Bonnie Brinton

Life on a Tricycle

Social Challenges of Children with Language Impairment

 

House of Learning

402

(Season 4, Episode 2)

 

OFFICIAL TRANSCRIPT

 

 

Produced by the Harold B. Lee Library

At Brigham Young University

Thursday, October 6, 2005

 

 

 

Thank you. It's an honor to give a lecture under the entitle "House of Learning." As I left my own home this morning, I thought, "I'm really glad this isn't called the House of Order series," because I just don't have a lot of credibility, you know. So, House of Learning, we can move on. I was happy to share some of the things that we've learned over the years about children with language impairment. Think about language impairment in kids. Think about children. Children learn to talk. Typical children, it's something that they learn to do. They learn to understand language and talk as part of the course of their normal development. And they do this anywhere in any language and in any culture. Now, there are some building blocks, some things kids need to learn verbal language. One of those things is that you need to learn to hear, or need to be able to hear. You need to have an intact auditory system so you can hear the language around you. And you also need to have an intact oral motor system. So you have to have a tongue and lips that move in a very sophisticated way in order to produce speech. And you have to have a certain level of cognitive development, but when you think about that, it doesn't have to be very mature.

 

Think about the last 3-year-old that you chatted with. 3-year-old is pretty unsophisticated individual as things go in terms of world knowledge, but that individual may have had a lot to say. I had a conversation with a 3-year-old yesterday, and in the course of about 90 seconds we discovered that I did not possess any treats at the time, and she did not have any treats, but we were both somewhat comforted by the fact that we each had chocolate in our respective homes. And we wished that we had it with us where we were. All that went by in 90 seconds, and, you know, that was easy and this was a 3-year-old. You just don't have to be terribly mature cognitively to be able to talk a lot. Another thing that kids need, is they need some exposure to language. Children, who are severely deprived of environment, I mean like, locked in a closet, don't learn to talk normally. But those conditions being met, that you can hear, and you have an intact oral motor system and a sufficient level of cognitive development and exposure to language, those conditions being met. Children can learn one or more languages without formal teaching. And this becomes evident to you when you're a parent as soon as your kids start to talk. You understand that they say things that you didn't teach them. They say a lot of things you didn't teach them.

 

            There are a lot of things that parents can do to help the language acquisition process along. But typical kids are going to learn to talk under a variety of circumstances. When you think about it, that's a really good thing, because our culture is built so much around language. We use language to communicate with each other. We use language to establish relationships with each other. We use language to learn in school. When you think about language including written language, your access to knowledge in school is determined to a great extent on your ability to deal with that language. It's the medium of instruction a lot of the time. And you need language to survive in society. You need a certain amount of language to get a driver's license. You need to be able to understand the directions when you get there. You've got to be able to read the words on those road signs. You've got to be able to pass that test. You've got to be able to communicate. So we're a very language-dependent society. So it's a good thing that kids do learn to talk so readily.

 

Now, there are some children who do not learn language normally, even though they seem to have those basic building blocks. And we refer to these children as having language impairment. So, the population that I am talking about today when I talk about language impairment, these children have normal hearing, they have an intact oral motor mechanism, so they can, say words. They have a typical non-verbal IQ, and that means if you give them cognitive kinds of tasks that do not require that they understand language or talk a lot, then they perform like typical kids do. So it'd be stuff like block construction and understanding, a whole from the parts visually, those kinds of things. We're talking about children here who have adequate exposure to language, so they come from the kind of environment where they hear language. These children with language impairment show a very different developmental pattern. Most of these kids talk late, they start talking late. And when they start, it doesn't go quickly and balloon like with typical kids. Typical kids learn so much so quickly, and that doesn't happen easily for children with language impairment. They have trouble learning words. They have small vocabulary when they're little. They have trouble understanding language, trouble putting sentences together, trouble learning grammatical forms and little grammatical markers that make language and help language communicate and make it sound conventional to us. They have trouble understanding directions and stories, trouble producing narratives, putting sentences together to produce narratives. Now, these children are not silent. It's not like they don't learn to talk at all, but when they talk it's typically immature, it's labored, it's difficult, and it's just really hard for them. They learn language, but they tend to always lag behind their typically developing peers.

 

            Now, to appreciate what it's like to have language impairment, let's engage in a little exercise of the imagination. Now, imagine that you are born into a world where everyone has a clarinet in his or her hand, okay? Everybody in your culture has a clarinet when they're born. And people communicate by playing the clarinet. They express love, and anger, and joy to each other by playing tunes on their clarinets. The evening news is broadcast as the anchor plays the clarinet. Everyone knows what these tunes mean. When you are born, like other babies, you cannot play the clarinet. You blow lots of noises and squeaks on your tiny clarinet and your parents find these just delightful. And they express their love for you by playing little tunes that are easy for babies to pick out from the other sounds in the environment. Now, other babies quickly recognize these tunes and start to play notes of their own. But you, on the other hand, can't make sense of those tunes played around you. You can't seem to remember them or maybe you just can't pick them out from all the background music. In any event, the tunes don't mean much to you. You manage to make some squeaks and eventually you eke out a few notes. Your parents are thrilled. Finally, you're starting to play! Other kids your age, however, are playing "Go Tell Aunt Rhodie" and "Mary Had a Little Lamb." No one gave these children formal clarinet lessons. They just seemed to learn to play naturally as they communicated with their parents, via their clarinets.

 

Well you try to communicate with your parents too, and by the time you get to kindergarten, you can play "Mary Had a Little Lamb" just fine. Hurray! The only problem is, the other kids are playing sonatas by Handel, and the teacher is communicating to you by playing Beethoven's symphonies. You try to figure out what's going on, but you cannot find tunes that you understand within the music around you. You don't know what to do and where to go at school cause you can only pick out bits and pieces of what the teacher is playing. And oh no, what are those weird dots and lines the teacher's writing on the board? The other kids seem to get meaning from those marks the teacher calls "notes." But you can't figure out what they represent. But by the end of the second grade, you've made progress. You can communicate your basic needs by playing tunes, and you can recognize what the teacher means when she plays a Clair de Lune. You even recognize and write a few notes on that staff. The other kids in your class are composing symphonies, all by themselves. The instruction is geared to their level, and you get more and more behind at school. Clarinet music is the means of communication in your culture, and clarinet music is your Achilles heel. What seems to come easily for other children is difficult and laborious for you.

 

            Now, like our clarinet analogy, a child with language impairment will have difficulty with virtually every task within the school day. These children work twice as hard to get half as far as their typically developing peers. Well, how many of kids are affected with this? There's been a huge research study that identified 7 percent of kindergarteners with language impairment. Now, these are exclusive, or do not include children identified with autistic spectrum disorder or some other disorder. Now, within language impairment, there are varying levels of severity. Sometimes it's mild, and sometimes it can be quite severe. But at any level, it will constitute a learning problem in school. And what we found out also is that children with language impairment are at risk for social problems, and this is where our research has centered.

 

Children with language impairment have certain social challenges. For one thing, and these are things that we've shown in the research studies that have been conducted here at BYU, they show withdrawal, especially reticence, and reticence means, it's the kind of child would who would like to enter in an interaction, but just kind of can't. That child stands on the outskirts and has kind of approach avoids "I'd really like to play with them but I can't and I'm too shy." That child tends to stand around, when other kids are working or playing and not doing anything, even though there's lots of stuff to do. These children report limited interaction with peers outside of school. These are not kids that are frequently invited over to friend's houses to play. These are not the kids that go to the sleepovers. These are kids who kind of stay home, and play within their families. Some of these kids have difficulty making friends at school. It's a hard time. And a lot of these kids report loneliness at school because they tend to be excluded. Now, here again, there are levels. Some kids with language impairment tend to do okay socially, they tend to do fine. But a lot of them do not do so well, and these are the kids that we're talking about.

 

            Now, kids with language impairment have difficulty with certain specific social tasks. They have trouble entering interactions or joining the play of other children. We find this out, we've got some typically developing children, a couple children, we get them engaged in a play or work activity, and then we introduce the third child and see how well that child enters into the interaction of the other kids. Typically developing kids don't have much trouble with this. They're able to make themselves part of the work or play. Kids with language impairment, a lot of them have a lot of trouble. They'll just kind of hover sometimes, or they may enter the play and they don't say anything, or maybe just leave. But it's just a lot harder for them. We know that kids with language impairment often have trouble joining play groups at recess. They may wander from group to group or alone at recess. And if you ask us how we know this, we know this because we have actually wired some of these little guys with, wireless mics that we disguise as little necklaces, and then of course you have to put necklaces on some other kids too so nobody knows who has the mic and who doesn't. And we have followed these kids around at recess with video cameras, taped them, and then we take the video camera and we transcribe everything everybody says, and look at the play interactions and how those kids spend their time. We found that here again, they wander from group to group, they have trouble getting access to groups, sometimes they just don't have anything to do and it's kind of a lonely time for them. Kids with language impairment also have trouble negotiating with other kids. We have actually set up scenarios where we will put a child with language impairment and some typically developing kids in a situation where they earn some tokens. And then we let them cash those tokens in for a treat in a snack box. But they have to combine their tokens to get enough to buy anything. So then you get a little period of negotiation. What shall we buy? Children with language impairment frequently don't have much part in this negotiation. They just get what the other kids pick. They don't much of a voice there.

 

These children frequently have trouble working or playing cooperatively with other kids. We've looked at a lot of cooperative work and play situations. And they tend to be not part of the interaction even if we reduce the language demands. Okay, if their language is poor, they're gonna have trouble talking and interacting with these other kids, but what if we give them something that they can do stuff without talking? Would it help? The answer is no. It didn't help. They were still excluded from the work and play. Children with language impairment frequently have trouble responding to others in conversation. They are not as responsive as their typical peers, which means that they don't pick up on the cues and the things that other people say as well.

 

            So we've asked ourselves, why do so many children with language impairment struggle so much socially? Why do they have so many social problems? Well, for heaven's sakes, they have poor language. That should be part of the problem. If you don't have very good language, you're gonna have trouble communicating, you don't talk very well, you're gonna have trouble, entering an interaction. Certainly, that would be this huge explanatory factor. And that is part of the problem. But it is, we have found in our research, only part of the problem. The language alone doesn't explain it. For one thing, there's not a perfect correlation with the severity of language, with the severity of the language problem and the severity of the social problems. In other words, if you look at a pool of kids with language impairment, and you say, ďokay, they have social problems because of this language impairment,Ē then you would expect that the kids with the most severe language impairment would also have the poorest social life there, and that their social skills would be the poorest. And that's not necessarily the case. You can't predict always how much social trouble a child with language impairment's going to have by looking at the level of their impairment. So, you know, that makes us think, there's probably some other factors in here.

 

As I alluded to before, if you take these children and put them in a social task, and remove the language demands, they still have social problems. The problems don't go away, so you think, hmm. Something else is going on there. And that's also not the case, is these kids grow up, their language gets better. It still lags behind their peers, but it gets better. So if they become more able communicators, shouldn't they do better socially? And we found the answer is no. They don't necessarily. In fact, sometimes, some kids do worse. Some kids it's harder, even though they have more language. So we thought, there are other factors here. What other factors could be important here, and how could we probe these factors?

 

            So, we have had over the years a BYU research team. I have a couple of slides here with the names of some undergraduate and graduate students and some of these people are still with us, and some have graduated and a lot of these students are practicing speech language pathology all over the country now. So we're happy for that. And we also have at BYU, faculty collaborators. When I say "we," I'm not using the royal we here, I'm talking about Dr. Martin Fujiki and myself. Martin is my research partner and also my life partner, and all of our research has been joint for 23 years. Martin is the other half of my brain, and luckily that half is bigger. That's good. We have also collaborated the last 3 or 4 years with Dr. Matt Spackman from Psychology. He's a specialist in emotion, he's helped us out a lot. We've collaborated on campus with Dr. Craig Hart from Family Science and Human Development. Craig is a social psychologist of social psychology kinds of things and he's done a lot of very significant work and has helped us a lot, especially with kinds of playground and social world things. We've also collaborated with Dr. Annette Gerome, who's formerly a faculty member here at BYU in counseling psychology. So it's been a lot of group work because we basically have to look at things from a lot of different disciplines. We need to know something about language impairment, we need to know something about psychological functioning, we need to know something about their emotional functioning, we need to know a lot of things and that means we need a lot of collaborative work.

 

            So one of the factors that we wanted to look at was the emotional competence of children with language impairment, so we thought this might be a factor. Now, emotional competence refers to the ability to manage one's emotions. And that includes the expression of emotions, the understanding of emotions, and the regulation of emotions. So that has kind of everything we do with regard to handling our emotions. And we thought emotional competence or some aspect of emotional competence would be adding to the problem here? Now, we think about traditional definitions of children with language impairment. This has not been in the equation, okay? Emotion competence has not been an issue that is thought to be important here, or even very salient to the issue. But we wanted to look at it because of our clinical experience of looking at the way these kids handled social, emotional situations and tasks. And we thought, this is just hard for them. This is hard, there's just something here and we wanted to probe and see if we could find out what that was, what some of those factors were. So we came up with a series of probes. And, looking at a very basic aspect of emotional competence, we looked at the ability to read emotions expressed on faces. This is something that everybody needs to do. As you well know, not everything that is communicated is communicated through the words that come out of your mouth. Your face has a lot to do with that and the emotion that you express. Get a lot of cues by looking at someone's face. And meaning especially the social implications are not all in the words. And, Dr. Matt Spackman again, helped us with this and we decided to probe how well about 6 to 11-year-old children with language impairment and their typically developing peers could read the emotions on faces. And we found out that they may do okay with the more basic emotions, like happy, sad, mad, but when we get to things like disgusted and surprise, it's more difficult. See what I mean? So. Happy? Easy, right? I'm not having much trouble with this one. Sad? You know this, sad. But what about, disgusted? Grossed out? Can you interpret that? Or, surprised? These are a little bit more difficult that children with language impairment don't do as well on these. Now you could ask, well so what? You know, if you can read happy, mad, sad, aren't those kinda the basics? And, and wouldn't you be okay? But, you know, if you can't read the emotion on faces quickly and accurately, you're gonna have a hard time negotiating the social landscape. Let's say you want to bring a treat to a friend and you hand the friend a bag with your mom's special sushi inside. You watch your friend's face as he or she opens up the bag. Does it matter if you can tell the difference between disgust and surprise? Yeah, that matters a lot. It matters a lot. And if you can't tell the difference, or if you're unsure about that, you're going to make a lot of wrong turns in conversation.

 

            Now, this is kind of a basic aspect of emotional competence. I mean, even babies learn to read faces to some extent. If you smile at a baby, you get a different response than if you give them a really mean look. Which I wouldn't recommend, but experimentally, some of us have had to try this to see what would happen. Only with our own babies, though, so it's okay. It's part of emotion understanding but it's kind of basic, so we thought, we've looked at some other kinds of things too like porosity. What's carried in the intonation of your voice? How can kids understand that? And also, we've looked at how well they could, um, tell or anticipate what kind of an emotional reaction a specific situation might elicit. In other words, if somebody thinks he might fall off a cliff, how would he feel? But we've looked at those kinds of things. But one really fun task that I wanted to show you about today has to do with emotional dissemblance. And answers the question, can you hide what you feel? If we think about the way that we display emotion to others, sometimes we show how we feel and sometimes we hide that. And hiding that emotion is called dissemblance. Now this is what you learn to do when your brother gets in trouble. Now you may really enjoy it, but you don't want to look too happy, or you don't want to look too self-satisfied, or your parents might get after you too. So what you want to do is you want to look grieved with the level of his sin. Or victimized by what he's done, but you don't want to look just jazzed cause he's finally getting what's coming to him. So you will hide that emotion.

 

What if your very favorite aunt, whom you love dearly, gives you a sweater for your birthday that she's knit, and it's really, really ugly? It's not easy to dissemble your emotions. To do that, you have to first understand your own emotion. You have to know kind of where you are. Then you have to know about the display rules. And that has to do with what's conventional in your culture and your society. What can you show here? What's it okay to show and what's it not okay to show? You have to be able to perspective take, to know how what you show on your face is going to be received by the person you're talking to and what it might do to your relationship. And you have to do something; you have to realize that you might want to protect the feelings of others to protect a relationship in some way. And this is hard. This is hard.

 

So what we wanted to do is we wanted to give kids some scenarios that they could understand, where one would feel an emotion that one might want to hide for social purposes. So, we want to know 2 things out of that. We'd want to know, 1.) Would kids recognize the social convention? Would they recognize what they should do? And number 2.) Would they do it? Or would they recommend doing it? So should they, 1.) Know that they ought to dissemble their emotions and number 2.) Would they indeed dissemble them? And we found a way to probe this indirectly, so that the language demands would not be too great for the kids. So we use very simple language, we make sure they can understand the language, and we give them ways to respond where they can either talk or they can point to some pictures so that we remove some of the demands that way. And we compared typically developing 7 to 11-year-old children, kids with language impairment and typically developing kids.

 

            Now first, we introduce Chris. Said now, I'm going to tell you some stories about Chris. And they just see the picture; they don't see the words, so they don't have to read anything. Iím going to tell you some stories about Chris. I want you to point to how Chris feels. For some questions, we'll use our cards, so that's one where they can just point if they want to. For other questions, you can just tell me the answer. So they can respond any way that they respond any way that they want to. This is Chris. This is Chris' mom. Chris' mom always cooks something good for dinner. One day, Chris' mom is sick. She has to stay in bed. The next door neighbor, Mrs. Smith, brings dinner for Chris' family. Mrs. Smith brings a tuna casserole. Chris thinks that tuna casserole is very yucky. Ok? Then we ask, "how does the casserole taste?" This is a comprehension check, we want to know if the kid picked up on the story or not, and virtually all the kids that we tested said "yucky, disgusting, gross, he doesn't like it." And one kid said, "According to Chris, it isn't very good."

            2.) "How does Chris feel?"

            The kids will say, "Disgusted, sad, mad." We were going for disgusted there, but we got a number of negative emotions. Everybody knew Chris wasn't happy by the sad, mad, disgusted. Any of those would do.

 

            And then we'd ask, "What should Chris say to Mrs. Smith?" Here's where the rubber hits the road. What would these kids recommend doing? And then the next one, "What would Chris' parents want him to do?" And this question probes what the kid knows about the social convention, cause we figured, you know what your parent tells you to do is what you would figure the social convention was. I just love this task; I think this is just a kick. But I've been doing research a long time and I guess this is as entertaining as it gets for me, you know. This task is hard for kids. It was hard for all of the kids that we tested. We basically got 3 different kinds of responses. There are some kids who did not know that they ought to hide that emotion and therefore didn't hide it. There are some kids, a lot of kids that knew that their parents would want them to hide that, but they did not indicate that Chris should do it. So, you know, I know what the convention is, but I'm not gonna tell her it's good. You know, that kind of thing. And a few kids knew the convention, and said that they would hide it. So, let me give you some examples from a kid who could dissemble.

            "Say, how does the casserole taste?"

            "He doesn't like it."

            "How does Chris feel?"

            "Um, mad, probably."

            "What should Chris say to Mrs. Smith?"

            "He should probably just say thanks and if he doesn't like it, he should just keep it to himself."

            "What would Chris' parents want him to do?"

            "Just say he really liked the casserole."

            This kid knows that this is what we should do and they can connect that and they know the convention. How about a child who knows the convention but can't dissemble it?

            "How does the casserole taste?"

            "Very yucky."

            "How does Chris feel?"

            "Mad."

            "What should Chris say to Mrs. Smith?"

            "That he thinks it's disgusting and he doesn't wanna eat it."

            "What would Chris' parents want him to do?"

            "Um, eat it."

 

            Those kids know, how, I really love that. Cause sometimes we'll get things like, "Tell her he's allergic." Or, "I'm not hungry right now," "What did you put in that?" You get various sorts of things. Now, one thing that I should note here is the sophistication of the response in terms of language doesn't matter in our analysis system. So a kid who says, "Well, I think it's pretty disgusting and it probably has preservatives in it and no one should eat that," would be graded the same as the kid who says, "Hates it." So the level of language doesn't matter here. But the emotion that they're conveying does matter. Look at this one, this is even better. This is Chris. This is Chris' grandma. Chris wants to be a dinosaur for Halloween. He wants his costume to be really scary. Grandma's been working for weeks on Chris' Halloween costume. Grandma finishes the costume and shows it to Chris. It is a Barney costume. Yeah, it reminds you of Ralphy doesn't it? In A Christmas Story, and the bunny suit? Yeah. Yeah, it's part of our culture now. The questions are, "What kind of costume does Grandma make?"

            Virtually all the kids say, "Itís a Barney costume."

            "How does Chris feel?"

            Most of them go, "sad, bad, mad." But they know Chris isn't happy.

            And then, "what should Chris say to his grandma?" Now here again, if you can dissemble, you say you like it anyway.

            One child said, "He should probably keep his thoughts to himself if he's mad at his grandma."

            And then that's probably true, but if you can't dissemble, you say, "It's not scary enough."

            "He doesn't like it."

            "Grandma, I want to be a dinosaur, not Barney. I hate Barney anyways."

            "He should say he doesn't like it cause Barney's a little kid's thing."

            And, one other kid says, "Well, he could tell her to put some scary mouth on it, and make the eyes meaner, and take off the purple too." But, that's not dissembling.

            And then the question, "What would Chris' parents want him to do?"

            A lot of the kids knew. "Wear the costume."

            "Say thanks."

 

            Or one kid says, "Be happy." How 'bout that? So, here again, some kids don't know that they should dissemble that, they don't understand the social convention. And here again, you know, we're probing this second-hand, we're not actually watching what they do, cause this would be a very hard behavior to capture in a natural setting. I mean to get very many instances of that would take a really long time to do. So we have to devise these experimental tasks to do that. But I mean, we don't know for sure what the parents would really tell them to do. But we can make some assumptions as a group, and judging by how many kids thought their parents would want them to dissemble,  it was probably not a bad task at finding that out. So the results of this, we found out the dissemblance is hard for kids, hard for all kids. And, only some older kids could do it really well. And we found out that a lot of kids knew what the social convention is, including some, a lot of the kids with language impairment. But they did not advise following it. Kids with language impairment found it harder to dissemble than did the typically developing kids. Here's one more thing that was harder for them. Sometimes, they didn't recognize that they should dissemble, and other times they recognized it but they just didn't seem to think that was necessary for them. So, what does it mean? Well obviously, if you can't dissemble you're gonna put your foot in your mouth quite frequently, socially. You know, if you don't know you should dissemble, you might not be able to figure out why people are offended. You're gonna go through your life offending people and having no idea why you did that. You know, this is not just a matter of civility or trying to be charming, this is a matter of perspective taking, about learning about the social landscape and what you need to do. Being able to appreciate, understand the emotions of others as well as your own, and to gear your language to the feelings and needs of another person. That is extremely important. It matters a lot. So kids with language impairment have trouble with language, but they also have social problems. And these social problems cannot be ignored because they don't get better by themselves. They have trouble with basic stuff like reading faces, and they have trouble with the harder things like dissembling emotions. Now, these difficulties with emotion competence make the social world very difficult to navigate. We have one individual that we have followed from age 4 and 1/2 through 19. And at 18 he described his social competence with respect to that of his peers by saying, "It's like they're driving sports cars, and I'm on a tricycle." He knows he's moving forward but he just absolutely cannot keep up. Just very difficult.

 

            Now what we have done traditionally as speech language pathologists and special educators for these kids may not be enough. Traditionally, we have worked on their language. And we've found we've especially helped them with structure. Just put sentences together and to learn new words. And that's important, but it isn't enough. There really isn't a good reason to believe that learning better language all by itself is going to help you socially, we haven't seen that and we can't count on it. These kids need specific help with social communication. They need treatment to enhance their social communication and emotional competence. It looks like it's going to be an important factor in there, and they need help with these basic emotion tasks. These kinds of things are learned. Kids learn them in the course of development, so if they're learned, it ought to be something that we can help them learn a little more quickly to help them communicate with others. Intervention programs can and should address social communication and language structure simultaneously. As speech language pathologists, we can do this at the same time. We can work with the language structure, with the words and the sentences, how they're put together, and we can work with the social impact of what the children are saying.

 

We've done some cool things in our clinics and innovative things to come up with some kinds of treatment mechanisms. For example, we had a very clever graduate student a year or two ago who was working with an adolescent with language impairment who had a lot of social problems. He had a lot of trouble trying to understand the emotions of others and understanding that he needed to dissemble. So she got together with her husband and some friends, and they made a series of films and videos for this young man to use in therapy. And these videos depicted 2 missionaries, missionary companions. And one was socially adept, and the other one had some real social problems. And in one scene for example, they go into somebody's house for dinner, they have dinner, they're served something unusual and the missionary who is not adept says, "Oh, yuck, I don't like this!" And then the hostess shows her emotions, and it shows his companion's emotions. And then they would turn that off and, and go over it afterward and say, what happened here? How did the people feel? Why did this happen? What should have happened, how could we negotiate this better? Then they would role-play some different scenarios, because I mean, there's a real live situation where if you don't like the food, don't show it. You should be gracious about it anyway, and learn to like a lot of things you never ate before.

 

            So, you know, these are kinds of real world things where we're working with how his language sounds, but we're also working with how he uses it in real conversations. As a mother of a child with language impairment explained to me, "If you can have a conversation, you can have a relationship." And that's what we'd like to help make happen. Thank you.