Receptive and Expressive Communication The Quickest of Surveys of the ‘back side of the FEDL’
The theme: What if? • • • • •
For each of these examples on these lists I try to think of what it looks like What new ability it reflects for the child And what it looks like if it isn’t there And examples of that too
Response to the Sounds, Gestures and Verbal Communication (in back and forth reciprocal interactions for communication) 1. Orient to the auditory source in the environment (auditory figure ground). (0-2 mo)* 2. Attune to key tones in another’s vocalizations. (0-2 mo) 3. Respond to key gestures in another interaction. (2-4 mo) 4. Respond to key words in another interaction. (4 – 7 mo) 5. Switch auditory attention back and forth between self and others (self monitor, other monitor & integration) (5-8 mo) 6. Follow directions (record # ___). (simple 8 – 10- mo ‘roll it to me!’; more and more complex with age) 7. Understand questions (simple 11-15 mo ‘What do you want?’ ‘Ba!’ – ‘Oh, ok you want the ball!’, complex 18-36 mo) (how, who, what, where, when, what if, if then). 8.Engage in conversations with abstract ideas (36-48 mo, i.e. symbolic and logical social problem solving)
Ages of ‘stages’ disclaimer • • • •
Approximations Based on experience And reading And open to discussion, correction,and clarification • (To paraphrase Bone McCoy: I’m a psychiatrist, not a speech and language therapist!)
1. Orient to the auditory source in the environment (auditory figure ground). (0-2 mo)* • Babies can do this – mom vs. stranger • People with ADHD do this constantly – inability to suppress orienting • What if you don’t orient? • What if you can’t discriminate what’s important? • What if you can’t organize your head to move?
2. Attune to key tones in another’s vocalizations. (0-2 mo) • oooooooo….. vs. ooooooooo! • Think about Chinese, and other languages, where tone conveys concrete meaning. • Now think about the emotional tone that vocalizations always convey. • And what if you can’t do this?
3. Respond to key gestures in another interaction. (2-4 mo) • • • •
A visual thing Or tactile Again, there is emotional tone in these And these convey more specific meaning, over time • But at this point it is figure-ground • And if the child can’t do this?...
4. Respond to key words in another interaction. (4 – 7 mo, and beyond) • Sweetie! • Here’s daddy! • No! (Don’t put you finger in the socket, you crawling baby) • What does it look like if the child cannot do this?
5. Switch auditory attention back and forth between self and others (self monitor, other monitor & integration) (5-8 mo) • Makes possible anticipatory games such as back and forth cooing; helpful in peek a boo too • When the child cannot do this, there is no organized reciprocal auditory based communication • May need to support development using more modalities, e.g. tactile
6. Follow directions (record # ___). (simple 8 – 10- mo ‘roll it to me!’; more and more complex with age) • • • • • • • •
Processing and comprehending auditory information This has a ‘behavioral’ feel to it but compliance is important, just not as important as engagement this is about basic comprehension Remember that affect plays a key role in comprehension And every time is different, because the affect in a situation is NEVER the same twice But the factual comprehension of a command should have robust cognitive stability And you do not have this cognitive stability of auditory processing, you do not comprehend and you do not do it, and people become frustrated with you for ailing to comply.
7. Understand questions (simple 11-15 mo ‘What do you want?’ ‘Ba!’ – ‘Oh, ok you want the ball!’, complex 18-36 mo) • Critical to supporting a child’s capacity to initiate • Gives the child the freedom to express desres in a supportive environment • What happens if the child cannot understand? • What happens if the adults do not give the child an opportunity to initiate? • Increasing complexity: how, who, what, where, when, what if, if then.
8.Engage in conversations with abstract ideas (36-48 mo, i.e. symbolic and logical social problem solving) • Here it is – the holy grail of therapy • And we have so many people who cannot do this but can talk ‘at’ us. • Don’t be fooled. • Look for the shared meanings of words early on • Be careful that you aren’t filling the logic for the child.
Use of Vocalizations, Gestures, Words and Language for Communication (in back and forth reciprocal interactions for communication) 1. Mirror vocalizations with the intention to communicate [2-4 mo] 2. Mirroring gestures with intention to communicate. [2-4 mo] 3. Intentional use of unique non-verbal gestures to convey intentions. [4-6 mo] 4. Intentional use of affective tones and sounds to convey intentions. [4-6 mo] 5.Uses single meaningful words to convey intentions, actions and desires. [814 mo] 6. Uses two word phrases meaningfully. [18- 26 mo] 7.Uses sentences meaningfully. [20 – 36 mo] DANGER 8. Uses phrases and sentences in back and forth exchanges with a logical flow. [26 – 48 mo] DANGER
1. Mirror vocalizations with the intention to communicate [2-4 mo] • Coos back while looking • Babies are only sometimes in a state in which they can communicate • But they need to be able to sometimes… • And if they can’t do this, what do you think it looks like? • A mother who’s baby isn’t cooing back…think about that • If mother is depressed, will people notice? • Will the baby have less of this developing if she is not stimulated?
2. Mirroring gestures with intention to communicate. [2-4 mo] • When is it ‘mirror neurons firing’ e.g. with sticking out one’s tongue, and when is it true intent to communicate? • Does the baby laugh? (multimodal). • And if the baby can’t gesture? • Notice, again, the overlap with other areas – visual, postural, ‘executive function’, etc.
3. Intentional use of unique non-verbal gestures to convey intentions. [4-6 mo] • Now the baby can make up his own games and meanings – and he often invents ‘drop the bottle’ • Think about what the absence of this would look like. • Could the baby co-create a relationship? • Will we allow the baby to use these? What if we don’t because they are not what we expect as ‘appropriate’?
4. Intentional use of affective tones and sounds to convey intentions. [4-6 mo] • Ever hear a baby sing a sigh to get you to do something? • And if the baby is unable to do this, unable to use her voice to let you know how she feels? • Will she feel frustrated? Misunderstood? • Will her inability to communicate affect and our resultant inability to understand her rob her of the experience of feeling understood and thus impede her ability to develop empathic capacity?
5.Uses single meaningful words to convey intentions, actions and desires. [8-14 mo]
• Amazing power at a distance • Will we allow him to express this and experience that power? • And, again, what if he is unable to pull out a word to express himself? • (Psychiatrist’s note: Topamax and some other medicines can rob people of word finding) • Child development for dummies: 18 words by 18 months
6. Uses two word phrases meaningfully. [18- 26 mo] • Child development for dummies: two words by two years • Exponential increase in power: ‘cat bite!’ • Specificity of communication, clarity of communication, and affective expressiveness • It is enough for most guys’ communication most of the time • If it isn’t there, if it doesn’t happen, what do you have? • Think of your adolescent or adult clients who have only single words, and how impaired they are because they cannot put two words together
7.Uses sentences meaningfully. [20 – 36 mo] DANGER • The ability to participate in fantasy in a more robust, symbolic manner – you can be a princess, or a superhero • And when it isn’t there, it is very hard to engage in symbolic solutions to problems • Sentences, even if present, aren’t always meaningful • They might have been trained • They could be perseverating at you, without it serving a reciprocal purpose per se (COMMON ERROR)
8. Uses phrases and sentences in back and forth exchanges with a logical flow. [26 – 48 mo] DANGER • The sine qua non of social problem solving capacity – makes true negotiation of issues possible • Such abilities are not always present – it is a dynamic ability – all people lose this ability at times, e.g, when under stress (think about when you have been irrational even in adult life) • Failure to develop leaves a person unable to truly deal with reality in a manner that allows a person to step back, solve the problem, and take reasoned action
DMIC 400. Language Disorders with Compromises in‌. 401. Self Regulation and Interest in the World (0-3 months) 401.1 In Comprehension 401.2 In Production 401.3 In Both 402. Forming Relationships: Affective Vocal Synchrony (2-7 months) 402.1 In Comprehension 402.2 In Production 402.3 In Both 403. Intentional Two Way Communication (8-12 months) 403.1 In Comprehension 403.2 In Production 403.3 In Both 404. First Words: Shared meaning in Gestures and Words (12-18 months) 404.1 In Comprehension 404.2 In Production 404.3 In Both 405. Word Combinations - Sharing Experiences Symbolically (18-24 months) 405.1 In Comprehension 405.2 In Production 405.3 In Both 406. Early Discourse - Reciprocal Symbolic Interactions with Others (24-36 months and beyond) 406.1 In Comprehension 406.2 In Production 406.3 In Both each characterized by seven modalities: shared attention; affective engagement; reciprocity; shared intentions; shared forms and meanings; sensory processing and audition; motor planning, including oral-motor functioning