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 in the environment and actively engaging in spontaneous movements of the limbs. The most critical period for developmental growth occurs during early childhood. 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. 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. Parents are pivotal as their infants' and toddlers' primary communicators. 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.

Methods and Stages of Child's Communication

Children have 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
  • Smile
  • Pointing
  • Some noises that they might make
  • Grabbing
  • Crying

• Stimulus-response relation (12 months of age)
  • Gazes at the mother to search for cues
  • Critical for an infant learning gestural communication
  • The absence of sustained infant eye contact with caregivers may indicate that the infant may have language delay
• Joint attention (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."
  • It helps in the early learning of language skills, including naming and provides a basis for cognitive development and social referencing.
  • Social reinforcers (nod or a gestural expression) facilitate and maintain the 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

• Responding to symbolic language cues (6 months)
• Pointing and naming objects (12 months)
  • It involves several steps:
    • Eye gaze of the person naming the object
    • Determining what the person is naming
    • Repeating the name in the presence of the object
    • Looking back at the caregiver for confirmation

• Receptive language can contain above 100 words
• Expressive vocabulary develops by the age of 18 months

Child and Parent Styles of Communication

Understanding how the child communicates:

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:

• Analyse how and why they communicate.
  • What did they do to communicate with others?

• Start to identify similar communication behaviours in their children.
• Start to understand and anticipate how to help their child communicate more.

Understanding what is the child's style of communication:

To help the parent understand their child's style of communication, ask them to respond to the following questions:

• Is your child very sociable?
• Does your child have an 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 what is the parent style of communication:

To better help the parent to communicate with their child, respond to the following questions:

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

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:

• We cannot always expect our children to communicate in every environment.

• The child may not want to communicate after a long day, just like an adult.

Child's Stage of Development

We can identify four stages of a child's development: the discoverer stage, communicator stage, first-word user stage, and combiner stage. 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.

1. Discoverer stage (birth to 8 months)
   • Infancy stage
   • No back-and-forth reaction
   • Communicates through crying to get the 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

The general qualities of an excellent person to have a conversation with are as follows:

• Listens to us
• Does not interrupt
• Follows our lead

Get Face to Face

• Standing over the child can be intimidating and uncomfortable for them.
• Speaking on the same level as your child makes them feel more comfortable, less intimidating, and more fluid.
• Getting face-to-face with your child will:
  • Ease their interaction.
  • Help them understand what you are saying to them.
  • Help them model some of the words you might be saying to them by looking at your mouth.
• 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:
  • Walking or pushing the stroller.
  • Talking from your back, like standing at the kitchen sink preparing dinner, and the child is playing on the kitchen floor.
  • Driving a car with your child in the car seat.

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.

Careful observation will help the parent to acknowledge 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?

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.

Follow the Child Lead

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

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

The following strategies will help the parent communicate with the child:

• Allow your child to initiate conversation. It is the natural first step of children using expressive language or language to communicate with others.
• Understand that there is a pause, give, and take in the conversation with your child.
• Do not talk the entire time.
• Wait five to ten seconds for the child to send a message.
• The silence allows your child to process what is happening and what they want to communicate next.

Conclusion

The following strategies used by parents will help their children learn the language and start using it expressively:

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

Watch this short video that highlights parents' and children's 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 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 following are examples of factors relevant to spoken language comprehension in typically developed infant:

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 from the Using the ICF with Cerebral Palsy Plus course.

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