Aprender a comunicarse
Una de las metas más urgentes en el tratamiento de niños en el espectro autista es ayudarlos a desarrollar habilidades de comunicación.
Cuando los niños no tienen un desarrollo típico de las habilidades lingüísticas, es posible que no tengan una forma efectiva de transmitir sus deseos y necesidades.
Como resultado, corren el riesgo de desarrollar berrinches, agresiones o conductas autolesivas como reemplazo. Estos comportamientos no solo son potencialmente dañinos, sino que a menudo no se comprenden.
Ahí es donde entra en juego la capacitación en comunicación funcional (FCT, por sus siglas en inglés). La FCT implica enseñarle a un individuo una forma confiable de transmitir información, con lenguaje, señales y/o imágenes para lograr un determinado propósito.
Se llama “funcional” porque no solo enseña a los niños a etiquetar un artículo (es decir, asociar la palabra ROJO a una imagen de una manzana), sino que se enfoca en usar palabras o señales para obtener algo necesario o deseado: una comida, un juguete, una actividad, una ida al baño, un descanso de algo.
La FCT implica el uso del refuerzo positivo para enseñar a los niños sobre el lenguaje y la comunicación, con el fin de aumentar su capacidad de interactuar de manera efectiva con otros al buscar satisfacer sus necesidades.
Cómo funciona la capacitación en comunicación funcional
Stephanie Lee, PsyD, psicóloga clínica del Child Mind Institute, explica cómo trabaja un médico cuando pone en práctica la FCT. Lo primero, dice la Dra. Lee, es identificar algo que el niño quiera conseguir, por ejemplo, una comida favorita, un juguete o alguna actividad. Eso servirá como la recompensa natural por usar una señal o imagen que represente esa cosa.
“Entonces, si al niño realmente le gustan las Tortugas Ninja o Thomas y sus amigos, o si lo que más le gusta comer a un niño son los Cheetos, tomamos ese objeto y luego le enseñamos al niño una señal o una imagen que represente ese objeto”.
Inicialmente, se prepara al niño para lo que la Dra. Lee llama “aprendizaje sin errores”, en el cual el terapeuta guía al niño a usar la señal o la imagen y obtener la recompensa. Esta comunicación con apoyo se repite, resultando cada vez en la recompensa ganada, hasta que el niño pueda lograrlo con cada vez menos ayuda del terapeuta.
“A medida que disminuimos esas ayudas, el niño se vuelve cada vez más independiente en su comunicación”, dice la Dra. Lee.
Una vez que los niños usan con confianza la palabra, señal o imagen para un objeto en particular, cuando el objeto está presente, el siguiente paso es que “generalicen” o lo usen fuera de la situación específica que se les enseñó.
Por ejemplo, si un niño está viendo la televisión y quiere unas papas fritas, podría usar la imagen como una forma de obtener esas papas, señala la Dra. Lee. Ese tipo de uso espontáneo o esporádico de la habilidad también debe reforzarse a lo largo del tiempo. Después de que una palabra o señal en particular se usa de manera consistente, se pueden agregar otras nuevas para construir gradualmente el repertorio del niño.
“Una vez que el niño ha aprendido este sistema de comunicación, que la señal o la imagen que está utilizando deben ser recibidos por otra persona para que puedan obtener su objeto, entonces, de manera lenta pero segura, podemos enseñarle una nueva señal o presentar una nueva imagen”, explica la Dra. Lee.
Metas en la FCT
La rapidez con que los niños progresan con la FCT a menudo depende de su funcionamiento o nivel cognitivo. Para los niños con necesidades más complejas o con un deterioro del lenguaje más significativo, podrían ser necesarios muchos ensayos para que adquieran algunas señales o imágenes.
“Pueden terminar con un pequeño repertorio de comunicación funcional —señala la Dra. Lee— pero es el repertorio que más necesitan: los alimentos que les gustan, usar el baño, ese tipo de cosas”.
Los niños con necesidades menos complejas y cuyo nivel de funcionamiento es más alto, en realidad podrían terminar logrando la misma cantidad de lenguaje, si no es que más, que sus compañeros con un desarrollo típico”.
Algunos niños podrán hablar con oraciones completas, utilizando un dispositivo de asistencia técnica. Otros adquirirán solo palabras sueltas. “Con estos últimos, buscaríamos determinar las metas más apropiadas para ellos”, señala la Dra. Lee.
El beneficio se tendría que comparar con el esfuerzo que se necesitaría para lograrlo. Es importante recordar que el tratamiento se adapta a las necesidades y habilidades específicas de cada niño.
La capacitación en comunicación funcional a menudo se imparte de manera individual con un médico que es un patólogo del habla y del lenguaje o con un psicólogo conductual capacitado en análisis del comportamiento aplicado (ABA, por sus siglas en inglés).
Los padres tienen un papel importante en reforzar la capacitación, practicar lo que el niño aprendió y usarlo en una variedad de situaciones. Cuando la FCT se realiza en la escuela, los maestros deberían ayudar a los niños a practicar las señales que han aprendido.
La FCT y los comportamientos problemáticos
La capacitación en comunicación funcional se desarrolló originalmente en la década de 1980 como una forma de reducir los comportamientos problemáticos asociados con el autismo, incluidas las autolesiones y la agresión. La idea era que estos comportamientos se derivan de la imposibilidad de comunicar sus necesidades de manera efectiva.
Para utilizar la FCT para reducir el comportamiento problemático, explica la Dra. Lee, el punto de partida es observar la función de esos comportamientos, a lo que los médicos llaman una “evaluación funcional”. Eso requiere una observación atenta del niño.
Si un niño se golpea la cabeza contra la pared, se abofetea a sí mismo o si golpea a otro niño, ¿cuál es la función de este comportamiento? “Para llegar al fondo de estos comportamientos, observamos los antecedentes y las consecuencias. ¿Qué prepara el escenario para el comportamiento? ¿Cuándo sucede? ¿Cuándo no sucede? ¿Con quién pasa? ¿Qué suele suceder después?”.
Si el desencadenante de las conductas problemáticas parece ser algo que el niño no puede comunicar, entonces enseñarle una forma más confiable de comunicar sus necesidades puede eliminar esa conducta.
La Dra. Lee enfatiza que la FCT solo funciona para reducir el comportamiento problemático si usted puede evaluar correctamente la función del comportamiento para ese individuo.
“El tipo de comportamiento o tipografía (ese es el término técnico) realmente varía según el individuo”, explica. “Y puede variar para un individuo en diferentes momentos. Por ejemplo, alguien podría comenzar con un comportamiento autolesivo y luego volverse agresivo, si encuentra que la agresión es más eficiente”.
Reemplazar la autolesión con lenguaje
Como todo comportamiento, el comportamiento autolesivo cumple una función. Generalmente una de estas:
- Llamar la atención.
- Acceder a un elemento o actividad deseada.
- Escapar de una tarea no deseada.
- Responder a una necesidad sensorial.
Cuando los golpes en la cabeza o las bofetadas hacen que un niño reciba atención, obtenga algo que quiere, se libere de algo que no quiere hacer o escape de una situación incómoda, el comportamiento se refuerza accidentalmente. La FCT puede ayudar a romper estos patrones de comportamiento poco saludables.
Una vez que los niños aprenden a pedir un descanso con una palabra, una señal o una imagen, y obtienen resultados de manera rápida y eficiente, es probable que elijan el comportamiento apropiado en lugar del comportamiento autolesivo.
La capacitación en comunicación funcional puede y de hecho se ha aplicado a todas las edades, desde preescolar hasta la edad adulta, pero a los expertos les gusta que comience lo antes posible.
“Lo que sabemos sobre el desarrollo del lenguaje es que cuanto antes sea la intervención, mejor”, señala la Dra. Lee. “Así que cuanto más rápido podamos abordar estas cosas y más rápido podamos construir el repertorio de comunicación del niño, mejor estará”.
Pero la Dra. Lee agrega que ella ha visto que la FCT trabaja muy efectivamente con adultos que no tenían este tipo de entrenamiento antes, y algunos adquieren habilidades rápidamente.
“También he visto adultos que tardaron mucho tiempo en desarrollar un repertorio de palabras muy pequeño— agrega— pero ese pequeño repertorio fue muy, muy importante para ellos y para las personas a su alrededor en términos de una mejor comprensión sobre lo que necesitan y desean”.
FUENTE: https://childmind.org/article/como-ayudar-a-los-ninos-con-autismo-a-aprender-a-comunicarse/
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