Although parents and service providers can refer to developmental guidelines and general interests for young children, each child has unique interests and learning styles. When a child has delays in communication, making use of current research to guide the discovery of these unique features is the key to supporting her communicative development.

Encouraging communication in infants/toddlers with delays is a two part process. The first is careful observation of the infant/toddler. Observation would include:

• what the infant/toddler responds to (stimulus) and what the response looks like (form of the behavior),
• her learning style and how her sensory system impacts her learning and early communication attempts.

Careful observation will result in information about the child and environmental factors which facilitate or inhibit interaction (Campbell, l995). For example, a child who has difficulty organizing purposeful behavior may respond randomly or infrequently to other people. This would indicate the need to develop other ways for the child to express herself to prevent weakening of the connection between intent and action (Greenspan & Weider, l998).

Figure 1 (see below) indicates the framework for a communication map developed by Kathleen Stremel (Stremel, l995). Combining this map with good observation skills can assist parents and providers to develop a visual picture of an infant/toddler's receptive and expressive communicative strengths and interests. Building on what the child knows and is comfortable with will capture the infant/toddler's attention and encourage further interaction.

The second part of the process is responding to the infant's behavior. Once parents and providers are aware of an infant/toddler's communication signals, the next step is to increase the adult's response to these signals. They can add information at the child's level during an interaction, "Oh, you want up?" and encourage the child's response by giving the child prompts (hold arms out and wait expectantly for the child to make a movement that indicates she wants up).

Incorporating communication opportunities into routines is an excellent way to support parent/child interaction. Preplanning activities to include communication (allow the child to select which food item she wants to have first rather than just placing her whole lunch in front of her) and making sure that the child has what she needs to initiate and respond (i.e., positioned appropriately, attention to any sensory issues, use of objects, food the infant is interested in) will increase the likelihood of success (Rossetti, l996, Stremel, l995).

During routines there are several techniques that can be used to enhance communicative exchanges including:

• Building anticipation by allowing time for the child to get excited about what happens next in the routine. For example, rather than picking up her son without warning, a mom might say, "Do you want up?" and extend her hands followed by a pause and then, "Up?" in an excited voice.
• Interrupting the routine to allow the child to indicate a desire to continue. A dad might pause during a game of pat-a-cake and wait for his daughter's signal that she wants to continue the action by moving her dad's hands. For the child who is hesitant to try anything new, a parent might interrupt a repetitive activity by introducing a small change in a familiar sequence or a new element such as adding a new animal to the child's farm set.
• Providing consistent prompts for communication is important for children with communication challenges. They may not be able to process the variations in words and gestures that an adult might use to express one idea. For example, to determine whether an infant would like a back rub, it would be important to decide on a consistent way to communicate to the baby (rubbing hands together and saying, "Do you want a back rub?"), rather than varying the prompt each time (i.e., one time tickling the baby's stomach and saying, "Would a back rub feel good?" and the next time omitting the gesture and saying, "I’ll bet a backrub would feel good. How about it?").

To assist in implementing these strategies, Stremel has identified a simple reminder for parents and providers to keep in mind as they interact with infants/toddlers: "Nothing is free." This reminder encourages adult to pause before and during an interaction to allow time for the child to begin or continue the action. This is particularly important for a child with processing or motor challenges who will need extra time to respond. These small changes will help build new interaction patterns for a child with communication delays.

Most of us never stop to think about our own communication competence. We think that language is a natural skill that is simply acquired. Parents may say their children learned how to communicate when their first word was spoken, however, communication begins in infancy from the birth cry onward. As babies grow, their cries take on more communicative intent and form into vocalizations. As they begin to understand how sounds and movements can make things happen, they may use eye gaze to request a favorite toy, smile or babble in response to play and as a way to request the caregiver to, "Do it again." As infants learn how communication impacts the adults in their world, it literally unfolds.

Speech/Language Pathologists and teachers who work with small children understand that language may be the most important skill for a young child to learn. Language is a child’s bridge to learning more about their environment and community. It helps them build friendships, acquire self-confidence, and sets the stage for other learning skills such as auditory attention span and memory, listening skills, and reading comprehension. Some conditions which delay sound and vocabulary development in a young child may include:

• hearing loss,
• physical disabilities that may interfere with learning experiences,
• problems which directly affect the development of oral motor processes, (cleft palate, dyspraxia of speech,
• aphasia due to brain damage,
• overall delays in development and learning.

By age three, children should speak clearly enough for a stranger to understand 80-90% of the time. They should begin to produce clear consonant sounds, especially in the initial position of words. Final consonants usually develop following good production in the beginning position of words.

Parents and caregivers, educators, and physicians need to be aware of these general guidelines. If a child is not initiating words or beginning sounds, a Speech/Language Pathologist from the Early Intervention/Early Childhood Special Education (EI/ECSE) Program should be consulted for an evaluation. In Oregon, ECSE services are provided by Education Service Districts within each county of a child’s residence. Once eligibility for services is evaluated and parents and service providers meet, speech and language intervention can begin.

Speech therapy has taken on a different look these days. Some parents have relayed stories about speech therapy experiences when they were young. Some talk about the boring drill work to learn their sounds or vocabulary. It is fun to tell them what therapy looks like now. Language is best learned while doing, seeing, smelling, and listening. While it is important to label, comment and provide little ones with words and sounds to describe an experience, it is equally important to allow for some silence. Silence gives a child the time to ask or answer a question, make a comment, or just "make some connections" about their world. More modeling than correcting is used. It is equally important to follow a child’s lead and interests.

Some of the best speech therapy sessions are those where the lesson plan gets tossed out! A therapist can incorporate a child’s target sound while playing any activity of the child's choosing. A language book can be made describing the sequence of events during play while targeted words are added to reinforce the sound the child is working on. Since the book is made by the child, he/she feels they can "read" it by looking at the pictures drawn or glued with the underlined words or key pictures reinforcing the targeted sound. This type of activity can be done following a field trip or after making an art project in class or while at home.

Although there is so much more to providing effective speech/language services, the most important piece that needs to fall into place is the child's ability to feel successful each step of the way.

Resources available to parents and professionals working with young children with communication issues include "The Child with Special Needs" by Greenspan & Wieder (1998), "Communication Intervention Birth to Three" by Rosetti (1996), and "Transitions in Prelinguistic Communication" by Wetherby, Warren and Reichle (1988).

In addition, two new federal projects have been funded to develop family friendly strategies which enhance communication and social interaction in infants and toddlers at risk for communication disorders.

One is the First Words Project at the Department of Communication Disorders at Florida State University. This grant, directed by Amy Wetherby and Howard Goldstein, includes child find and the development of strategies that support communication for very young children. See their website at www.firstwords.fsu.edu.

The other grant will be conducted by Teaching Research’s Early Childhood Department.The new project, Communication Links, will develop a system for identifying infants at risk, and assemble a series of user friendly strategies that both parents and service providers can use. This will be done by combining Teaching Research's information about adult training with research on promising practices for identifying and serving very young children at risk for communication disorders.

The four year grant, which begins in January, l999, will work with field test sites in Linn and Jackson Counties in Oregon to refine identification processes and strategies. Staff will collaborate closely with a number of agencies that serve infants and toddlers as well as parents to assure that strategies are usable in a variety of settings.

A videotaped training series, one of the project outcomes, will be available within two to three years. For further information contact Carol Bunse, bunsec@wou.edu or Carol Greer, greerc@wou.edu.

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