The communication skills of severely physically disabled children

This thesis considers why, in interaction between physically disabled children and familiar adults, adults frequently dominate, initiating topics, using commands and closed questions, and children mainly produce responses, often yes/no answers or limited information. It also considers why children may use more communication skills in structured eliciting situations than in conversation. These patterns of interaction may arise because the children produce communication signals that are difficult to interpret (readability hypothesis) or because adults are reacting to the children's general level of physical dependence (physical dependence hypothesis) Previous research has not analysed the possible association between severity of speech disorder or motor impairment and interaction patterns. Finally, the cognition hypothesis suggests that children may not acquire a full range of communication skills because of the limited opportunities to practice them in conversation. This study involves two groups of twenty children aged two to ten years with four limb cerebral palsy, and without marked learning difficulties. One group had speech intelligible to their parents without contextual cues, and the other were unintelligible to their parents. Mother-child interaction in a standard situation was analysed in terms of its structure and the communicative functions used by each partner. Functions were also elicited from the children using a semi-scripted conversation with a clinician. Verbal children used more initiations and a wider range of functions with their mothers than did nonspeaking children. Positive correlations were obtained between child interaction measures and both motor skill and speech production. Children's results support the physical dependence and readability hypotheses, but those obtained for mothers were unexpected. Few differences were observed in the interaction patterns of the mothers in the two groups. Both groups of children produced more functions in the eliciting situation than with their mothers, contradicting the cognition hypothesis. Implications for intervention are discussed.