Communication in Early Intervention: Difference between revisions

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== Introduction ==
== Introduction ==
Infants start learning how to move, explore, and communicate in the first twelve months of life.<ref name=":3">Dinkel D, Rasmussen M, Rech JP, Snyder K, Dev DA. A qualitative comparison of parent and childcare provider perceptions of communication and family engagement in children's healthy eating and physical activity. Child Care Health Dev. 2022 Jan;48(1):99-109. </ref> Research shows that motor problems in children often co-occur with communication problems.<ref name=":4" /> Up to 81% of children with mild to moderate functional mobility limitations are diagnosed with communication problems.<ref name=":4">Vaillant E, Geytenbeek JJM, Jansma EP, Oostrom KJ, Vermeulen RJ, Buizer AI. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7692918/pdf/DMCN-62-1363.pdf Factors associated with spoken language comprehension in children with cerebral palsy: a systematic review.] Dev Med Child Neurol. 2020 Dec;62(12):1363-1373.</ref> <ref>Valla L, Slinning K, Kalleson R, Wentzel‐Larsen T, Riiser K. Motor skills and later communication development in early childhood: Results from a population‐based study. Child: Care, Health and Development. 2020 Jul;46(4):407-13.</ref> Poor language skills and a decreased ability or inability to communicate can affect a child's social development, which includes self-identity, self-esteem, self-control and the ability to interact with others. <ref>Sainain NS, Omar R, Ismail H, Mamat N, Abdullah R. [https://www.researchgate.net/profile/Hazhari-Ismail-3/publication/341579315_Parental_Knowledge_And_Development_Of_Languages_And_Literacy_Communication_And_Socializations_In_The_Early_Childhood_Education/links/5fd4e0e5299bf14088042e3a/Parental-Knowledge-And-Development-Of-Languages-And-Literacy-Communication-And-Socializations-In-The-Early-Childhood-Education.pdf Parental knowledge and development of languages and literacy, communication and socializations in the early childhood education.] International Journal of Psychosocial Rehabilitation. 2020;24(9):2070-80.</ref> Parents are pivotal as their infants' and toddlers' primary communicators. <ref name=":3" /> This article will discuss how and why the child communicates and analyse parents' behaviour and communication style. Additionally, the article will offer basic communication strategies that parents can immediately utilise in everyday routines.   
Infants start interacting with their environment from birth, responding to visual and auditory events and actively engaging in spontaneous movements of their limbs.<ref>Versfeld P. The Newborn Infant – Setting the Scene Course. Plus, 2023.</ref> When working with children, it is important to note that motor problems often co-occur with communication problems.<ref name=":4" /> Up to 81% of children with mild to moderate functional mobility limitations are diagnosed with communication problems.<ref name=":4">Vaillant E, Geytenbeek JJM, Jansma EP, Oostrom KJ, Vermeulen RJ, Buizer AI. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7692918/pdf/DMCN-62-1363.pdf Factors associated with spoken language comprehension in children with cerebral palsy: a systematic review.] Dev Med Child Neurol. 2020 Dec;62(12):1363-1373.</ref> <ref>Valla L, Slinning K, Kalleson R, Wentzel‐Larsen T, Riiser K. Motor skills and later communication development in early childhood: Results from a population‐based study. Child: Care, Health and Development. 2020 Jul;46(4):407-13.</ref> Reduced language skills and a decreased ability or inability to communicate can affect a child's social development, impacting their self-identity, self-esteem, self-control and interactions with others.<ref>Sainain NS, Omar R, Ismail H, Mamat N, Abdullah R. [https://www.researchgate.net/profile/Hazhari-Ismail-3/publication/341579315_Parental_Knowledge_And_Development_Of_Languages_And_Literacy_Communication_And_Socializations_In_The_Early_Childhood_Education/links/5fd4e0e5299bf14088042e3a/Parental-Knowledge-And-Development-Of-Languages-And-Literacy-Communication-And-Socializations-In-The-Early-Childhood-Education.pdf Parental knowledge and development of languages and literacy, communication and socializations in the early childhood education.] International Journal of Psychosocial Rehabilitation. 2020;24(9):2070-80.</ref> Caregivers play a pivotal role in the development of communication as they are their infants' and toddlers' primary communicators.<ref name=":3">Dinkel D, Rasmussen M, Rech JP, Snyder K, Dev DA. A qualitative comparison of parent and childcare provider perceptions of communication and family engagement in children's healthy eating and physical activity. Child Care Health Dev. 2022 Jan;48(1):99-109. </ref> This article discusses how and why a child communicates and offers basic communication strategies for caregivers to enhance communication with their children.   


== Methods and Stages of Child's Communication ==
== Methods of Communication in Children ==
Children have different communication strategies from infancy to when they become verbal.
Children adopt different communication strategies from infancy to when they become verbal.


=== Non-verbal Communication ===
=== Non-verbal Communication ===
<blockquote>"Infants as young as eight weeks of age actively engage in turn-taking in vocal interactions with their caregivers"<ref>Nguyen T, Zimmer L, Hoehl S. [https://royalsocietypublishing.org/doi/epdf/10.1098/rstb.2021.0488 Your turn, my turn. Neural synchrony in mother–infant proto-conversation.] Philosophical Transactions of the Royal Society B. 2023 Apr 24;378(1875):20210488.</ref></blockquote>
<blockquote>"Infants as young as eight weeks of age actively engage in turn-taking in vocal interactions with their caregivers"<ref>Nguyen T, Zimmer L, Hoehl S. [https://royalsocietypublishing.org/doi/epdf/10.1098/rstb.2021.0488 Your turn, my turn. Neural synchrony in mother–infant proto-conversation.] Philosophical Transactions of the Royal Society B. 2023 Apr 24;378(1875):20210488.</ref></blockquote>
* Non-verbal communication
* Non-verbal communication<ref name=":1">Willard D. Communication in Early Intervention Course. Plus, 2024.</ref>
** Eye-gaze
** eye gaze
** Smile
** smiling
** Pointing
** pointing
** Some noises that they might make
** certain noises
** Grabbing
** grabbing
** Crying
** crying


* Stimulus-response relation (12 months of age)<ref name=":0">Pelaez M, Monlux K. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6701736/pdf/40614_2018_Article_151.pdf Development of Communication in Infants: Implications for Stimulus Relations Research.] Perspect Behav Sci. 2018 Apr 17;41(1):175-188.</ref>
* Stimulus-response relation (usually learned by 12 months of age)<ref name=":0">Pelaez M, Monlux K. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6701736/pdf/40614_2018_Article_151.pdf Development of Communication in Infants: Implications for Stimulus Relations Research.] Perspect Behav Sci. 2018 Apr 17;41(1):175-188.</ref>
** Gazes at the mother to search for cues
** an infant orients towards the caregiver to search for cues - e.g. in response to a new toy
** Critical for an infant learning gestural communication
** gazing towards the caregiver is critical for learning gestural communication
** The absence of sustained infant eye contact with caregivers may indicate that the infant may have language delay <ref name=":0" />
** the absence of sustained infant eye contact with caregivers may indicate that the infant has a developmental delay, with "associated delays in language and / or the absence of learning new stimulus–stimulus relations"<ref name=":0" />
*Joint attention (9-12 months of age)
*Joint attention (usually starts 9-12 months of age)
**"Infant’s ability to make eye contact with another individual, shift her gaze to some stimuli and regain eye contact with the same caregiver."<ref name=":0" />
**an infant's "ability to make eye contact with another individual, shift her gaze to some stimuli and regain eye contact with the same caregiver"<ref name=":0" />
**It helps in the early learning of language skills, including naming and provides a basis for cognitive development and social referencing.<ref name=":0" />
**joint attention helps in the early learning of language skills, including naming, and provides a basis for cognitive development and social referencing<ref name=":0" />
**Social reinforcers (nod or a gestural expression) facilitate and maintain the infant's joint attention
**social reinforcers (e.g. a nod or a gestural expression) facilitate and maintain an infant's joint attention
*Social referencing
*Social referencing
**"Behaviour chain in which two individuals (caregiver and child) were involved in an interaction", including eye contact, gaze shift to a new stimulus, return of gaze shift to each other, and altered facial cues. <ref>Pelaez M, Virués-Ortega J, Gewirtz J. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3297351/pdf/jaba-45-01-23.pdf Acquisition of social referencing via discrimination training in infants.] Journal of Applied Behavior Analysis. 2012;45:23–35.</ref>
**"Behaviour chain in which two individuals (caregiver and child) were involved in an interaction"<ref name=":5">Pelaez M, Monlux K. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6701736/pdf/40614_2018_Article_151.pdf Development of Communication in Infants: Implications for Stimulus Relations Research.] Perspect Behav Sci. 2018 Apr 17;41(1):175-188.</ref>, including eye contact, gaze shift to a new stimulus, return of gaze shift to each other, and altered facial cues.<ref name=":5" />


=== Verbal communication ===
=== Verbal communication ===


* Responding to symbolic language cues (6 months)<ref name=":0" />
* Infants begin to respond to symbolic language cues from 6 months<ref name=":0" />
* Pointing and naming objects (12 months)
* They are pointing to and naming objects by 12 months
** It involves several steps:
** usually involves several steps:
*** Eye gaze of the person naming the object
*** tracking the eye gaze of the person naming the object to ascertain what they are naming
*** Determining what the person is naming
*** repeating the name in the presence of the object
*** Repeating the name in the presence of the object
*** looking back at the caregiver for confirmation
*** Looking back at the caregiver for confirmation


* Receptive language can contain above 100 words<ref name=":0" />
* By 12 months, an infant's receptive language can be more than 100 words<ref name=":0" />
* Expressive vocabulary develops by the age of 18 months<ref name=":0" />
* Expressive vocabulary usually catches up at around 18 months<ref name=":0" />


== Child and Parent Styles of Communication ==
== Understanding Styles of Communication ==
'''Understanding how the child communicates:'''<ref name=":1">Willard D. Communication in Early Intervention. Plus Course 2023</ref>
The following strategies can enable caregivers to help their children learn language and start to use it expressively.<ref name=":1" />
* Caregivers first need to understand how their child is ''already'' communicating (e.g. gaze, smiles etc) - they should aim to analyse how and why the child is communicating


To help the parents understand how their child communicates, use the following strategies to make them recognise their purpose of communication. They should complete the following exercises:
* Caregivers should then identify how and why ''they'' communicate and identify these same behaviours in their children
* Caregivers can start to understand and anticipate how to help their child communicate more


* Analyse how and why they communicate.
'''Understanding the child's style of communication'''<ref name=":1" />
** What did they do to communicate with others?


* Start to identify similar communication behaviours in their children.
To help caregivers understand their child's style of communication, ask the following questions:
* Start to understand and anticipate how to help their child communicate more.
 
'''Understanding what is the child's style of communication:'''<ref name=":1" />
 
To help the parent understand their child's style of communication, ask them to respond to the following questions:


* Is your child very sociable?
* Is your child very sociable?
* Does your child have an easy back-and-forth conversation and communication?
* Does your child have easy back-and-forth conversation and communication?
* Is your child passive during conversation and communication?
* Is your child passive during conversation and communication?
* Does your child have a reluctant style of communication?
* Does your child have a reluctant style of communication?


'''Understanding what is the parent style of communication:'''
'''Understanding the caregiver's style of communication'''<ref name=":1" />


To better help the parent to communicate with their child, respond to the following questions:<ref name=":1" />
You can ask similar questions to help the caregiver understand their communication style:<ref name=":1" />


* What kind of style does the parent have that you are trying to help?
* What kind of communication style does the caregiver have?
* Do they have a passive style?
* Do they have a passive style?
* Do they have a sociable style?
* Do they have a sociable style?


'''Understanding how the environment and personal feelings affect communication:'''
'''Understanding how the environment and personal feelings affect communication'''


To help the parents understand that communication depends on our environment and how we are feeling, you should explain the following:<ref name=":1" />
It is important that caregivers understand that communication depends on our environment and how we are feeling:<ref name=":1" />


* We cannot always expect our children to communicate in every environment.
* We cannot always expect our children to communicate in every environment  
* Children may not want to communicate after a long day, just like an adult


* The child may not want to communicate after a long day, just like an adult.
== Four Stages of Early Communication ==
There are four identifiable stages of early communication: the discoverer stage, communicator stage, first-word user stage, and combiner stage.<ref>Hanen's Four Stages of Early Communication: A Short Guide for Parents. Available from https://www.hanen.org/About-Us/Who-We-Help/Academia/Hanen-Insider/Hanen-s-Four-Stages-of-Early-Communication--A-Shor.aspx [last access 17.12.2023]</ref> Each child is unique and can transition to the next step at different times. One child may move more slowly through the stages than other children of the same age - this can be influenced by developmental delay or illness. Understanding where a child is in their development helps to set realistic expectations and goals.<ref name=":1" />


== Child's Stage of Development ==
# Discoverer stage (birth-8 months<ref name=":2">Weitzman E, Greenberg J. The Six Stages of Communication and Language Development. Learning Language and Loving It. Hanen Publication 2002. </ref>)
We can identify four stages of a child's development: the discoverer stage, communicator stage, first-word user stage, and combiner stage.<ref>Hanen's Four Stages of Early Communication: A Short Guide for Parents. Available from https://www.hanen.org/About-Us/Who-We-Help/Academia/Hanen-Insider/Hanen-s-Four-Stages-of-Early-Communication--A-Shor.aspx [last access 17.12.2023]</ref> Each child is unique and can transition to the next development step at different times. One may move slower than others from the same age group, mainly when influenced by developmental delay or illness. Understanding where the child is in their development will help to set expectations and goals. <ref name=":1" />
#* infancy stage
 
#* no back-and-forth reaction
# Discoverer stage (birth to 8 months<ref name=":2">Weitzman E, Greenberg J. The Six Stages of Communication and Language Development.
#* infants at this stage communicate through reflexive responses (e.g. crying, smiling, fussing) to get their needs met
 
#Communicator stage (8-13 months<ref name=":2" />)
Learning Language and Loving It. Hanen Publication 2002. </ref>)
#*eye gaze
#* Infancy stage
#*the child understands meaningful conversation and starts to formulate or send messages with a specific purpose in mind
#* No back-and-forth reaction
#*uses pointing or grunting to send messages with intent
#* Communicates through crying to get the needs met
#*non-verbal communication only
#Communicator stage(8-13 months <ref name=":2" />)
#First word user stage (12-18 months<ref name=":2" />)
#*Eye gaze  
#*uses words or signs regularly
#*The child understands meaningful conversation and starts to intent or send messages with intent
#Combiner stage (18-24 months<ref name=":2" />)
#*Uses pointing or grunting to send messages with intent
#*begins to combine words
#*Non-verbal communication only
#*starts combining two- and three-word phrases
#First word user stage (12-18 months <ref name=":2" />)
#*Uses words or signs regularly
#Combiner stage (18-24 months <ref name=":2" />)
#*Begins to combine words
#*Starts combining two- and three-word phrases


== Communication Strategies for Parents ==
== Communication Strategies for Parents ==
The general qualities of an excellent person to have a conversation with are as follows:<ref name=":1" />
An excellent communicator usually does the following:<ref name=":1" />


* Listens to us
* listens
* Does not interrupt
* does not interrupt
* Follows our lead
* follows our lead
The following strategies can help caregivers communicate more effectively with their children.


=== Get Face to Face ===
=== 1. Get Face-to-Face ===


* Standing over the child can be intimidating and uncomfortable for them.<ref name=":1" />
* Standing over a child can make them feel intimidated and uncomfortable<ref name=":1" />
* Speaking on the same level as your child makes them feel more comfortable, less intimidating, and more fluid.<ref name=":1" />
* Getting down at the same level (face-to-face) as a child makes them feel more comfortable, less intimidated, and communication is more fluid<ref name=":1" />
* Getting face-to-face with your child will:<ref name=":1" />
* Getting face-to-face with a child will:<ref name=":1" />
** Ease their interaction.
** help them understand what you are saying to them
** Help them understand what you are saying to them.
** help them model your words, as they can look at your mouth
** Help them model some of the words you might be saying to them by looking at your mouth.
* In some situations, you won't be able to get face-to-face, such as:<ref name=":1" />
* The following are the examples of NOT the best times for interaction with your child because you are not face to face with your child:<ref name=":1" />
** when walking or pushing a stroller (if they are facing away)
** Walking or pushing the stroller.
** while driving with your child in their car seat behind you
** Talking from your back, like standing at the kitchen sink preparing dinner, and the child is playing on the kitchen floor.
** talking with your back to them - e.g. talking while standing at a sink preparing dinner while the child plays on the kitchen floor behind you
** Driving a car with your child in the car seat.


=== Observe the Child ===
=== 2. Observe the Child ===
The clinician's role is to teach the parent to become a better tuned-in listener, to understand the importance of getting face-to-face with a child, and to wait and observe how their child communicates.<ref name=":1" />
The clinician's role is to help the caregiver become a tuned-in listener, to understand the importance of getting face-to-face with a child, and to ''wait and observe'' how a child communicates.<ref name=":1" />


Careful observation will help the parent to acknowledge the following: <ref name=":1" />
Careful observation will help the parent to determine the following:<ref name=":1" />


* What is my child trying to tell me?  
* What is my child trying to tell me?  
* What messages are they sending?  
* What messages are they sending?  
* How does my child communicate? Are they pointing? Are they grunting? Are they smiling?  
* How does my child communicate? Are they pointing? Are they grunting? Are they smiling?  
* Why are they choosing this style of communication? Because they are happy? Because they enjoyed something?
* Why are they choosing this style of communication? Because they are happy? Because they enjoyed something?  


=== Respond To the Child's Communication ===
=== 3. Respond to the Child's Communication ===
<blockquote>"When children learn to communicate, it's for a desire from within."<ref name=":1" />---Dawn Willard</blockquote>
<blockquote>"When children learn to communicate, it's for a desire from within."<ref name=":1" />---Dawn Willard</blockquote>


* Do not start your response by attempting to teach, control, or show.
* Do not start your response by attempting to teach, control, or show
 
* Help your child learn to verbalise and communicate with you from a desire to tell you what they want.
* As soon as your child sends a message, you must respond immediately.
* If your child is not listened to, they may leave the interaction quickly.


=== Follow the Child Lead ===
* Help your child learn to verbalise and communicate with you from a desire to tell you what they want
<blockquote>"Silence is the sound of someone thinking." <ref name=":1" />--Questlove</blockquote><blockquote>"Play the way the child wants to play is the most important part of following their lead."<ref name=":1" />--Dawn Willard</blockquote>The following strategies will help the parent communicate with the child:<ref name=":1" />
* As soon as your child sends a message, you must respond immediately
* If your child is not listened to, they may leave the interaction quickly


* Allow your child to initiate conversation. It is the natural first step of children using expressive language or language to communicate with others.
=== 4. Follow the Child's Lead ===
* Understand that there is a pause, give, and take in the conversation with your child.
<blockquote>"Silence is the sound of someone thinking."<ref name=":1" />--Questlove</blockquote><blockquote>"Playing the way the child wants to play is the most important part of following their lead."<ref name=":1" />--Dawn Willard</blockquote>
* Do not talk the entire time.
* Allow your child to initiate conversation, as this is the first step to using expressive language or language to communicate with others
* Wait five to ten seconds for the child to send a message.
* Understand that there should be a pause, give, and take during a conversation with your child
* The silence allows your child to process what is happening and what they want to communicate next.
* Do not talk the entire time
* Wait five to ten seconds for your child to send a message
* Silence allows your child to process what is happening and what they want to communicate next<ref name=":1" />


== Conclusion ==
== Summary of Strategies for Parents and Caregivers ==
The following strategies used by parents will help their children learn the language and start using it expressively:<ref name=":1" />
Caregivers can use the following strategies to help their children develop language and start using it expressively:<ref name=":1" />


# Get face to face  
# Get face to face  
# Observe  
# Observe  
# Waiting
# Listen
# Listen
# Follow the child's lead by staying on that topic  
# Follow the child's lead by staying on topic
Watch this short video that highlights parents' and children's communication skills:{{#ev:youtube|v=2JG9AC0ZxuY|300}}<ref>Speech in a Sec. Developing a child’s communication skills. Available from:https://www.youtube.com/watch?v=2JG9AC0ZxuY [last accessed 12/12/2023]</ref>
The short video below describes back-and-forth interactions and considers how to help children develop communication skills:{{#ev:youtube|v=2JG9AC0ZxuY|300}}<ref>Speech in a Sec. Developing a child’s communication skills. Available from:https://www.youtube.com/watch?v=2JG9AC0ZxuY [last accessed 12/12/2023]</ref>


== ICF-CY Resources ==
== ICF-CY Resources ==
The International Classification of Functioning, Disability and Health – Children and Youth ([[ICF-CY International Classification of Functioning, Disability and Health Children and Youth Version|ICF-CY]]) can be used to define the impact of communication problems on the child's functional skills. The cognitive functions of language include "recognising and using signs, symbols, and other components of a language, " as described in the ICF-CY.
The International Classification of Functioning, Disability and Health – Children and Youth ([[ICF-CY International Classification of Functioning, Disability and Health Children and Youth Version|ICF-CY]]) can be used to define the impact of communication problems on a child's functional skills. The cognitive functions of language include "recognising and using signs, symbols, and other components of a language", as described in the ICF-CY.


The following are '''examples''' of factors relevant to '''spoken language comprehension''' in typically developed '''infant:'''
The following are '''examples''' of factors relevant to '''spoken language comprehension''' in typically developing '''infants:'''


'''Body structure:'''
'''Body structure:'''
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* Sex
* Sex


You can learn more about the ICF-CY from the [https://members.physio-pedia.com/using-the-icf-with-cerebral-palsy-course/ Using the ICF with Cerebral Palsy] Plus course.
You can learn more about the ICF-CY in the Plus course, [https://members.physio-pedia.com/using-the-icf-with-cerebral-palsy-course/ Using the ICF with Cerebral Palsy].


== Resources ==
== Resources ==
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<references />
<references />
[[Category:Language]]
[[Category:Communication]]
[[Category:Communication]]
[[Category:Early Intervention]]
[[Category:Rehabilitation]]
[[Category:Rehabilitation]]
[[Category:Paediatrics]]
[[Category:Paediatrics]]
[[Category:Course Pages]]
[[Category:Course Pages]]
[[Category:ReLAB-HS Course Page]]
[[Category:ReLAB-HS Course Page]]

Latest revision as of 12:24, 14 May 2024

Original Editor - Dawn Willard

Top Contributors - Ewa Jaraczewska, Jess Bell and Kim Jackson  

Introduction[edit | edit source]

Infants start interacting with their environment from birth, responding to visual and auditory events and actively engaging in spontaneous movements of their limbs.[1] When working with children, it is important to note that motor problems often co-occur with communication problems.[2] Up to 81% of children with mild to moderate functional mobility limitations are diagnosed with communication problems.[2] [3] Reduced language skills and a decreased ability or inability to communicate can affect a child's social development, impacting their self-identity, self-esteem, self-control and interactions with others.[4] Caregivers play a pivotal role in the development of communication as they are their infants' and toddlers' primary communicators.[5] This article discusses how and why a child communicates and offers basic communication strategies for caregivers to enhance communication with their children.

Methods of Communication in Children[edit | edit source]

Children adopt different communication strategies from infancy to when they become verbal.

Non-verbal Communication[edit | edit source]

"Infants as young as eight weeks of age actively engage in turn-taking in vocal interactions with their caregivers"[6]

  • Non-verbal communication[7]
    • eye gaze
    • smiling
    • pointing
    • certain noises
    • grabbing
    • crying
  • Stimulus-response relation (usually learned by 12 months of age)[8]
    • an infant orients towards the caregiver to search for cues - e.g. in response to a new toy
    • gazing towards the caregiver is critical for learning gestural communication
    • the absence of sustained infant eye contact with caregivers may indicate that the infant has a developmental delay, with "associated delays in language and / or the absence of learning new stimulus–stimulus relations"[8]
  • Joint attention (usually starts 9-12 months of age)
    • an infant's "ability to make eye contact with another individual, shift her gaze to some stimuli and regain eye contact with the same caregiver"[8]
    • joint attention helps in the early learning of language skills, including naming, and provides a basis for cognitive development and social referencing[8]
    • social reinforcers (e.g. a nod or a gestural expression) facilitate and maintain an infant's joint attention
  • Social referencing
    • "Behaviour chain in which two individuals (caregiver and child) were involved in an interaction"[9], including eye contact, gaze shift to a new stimulus, return of gaze shift to each other, and altered facial cues.[9]

Verbal communication[edit | edit source]

  • Infants begin to respond to symbolic language cues from 6 months[8]
  • They are pointing to and naming objects by 12 months
    • usually involves several steps:
      • tracking the eye gaze of the person naming the object to ascertain what they are naming
      • repeating the name in the presence of the object
      • looking back at the caregiver for confirmation
  • By 12 months, an infant's receptive language can be more than 100 words[8]
  • Expressive vocabulary usually catches up at around 18 months[8]

Understanding Styles of Communication[edit | edit source]

The following strategies can enable caregivers to help their children learn language and start to use it expressively.[7]

  • Caregivers first need to understand how their child is already communicating (e.g. gaze, smiles etc) - they should aim to analyse how and why the child is communicating
  • Caregivers should then identify how and why they communicate and identify these same behaviours in their children
  • Caregivers can start to understand and anticipate how to help their child communicate more

Understanding the child's style of communication[7]

To help caregivers understand their child's style of communication, ask the following questions:

  • Is your child very sociable?
  • Does your child have easy back-and-forth conversation and communication?
  • Is your child passive during conversation and communication?
  • Does your child have a reluctant style of communication?

Understanding the caregiver's style of communication[7]

You can ask similar questions to help the caregiver understand their communication style:[7]

  • What kind of communication style does the caregiver have?
  • Do they have a passive style?
  • Do they have a sociable style?

Understanding how the environment and personal feelings affect communication

It is important that caregivers understand that communication depends on our environment and how we are feeling:[7]

  • We cannot always expect our children to communicate in every environment
  • Children may not want to communicate after a long day, just like an adult

Four Stages of Early Communication[edit | edit source]

There are four identifiable stages of early communication: the discoverer stage, communicator stage, first-word user stage, and combiner stage.[10] Each child is unique and can transition to the next step at different times. One child may move more slowly through the stages than other children of the same age - this can be influenced by developmental delay or illness. Understanding where a child is in their development helps to set realistic expectations and goals.[7]

  1. Discoverer stage (birth-8 months[11])
    • infancy stage
    • no back-and-forth reaction
    • infants at this stage communicate through reflexive responses (e.g. crying, smiling, fussing) to get their needs met
  2. Communicator stage (8-13 months[11])
    • eye gaze
    • the child understands meaningful conversation and starts to formulate or send messages with a specific purpose in mind
    • uses pointing or grunting to send messages with intent
    • non-verbal communication only
  3. First word user stage (12-18 months[11])
    • uses words or signs regularly
  4. Combiner stage (18-24 months[11])
    • begins to combine words
    • starts combining two- and three-word phrases

Communication Strategies for Parents[edit | edit source]

An excellent communicator usually does the following:[7]

  • listens
  • does not interrupt
  • follows our lead

The following strategies can help caregivers communicate more effectively with their children.

1. Get Face-to-Face[edit | edit source]

  • Standing over a child can make them feel intimidated and uncomfortable[7]
  • Getting down at the same level (face-to-face) as a child makes them feel more comfortable, less intimidated, and communication is more fluid[7]
  • Getting face-to-face with a child will:[7]
    • help them understand what you are saying to them
    • help them model your words, as they can look at your mouth
  • In some situations, you won't be able to get face-to-face, such as:[7]
    • when walking or pushing a stroller (if they are facing away)
    • while driving with your child in their car seat behind you
    • talking with your back to them - e.g. talking while standing at a sink preparing dinner while the child plays on the kitchen floor behind you

2. Observe the Child[edit | edit source]

The clinician's role is to help the caregiver become a tuned-in listener, to understand the importance of getting face-to-face with a child, and to wait and observe how a child communicates.[7]

Careful observation will help the parent to determine the following:[7]

  • What is my child trying to tell me?
  • What messages are they sending?
  • How does my child communicate? Are they pointing? Are they grunting? Are they smiling?
  • Why are they choosing this style of communication? Because they are happy? Because they enjoyed something?

3. Respond to the Child's Communication[edit | edit source]

"When children learn to communicate, it's for a desire from within."[7]---Dawn Willard

  • Do not start your response by attempting to teach, control, or show
  • Help your child learn to verbalise and communicate with you from a desire to tell you what they want
  • As soon as your child sends a message, you must respond immediately
  • If your child is not listened to, they may leave the interaction quickly

4. Follow the Child's Lead[edit | edit source]

"Silence is the sound of someone thinking."[7]--Questlove

"Playing the way the child wants to play is the most important part of following their lead."[7]--Dawn Willard

  • Allow your child to initiate conversation, as this is the first step to using expressive language or language to communicate with others
  • Understand that there should be a pause, give, and take during a conversation with your child
  • Do not talk the entire time
  • Wait five to ten seconds for your child to send a message
  • Silence allows your child to process what is happening and what they want to communicate next[7]

Summary of Strategies for Parents and Caregivers[edit | edit source]

Caregivers can use the following strategies to help their children develop language and start using it expressively:[7]

  1. Get face to face
  2. Observe
  3. Listen
  4. Follow the child's lead by staying on topic

The short video below describes back-and-forth interactions and considers how to help children develop communication skills:

[12]

ICF-CY Resources[edit | edit source]

The International Classification of Functioning, Disability and Health – Children and Youth (ICF-CY) can be used to define the impact of communication problems on a child's functional skills. The cognitive functions of language include "recognising and using signs, symbols, and other components of a language", as described in the ICF-CY.

The following are examples of factors relevant to spoken language comprehension in typically developing infants:

Body structure:

  • Structure of brain (s110)

Body Function:

  • Seeing functions (b210)
  • Hearing functions (b230)
  • Speech functions (yes or no) (b320)

Activities and participation:

  • Communication (d350)
  • Social skills (d710,720,750)
  • Language activities (d810)
  • Symbolic play (d880)

Contextual domain/Environmental factors:

  • The educational level of the parents (e165)
  • Number of siblings and birth order (e310)
  • Language input/caregiver speech (e410)

Personal factors:

  • Age
  • Sex

You can learn more about the ICF-CY in the Plus course, Using the ICF with Cerebral Palsy.

Resources[edit | edit source]

References[edit | edit source]

  1. ↑ Versfeld P. The Newborn Infant – Setting the Scene Course. Plus, 2023.
  2. ↑ 2.0 2.1 Vaillant E, Geytenbeek JJM, Jansma EP, Oostrom KJ, Vermeulen RJ, Buizer AI. Factors associated with spoken language comprehension in children with cerebral palsy: a systematic review. Dev Med Child Neurol. 2020 Dec;62(12):1363-1373.
  3. ↑ Valla L, Slinning K, Kalleson R, Wentzel‐Larsen T, Riiser K. Motor skills and later communication development in early childhood: Results from a population‐based study. Child: Care, Health and Development. 2020 Jul;46(4):407-13.
  4. ↑ Sainain NS, Omar R, Ismail H, Mamat N, Abdullah R. Parental knowledge and development of languages and literacy, communication and socializations in the early childhood education. International Journal of Psychosocial Rehabilitation. 2020;24(9):2070-80.
  5. ↑ Dinkel D, Rasmussen M, Rech JP, Snyder K, Dev DA. A qualitative comparison of parent and childcare provider perceptions of communication and family engagement in children's healthy eating and physical activity. Child Care Health Dev. 2022 Jan;48(1):99-109.
  6. ↑ Nguyen T, Zimmer L, Hoehl S. Your turn, my turn. Neural synchrony in mother–infant proto-conversation. Philosophical Transactions of the Royal Society B. 2023 Apr 24;378(1875):20210488.
  7. ↑ 7.00 7.01 7.02 7.03 7.04 7.05 7.06 7.07 7.08 7.09 7.10 7.11 7.12 7.13 7.14 7.15 7.16 7.17 7.18 Willard D. Communication in Early Intervention Course. Plus, 2024.
  8. ↑ 8.0 8.1 8.2 8.3 8.4 8.5 8.6 Pelaez M, Monlux K. Development of Communication in Infants: Implications for Stimulus Relations Research. Perspect Behav Sci. 2018 Apr 17;41(1):175-188.
  9. ↑ 9.0 9.1 Pelaez M, Monlux K. Development of Communication in Infants: Implications for Stimulus Relations Research. Perspect Behav Sci. 2018 Apr 17;41(1):175-188.
  10. ↑ Hanen's Four Stages of Early Communication: A Short Guide for Parents. Available from https://www.hanen.org/About-Us/Who-We-Help/Academia/Hanen-Insider/Hanen-s-Four-Stages-of-Early-Communication--A-Shor.aspx [last access 17.12.2023]
  11. ↑ 11.0 11.1 11.2 11.3 Weitzman E, Greenberg J. The Six Stages of Communication and Language Development. Learning Language and Loving It. Hanen Publication 2002.
  12. ↑ Speech in a Sec. Developing a child’s communication skills. Available from:https://www.youtube.com/watch?v=2JG9AC0ZxuY [last accessed 12/12/2023]
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