But I Need to Hit Him!

But I need to hit him!
I swear I turned my head for just a second. Michael launched himself across the game board we were using at Nick. The board, pieces, cards went flying. I caught Michael mid leap, holding him securely. He struggled wildly saying, "But I NEED to hit him!". Nick repeated over and over, at higher and higher volume, "It's four spaces for red!". Krista wandered over to check out the window blinds while Jackie retrieved and lined up the scattered game pieces.

Michael was more "traditionally" language impaired; short sentences, poor grammar, disorganized explanations and descriptions, thus not often communicatively successful with his grade one peers. The other group members had reasonably good sentences and grammar, and excellent vocabularies. Social language skills were harder. Knowing when to talk, what to say, sharing attention and looking and generally letting others know they were engaged and participating. The group had been a good experience. The students were learning to wait, listen, look, initiate, take turns. Sometimes they needed a lot of support to set them up for success; reminders to look, adjustments of body posture, models of what to say. In this group, Nick was the "rule policeman". It was important to him that the correct number of spaces were moved, the order of turns exact, and the timing of the game, according to his internal timetable, be respected. He was constantly "helping" the others move their pieces and telling them what to do. We were working on helping Nick think about why his friends did not like this and modeling different strategies. Michael's sense of fair play was particularly affronted by Nick's interference. Today Michael, in his excitement to play, had taken Krista's turn. She did not notice. As I turned to her to guide her to notice, indicate, and tell her friends appropriately, our "rule policeman" sprang into action. He took Michael's piece off the board, and substituted Krista's red piece. But he did this silently, not looking at Michael, not saying "Hey, it's Krista's turn!" It was too much for Michael. Chaos.

In terms of social interaction and reaction, Michael was appropriate. In terms of game rules, Nick was correct. But in terms of social language comprehension and expression, what a mess.

Social language group therapy is challenging. Even in a small, highly structured therapy group, there are so many factors contributing to the smooth, natural looking social experiences we take for granted. For our social language impaired students, nothing can be taken for granted. In school and at home they are often told what to do, but these instructions may be only superficially understood. "Wait your turn"' , "It's not your job to tell the rules"', "Look at me when I am talking to you!". They struggle to comply, but often do not remember. After all, the pieces are not in the right order, he didn't move the right number of spaces, and who should I look at again? So confusing.

Is it possible to break down these subtle, fluid social skills, teach them, then build social language competence? I believe it is, but it does require constant examination of your perceptions of social success and failure, and a willingness to try and try again. Michelle Garcia Winner has it right I think, when she puts such emphasis on perspective taking. Your social success depends upon being able to appreciate and react to others' perceptions of your behavior, and your understanding of their motivations and thus behavior. This is true for all of us. Imagine if your brain just does not make those connections by itself? The speech language pathologist has a responsibility to address social language impairment as vigorously as sentence structure and grammar impairments. It is as crucial to communicative competence.

But was it wise to mix the social language impaired students and the expressive language impaired students in the same therapy group? Maybe not, in this case. It was also not wise to conduct this group without support, a therapy assistant makes for more effective treatment. Things you learn through experience.

It is encouraging to see more clinicians taking up the social language challenge. Evidence based treatment means integrating the client's perceptions and needs into the treatment plan, along with the best evidence and our best clinical judgment. This therapy is difficult, the concepts slippery, the implementation a definite work-in-progress! But the field demands our effort, and the children deserve it.
Michael didn't hit Nick. Play resumed. Everyone went home happy. I needed a cup of tea.