Communication is Key: Improving Participation for Adolescents with Communication Disorders (October 2021- Edition 06)

October 2021 Edition (06)

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Communication is Key: Improving Participation for Adolescents with Communication Disorders

AN INTERVIEW SUMMARY WITH Stefano Rezzonico

Stefano Rezzonico Ph.D.

Assistant professor, School of Speech-Language Pathology and Audiology, Université de Montréal

Researcher, CRIR–Institut universitaire sur la réadaptation en déficience physique de Montréal (IURDPM), Laurier Pavilion, CIUSSS du Centre-Sud-de-l’Île-de-Montréal

 

CLEA Laboratory — Communication and Language in Children and Adolescents

 

 

Let’s jump right in! Tell me the story of the project “Megaphone” …

Yes! “Megaphone” is a clinical group program of 8 adolescents with communication disorders, 1 speech-language pathologist and 1 social worker. The goal of the program is to use artistic activities – film in this cohort – to help improve communication skills in the adolescents with communication disorders. For 8 weeks (2.5 hours once a week), the group met up in person, discussed what types of films they liked and wanted to make, wrote a script, filmed and edited a short movie. As for the research component, we added 2 more weeks to the program (1 at the beginning and 1 at the end, for a total of 10 weeks) in order to add some questionnaires evaluating their language use as well as social anxiety. We also placed two cameras in the room to record and observe what went on during the sessions.

Where did the idea for this project come from?

The group program itself was not my idea. In this particular case, I actually saw it at the IURDPM Carrefour de connaissances! It’s a program that already existed in the Adolescent and Young Adult Program at the Institut Raymond-Dewar (IRD) and Jessica Swallert, a speech-language pathologist was presenting a poster and I told her “Wow! This is exactly what I’m interested in as a researcher, the pragmatic side, can we collaborate?”. So, we applied to CRIR’s New Initiatives program and once we received the grant we started a new cohort where I was able to add in research evaluations around language and social anxiety.

What was your biggest challenge?

Megaphone was a pilot for many things and a pioneer in many ways. There is not much data or many tools in the literature for understanding how language functions in adolescents, so one of our major questions was precisely, how do we evaluate language in adolescents with communication disorders?

Adolescents are a bit left out when we talk about communication skills in the literature. For example, in an international conference on the development of language, you’ll see roughly 60% of presentations about children under 5 years old, 40% about elementary school age, and then only 4 presentations on adolescence. A lot of research and clinical tools are validated for up until 16 years old and the ones that start at 16 years are more for individuals who have had a stroke or a traumatic brain injury. But what about from a developmental perspective? It’s not the same thing. In that respect, Megaphone was very interesting because we had to develop tools on-the-go to evaluate things like communication, interaction, etc. This actually gave way for a bigger theoretical project funded by the Social Sciences and Humanities Research Council (SSHRC) which is underway as we speak.

What surprised you the most about the results of Megaphone?

There were two major things got us excited. First, was in regards to social anxiety and the avoidance of certain communication situations. For some adolescents, at pre-test they told us they didn’t avoid communication situations and then at post-test they said they did. But let me explain, I don’t think it was the intervention that made them avoid situations, I think it just made them realize they were avoiding them. For example, in a pre-test questionnaire they would say “yes” to ‘does this situation make you scared?’ and “no” to ‘do you avoid it?’ but then post-test it became “yes, it scares me” and “yes, I avoid it”. I think the intervention gave them a better awareness of how they manage their anxiety and that was something we didn’t expect.

The second thing was the power of the pauses. Over the 2.5 hours at some point, they would take a little pause, eat some chips, talk a little, etc., and it was in these pauses where they put in practice their objectives. Each person had their own mini objective for the day, for example, ‘talk to 3 people’ or ‘ask someone what their favourite film is’, and it was in the pauses where they completed those tasks. This was exciting because the clinicians hadn’t originally planned the pauses in their program so moving forward it’s definitely an element to maintain and spawned numerous questions to research further!

It seems like your collaboration with clinicians is a key component of this project. Do you always collaborate with clinicians?

I’m a non-clinician researcher, so it’s really clear to me that my role is to look for the literature, bring evaluation instruments to the table, brainstorm for the methodology and how to validate and measure things, do the statistics, etc. But I don’t have the impression that the clinical interventions belong to me, I’m not the one who intervenes with the children. It’s like I am a hammer builder but not a carpenter; I build the hammer and then you use the hammer to make your house as you wish. Similarly, it’s not my job to tell people how to intervene, but I am here to help so that we can evaluate together with an objective eye. This is where the collaboration is extremely fruitful. Clinicians have a very developed antenna; they know a lot of things and in this case, they’re probably a bit ahead of the literature. I feel lucky as a researcher to be able to study this because I feel like it’s coming out of years of practice. With that being said, I’m more detached emotionally so it’s also a little easier to say “listen, it didn’t work” if need be, but I think they’re all good programs and projects or else I wouldn’t be spending my time on it.

We are actually currently starting up a new project in collaboration with clinicians, also funded by New Initiatives, where we will be evaluating the “Je me raconte” intervention in the Language and Auditory Processing Disorder program at the IRD. The intervention has been offered for roughly 10 years now for children between 7 and 12 years old with the goal of facilitating and encouraging their storytelling abilities. I’m collaborating with Elin Thordadottir, Ph.D. and with the help of the Clinical Research Coordinator, Patrizia Mazzocca, we spoke to the program director a couple years ago about our respective interests and now, here we are with a research project we are all engaged in. So, to come back to your question, I regularly work with clinicians and I love it!

Given that you work with minors, can I assume that parents are also a large part of your work?

Absolutely. With “Je me raconte” we are working with parent-child dyads so parents will be participants as well. But even if they are not formal participants, they can have a strong influence on our work. For example, in Megaphone an adolescent mentioned at post-test that their mother noted their speech was getting better. It seems anecdotal but it’s really making us think of the importance of parents’ perceptions on the confidence and progress of our participants and how best to evaluate that. Parents can also influence recruitment. Many parents tell us “My child needs this and it’s not a group that can provide it” but you’d be surprised how much a group intervention can have individualized benefits. The Megaphone group allows them to practice with others who are their age; to be confronted by other adolescents, to help them and to be helped by them, to observe how others work through their difficulties, etc. The quality of a group intervention is not lower just because it’s cheaper.

Talk to me about the future…where are these projects taking you next?

Megaphone launched about a million new questions and the pandemic launched hundreds more! Questions like, how does the intervention change if it were to take place online? What about a video gaming intervention for adolescents? Would virtual reality increase engagement and participation in the program? Could this program take place in a community setting? Could it transfer easily to other speech and language pathologists in another CIUSSS? Do the adolescents stay in contact after the program has ended? Currently, it’s all in French but could we imagine a bilingual group? Or a group with more attention to cultural diversity? How can we have a partnership with the school system?

 

We’ll be continuing to do more pilot projects to further define these research avenues and then hopefully get some larger grants for larger cohorts that can have a greater effect on the literature!

 

Wow. You certainly have your work cut out for you! Is there anything else you’d like to share today?

Our social system is based on the fact that we communicate. A society exists because of communication. To be a citizen, you need to be able to communicate. For example, to have an active life, to have a life partner, to work, to vote, it pretty much all happens around communication. Communication really is key! So, I think it’s our responsibility as a society to create an inclusive, safe, and supportive communicational environment which allows everyone to express themselves and participate.

Stefano, thank you so much! It’s been a great pleasure learning more about this incredible research and I can’t wait to see how things advance. Best of luck in your continuation!