Tuesday, March 26, 2013

Building Language In The Bathtub

Bathtubs can be a wonderful place to build language! Why? Because one of the most powerful ways to build language is inside of routines, especially those routines that occur on a daily basis.  What's more, many children love bath time! The only thing better for language than a routine is a routine that children truly love.  As a bonus, bath time is something that is already built into the day - no need to buy any new toys or find time to sit on the floor and play. As parents, we can create many teachable moments inside something we are already doing, almost every day. Here's how.

During baths:
  • Use self talk and parallel talk to describe what your child is doing or seeing.  Label each part of the routine, each night you take a bath.  Water on. Shirt off. Pants off. Socks off! Climb in tub. Water off! Wash toes. Wash tummy.  Get out. Dry, dry, dry! Dry hair. Dry tummy. Dry toes. Bye water! Water's going down.  Water's all gone.  Diaper on. Pjs on. All done!
  • Every once in a while, interrupt the routine. Stop and simply wait! See what your child does. She might verbalize the next step of the routine.
  • Model first words with easy developing sounds (p, b, t, d, m, n, h, w) as well as nouns, simple actions, and simple concepts (on, off, up, down).   Some of the words you might choose to model during bath time include: bath, water, off, on, in, out, up, wash, bubble, soap, pour, wet, nose, eyes, toes, knees, ears, go, brrr, dry, beep beep, boat, (while playing with boats or cars that float!), tummy, bye (while boats float away or toys sink to the bottom), more, two, done, tea, mmm & nummy, (while pretending to have a tea party in the tub!), milk, hot (when the tea you drink is too hot!), and eat (while eating the crackers that come with your tea). 
  •  Pair actions with words as you model the words.  Model "wash wash wash" as you scrub her little body with a washcloth.  Give her a baby to wash and a washcloth, too!  Model "go go go" as you send a boat skimming across the water.  Line up pretend animals on the edge of the tub and have them jump in one by one; say "in" each time an animal jumps in.  Say "splash, splash, splash" as you splash the water with your little girl.  Say "pour pour pour" as you and little boy pour water in and out of cups.  Children are much more likely to imitate a word if it is paired with an action!
  • Use expansion and extension to respond to what your child says. 
    • If he says, "wash," you say, "wash toes!"
    • If he says "water" you say "more water" 
    • If she says "bath," you say "in bath"
    • If she says "boat" you say "go boat go!"
  • Create communication temptations to create teachable moments in the bath.  Run a little water and then wait. Or, give her just one toy and then wait. Or blow bubbles (in our house, I love to blow bubbles in the tub! Much less mess that way) and wait.  Or create a silly game in the bath, such as pouring water on her toes.  Then, just as you are about to take another turn, wait.  Remember to wait! As soon as your child shows you she wants more of whatever you were doing, model a higher level response than what she used.  If she uses a gesture, you interpret her gesture with one word. If she uses one word, you model two. If she uses three words, model a longer, more grammatically correct sentence. Encourage her to imitate you and then carry on with the fun.
  • Structure your phrases carefully to encourage the use of early developing  two-word phrases. To do this, I often pick one word in the two-word phrase to remain the same, while the other word changes.  Then, I create an activity to match.  You can do the same! Say, for example, you want your little one to use more "person + action" two-word phrases.  You might line little animals up on the edge of the tub and command them to jump in, one at a time. Dog jump! (And the dog "jumps" in the water with a big splash). Cow jump! (And the cow does the same). Do the first few and then pause just before you have the next animal jump in. Your child might just follow your lead and come up with her own two-word phrase!
  • While using communication temptations, offer choices as a way to build her language. If she says, "water" to request more water, ask her if she wants "hot water or cold water?" When she giggles and requests more water poured on her body, ask her, "on toes or on knee?"  As you wash up her little body, make a point of putting soap on each part of her body.  When she asks for more, ask "soap on knees" or "soap on tummy?" Create fun, create a communication temptations, and then create a choice!
And most importantly, have fun and enjoy the moments with your little one.  Building language is fun, but building memories is priceless. :)

Sunday, March 17, 2013

Using Gestures to Predict and Promote Language in Children

Most people don't automatically think of gestures as an important part of speech and language development. Quite the opposite, in fact. When most people think of the milestones that make up a child's early communication development, the focus tends to be on spoken language: first sounds, first words, first sentences. It turns out, however, that gestures play a big part in both predicting language and promoting it.
Gestures Predict Language Development

An important turning point in young children's early language development occurs when infants become intentional communicators.  This occurs when children begin to communicate messages to others in their life and, in doing so, begin to control the environment around them. My husband and I jokingly called this the "Dance Puppet Dance," stage of babyhood- the time when adults are so enamored by the fact that their little one is communicating that they are willing to drop whatever they are doing to meet the whims of their child!
Although it may seem like children's intentional communication starts with their first word, communication actually starts long before this.  Think of a nine-month-old child reaching toward something he wants, while looking back at his mom.  This child is clearly communicating without saying a word.  In fact, when we look at how children first communicate, we find that they use some very consistent forms of gestures along the way. According to Capone and McGregor (2004): 
  • One of the earliest form of gestures is showing off. This occurs when infants repeat their behavior in order to get an adult to laugh or comment on what they are doing. 
  •  "Ritualized requests" occur between 9 and 13 months of age.  These gestures occur when, instead of whining or fussing, children use more mature gestures as a form of requesting. Ritualized request gestures include reaching toward a desired object with hands that open and close rapidly ("I want, I want, I want!") and placing an object in an adult's hand to get help with that object.
  • Children begin to use deictic gestures around 10-11 months.  Deictic gestures are "showing" gestures that are used to get someone to attend to something in the child's environment.  Early deictic gestures include: showing an object to an adult to get that adult to look at it, giving  an object to an adult to show it to them, and pointing at objects to draw another's attention to that object. 
  • Representational gestures emerge prior to, and along with, first words.  Representational gestures occur when a child uses a gesture in place of a word.  For example, the child might flap his arms to indicate "bird".  The ability to use representational gestures tells us that a child is starting to think symbolically; in other words, the child who flaps his arms is using a symbol to represent "bird." This early-developing demonstration of symbol use is something we all look for as early interventionists, because words are symbols! When a child shows us he is beginning to understand and use symbols, we know he is ready for first words.
Looking at gestures in little ones becomes a very important step in assessing communication skills for a number of reasons.  First, gesture use indicates that a child is an intentional commmunicator.  Intentional communication is a huge stepping-stone toward verbal language, so we get really excited when we see a child is communicating with gestures, even if he isn't yet communicating with words. We worry less about a child who is using the right gestures at the right time than one who isn't.

A lack of gesture use, then, helps us to identify those children who might be at risk for a more significant diagnosis.  Research indicates that children who don't use the deictic gesture of pointing by 18-24 months are at risk for a diagnosis of autism spectrum disorder.  You can find out more about this by reading my post on the Red Flags for Autism in Toddlers. Although it can be really scary to see these signs in a little one, early diagnosis and treatment can be extremely helpful for children with autism spectrum disorders. The earlier we figure out what is going on, the earlier we can help.

Looking at gesture use can also help us tell the difference between late bloomers (toddlers who speak late but catch up by the age of 3) and late talkers (toddlers who speak late and continue to struggle even at the age of 3). It turns out that late bloomers use significantly more gestures to communicate than do late talkers (Thal et al., 1991).  Although late talkers use gestures, those gestures are more limited and are produced less frequently. If we see that a late talker isn't using a wide range of gestures to help communicate, we might be more likely to provide speech and language therapy.

Gestures Promote Language Development

So, gestures can be really helpful when we are trying to decide if a child needs some additional help with speech and language. And, they can help us identify those children who do need help at a pretty early age.  That's the good news.  Here's the even better news: gestures can also be helpful in assisting children to develop speech and language. 

According to Capone and McGregor (2004), gestures and verbal language are related neurologically. In other words, the brain mechanisms that support the use of gestures seem to be related to those that support speech and language.  Encouraging use of one may facilitate use of the other.  I use this all the time in my work a pediatric speech-language therapist.  I've long known that pairing an action with a word is more likely to get a child to imitate the verbal word.  Further, I frequently use Baby Signs as a bridge to verbal language. Although parents sometimes worry that this will keep their child from talking, I've found the opposite to be true: using the Baby Signs as representational gestures is an excellent bridge to verbal language. Gestures are also fantastic because:
  • Children often imitate gestures and verbal words at the same time
  • We can help children use gestures and signs by actually moving their hands to show them how to do the gestures or sign, something we can't do with spoken language
  • Gestures help children learn to understand language and seem to promote the conceptual, symbolic thought needed for language
  • Gestures and signs are more concrete and last longer in time than verbal words; this is a huge advantage for children who process information just a bit more slowly than others
  • Gestures and signs are great for children who are visual learners, such as children with Autism
  • Some children, such as children with Down Syndrome, have a very specific strength in use of gestures - tapping into this strength can be a beautiful way to increase language skills overall,
  • Gestures and signs increase a child's ability to communicate with those around him, which descreases frustration.  And decreased frustration is good for everyone!

Capone and McGregor (2004). Gesture Use: A Review for Clinical and Research Practices. Journal of Speech Language and Hearing Research, Vol 47: 173-186. 

Thal, D., Tobias, S., & Morrison, D. (1991). Language and gesture in late talkers: A one-year follow-up. Journal of Speech and Hearing Research, 34, 604–612.

Monday, March 4, 2013

Using Expansion and Extension To Grow Your Child's Language

As a pediatric speech-language therapist, I often use indirect language facilitation strategies to help grow a child's language. I've written about these strategies before, such as when I wrote about how the way you talk to your child impacts his language learning and when I described how to use self-talk and parallel talk.

This time around, I''m pulling out a couple more indirect language facilitation strategies that parents can put in their language-boosting tool box: expansion and extension. These both fall under the category of "indirect language facilitation" because they are built around a child's utterance (what the child says) and because they do not require a response from the child.  This differs from strategies
that are based on the principles of applied behavioral analysis (ABA).  ABA techniques usually involve a specific, targeted response from the child that is prompted or elicited, required, and reinforced. (As a slight aside, I certainly think that both child-directed/indirect language facilitation techniques AND clinician-directed/ABA strategies can be- and often should be - used together.  And, there is a time and a place where each is more effective than the other. But that's a different post all together).

Expansion and extension are very similar. The most important part of these techniques is that the parent uses them to respond to the child.  This requires that a child initiate (start) an interaction somehow.  The child might point, or vocalize, or say a word .... anything that starts an interaction. Then a parent either expands on or extends what the child has to say.

In my experience in working with parents, the hardest part about these strategies is that they require parents to wait.  Often, when we are in teaching mode, we are inclined to instruct- to direct a child,  to tell a child what to do or how to do it.  Again, there is most definitely a place for this (heaven knows I have directed many children to do many things in my career).  There also need to be times, however, when we respond to a child's language instead of directing it. And that's where expansion and extension come in.

So how are they different? When we EXPAND a child's utterance, we keep the child's word order the same and expand it just slightly to make it a bit longer and/or more grammatically correct.   When we EXTEND a child's utterance, we simply respond to the child's utterance in a conversational way, providing a bit of new information that is related to what the child had to say.

So, if a child says, "Puppy outside...."

We can expand this utterance by saying, "Puppy IS outside".  We've expanded because we've kept his word order the same (puppy is the first word, outside is the second- and we haven't changed this), but we've made it just a bit longer (in this case we made it just one word longer) and more grammatically correct (in this case we add in the 'contractible copula' grammatical morpheme- the fancy word for is). I coach parents to expand their child's utterance just by just one or two words. This makes the newly expanded phrase a perfect match for the child - it's not too simple because it's longer and more complex than what the child said, but it's not so tough that it loses meaning for the child. 

Back to the "Puppy outside" phrase. If we choose not to expand it...

We can extend this utterance instead by saying, "He's barking."  In this case, we've responded to the child's utterance and we've stayed on the same topic (the puppy who is outside) but now we've added new information.  We've extended the conversation by adding a bit more information. This is the key to extension.

Expansion and extension seem to work best with toddlers and young preschoolers, or children whose language levels match those of a typical toddler or young preschooler. These children often imitate the newly expanded or extended utterances, which we think helps them to grow their language.  Plus, because we are responding to the child's lead, we are tapping into whatever is interesting to the child at the moment, making our input (the language they hear) that much more salient, or pronounced, so that children are that much more likely to learn from it.

Research seems to indicate that many children learn language faster when their parents use more conversational language-learning strategies like expansion and extension, as compared to parents who are more directive with their children.  And use of these techniques is also linked to longer utterances in children - in other words, children who are exposed to these types of responsive language facilitation techniques seem to use longer sentences overall.  Seems like a good deal to me!

Looking for more strategies and activities to help your child learn speech and language?