Communication Therapy in childhood psychosis involves treatment of speech, language, and interactional behaviour as well as attention to the cognitive substrate that underlies communication performance. As such, Communication Therapy with the psychotic child is concerned with the child’s difficulties with the structure, the meaning, and the function of a speech act.
The particular approach to be described here is based on the hypothesis that self-awareness and other awareness deficits that characterize childhood psychosis have consequences for speech, language, and concept acquisition and maintenance. A child who is psychotic is not adequately aware of his own internal states and action, and not adequately open to receiving information from the environment. The development of language and concepts seems to be dependent on:
1) The ability to adequately monitor one’s own actions and thoughts.
2) The ability to monitor actions and events outside the self (including language).
3) The ability to assess and make comparisons between the two. It is the continual ability to make such comparisons and, consequently, to make any necessary adjustments in language and thought (concepts) that characterize a developing and active child in Piaget’s developmental psychology (equilibration theory) and in the auditory feedback model of language acquisition and maintenance. From the viewpoint of communication, then, psychotic children exhibit deficits in auditory monitoring, both as it relates to attending to salient and relevant language and associated nonlanguage experiences outside themselves (external monitoring), and as it relates to attending to information about language and the world that they have already taken in and stored in their memories (internal monitoring). This auditory monitoring disturbance, crucial to their communication failure, exists as part of their total disturbance in self-awareness and self-regulation.
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