socially appropriate.
  • Autism Spectrum Disorder - Autism Spectrum Disorder (ASD) is a complex developmental condition that involves persistent challenges in social interaction, speech and nonverbal communication, and restricted/repetitive behaviors. The effects of ASD and the severity of symptoms are different in each person.
  • Post-traumatic stress disorder - Post-traumatic stress disorder (PTSD) is a psychiatric disorder that may occur in people who have experienced or witnessed a traumatic event such as a natural disaster, a serious accident, a terrorist act, war/combat, or rape or who have been threatened with death, sexual violence or serious injury.
  • Attention-Deficit/Hyperactivity Disorder (ADHD) - Attention-Deficit/Hyperactivity Disorder (ADHD) is a disorder marked by an ongoing pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development.
  • Neurological Conditions - Types of neurological conditions may include: Alzheimer’s Disease, Dementias, Brain Cancer, Epilepsy and Other Seizure Disorders, Mental Disorders, Parkinson’s and Other Movement Disorders, and Stroke and Transient Ischemic Attack (TIA).
  • Selective mutism - Selective Mutism is a complex childhood anxiety disorder characterized by a child's inability to speak and communicate effectively in select social settings, such as school. These children are able to speak and communicate in settings where they are comfortable, secure, and relaxed.

Assessments

Goal Bank

  • Jennifer will respond to greetings of familiar people over a 6 week therapy period. 1
  • Jacob will initiate greetings with familiar people over a 6 week therapy period. 1
  • Jody will follow a daily sensory and movement diet with age-appropriate preferred regulatory activities 10 minutes per day, min 4 times per week, with visual and 50% verbal cues, to improve active participation at home and school, 80% of the time. 0

Organizations

Organizations who selected this major focus area as their top area of expertise.

  • christina@collaborativemindsconsulting.com

    Individual account

    Individual
    1 employee

    Parent and Professional Consulting & Therapy Services for Neurodivergent Children and Teens

Therapists

Therapists who selected this major focus area as their top area of expertise.

  • Emily Bultman

    Emily Bultman

    Full-time Therapist CF-SLP

    I am a Speech-Language Pathology Clinical Fellow and have the most experience providing treatment...

  • Leslie Edwards

    Leslie Edwards

    CCC-SLP
    • MSU Denver Assessment Class MSU Denver Assessment Class
  • Jennifer Pierce

    Jennifer Pierce

    CCC-SLP
    • Advanced Therapy Clinic LLC Advanced Therapy Clinic LLC