Realities and Possibilities: The beginning Part 3 – Suggestions

April-2010ParentChild

What you can do to help your child if he is at Stage 1 of communication and language development.

One way we can help your child is to determine what stage of communication development he is in. The following stages will help us ‘place’ your child based on what we would refer to as his ‘developmental language stage’ rather than his ‘chronological age.’

This is a difficult step to take because your child’s developmental age may be quite different from his chronological age; and yet, this is one of the most important steps you can take to get started. Billy, the child in the vignette, was 4 years old but at Stage 1 of communication-language acquisition. Of course, a child might have skills at various levels and that will certainly be taken into account in planning what goals to address.

 

Stages of Communication-Language Acquisition*

Stage 1.     Pre-Intentional (0–8 months)

(The communicative partner infers the child’s messages, feelings, and intentions)

The child demonstrates a variety of behaviors, including gazing, crying, touching, smiling, laughing, vocalizing, and grasping; the adult responds to these behaviors as if they had meaning.

 

Stage 2.     Pre-Linguistic Intentional (8-12 months)

(Emergence of intentional communication)

The child now communicates his messages intentionally using a combination of body language, facial expressions, gestures, vocalizations, and eventually, words.

The child is beginning to understand other people’s words and phrases.

 

Stage 3.     First Words (12–18 months)

(Emerging symbolic communication, i.e., meaningful words and phrases)

The child begins to understand and use language – single words, two word combinations- within the contexts of his daily life.

 

Stage 4.     Two Word Utterances (18-24 months)

(Vocabulary explosion and early multi-word combinations)

The child begins to combine words to form utterances that are governed by pragmatic- semantic-syntactic rules.

The child comprehends a great deal of what his caregivers say to him in the context of his daily life.

 

Stage 5.     Early Pragmatic-Semantic-Syntactic Devt. (24-36 months)

(Later multiword, beginning complex sentences)

The child develops the basic syntactic structures of the language, talks about many ideas and notions, and uses language for a broad range of communicative functions.

The child comprehends language related to the ‘here and now’ and also, the past and future.

 

Stage 6.     Later Pragmatic- Semantic-Syntactic Devt. (36 months +)

(Multiverb utterances, complex sentences, and discourse)

The child uses more complex language to talk about events and engages in various kinds of discourse.

*(Adapted from Gerber & Prizant, 2001)

 

If your child is at Stage 1, this is where we would begin:

If your child is at the earliest stages of communicative-language development, the ‘work’ (and play) begins by trying to create the rhythms and eventually, the dance so typical of the first months of a child’s life. In the dance, the adult leads the way, by regulating the baby’s physical and emotional state, tuning into the baby’s messages, and responding with a well-matched communication in response to the baby. .

Let’s think of the activities that babies and caregivers are involved in throughout their typical day. You might think of these routines as mundane events of daily life. You might think that to help your child you must engage in educational activities that will lead to talking, playing, and responding. But, the fact is that the best way to help your child without a doubt will happen during these daily life routines. All healthy babies and caregivers participate in these interactions over and over again way before they participate in educational activities. What happens during these natural interactions sets the stage for all development. Later, children learn more directly and didactically in many ways; but the beginnings are loving, sensitive, respectful interactions where the baby starts to become a person, communicator, and language user. And this happens during playful episodes not during teaching episodes.

At the early stages, we can think of the goals for you, the adult, rather than focusing on goals for the child. These goals are meant to encompass what we discussed in Part 2 as critical and commonplace in interactions between caregivers and their children. The following quotes guide us as to how we can begin to turn what we know about development into intervention goals for children who have significant challenges in communication, language, and speech.

 

Emotional meaningful events can enable continued learning from experience throughout the lifespan. Siegel, 2012.

Research shows that reading and responding to a baby’s cues are more important than any structured learning activity. Hatkoff, 2007.

Babies who feel understood learn more easily, have a positive sense of self, develop empathy, and can decipher social cues of others. Hatkoff, 2007.

 

Goal #1  

In order to help your child see himself as a ‘communicator,’ all of his behaviors and actions need to be responded to as meaningful communication. Mom and Dad will be the ones to help the child begin to see how to connect and ‘make meaning’ with other people. This requires following his lead and trying to turn the actions he delights in into moments of communication. For example, if the child enjoys looking out the window, as Billy did, perhaps, Mommy or Daddy can be on the other side of the window and begin a Peek-a-Boo game with the child. This will help him see he has communicated by looking out the window.

 

Many children enjoy running back and forth across the room as Billy did. Perhaps Mommy or Daddy can be waiting at the other end of the room and swoop their child up when he gets near them. Billy enjoyed opening and closing his hands while making sounds. Here, Mommy and Daddy can try to join him, adding a song to the action (e.g., ‘open and shut them’). In this way, Billy’s more ‘random’ movements can be made into meaningful messages that have been sent and received.

 

When parents interpret their child’s actions as a bid for interaction, an interaction has begun. In addition, on the way, to helping a child develop language, we must remember that one of the most important things we can do, is respond to the child as if he is communicating, right now, in whatever way he has available to him. All body movements, sounds, ‘true’ words, and other behaviors can be thought of as the child’s communicative attempts. By doing this, you will be communicating to your child that his ‘voice’ and his messages are being heard. This promotes ‘proto-conversations’ the early back and forth turns which are the precursors to true conversations. This is the kind of experience that typically developing children have many, many times each day!

 

In the next video, the speech-language pathologist guides mom so that she can create a peek-a-boo game with her son, Amir.  All of his actions are interpreted as his desire to continue the game – vocalizing, jumping, and looking- in other words, as intentional communication. Mom creates a rhythm to the interaction so that the beginnings of ‘proto-conversations’ can emerge. By the end of the segment, the child uses a more conventional means of communicating by touching the parachute to indicate that he would like Mommy to hide again!

 

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To start, you might take an inventory of how your child shows you what he does and does not enjoy. These behaviors might look different than a typically developing child who often has a more conventional repertoire of communicating. For example, Billy looked at his hand and opened and closed his fingers as he made some sounds. This is a different hand gesture than a child who claps and smiles. But we are interested in Billy and his ‘communication’ system, unique to him. Your child might turn away when you are trying to play with him. This is a communication, which can be responded to (‘okay, Mommy sees, no blocks now’).

So your first goal is to help your child become part of a reciprocal interaction, experience being a communicator, and give meaning to his behaviors. This is best done by ‘following the child’s lead’ and delighting in what he delights in!

In the next video, we have another beautiful example of the parent of a child with developmental challenges responding to his child’s communication and delighting in the joyful game they have created. When Adiel smiles, looks at Daddy, touches his lips, or claps, Daddy continues the silly sound game. Notice that although the child is 3 years old, Daddy doesn’t require that the child use words to communicate, but rather is responsive to all the non-verbal means the child uses. This child’s repertoire is more developed than Amir’s and includes facial expressions, eye gaze, and body language, all of which have emerged more recently for this boy.

 

PARENTS OFTEN RESPOND TO THIS SUGGESTION BY SAYING, ‘BUT THE THINGS MY CHILD LIKES TO DO ARE ODD. OTHER CHILDREN DON’T DO THEM. IF I DO THEM WITH HIM, HE WILL DO THEM MORE OFTEN AND LOOK EVEN MORE INAPPROPRIATE AND UNUSUAL’.

 

YES, THAT MAKES SENSE. BUT THE THINGS YOUR CHILD DOES, HAVE MEANING TO HIM AND AT THE PRESENT TIME, THIS IS HIS BEST WAY (AND PERHAPS ONLY WAY) TO EXPRESS HIMSELF. IF WE LET HIM KNOW THAT WE ARE RESPONDING TO WHAT HE HAS EXPRESSED (EVEN WHEN WE DO NOT KNOW WHAT IT MEANS) WE ARE SENDING A LOUD AND CLEAR MESSAGE – YOU ARE COMMUNICATING, I AM LISTENING, WE ARE DOING SOMETHING IMPORTANT TOGETHER. THINK OF THESE ACTIONS, SOUNDS, MOVEMENTS AS THE CHILD’S LANGUAGE – A DIFFERENT LANGUAGE THAN YOURS BUT A LANGUAGE NONETHELESS.

 

BY THE WAY, MANY OF THE THINGS YOUR CHILD DOES THAT SEEM UNUSUAL ARE ACTUALLY DONE BY TYPICALLY DEVELOPING CHILDREN TOO! ALL CHILDREN LIKE TO RUN, PLAY FINGER GAMES, JUMP, AND MOVE THEIR BODIES. MAYBE IT ALL SEEMS DIFFERENT WITH YOUR CHILD BECAUSE OF WHAT HE ISN’T DOING. HOWEVER, IF WE INTERPRET HIS ACTIONS IN A MORE POSITIVE WAY, YOU WILL BE GIVING YOUR CHILD A CHANCE TO BE HIMSELF AND ENJOY IT. THIS IS A PROCESS THAT ALL HUMANS THRIVE ON.

 

 

Goal #2

Becoming includes the infant’s attachment to caregivers, attention to and sensitivity to linguistic patterns, engagement in joint attention and imitation, attention to objects and their potential for engagement, and engagement in social play and games. (Nelson, 2007)

 

Here is another way to think about giving your child the kinds of moments that typically developing children experience. We would suggest that you increase the frequency of social games between your child and yourself. Many parents have one or two of these ‘games’ in their repertoire with their child. It could be Peek-a-Boo, or Pat-a-Cake, or ‘this little piggy’. During these games, the caregiver and child share joyful moments that are filled with emotion and that set the stage for the ‘conversational rhythm’ of communication. Your child may not have as many games as other children; he may only like to play patty cake. But while playing this game with you, your child will learn so much about how to interact with another human being. We would suggest you play this game as much as possible and then, hope to find other ones that are as interesting to him. Without these games, your child will not be experiencing the rhythms of communication that serve as the foundation for language, in other words, ‘exercising’ the interactive person to person dance.

 

Keep in mind many important things happen during these games:

  • moments of engagement – you and your child are thinking about each other
  • reciprocal interactions – you and your child are taking turns in the play
  • shared attention – you and your child are focusing on the same object, event, or person

 

We always want to start with what brings a twinkle to your child’s eye and to yours. These twinkling moments will be the foundations for his further development as a communicator.

 

Billy who was on the periphery of the room approached his mother when she started to sing the pat-a-cake song. He looked at her, filled in words to the rhyme, and was clearly engaged with her. So we would ask Billy’s Mom to play this game with him many times throughout the day and see if she could expand the playfulness within the routine by changing the rhythm or volume, so that Billy would stay with her longer and longer and have more and more fun.

 

In this next video, the child’s speech-language pathologist is taking what the child is enjoying, ‘writing on the board’ and using this to create an interpersonal social game with the child. The most important thing that is happening here is that the child and adult are creating moments of engagement, reciprocity, and shared attention.

 

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PARENTS OFTEN RESPOND TO THIS KIND OF ADVICE BY SAYING “MY CHILD IS NOT AN INFANT; HE IS THREE YEARS OLD. HE SHOULD BE DOING THINGS THAT THREE YEAR OLDS DO. 

BUT IF YOUR CHILD HASN’T YET DEVELOPED THE COMPETENCIES THAT CHILDREN ONLY LEARN DURING EARLY INTERACTIONS WITH THEIR CAREGIVERS, THEN HE IS NOT YET AT A THREE YEAR OLD STAGE IN SOME AREAS OF DEVELOPMENT. THIS IS HARD TO BELIEVE. ESPECIALLY, BECAUSE YOUR CHILD CAN DO OTHER ADVANCED THINGS LIKE SAY THE ALPHABET, COUNT TO 100, IDENTIFY ALL THE THOMAS TRAINS, ETC. THOSE SKILLS SHOW HIS STRENGTHS AND WE WILL TAKE ADVANTAGE OF THEM, BUT THAT KIND OF KNOWLEDGE ALONE WILL NOT TAKE HIM INTO THE INTERPERSONAL WORLD OF DEEPLY HUMAN INTERACTIONS AND THAT IS WHERE WE NEED TO HELP HIM GO!

 

Perhaps, I have made all of this sound easy. In my 40 years of experience as a speech-language pathologist, the kinds of suggestions that I have given here are clearly difficult for clinicians (including myself of course!), educators, and parents to follow. Dismissing the child’s age from your mind, thinking of unusual behaviors as worth joining, choreographing the timing and rhythm of interaction are enormous challenges for the adult. It can be painful and discouraging to maintain a positive perspective on these interactions between your child and yourself. The parents who are most successful have a kind of tunnel vision about what they need to do and a commitment to this way of thinking that is certainly not easy to embrace, especially with so many conflicting views about what you should be doing. I empathize with this and understand if the task is just too overwhelming at certain points in your child’s life. In that case, don’t give up the approach for another one. Try to find people who can help you provide what your child needs when you feel you are unable to. This is not a moment of weakness, but one that every human being experiences at moments in her life when he or she needs a supportive community to face the challenges of life.

 

The realities of playing with a child who is difficult to connect with could leave us feeling defeated. Perhaps, we can try to counteract those defeated moments with ones where we practice noticing all the steps you and your child have taken in the right direction – some will be big and some may seen small, but all deserve awe and wonder. Hope and optimism will be important mantras for us to embrace. And finally, let’s all (parent, teacher, clinician) find someone to ‘hold’ us when we are lost and consider ourselves lucky when we are asked to be the holder.

 

A tremendous thank you to Caroline Ferguson, Michele Ricamato, and Kerry Wallace for sharing their intervention videos with me and to the parents who have allowed us to share them with you.

References:

Bronfenbrenner, U. (1979). The ecology of human development: experiments by nature and design. Cambridge, Mass.: Harvard University Press.

Gerber, S. and Prizant, B. (2001).  A developmental approach to assessment and intervention with speech and language challenges.

In Clinical Practice Guidelines: Redefining the standards of care for infants, children, and families with special needs. MD: ICDL Press.

Hatkoff, A. (2007). You are my world: How a parent’s love shapes a baby’s mind.  NY: Stewart, Tabori, and Chang.

Nelson, K. (2007). Young minds in social worlds. Cambridge: Harvard University.

Siegel, D. (2012). The developing mind: How relationships and the brain interact to shape who we are.  N.Y.: Guilford Press.

About Sima Gerber, Ph.D, CCC

Sima Gerber is a Professor of Speech-Language Pathology in the Department of Linguistics and Communication Disorders of Queens College, City University of New York. Dr. Gerber has over 40 years of clinical experience, specializing in the treatment of children with autism spectrum disorders and other developmental challenges. Dr. Gerber is on the faculty of Profectum Academy and the Advisory Board of the New York Zero-to-Three Network. Dr. Gerber has presented nationally and abroad on the topics of language acquisition, developmental approaches to intervention for children with challenges in language development, and contemporary perspectives on language intervention for children on the autism spectrum. Dr. Gerber is a Fellow of the American Speech-Language-Hearing Association.
simagerberqc@gmail.com