How many of us received clear direction for “how to” speak to a very young child with language delays? If you’re lucky, you may have spent some time talking about this in terms of parent education, but often our clinical training programs don’t address this area as directly as we should with students and new professionals. How can we teach parents to effectively talk to young children with language delays if we don’t know ourselves?
Here are some reminders:
- Effective professionals demonstrate communicative affect.
We’ve already discussed how important it is to be fun and playful with a young child, but this is a little different. Sometimes the children we see are oblivious to another person’s presence, much less the non-verbal messages the other person may be sending their way. These children miss much of the interaction because, to put it bluntly, the other person isn’t interesting enough to attract their attention.
Because of these deficits in social awareness, we should model heightened affect during all of our interactions with each child, and especially with those who routinely tune out other people. Using exaggerated, animated expressions, along with very simplified language, will make it much more likely that a child will first attend to another person, and begin to respond, and hopefully, eventually be able to initiate social interaction. By changing our own communicative affect, we’re beginning to address a child’s social skill deficits. Making it more likely that he will notice us is a nice first step.
- Effective therapists model simplified language so that a child (and her parents) will understand and imitate.
Some therapists model simplified language during “therapy” tasks, but revert back to adult patterns for the rest of the session believing that in order to learn to understand age-appropriate language, a child must hear an adult model during a therapy session. If that’s your belief, I challenge you to rethink this.
I believe that we must modify how we speak to nearly all of the children on our caseloads. While we do treat some clients with intact cognition and normal receptive language skills, children with at least some degree of receptive language difficulty dominate our practices in birth to 3 and preschool programs. Every person who’s seen that child before you may have glossed over that delay, but that doesn’t mean it’s not there!
We must be very deliberate about simplifying our language with children with receptive language delays that have been identified. Those kids are obviously not learning to understand language from hearing standard adult models. If that weren’t true, would the child have been referred for speech therapy services in the first place?
- Effective clinicians establish Verbal Routines during sessions and help parents establish Verbal Routines at home.
Many experts recommend Verbal Routines for children with language delays and disorders. Dr. Rossetti, SLP and author of The Rossetti Infant-Toddler Language Scale, suggests that SLPs teach parents the value of using verbal rituals during daily activities such as meals, bath time, and bedtime. The TEACHH method for children with autism emphasizes establishing Joint Activity routines involving predictable language for play and daily events at home so that a child begins to participate, sequence actions, and understand words. In her great book Giggle Time, educator Susan Aud Sonders recommends using the same words each time you introduce and play a preferred movement game or sing a song.
SLPs can use this same advice to establish Verbal Routines with regular play activities during sessions. By using a core set of vocabulary for each of a child’s favorite therapy routines, you increase the likelihood that a child with receptive language delays learns to link word meanings with specific objects and events.
The repetitiveness and predictability of your Verbal Routines will be particularly appealing to children who crave order, such as a toddler who may go on to be diagnosed with autism. When you use the same words, toys, and sequence of events during play, a child begins to recognize the routine and respond. Once the routine is familiar, the child begins to participate and then understands the words.
Many times the repetitiveness and predictability of your Verbal Routines will also facilitate early word attempts during a familiar activity. Think about how you already use Verbal Routines in this way. For example, when getting ready to play a running game or race cars, most of us instinctively count, “1, 2, 3,” or say, “Ready, Set, Go!” What happens over time? When we pause as we’re saying this familiar start to a favorite activity, many children on our caseloads join in and begin to finish that utterance with little additional prompting.
- Effective therapists cue a child appropriately.
We must use cues to facilitate both a child’s receptive and expressive language. In my DVD Teach Me to Listen and Obey 1, I introduced the tag-line, “Tell him, Show him, Help him” as a way for parents to learn to cue a child to improve comprehension.
Here’s how it works:
“Tell him” means to provide verbal cues and to use other strategies such as rewording what a child doesn’t seem to understand.
“Show him” means to use visual cues such as pointing to supplement your verbal message. Demonstrate what you want a child to do so that he can imitate your actions.
“Help him” is using tactile cues and is my much nicer way of saying, “Make him!” Physical, hands-on assistance is sometimes necessary to help a child follow through with a verbal direction.
Introduce this method in sessions with the tag-line for parents to see this approach in action. Use the words yourself as you’re demonstrating helping a child follow a verbal direction. Say: First I’ll “Tell him” what I want him to do. If he can’t do it, then I’ll point to “Show him,” and if he still can’t do it, then I’ll have to “Help him” so he can complete my request.
This tag-line is also a very easy way for professionals to monitor themselves and their cueing methods. When we’re cueing a child, we want to provide the least amount of assistance necessary to help her learn a new skill. Physical cues should only be used when all other means have failed. Using the “Tell her, Show her, Help her” method ensures that we’re following the correct hierarchy.
- Effective professionals are persistent and repetitive when modeling language.
Establishing Verbal Routines is one way to ensure that you’re repetitive enough for a child to learn to understand and use words in play or during a daily routine. I want to encourage you to think more about why and how persistence and repetitiveness is recommended by experts in our field.
Dr. Caroline Bowen, ASHA fellow and SLP from Australia, and author of the ultra-informative website for SLPs at www.speech-language-therapy.com, recommends the following guidelines for the technique Recasting. She advises adults to aim for 12 to 18 models, or recasts, per specific target. What does this sound like in play? If your goal is for a child to learn a new word, you would say the word 12 to 18 times as you play. That’s a lot of repetition! It takes persistence to be sure you’re that purposeful about modeling your target words. This is exactly what toddlers with language delays need to be able to first understand and then later imitate that new word.
Another reason we want to be repetitive and persistent is so that parents can see us using language in this way. Many of the children we see in therapy can’t learn language until it’s presented in a predictable and structured pattern. Parents don’t learn to be this purposeful until they see and hear us being very intentional in the way we speak with their child. Sometimes when a mom hears me model a word or sees me model a sign many, many, many times in a session, when her child finally imitates, she says, “No wonder she learned how to say that today. Look how many times you said it!”
This information was summarized from Teach Me To Talk: The Therapy Manual. Get your own copy today to address EVERY receptive and expressive language milestone for toddlers in the under 12 month to 48 month old developmental range. Therapists… this is the one tool that EI therapists tell me they use everyday to set goals and select fun activities for sessions. Use the coupon code SAVE15 for 15% off.