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Die Kommunikations- und Sprachentwicklung von Kindern mit globaler Entwicklungsstörung ist erheblich beeinträchtigt. Die notwendige Frühintervention nutzt lautsprachunterstützende Gebärden (LUG), um den Kindern eine Kommunikation mit der Umwelt zu ermöglichen und den Einstieg in den Lautspracherwerb zu erleichtern. Hierzu ist es notwendig, die Eltern als Hauptbezugspersonen der Kinder in der Gebärdenanwendung zu schulen. In Deutschland fehlen häufig entsprechende Schulungsangebote oder es geschieht in vergleichsweise kurzen eintägigen Seminaren. Mit dem Programm „Kommunikation mit unterstützenden Gebärden – ein Eltern-Kind-Gruppenprogramm (KUGEL)“ wurde ein mehrteiliges Konzept zur systematischen Elternanleitung in der Kleingruppe entwickelt. Ein vergleichbares Programm zur Gebärdenanleitung liegt im deutschsprachigen Raum bislang nicht vor.
Die Evaluation des KUGEL-Programms erfolgte in einer randomisierten Studie im Prä-Post-Kontrollgruppendesign. Die Eltern der Kontrollgruppe nahmen an einer in der Praxis üblichen eintägigen Anleitung zum Einsatz von LUG teil, dem KUGEL-Tageskurs.
Die Eltern beider Gruppen äußerten sich nach der Intervention sehr zufrieden und gaben an, Gebärden zukünftig häufiger und mit mehr Freude einzusetzen. Darüber hinaus nahmen sie an, dass sich ihr sprachliches Verhalten gegenüber ihrem Kind positiv verändert hätte und sie besser in der Lage seien, ihr Kind in seiner kommunikativen und sprachlichen Entwicklung zu unterstützen. Objektiv erhobene Daten konnten dies bestätigen. Die Eltern beider Gruppen waren gleichermaßen befähigt, mehr Gebärden in Verbindung mit einer lautsprachlichen Äußerung in der Interaktion mit ihrem Kind zu verwenden und positiver auf die Gebärdenversuche des Kindes zu reagieren als vor der Intervention. Die Eltern des mehrteiligen KUGEL-Programms verfügten darüber hinaus über einen signifikant größeren Gebärden-Wortschatz und boten ihrem Kind signifikant mehr unterschiedliche Gebärden in der Interaktion an als Eltern aus dem KUGEL-Tageskurs.
Die Kinder beider Gruppen waren nach der Anleitung der Eltern besser in der Lage, ihre kommunikativen Intentionen auszudrücken und auf Interaktionsinitiierungen der Bezugspersonen zu reagieren. Sie nutzten gleichermaßen mehr Gebärden. Zudem zeigte sich bei den Kindern unabhängig von der Dauer der Anleitung der Eltern eine Verbesserung im passiven Wortschatz und die Kinder nutzen mehr lautliche Äußerungen als vor der Intervention.
Die vorliegende Dissertation liefert einen Überblick über die Evaluation des neu entwickelten Programms KUGEL im Vergleich zu einer eintägigen Elternanleitung. Es zeigte sich, dass Eltern grundsätzlich von einer Anleitung zum Einsatz von LUG profitieren. Sie sind befähigt, nach einer Anleitung ihr Sprach- und Interaktionsverhalten zu verändern, sodass die Kinder daraus einen Vorteil erzielen. Sowohl mit dem KUGEL-Programm als auch mit dem KUGEL-Tageskurs liegen zwei vollständig ausgearbeitete und evaluierte Konzepte für Gruppenangebote vor, die den Eltern neben Wissen auch Handlungskompetenz vermitteln. Eine gezielte Anleitung der Eltern zum Einsatz von LUG auf Basis einer sprachförderlichen Grundhaltung sollte als integraler Bestandteil therapeutischer Angebote bei Kindern mit globaler Entwicklungsstörung verstanden werden.
The term “disability“ seems to sum up a rather semantically fuzzy form of denotation and a huge amount of possible connotations. While researching the term “severe multiple disabilities”, an observer may conclude, that this form of semantical fuzziness continues into the conceptual world of this special kind of subcategory. Studying the group of people eligible for organizations called “Förder- und Betreuungsbereich”, abbreviated with “FuB”, or “day activity centers” this fuzziness shows up again. This linguistic phenomenon seems to be reflected once more in the variety of activities offered by these institutions. Popping up currently this semantical fuzziness seems to be less random than much more functional especially for this kind of organization. Since 10/09/2020 a new sort of activity has to be offered to people addressable by “FuBs” or “day activity centers”: According to law, eligible people have to be offered work-related activities by the organizational staff. The more deeply an observer deals with this phenomenon, the more he gets the impression, that there seems to be an inevitable connection between this special kind of semantically generated imagination and human interaction. Bringing together semantical and syntactical analysis and the research question concerning the social function of “FuBs” or “day activity centers”, sociological system theory offers not only the necessary theoretical complexity but also the tool called “functional analysis” to undergo this scientific challenge. System theory has been updated by Fuchs: Now an observer can consider social systems as distributors of opportunities for meaning-orientated interpretations and psychological systems, that can read and interpret these opportunities. Thus, individual people function as points of communicational offers and connections. That is why Fuchs and Rolf Balgo speak about the co-production of communicational systems, biological systems, and psychological systems, none of these systems can stand for itself alone. If one sort of system is missing, the others are not able to exist furthermore. An observer has just to consider the infant experiments to explore the original human language or the inhibiting impact of a lack of communication with infants, small children, and furthermore. The research results show clearly that “FuBs” and “day activity centers” function socially as inclusion systems: People eligible for these organizations for the most part are excluded from the services of almost every “functional system” despite healthcare and social welfare . While, due to the revised version of the German disability law, employees with disabilities of “workshops for disabled people” are more and more integrated into “sheltered employment”, people with severe and multiple disabilities remain in their communicational precarious state. Given this drift towards social exclusion, the staffs of “FuBs” and day activity centers have to provide their clients with a huge variety of activities simulating all kinds of different situations, if the organization wants to comply with the extent of inclusion required by modern society. Simulating social interactions oriented towards different functional systems is not inherently bad: If an observer takes a close look at the interactions between curative educators and severely multiple handicapped clients, most social theories are not complex enough to gather the instructive and innovative manuals designed by the most professionals in the field. The genuine conception of communication offered by Niklas Luhmann and Peter Fuchs can shield these approaches theoretically without lacking complexity. In analytical terms, communication can be understood here as a synthesis of three selections: information, message, and understanding. Understanding, in this case, does not mean cognitive comprehension but reacting towards a communicational offer. Because no observer can observe communication itself despite gathering a glimpse of the thoughts of the significant other, communication flags out as communication acts – attributable to the respective social address. In system theory terms an observer can attribute both communicational offers and communicational linking to different social addresses, created and provided by communication. That means communicational offers and communicational linking are achievements of observation. On the one hand, there is communication without observation. If it is valid that communicative linking also comes only to existence if it is observed and thus attributed to the social address of the significant other, an observer can indeed observe communication between curative educators and severely multiple handicapped clients: Psychological systems, even before being linguistically formatted through education and socialization, function as points of communication. Not only language functions as a communication medium but also the observed living body: Blushing with compliments, startling when frightened, increased pulse with joy, goose¬bumps while shivering and all the other body-related behavioral chances are just as suitable for communication as language, vocalizations, facial expressions, and gestures. To observe these basal forms of communicational offers and links the professional curative educator needs enough time but also an extremely precise and sensitive ability to observe. If this is the case, Fuchs speaks of top relevance. An observer usually can detect that highest form of observational relevance in families and partnerships, where every change in appearance and behavior can become the subject of system-specific communication because of the communication medium love. In professional inclusion-systems, an observer needs not seeking morality to describe the desired professional attitude: Fuchs introduces amicalitiy as the communication medium that makes the highest level of relevance in curative-educator-client communication probable. From the research results it follows that the clients of the “FuB” and the day activity centers are threatened by an exclusion drift not only beyond this professional communicational context: Only half a staff position is allocated to a client who behaves inconspicuously and therefore is considered as “easy to care for”. This drastically reduces the possible opportunities to treat him in the mode of top relevance. The new legal requirements that ought to increase the social participation of all people with disabilities only take into account those people with disabilities who can do whatever kind of minimum economically viable work. Except for the offers for job-related work, this group of people remains largely neglected. The expectations of many professionals in the field have been disappointed: no access to the entrance or the training areas of the workshops for people with disabilities, no participation and right of co-determination in organizational matters, no social response appropriate to their needs. If an observer considers, that the inclusion drift of workshop-employees with disabilities into sheltered employment results in a decrease of employees with disabilities at a given workshop for people with disabilities, a dark future seems to emerge for the clients of the spatially attached “FuB”: Either this form of inclusion system turns into a day activity center, that is spatially independent of the workshop, or the workshop opens its doors for this clientele or these clients run the risk of being deported to nursing homes and being robbed of their communicative relevant even more.