Giving a voice to the hard to reach: Song as an effective medium for communicating with PMLD children who have low social tolerance

Abstract

Common practice in special schools is to sing rather than speak to children with Profound and Multiple Learning Difficulties (PMLD), in order to initiate and maintain interactions; however, there is little formal evidence to support this practice. This study explored the extent to which singing is effective with this ‘hard to reach’ cohort. Five pupils participated, who had PMLD and low social tolerance. These individuals do not like to be touched, talked to or to be in close proximity with other people. This research set out to explore the effectiveness of different sorts of interactive approaches, notably singing or speaking, as a starting point for building an evidence base to underpin practice.
The study used a single subject research methodology, with an adult as a communication partner who initiated interactions, and responded to the behavioural cues of the child. Interactions were video recorded. A system to code participants’ responses to different interactions was developed, based on detailed descriptions of each individual’s behaviour on three major dimensions: Attention Focus, Social Proximity, and Facial Expression. Pupils’ vocalisations and coordinated actions were also recorded. Events were presented graphically; statistical analyses explored the effectiveness of different interaction approaches; sessions were described qualitatively.
The research revealed consistent communicative behaviours (and a means to identify these) in individuals with PMLD and poor social tolerance. Participants were able to express their internal states through consistent patterns in their eye gaze, social proximity, facial expression, and vocal behaviours. The communication partner played a critical role in structuring and directing the interactions; interactions were shaped and influenced by both environment and context.
Simple behavioural descriptors are insensitive to context. The research showed that, used on their own, they can lead to misinterpretations of events, and so must be complemented by qualitative descriptions. Nevertheless, the microanalysis of behaviours revealed ‘moments of wonder’ which overturned expectations about who was leading interactions; none of the participants was thought (by staff) to be capable of the secondary intersubjectivity and attention directing behaviours that were documented.
There were individual differences in response to singing: however, overall, singing was associated with more positive facial expressions (smiles), higher levels of social tolerance (to touch and proximity), and improved communicative responses (eye contact, vocalisations, and coordinated actions). This provides evidence to support current practices of singing to children with PMLD.
This thesis modelled a strategy for collating a profile of communicative behaviours. A practical outcome of the research was that details of the communicative behaviours of participants were circulated via a ‘communication passport’ for each participant, and shared with parents and carers. The use of song became a more explicit part of the daily routine and a planned element in lessons.
Findings are related to research on mother-infant communication and infant development, and on the role of music in emotional regulation, and the psychology of music. Directions for future research are discussed.