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Week of 5 February 1999 Vol. II, No. 22 Feature Article Speech clinic coaches children and adults in conversation basics By Hope Green Brain damage and learning disorders can turn the conversational skills that many of us take for granted -- such as asking questions, taking turns speaking, and reading a listener's facial expression -- into stumbling blocks to communication. Without such basic tools of dialogue, children are shunned on school playgrounds and otherwise intelligent adults cannot hold satisfying jobs. Elsa Abele wants to see that such individuals receive the right help. In a program widely recognized by parents and special-needs educators throughout eastern Massachusetts, Abele, a clinical assistant professor of communication disorders at Sargent College of Health and Rehabilitation Sciences, supervises student-run treatment groups designed to improve clients' daily social interactions. The groups, launched in 1994, were born of a growing speech pathology subspecialty known as pragmatics, or the study of how language connects units of thought to convey information. "We teach people how to act appropriately by picking up the cues they need and knowing the unspoken rules, sometimes culturally determined, for how long you talk on a particular subject, or how long you pause before responding to a question," Abele explains. "A lot of the timing for these kinds of interactions is learned in the first months of life from our parents, but a neurological disorder can prevent these connections from being made." Taking turns On a recent Friday afternoon in Sargent's Academic Speech, Language, and Hearing Clinic, Elisabeth Kyriakopoulou (SAR'00) begins her first session of Friendship Group, a weekly meeting in which she will tutor a girl and three boys with a mild form of autism known as Asperger's disorder. Today's agenda is for the new coach and her 9- and 10-year-old charges to become better acquainted. Parents observe the action from behind a two-way mirror, while in another room, Abele watches the proceedings on a wall of video monitors. The "penalizing behaviors" are easy to spot. One child will not speak without prompting. Another has trouble yielding the floor. A third inquires anxiously when the session will be over. And a fourth, asking a companion to imagine being transformed into a favorite animal, tries aggressively to veto the response when a cartoon character is named. Kyriakopoulou gently suggests that Tweety Bird falls within the acceptable range. "For children with Asperger's, rules have inordinate importance, and they tend to lock onto one idea," Abele explains. "So we try to teach them that life is full of options, and there is more than one way to handle a situation." Elisabeth Kyriakopoulou (SAR'00) shows a map of her native Greece to children in Friendship Group at Sargent's Academic Speech, Language, and Hearing Clinic. Photo by Kalman Zabarsky This semester, graduate students are working with one group of adults and five sets of children ages 7 through 16, as a segment of their required practicum. Besides autism, their clients' language impairments are caused by attention deficits, head injuries, various learning disabilities, brain tumors, and strokes. The academic clinic provides services for only $10 a session, and many children return for multiple semesters. "We're hearing a lot of anecdotal evidence from parents and school systems that the children's feelings of competence with peers, at home and at school, have increased significantly," Abele says. A change of direction Pragmatics is a relatively new frontier, explains Abele (SAR'80), who worked as a speech pathologist for 17 years in the Burlington, Mass., public schools before she was hired at Sargent in the fall of 1991. More developed areas of speech and language research explore issues such as delays in the use of complex sentences, trouble in producing sounds to form words properly, and barriers to learning new vocabulary. Abele has observed a frustrating lack of progress for special-needs children with pragmatic dysfunction when they are placed in groups run by guidance counselors and school social workers. There, the focus is on emotional adjustment issues, she says, when what the children really need is practical, step-by-step communication coaching. While some treatments for learning disabilities do contain a pragmatics component, Abele says, there are no other programs in the Boston area like Sargent's. "Children have told us that this is the best part of their week," she says, "because here they have friends who understand their situation and they can practice the social interactions they so badly miss at school. People travel a long way to come here, and we have many more requests for the clinic than we can meet. But our hope," she adds, "is that after our students graduate, they will establish groups like this in other places so the need won't be as great." Asperger's Disorder and High Functioning Autism: New Perspectives will be the subject of the 20th Annual Communication Disorders Conference, hosted by the Boston University chapter of the National Student Speech, Language, and Hearing Association on March 22. The conference will be held in the George Sherman Union, 775 Commonwealth Ave. Preregistration is required, and participation is limited to 250. For information, call (617) 353-3188.