Communication in Early Intervention

Original Editor - Dawn Willard

Top Contributors - Ewa Jaraczewska, Jess Bell and Kim Jackson  

Introduction

Infants start interacting with their environment from birth, responding to visual and auditory events and actively engaging in spontaneous movements of the limbs. When working with children, it is important to note that motor problems often co-occur with communication problems. Up to 81% of children with mild to moderate functional mobility limitations are diagnosed with communication problems. 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 ability to interact with others. Caregivers play a pivotal role in the development of communication as they are their infants' and toddlers' primary communicators. 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

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

Non-verbal Communication

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

• Non-verbal communication
  • eye gaze
  • smiling
  • pointing
  • certain noises
  • grabbing
  • crying

• Stimulus-response relation (usually learned by 12 months of age)
  • 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"
• 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"
  • joint attention helps in the early learning of language skills, including naming, and provides a basis for cognitive development and social referencing
  • 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", including eye contact, gaze shift to a new stimulus, return of gaze shift to each other, and altered facial cues

Verbal communication

• Infants begin to respond to symbolic language cues from 6 months
• 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
• Expressive vocabulary usually catches up at around 18 months

Understanding Styles of Communication

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

• 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

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

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

• 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:

• 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

There are four identifiable stages of early communication: the discoverer stage, communicator stage, first-word user stage, and combiner stage. 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.

1. Discoverer stage (birth-8 months)
   • 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)
   • eye gaze
   • the child understands meaningful conversation and starts to intent or send messages with intent
   • uses pointing or grunting to send messages with intent
   • non-verbal communication only
3. First word user stage (12-18 months)
   • uses words or signs regularly
4. Combiner stage (18-24 months)
   • begins to combine words
   • starts combining two- and three-word phrases

Communication Strategies for Parents

An excellent communicator usually does the following:

• listens
• does not interrupt
• follows our lead

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

1. Get Face-to-Face

• Standing over a child can make them feel intimidated and uncomfortable
• Getting down at the same level (face-to-face) as a child makes them feel more comfortable, less intimidated, and communication is more fluid
• Getting face-to-face with a child will:
  • 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:
  • 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

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.

Careful observation will help the parent to determine the following:

• 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

"When children learn to communicate, it's for a desire from within."---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

"Silence is the sound of someone thinking."--Questlove

"Playing the way the child wants to play is the most important part of following their lead."--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

Summary of Strategies for Parents and Caregivers

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

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:

ICF-CY Resources

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

• Gratier M, Devouche E, Guellai B, Infanti R, Yilmaz E, Parlato-Oliveira E. Early development of turn-taking in vocal interaction between mothers and infants. Front Psychol. 2015 Sep 4;6:1167.
• Overview of Early Intervention