I have seen many parents and daycare teachers label toddlers as “difficult” or a behavior problem when the real problem is that the child doesn’t understand and process language as well as other children his age. Parents sometimes overestimate what their child who is not talking is able to understand. When I was talking about this with a good friend of mine who is a developmental interventionist, she offered an insightful comment. To paraphrase her, there are parents who would rather think of their child as “bad” rather than admit that he or she doesn’t understand much.
This is so unfortunate because a child must understand words before we expect him to talk and before we expect him to obey. A child who doesn’t understand much really can’t (and shouldn’t) say much either. To expect more is simply wrong. Many times toddlers don’t follow directions, and it’s not because they’re being disobedient, stubborn, or lazy. They don’t follow directions because they don’t understand what’s being said. They seem to ignore language because words don’t mean anything to them yet. Speech-language pathologists think of working on receptive language hand-in-hand with expressive language. When parents get on board with this approach, wonderful things happen. Before I give you ways to target this at home, let’s review the definition of receptive language, discuss the characteristics of children with receptive language problems, and then finally talk about ways to improve these skills.
What is receptive language?
Receptive language can also be referred to as language comprehension or auditory comprehension skills. This means how well your baby understands the language he hears. Examples of receptive language include how your toddler follows directions such as “Give me your cup,” or how he might walk toward the bathroom when you announce, “It’s time for bath.” These skills begin from birth when your baby early on begins to purposefully look at you and enjoy your attention and when he starts to notice environmental sounds such as the neighbor’s dog barking or a loud fire engine. It progresses when he begins to pay attention to what you’re talking about so that he looks around when you announce “Daddy’s home,” or watches as you point to a bird outside the window. He begins to understand early games such as “Peek-a-boo” well enough to cover his head himself and lights up when he pulls the blanket off and you yell, “Boo.” It includes being able to point to body parts when you ask, “Where’s your nose” and find pictures in books when you say, “Show me the dog.” Receptive language is closely tied to a baby’s cognitive, or thinking skills.
Until a child is age 3 or older, it is very difficult to separate receptive language and cognition. In fact, most of the skills listed on early developmental charts are actually similar for both domains. While it is true that some children may demonstrate cognitive strengths such as a good memory or exceptional visual skills, many times poor language comprehension skills are linked to underlying cognitive deficits. When assessing how your baby understands language at home, it is very important to be sure that your child is responding to the words you’re saying and not the nonverbal cues you might be giving. For example, when you’re asking your child, “Give me the block,” he may be responding to your outstretched hand as he gives it to you, or he may see the juice box you’re getting out of the refrigerator rather than understand, “Are you thirsty?”
What is a receptive language disorder?
A receptive language disorder is difficulty understanding language that results in differences in how and what a child understands when compared to other children his same age. Receptive language disorders can also be called auditory comprehension disorders. Another diagnosis which is closely related for young children is Central Auditory Processing Disorder (CAPD), which is difficulty in the ability to attend to, process, comprehend, retain, or integrate spoken language. Kids who have receptive language disorders often don’t follow directions and not because they’re being “bad.” They don’t follow directions because they don’t understand what’s said to them. They also may seem to “tune out” because words don’t mean anything to them yet.
Early signs and symptoms of a receptive language problem:
- Ignoring spoken language
- Difficulty following verbal directions, especially if the command is new or you’re not using visual cues such as pointing or showing them what you want them to do
- Repeating a question rather than answering it
- Answering a question incorrectly (Such as shaking their heads “yes” when you ask them a question with 2 choices. Giving an off-target response such as saying “2″ when you ask, “What’s your name?”)
- Most of their speech is jargon or the same set of core words and phrases
Practical Ways to Work on Receptive Language at Home
During your daily routines at home, pay attention to HOW you’re talking to him. Toddlers with receptive language difficulties often need very specific and focused “teaching” (for lack of a better word) to begin to link words with objects, people, and events. If they were just going to “pick it up” in daily conversations, they would have already done it, and there wouldn’t be a problem.
Kids with difficulty understanding and processing language need adults who are there to “interpret” the world for them. They benefit from nurturing parents and teachers who can provide support to help them understand words and associate them with their environments. How can you do this for your child?
1. Reduce the complexity of what you’re saying.
Break it down for a kid who is struggling to understand. Use mostly single words and short phrases when you’re talking to him. Sometimes this isn’t stated to parents clearly enough. The advice is simply talk to your child. This doesn’t always work with children with receptive language disorders. Since there’s a problem with your child learning to understand, you must simplify what you’re trying to teach since he’s not getting it the “regular” way.
Let me give you an example you can relate to. This is like sitting in a college calculus class and knowing how to add and subtract, but you have forgotten how to solve an algebraic equation. Or imagine being dropped off in Mexico when the only Spanish you know is how to count to 5 and a few food words like “taco,” and being expected to understand directions to the airport to book the next flight home. You’re in over your head. That’s how it is for a child with a language delay. He understands some of it, but not enough to get him through the day.
Use lots of single words. Use lots of short phrases. Avoid long explanations or questions. When you’re asking your kid with language delays if he wants a cookie, don’t launch into, “Do you want one of these yummy chocolate chip cookies that Mommy just bought at the grocery store?” Hold up the cookie and ask, “Want a cookie?” See the difference?
For multilingual families, pick one primary language and stick to it. If your child is struggling to learn language, doesn’t it make sense that he’s more likely to succeed if he’s learning just one? That doesn’t mean that you won’t get to teach him other languages later. Educators who recommend teaching your baby several languages at once are not considering the effects on a child with language processing issues. If your child is having difficulty learning to understand and use language, please let him master (that is, catch up to his age level) in one language before moving on.
2. Talk about what he’s paying attention to.
When you’re eating breakfast in the morning and he’s looking at his cereal and milk, use those words and talk about the meal. Don’t break into a dialogue about what happened at daycare yesterday or grandma’s visit next weekend. Keep it simple and in the here and now so it “makes sense.”
In order to know what he’s paying attention to, you’re going to need to be “with” him and engage him most of the day.? Insist that he participate and stay engaged with you to limit the time he “zones out” or “shuts down.”
3. Talk directly to him using words he can use.
Kids with language problems need parents who go out of their way to “teach” them the words they need to communicate. Don’t spend lots of your time talking to him with baby talk or using adult conversational styles. While we all break into, “Look at mama’s sweet, sweet little, bitty baby boy,” and spend lots of time talking to our spouses in their presence, don’t miss opportunities to talk using single words and simple sentence structures he can learn.
4. Give him clues (or “cues” in SLP terms) as to what you’re talking about.
Usually children with language comprehension delays rely heavily on visual cues since they don’t consistently understand or process words. Point to direct his attention. When practical, show him the object. If you’re using books, point directly to the picture, say its name, and then make a brief comment. Provide other visual cues including gestures such as leading him and moving objects within his line of vision to be sure he knows what you are talking about.
Because they need visual cues, kids with language delays may depend on your facial expressions to add meaning to your comments. Make your expressions match your words. If you’re upset and he’s about to be in trouble, don’t send mixed messages by continuing to smile as you warn him. He may misread your cues. (This goes for husbands too!)
Some kids need picture schedules to help them know what to expect next. Many preschools use these kinds of systems to provide additional support. Take digital pictures and put them in a small album or post them on the refrigerator to “show” him things he doesn’t understand in daily routines.
5. Repeat directions (again & again) when he doesn’t seem to understand.
Toddlers with language delays need extra repetitions of information to be able to process what’s been said. Resist the urge to think and say, “I’ve already told you once (or twice).” Repetition helps his little brain to learn.
6. Break commands into smaller chunks of information.
Until he’s following directions consistently, limit yourself to simple commands with one piece of information, “Go get your cup,” rather than “Take your cup to the sink.” Once he’s gotten the hang of familiar directions, then work on adding more parts. “Get your shoes and bring them to Mommy.”
7. Reword what he doesn’t understand.
When you’re getting that look (like “Huh?”) or if he’s tuning you out, try using other words. If you’re saying, “Our family is going to church now. We have to get ready to leave,” and he’s not looking, you might try calling his name and saying, “It’s time to go bye-bye.” Pause. “Come here.”
8. Give him frequent opportunities to demonstrate that he understands.
Consistently ask him, “Show me the ____, ” and “Where’s the _______.” If he’s not pointing yet, encourage him to look around to find what you’ve asked him to locate. Other activities you can include in your daily routines:
- Have him point to pictures in books. Focus on names of objects & actions. “Where’s the dog?” and “Show me who is sleeping.”
- Once he’s mastered basics names for objects and common actions, up the ante. Teach object use/function with words such as, “Which one is for riding? Which one goes on your feet? Which one do you use to drink? Which one says moo?” ?Help him identify parts of an object rather than the whole picture – “Find the door of the house, the wheel of the car, the dog’s foot, etc..”
- Retrieve objects on requests. Have him get items or put away specific toys on request, “Get your ball,” or “Bring me your puzzle.”
- Have her perform familiar tasks related to daily routines. Toddlers can get diapers or wipes before changing time, throw things in the trash, put their own cups in the sink, take off their own shoes and socks, close a door, wipe off a high chair tray, pet the dog, and help you clean up toys by placing them in a basket. Involving them regularly in these kinds of activities increases their opportunities to follow directions (and help you out!)
- During playtime give short directions and help him perform the action. For example, “Put ball in,” and then help him do it.
- When you’re playing with puzzles, hold up a piece and label it with a single word as he completes the puzzle. When he is finished, have him retrieve the puzzle pieces one at a time by asking, “Give me the ________.”
- When dressing, tell her to put her arm in the sleeve or leg in her pants. Hold up a sock and shoe and ask her to, “Get the sock.”
- When he’s seated near a toy, hold out your hand and say, “Give me the _____.”
- Place several items related to your play in front of her and ask, “Where’s the ______.”
- In the bathtub or during diaper changes, ask him to point to body parts, and help him follow through.
- During play time ask her to give her baby doll a drink or put her baby down to sleep.
9. To build compliance with everyday tasks, try telling him to do things that he’s already about to do.
For example, if he’s headed for a ball, say, “Get the ball.” If he’s reaching for a book, say, “Read your book.” Now you know he’s not doing this because you asked him, but using this method gives toddlers a way to “get in the habit” of doing what Mommy says.
10. Insist that he follow directions by providing physical assistance as necessary.
Once you’ve given him a verbal direction and repeated it one time (maybe twice if he wasn’t listening), get up and help (make) him do it. Repeat the direction so he can link the activity with the words.
When he’s not responding, move closer to him, get down on his level, and touch him to redirect his attention.
Some children respond to claping or finger snappin more readily than a word to get his attention. Beware! Don’t overuse this technique, or he may start to tune this out, but because it’s annoying rather than because he doesn’t understand.
Try to make some directions fun too, such as “Come here so I can tickle/hold/kiss you.” Teach fun standards like, “Gimme 5,” so that everything isn’t about “obeying.”
11. Pause frequently when you are talking to him to give him time to process what you’ve said.
This is hard for chatty parents, me included! Give him enough time to think during your conversations. You may have to purposefully (but silently) count to 5 before moving on to your next point, or before you repeat yourself to be sure he’s had time to respond.
12. Lastly, but probably the most important, be very consistent with realistic behavioral expectations.
Children with difficulty understanding language need the same rules day-in and day-out that are easy to remember and follow. They need to be able to count on learning and knowing their routines.
If your child’s ability to understand language is much lower than his chronological age, you’re going to need to keep that in mind when determining behavioral standards and even disciplinary methods. For example, time out is recommended for children who are 2 and older. If your child is 26 months old, but his comprehension is at the 16 month level, time out is not an appropriate choice for him.
Some parents disagree with this and think that this is how you “teach” them, but believe me, you’re fighting an uphill battle. This is like trying to teach a 3 year old to tie shoes or jump a full-size hurdle. He’s just not ready yet. Use the same discretion when determining what is and isn’t appropriate behavior based on his comprehension level, and you’ll be a much more fair parent.
UPDATED JANUARY 2009
I’m so pleased to announce my new DVD series to target receptive language in toddlers and young preschoolers. If you’d like to SEE these strategies in action, check out the DVDs Teach Me To Listen and Obey 1 and 2. Here’s the link for more information -
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