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Since 2016, separated parents in Sweden are expected to pay child maintenance directly to each other unless special reasons, such as intimate partner violence (IPV), can be invoked. Problems with maintenance payments, which may involve expressions of financial abuse, have become a common topic in interactions between parents and the Swedish Social Insurance Agency (SSIA) that handles these cases.

This article examines 132 phone calls to the SSIA and the results show that payment problems are typically framed as relating to inability or negligence, and not as possible indications of abuse. This highlights the need for training and capacity building regarding IPV in the Swedish welfare state.

Background: Parents with intellectual disability are vulnerable to parenting stress and overwhelming life events. The Covid-19 pandemic constitutes a potentially overwhelming event, but there is little knowledge concerning the effects on parents’ caregiving. The present study aimed to fill this gap.

Method: Semi-structured interviews with ten Swedish parents with intellectual disability were analysed using thematic analysis.

Results: One broad caregiving-related theme: Increased caregiving demands and reduced resources for coping resulting in strained parent-child interactions and relationships. Four subthemes highlighted influential factors: Pandemic information; professional support; social relationships and informal support; and children’s school activities. Strained parent-child interactions were particularly common in the absence of adapted pandemic information, if professional and informal support were compromised, and if the parents had dealt with school-related changes.

Conclusions: Findings support contextual models of caregiving and a stress-resources perspective, and emphasize the importance of adapted information and support to parents with intellectual disability during crises.

Bakgrund: Icke-talande barn med svår CP och utvecklingsstörning kan få en röst tack vare högteknologiska samtalsapparater. I Sverige är det företrädelsevis logopeder som förskriver samtalsapparater och som informerar, instruerar, tränar och följer upp användning av samtalsapparaten. Logopeden ger direkta insatser till barnet och indirekta insatser till kommunikationspartnern (såsom vårdnadshavare, lärare och assistenter). Ett hinder för kommunikation med stöd av samtalsapparaten är för lite och även bristfällig professionell support till kommunikationspartners, vilket kan leda till underanvändning. Den professionella supporten omfattar tex. val av vokabulär, programmering, målformulering samt direkt och indirekt träning av kommunikation med stöd av samtalsapparaten. Syfte: Att undersöka logopeders, vårdnadshavares, lärares och assistenters praktiska erfarenheter och uppfattning av kommunikation med stöd av högteknologisk samtalsapparat. Metod: Enkät till logopeder, vårdnadshavare, lärare och assistenter till barn med svår CP (GMFCS IV-V) och utvecklingsstörning. Deskriptiv och jämförande statistik samt deduktiv innehållsanalys med komponenter ur ICF-CF. Resultat: Deltagare (n=64) från hela Sverige besvarade enkäterna. Logopederna hade få besök med barnet respektive kommunikationspartnern. De använde muntliga instruktioner och modell, sällan feedback för att instruera kommunikationspartnern. Personalen (lärare och assistenter) fick mer support och använde kommunikationsstödjande strategier mer än vårdnadshavarna. Barnens dagliga användning av samtalsapparaten var högre med personal än med vårdnadshavare. Personalen upplevde att samtalsapparaten underlättade barnets delaktagande i undervisningen. Vårdnadshavare rapporterade optimism, tidsbrist och orkeslöshet. Rapporterade hinder var relaterade till barnet samt till omgivande faktorer (samtalsapparaten, support från professionella samt kommunikationspartnern). Slutsats: Barn med svår CP och utvecklingsstörning kan ha stor nytta av högteknologisk samtalapparat, men stödet från logopeder till kommunikationspartners behöver förbättras. 

Kommunikation med stöd av samtalsapparat kan bidra med ökad delaktighet för personer som saknar tal, men det kan vara problematiskt eftersom: (1) det tar längre tid än att producera tal, (2) vokabulären är ofta begränsad och bestämd av ngn annan och (3) bidraget saknar prosodiska ledtrådar vilket kan försvåra förståelsen. En viktig kontext för barn och ungdomar är skolan: de behöver får möjlighet att visa kompetens, inhämta kunskap och att umgås. Både lärare och elever har rapporterat om svårigheter och begränsningar att implementera samtalsapparater i helklass, men kliniska exempel visar att det är möjligt. Det är av stor vikt att identifiera dessa goda exempel och analysera dem för att kunna bidra med kunskap som kan leda till förbättrade insatser för dessa barn och ungdomar.

Syftet var att undersöka hur flerpartsinteraktion i klassrum är organiserad när en av eleverna kommunicerar med stöd av en samtalsapparat. Data utgjordes av videoinspelningar (2h 40 min) som analyserades med Conversation Analysis (CA). Deltagarna var två ungdomar med svår cerebral pares och utvecklingsstörning som kommunicerade med stöd av ögonstyrda samtalsapparater samt deras assistenter, lärare och klasskamrater.Studien visade att flerpartsinteraktion i klassrum underlättades om: (1) en tydlig turtagningsorganisation praktiserade, (2) frågor med välkända svar ställdes, (3) eleven hade ett anpassat vokabulär i sin samtalsapparat samt (4) läraren/assistenten använde skärmorienterande stöttningspraktiker. Slutsats: barn och ungdomar kan delta i flerpartsinteraktion i klassrummet med stöd av en ögonstyrd samtalsapparat förutsatt stöttande praktiker från lärare/assistent. Dessa praktiker är till viss del andra praktiker än de som gynnar den individuella språkutvecklingen. 

The overall aim of this thesis was to investigate the use of speech-generating device (SGD)-mediated interaction with children with anarthria, severe physical impairments and intellectual disabilities due to cerebral palsy with a focus on partner strategies and social practices.

Studies I and II were cross-sectional studies that used questionnaires, which were analyzed using descriptive statistics and directed content analysis. In Study I, speech and language pathologists’ (SLPs) practices and perceptions of communication partner training in SGD-mediated interaction were examined. In Study II, communication partners’ (i.e., caregivers’, teachers’, and assistants’) practices and perceptions of communication partner training in SGD-mediated interaction were examined.

Studies III and IV were qualitative observational studies that used video recordings, which were analyzed with ethnomethodological conversation analysis. Study III investigated how multiparty classroom interaction was organized when one of the students used an eye-gaze accessed SGD. Study IV explored the social actions that mobilized SGD-mediated responses when the child was a beginner user of the eye-gaze accessed SGD.

The findings suggest the following: all participants (i.e., SLPs, caregivers, teachers, and assistants) considered that SGD-mediated interaction was beneficial for the children. SLPs were important providers but they provided few training sessions and used mostly verbal instructions. Communication partners could benefit from more support from SLPs and SLPs should consider using additional instructional approaches such as feedback and role-play when coaching communication partners in SGD-mediated interaction. Children could interact with their eye-gaze accessed SGDs in multiparty classroom interactions provided that the turn-taking in Initiation-Response-Evaluation (IRE) sequences was applied and that the teacher or the assistant provided contingent on-screen gaze and deictic scaffolding actions. Communication partners to children who were beginner users of an eye-gaze accessed SGD may need to produce repeated turn transition relevance places and use contingent on-screen gaze and deictic practices to scaffold an SGD-mediated response.

This thesis brings new knowledge to the field of SGD-mediated interaction. Partner strategies that can enhance children’s linguistic skills were seldom used in multiparty classroom interaction, but other social practices were used, which facilitated social inclusion and participation.

The preconditions for communication with eye gaze accessed speech generating device (SGD) is different compared to typical talk-in-interactions. Firstly, gaze practices are needed in the production of the SGD-mediated contribution, which affects the typical use of gaze practices in the face-to-face-interaction. Secondly, the prolonged time producing an SGD-mediated contribution can contribute sequential and temporal challenges for both aided and naturally speaking conversational partners. Consequently, eye gaze accessed SGD-mediated interaction can imply specific challenges for both conversational partners.

This study investigated how classroom interaction was organized when an eye gaze accessed SGD was used by one of the participants. The participant using the SGD, Anna, was 15 years and had physical and cognitive disabilities due to cerebral palsy. She communicated through gaze practice, facial expression, vocalization and the SGD. Anna had no oral speech and could not read or write. Data is from a lesson in general sciences. Apart from Anna, there were five other students, three teaching assistants and one teacher in the classroom. All but Anna and another student were aided speaking and used SGDs.

Data was collected using video recordings at Anna’s school June 2018. Two cameras were used to capture (1) the SGD screen and (2) Anna and her speaking partner. The interactions were transcribed and analysed using the methods and principles of Conversation Analysis (Sidnell 2012; Higginbotham & Engelke 2013).

Overall, data showed that teacher-initiated Initiation-Response-Evaluation sequences (IRE) was frequently used in the classroom. The teacher used naming, pre sequences and reformulations in interaction with Anna. These practises provided a Turn-Relevance-Place in which Anna could respond with the SGD.

Being able to respond to and ask questions in teacher-fronted classroom talk is important for learning and assessment, as well as for student participation and social inclusion. About 8% of all students have a developmental language disorder and a subgroup even lack speech (Norbury et al., 2016). For those students, a speech-generating device (SGD) can be used to replace speech. SGDs provide students with enhanced opportunities to participate both in education and leisure time contexts. Despite the huge advantage that an SGD may offer, research shows that SGDs are seldom used in multiparty classroom talk. When they are used, a supportive environment is required, including for example teachers’ scaffolding practices (Tegler, Demmelmaier, Blom Johansson, & Norén, 2020). 

The aim of this study is to generate knowledge on interactional practices, organizations, and vocabulary that facilitate student-initiated (Waring, 2011) SGD-mediated questions in teacher-fronted classroom interaction. Specifically, we are interested in SGD-mediated student questions that are not preceded by an invitation or prompt from the teacher. 

The theoretical framework and methodology of ethnomethodological conversation analysis (EMCA) is used for detailed analysis of question design in multiparty interactions. 

Method: Data comprise of 18 hrs of video recordings of multiparty classroom lessons in nine special schools in Sweden. Twenty-three non-speaking students and their classmates, teachers and assistants participated in the study.

Findings: The analysis shows that of the 233 SGD-mediated contributions that we identified in our data, 11 were student-initiated SGD-mediated questions. These questions were produced by three students. SGD-mediated interaction faces several challenges. First, the production time is prolonged compared to speech, which means that a contribution (e.g. an answer or a question) easily receives a sequentially misplaced position in the ongoing interaction, which may cause misunderstandings. Second, if the student is illiterate someone else has to choose and arrange the vocabulary (e.g. drawn pictures). Having a limited vocabulary increases the risk of producing ambiguous contributions. Against this backdrop, the results of our study are discussed in four parts: (1) the linguistic structure of the contributions, (2) the sequential organization of the contributions within ongoing classroom talk, (3) the contributions’ topical relation to other talk, and (4) their interactional functions. 

Relevance to Nordic educational research: The study examines non-speaking students’ unsolicited SGD-mediated questions in multiparty classroom talk, which is sparsely studied. The study illustrates teachers’ challenges in promoting inclusive education and social inclusion for non-speaking students at the expense of progression and advancement. Furthermore, it contributes knowledge of how teachers with non-speaking students in the classroom, manage several dilemmas as they make “here and now” pedagogical judgements on inclusive practices.

References:

Norbury et al (2016). The impact of nonverbal ability on prevalence and clinical presentation of language disorder: evidence from a population study. Journal of Child Psychology and Psychiatry, 57(11), 1247-1257. 

Tegler et al (2020). Creating a Response Space in Multiparty Classroom Settings for Students using Eye-gaze Accessed Speech-Generating Devices. Augmentative and alternative communication, 36(4), 203-213. 

Waring (2011). Learner initiatives and learning opportunities in the language classroom. Classroom discourse, 2(2), 201-218.

Conversation Analysis was used to explore how teachers, personal care assistants, and students organized inclusive multiparty classroom interaction when one of the students in the classroom used an eye-gaze accessed speech-generating device (SGD). Scaffolding and collaborative practices that created a response space for the construction of the eye-gaze accessed SGD-mediated turn were identified and analyzed. The participants were two adolescent students with severe cerebral palsy and intellectual disability who relied on eye-gaze accessed SGDs, and their teachers, personal care assistants, and classmates with intellectual disabilities. The data consisted of 2 hr and 40 min of video recordings collected in the participants’ classrooms. Three practices were identified (a) the practice of explicit turn allocation organization and the use of display questions, (b) the practice of locally contingent on-screen scaffolding activities, and (c) the practice of dealing with turn competition by classmates. Teacher and assistant practices differed with regard to the student’s access to the vocabulary relevant to answering the teacher’s question. The practices were found to create a response space for students using SGDs accessed via eye gaze, thereby ensuring their educational inclusion in the classroom.

Interaction mediated by speech-generating devices (SGDs) may promote participation and independence for non-speaking children, but developing skills to use the SGD is time consuming and demanding. The present conversation analysis study aimed to identify features of interactional projects that mobilized SGD-mediated responses by two children with intellectual disability who were beginner-level users. The children and their professional communication partners were video recorded when interacting in an institutional setting. The analysis shows that SGD-mediated responses were mobilized by multimodal and sequentially organized actions combining different types of spoken initiatives, SGD modelling, and embodied resources that facilitated SGD use and hence participation. These results indicate a need for communication partners to use a wide range of practices to facilitate SGD-mediated interaction.

This study examines recent changes in Swedish regulations for child maintenance in relation to post-separation families with experiences of either intimate partner violence (IPV) or conflict. The reform limited the possibility to rely on the state for maintenance in cases of cooperation difficulties. For IPV cases, the Swedish Social Insurance Agency (SSIA) can function as an intermediary between parents, but such exceptions are made upon assessment and require disclosure of IPV. This study investigates consequences of the maintenance reform and the ways in which it may re-actualize conflict and IPV between separated parents. Data consist of 649 recorded phone calls (~ 55 h) to the SSIA concerning maintenance. Disclosures of post-separation conflict or IPV were found in 132 of these calls; these calls were analyzed using thematic analysis. The maintenance reform’s requirement to reinstate contact with a former partner can re-actualize experiences of parental conflict as well as IPV by (a) re-surfacing physical or psychological abuse; (b) continued or accelerated cooperative difficulties; (c) renewed financial control; and (d) ‘paper abuse’ and new possibilities to display diligence or exert camouflaged control. This can take the form of explicit acts of abuse, anxiety or concern caused by the renewed contact, or being forced to deal with difficult memories. We argue that the Swedish maintenance reform ignores the reality of parental conflicts and IPV by re-actualizing such experiences in a range of ways.

This paper uses conversation analysis to examine 671 calls to the Swedish Social Insurance Agency (SSIA), where separated parents raise concerns related to child maintenance. Parents in Sweden must sort out maintenance themselves but the SSIA can intervene if there is a history of domestic violence that make contact problematic. Where this is the case, the abused parent must disclose it to the SSIA officer. Our analysis shows that parents’ descriptions tend to be implicit and non-specific, which confirms what previous research in other institutional settings has found (Tennent & Weatherall 2019). In our data, orientations to violence are built in a step-wise manner, incrementally adding information that makes violence inferentially available. In most cases, however, call-takers respond minimally and do not treat violence as relevant, and callers must do considerable work to establish it as such. In the few instances where call-takers ask about violence, it is done with a preference for denial, placing additional burden on callers. Our findings highlight the need for training, both in recognizing variations of domestic violence and for developing communication skills relevant for facilitating disclosures.

References

Tennent, E. & Weatherall, A. (2019), Disclosing violence in calls for help. Gender & Language 13(2): 270-288.

In Sweden, family policies strongly promote gender equality and children’s rights. Post-separation child maintenance is underpinned by parents’ shared legal responsibility and the assumption that children benefit from contact with both parents. According to these regulations, the liable parent pays an agreed monthly amount directly to the resident parent and public authorities are not involved. However, if there is a history of violence in the family, or if the liable parent does not pay, the Swedish Social Insurance Agency (SSIA) can function as an intermediary between the parents to make sure that children receive necessary financial support. This means that parents with experiences of such problems must disclose them to the SSIA, and the need for the SSIA to step in is then re-assessed every six months. 

We argue that this scheme ignores the reality of gender inequality, parental conflicts, and intimate partner violence. For this analysis, we draw on a corpus of 649 recorded phone calls (~55 hrs) from parents to the SSIA. Post-separation conflict of some kind was disclosed in 133 of these calls, which were analysed thematically. Our analysis focuses on how violence is re-actualised in separated families through regulations and routines that facilitate economic abuse. We show how the SSIA in practice encourages parents to be in contact also in cases of possible violence, which may increase risks. Meanwhile, disclosures of experiences of violence to the SSIA can be traumatic. To avoid re-actualising violence, abused parents may abstain from maintenance, which may bring financial hardship.

Using the framework of conversation analysis, this paper examinesaided-speaking students’ unsolicited speech-generating device(SGD)-mediated questions in teacher-fronted classroom talk. Theanalysis draws on a corpus of 18 h of video-recorded classroominteractions including 23 aided-speaking students using SGDs orpicture-based communication boards. In all, 5% of the students’contributions were unsolicited questions, produced by three students.The students were found to orient to turn transition relevanceplaces, but due to prolonged production time their questionsrisked sequential and topical misplacement in the ongoing classroomtalk and were vulnerable to misunderstandings. To addressthis problem, students activated the synthetic voice before finalisingthe question, claiming the interactional floor while securingtime to complete their utterance. They also refrained from activatingthe synthetic voice and instead made the question visuallyavailable for the teacher to read, thereby transferring the responsibilityfor answering the question to the teacher when sequentiallyand topically relevant. The study demonstrates the complex interactionalprocess of formulating SGD-mediated questions, sometimesrequiring that the teacher, assistants, and students engagein repair work and scaffolding to establish the meaning ofa student’s utterance. The findings imply that the treatment of nonspeakingstudents’ contributions as questions requires designatedteacher work.

Eye gaze accessed speech generating device (SGD)-mediated communication presupposes additional communicative competence of both aided speaking and speaking interlocutors. For example, speaking interlocutors need to interpret the aided speaking interlocutor’s deviant gaze practice and handle the temporally dislocated SGD-mediated utterances clause-by-clause (Engelk & Higginbotham 2013; Hörmeyer & Renner 2013).

This study investigates how interaction, mediated by a SGD that is accessed with eye gaze technology, is organized in four different interactional contexts, and how these contexts impact Steve’s abilities to participate. The participant using the SGD, Steve, is 18 yrs and has physical and cognitive disabilities due to cerebral palsy. He communicates through gaze practice, facial expression, vocalization and the SGD. Steve has no oral speech and cannot read or write. Steve interacts with four conversational partners; his teacher, his personal assistant and his two occupational therapists. He had known the teacher for 1 year, the assistant for 1 ½ year, and the occupational therapists for 12 years and 5 months respectively. 

Data were collected using video recordings of social interaction at Steve’s school between August and November 2018. Two cameras were used to capture (1) the SGD screen and (2) Steve and his interlocutor. The interactions were transcribed and analysed using the methods and principles of Conversation Analysis (Sidnell 2012; von Tetzchner & Basil 2011).

The analysis demonstrates that the interaction between Steve and his speaking partners was differently organized, depending on the partner’s ways of scaffolding the interaction, such as confirming, reformulating, voicing and asking questions. The use of scaffolding practices varied significantly between the four partners, which provided Steve with different interactional opportunities to participate and co-construct meaning. Steve’s ability to use the SGD, gaze, facial expressions and vocalizations to respond or initiate in the turn-interaction appeared as dynamically dependent on these opportunities and the contexts in which they emerged.

The study demonstrates that aided speaking interlocutors are highly dependent on their speaking interlocutors’ ability to use scaffolding practices in eye gaze accessed SGD-mediated communication and the interactional contexts they contribute to construct. Interactional competence and participation emerge in interaction rather than from individual’s contributions.

This paper uses Conversation Analysis to examine four dyads of speech-generating device (SGD) mediated interaction involving two non-speaking children (Steve and Lucas) with severe physical impairments and intellectual disability. Participation in interaction with an SGD is often hard work. For example, turn production is prolonged in time (Savolainen et al., 2020) which affects temporality and sequentially, and the vocabulary is chosen and arranged by someone else. Embodied resources may be quicker and easier to use, but in the long run, SGD-mediated interaction can enhance non-speaking participants opportunities to participate in interaction (Caron & Light, 2016).

The video recordings (5 hr 46 min) were collected at Lucas’ and Steve’s schools in Sweden between May to November 2018. The first 30 minutes of every session were transcribed and screened for sequences where initiatives by the communication partner’s were followed by a contribution with the child’s’ SGD. We identified 134 sequences, and they were analysed for practices that mobilised the child’s SGD use.

The analysis showed that a combination of different practices mobilised SGD-mediated contributions: (a) environmental arrangements, (b) explicit embodied practices, (c) features of linguistic and prosodic resources, and (d) shifts from spoken turns that constructed an epistemic asymmetry to turns that increased the deontic pressure to use the SGD. Response mobilisation in SGD-mediated interaction involving beginner non-speaking users with intellectual disability appeared as joint communicative projects achieved within extended interactional sequences. These results indicate that non-speaking children with intellectual disability who are beginner SGD users need communication partners who show enhanced other-orientedness and responsiveness, and who use multimodal practices in motivating and joyful activities.

References

Caron, J. G. and J. Light (2016). "Social media experiences of adolescents and young adults with cerebral palsy who use augmentative and alternative communication." International Journal of Speech-Language Pathology 19(1): 30-42.

Savolainen, I., et al. (2020). "The structure of participants’ turn-transition practices in aided conversations that use speechoutput technologies." Augmentative and alternative communication 36(1): 17-30.

This study examines the displayed communicative competence and agency of a non-speaking student at a compulsory school for children with severe learning disabilities. The use of two different speech-generating devices (a single-message versus a multi-message speech-generating device) and the assignment of participation role (having the role of 'student' or 'teacher') were compared in two morning meetings. The two interactional sequences 'question-answers' and 'repair actions' were chosen because they provide participants with opportunities to display communicative competence and agency. The analysis showed that the displayed communicative competence and agency of the non-speaking student differed in relation to the kind of speech-generating device and the associated participatory role. Furthermore, the displayed communicative competence and agency was a product of the close collaboration between the student and the assistant and teachers who scaffolded the process. The study shows that teachers and assistants can influence the communicative competence and agency of non-speaking students.

Communication with speech generating devices (SGDs) with children with severe physical, communicative and cognitive impairments, such as children with cerebral palsy (CP), can be difficult. Use of partner strategies facilitates the communication and instructional approaches such as feedback and role play facilitate communication partners’ learning in how to use partner strategies. To describe communication partners’ use and learning about partner strategies in SGD-mediated communication with children with severe CP. Questionnaires (n = 65) were sent to caregivers (n = 30), teachers (n = 17), and teaching or personal assistants (n = 18) of children with severe CP. Response rate was 80%. To ask open-ended questions was the most frequently used partner strategy and aided augmented input the least frequently used partner strategy. Most commonly, participants learned partner strategies from speech and language pathologists (SLPs) who used verbal instructions when teaching partner strategies but seldom or never feedback, role play or video examples. Communication partners’ learning about partner strategies in SGD-mediated communication is inadequate and needs to be improved. SLPs, who are the main prescribers of SGDs and responsible for training and support in using them, should consider using instructional approaches when teaching communication partners about partner strategies in communication with an SGD.

Purpose: This study examined speech and language pathologists' (SLPs') perceptions and practices of communication partner training with high-tech speech generating devices (SGDs).

Method: Fifteen SLPs were recruited throughout Sweden. The SLPs answered a study-specific questionnaire on communication partner training in relation to communication partners to children with severe cerebral palsy and intellectual disability. The results were analysed with descriptive statistics (closed-ended questions, responses on Likert scales) and content analysis (open-ended question) using ICF-CY.

Results: Twelve SLPs completed the survey. Half had no or one training session with communication partners in the last year. One-third never used documents for goal-setting. Half seldom or never taught communication partner strategies. Three quarters only used verbal instructions. The main obstacles were environmental factors.

Conclusions: This study contributes valuable knowledge about high-tech SGD interventions targeting communication partners. The high-tech SGD intervention may benefit from goal-setting, extended number of training sessions and a range of instructional approaches.

Purpose of Review: Aided AAC modeling is an umbrella term for when communication partners model language on an aided AAC system to support an individual’s comprehension and/or communication development. This scoping review aims to provide an overview of aided AAC modeling studies targeting individuals with emergent communication and describing features and findings from these studies. Recent Findings: Research on interventions that includes aided AAC modeling is growing. Recent studies cover interventions for individuals that previously were excluded, such as individuals who use alternative access methods to select symbols. Summary: A search yielded 29 studies that encompassed a total of 237 participants using emergent communication. Positive outcomes from the aided AAC modeling interventions were reported in the majority of the studies. In future research, a clear description of the different components of the interventions and their expected effect on the outcome may assist in comparing the effect of different types of aided AAC modeling interventions.