Introduction:

A child's intentional communicative behaviour is a crucial precursor to language development. A significant delay in the onset of intentional communication can be an indicator of a child having a delayed onset of language (McCathren, Warren, & Yoder, 1996). Young children may be at a stage of expressing intentions through signals however not yet communicating with language, or may not be expressing intentional communication at all. Children may require intervention at these pre-linguistic, or pre-intentional stages to increase gestural and verbal communicative intents. Unfortunately, very little literature exists that focuses on pre-intentional or pre-linguistic communication interventions (Warren, Yoder, Gazdag, Kim and Jones, 1993; Warren and Yoder, 1998).

Although the literature is sparse there are some approaches which are documented as beneficially for intervention with preschooler to increase communicative intentionality. A brief summary of four intervention approaches for facilitating children's communicative intentionality is presented here.

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Title:

‘Upping the ante'

Explanation:

Bruner (1981) labelled the term ‘upping the ante' to the range of techniques used by parents to, once their child has provided a type of response, elicit a following raised level of response from their child. The idea is to provide scaffolding and support for their child to move from their current level of intentional communicative functioning to the next level.

This intervention is non-directive, that is, the parent is the primary agent for change. A speech pathologist will be required to work closely with the parents of the child to instruct them of how they may implement such strategies to facilitate their child's communicative intentionality behaviours.

Population:

The use of ‘Upping the Ante' is recommended with children at a developmental age of 9 – 18 months (Paul, 2001).

Procedure:

“Upping the ante' is a technique that parents or caregivers can use with their child in numerous situations. For example, a mother may be playing ‘peek-a-boo' with her child. After playing the game for sometime, she can ‘up-the ante' by keeping her face covered until her child does something. If the baby reaches us and pulls her hands away from her face, she can then continue to play the game like this. Then, to further ‘up-the-ante' she can refuse to let her child pull her hands away unless the child makes a vocalization to accompany his/her action. Another example of using ‘upping-the-ante' could be when a parent is reading a book with their child. First the parent shows the book to the child several times, while he child looks on in joint attention with their parent. Then, the parent should stop on a page and wait till the child does something. The child may point to a drawing on the page, and if so the parent should name the picture. Then after this has occurred several times, the parent may ‘up-the ante' by not naming the picture until the child points to it with an accompanying vocalisation.

Summary of Level of Evidence:

It appears that no formal research has been conducted on the effectiveness of this technique for facilitating the transition from pre-intentional to intentional communication. However ‘upping-the-ante' has been referred to as beneficial in texts written by experts in the field.

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Title:

Prelinguistic Milieu teaching (PMT)

Explanation:

Prelinguistic Milieu teaching is based on the basic Milieu teaching approach. Milieu teaching is a language intervention approach that is now well-established and has been widely investigated (Warren and Yoder, 1998). While maintaining the primary characteristics of the milieu model, PMT has been extended to be used for children functioning at a prelinguistic level, to facilitate their transition from pre-intentional to intentional communication (Warren and Yoder, 1998).

Population:

Intervention approaches to increase communicative intentionality could begin to be implemented with an at-risk child from 9 months of age and up.

Procedure:

Warren and Yoder (1998) describe to general approaches to implementing PMT. The Speech Pathologist can either directly teach communicative functions to a child, or choose an in-direct method, and train the parent or caregiver to be responsive to their child's communication intents. The specific procedures to directly teach PMT as outlined by Warren and Yoder (1998) are as follows:

  • Enabling contexts. Provide an optimal environment for the use of PMT techniques.
    • Arrange the Environment. Ensure a stimulating, interesting and developmentally appropriate environment. Place desired materials out of reach or in a way so that adult assistance will be necessary if the child wants these materials.
    • Follow the child's lead. Play with the toys or engage in the activities of interest to the child.
    • Build social routines. Social routines are basic repetitive games or rituals consisting of predictability and turn-taking. E.g. Peekaboo. They are also daily activities such as bathing and feeding.
  • Specific Techniques
    • Prompts. Use prompts to elicit intentional communicative attempts from the child. There are 2 types of prompts, time-delay prompts , and verbal prompts.
      • Time-delay prompts. A non-verbal prompt. E.g. When rolling a ball back and forth to a child, stop and withhold the ball while looking expectantly at the child until they initiate a request to continue.
      • Verbal prompts. For example open-ended questions.
    • Models. Models can either be gestural or vocal.
      • Gestural models. E.g. If an aeroplane passes point upwards to model for the child pointing as a way of commenting.
      • Vocal models. E.g. having heard the child make an utterance before (‘ga' for instance) use this vocalisation as a model.
    • Additional Consequences. Consequent the child's communication attempts in accordance with their intent. E.g. Present the child with what they have requested and direct your attention to what the child has commented on.

Summary of Level of Evidence:

A study by Warren, Yoder, Gazdag, Kim, and Jones (1993) aimed to ascertain the effectiveness of a milieu approach implemented to improve the use of intentionally requesting by children with developmental delays in an intervention context. This study was replicated soon after (Yoder, Warren, Gazdag, and Kim, 1994). The results indicated the approach was effective in increasing prelinguistic requesting behaviours. The method appears to be highly effective, especially for children with mothers who are already responsive to their child's communicative attempts.

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Title:

Routine/Script therapy

Explanation:

Script therapy, also known as Joint Action Routines (JAR) was discussed by Olswang and Bain (1991) as a method by which a child's level of cognitive effort in learning language may be reduced if the language learning occurs within a familiar routine. This approach can also be implemented to facilitate intentional communicative behaviours.

Population:

Intervention approaches to increase communicative intentionality could begin to be implemented with an at-risk child from 9 months of age and up. However routine or script therapy activities may be appropriate for older children who are at a functional level of being able to understand and remember routines.

Procedure:

In the script therapy approach a routine or ‘script' is instituted into the context of the intervention, then once routines have been established, a disruption is made by playfully ‘violating' the routine. This is in order to challenge the child to repair this disruption by using a protest or correction (Paul, 2001).

An example of using script therapy would be to teach the child an easy, repetitive song (preferably with accompanying actions). After singing it over several times, violate the song by singing the incorrect words. Another example would be to establish a routine where, when the child first enters the room at the beginning of a session, he/she gets to choose a stuffed animal (from a shelf) to sit with. Once the routine is established, purposefully forget to ask the child which animal he/she wants.

Summary of Level of Evidence:

Although this technique has been documented as beneficial for stimulating language development, it appears as though no formal research has been conducted on the effectiveness of routine/script therapy technique for facilitating the transition from pre-intentional to intentional communication. However, this technique has been described as beneficial in developing intentional communication by experts in the field.

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Title:

Communicative Temptations

Explanation:

Communicative Temptations involve creating a situation where are child may be motivated or tempted to attempt communicating with an adult. Temptations are used to foster the development of a child's intentional communication and provide the child with practice in using learned intentional behaviours (Paul, 2001).

Population:

Intervention approaches to increase communicative intentionality could begin to be implemented with an at-risk child from 9 months of age and up. However communicative temptation activities should be appropriately designed to suit the age of the child.

Procedure:

The possibilities for types of communicative temptations are abundant. Paul (2001) provides a substantial list of suggested Communication Temptations (adapted from Warren and Yoder, 1998, and Prizant, 1989). A selection of these suggestions are as follows:

  • Eat a desirable item of food in front of the child without offering any.
  • Give the child a number of blocks, one by one, to put into a can, before handing the child a toy figure to drop in.
  • Open a container of bubbles, blow some, and then place the lid back on the container tightly before handing it to the child.
  • Hold a food item that the child doesn't like near their mouth.
  • Blow up a balloon and then let the air. Hand the deflated balloon to the child.
  • Hold the child's hand into a cold, wet, or slimy substance.

Summary of Level of Evidence:

The effectiveness of using communicative temptations does not seem to have been formally researched. However the basic premise of communicative temptation intervention is similar to that of PMT, which is shown to be effective in increasing intentional communication in young children.

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