Learning to Communicate
At this point a child still does not understand rules so providing a lot of excess information to the child will only confuse him/her. When a child relies on rules they are relying on information that has been provided to them instead of just reacting to consequences and environmental cues. As behavior moves toward being controlled by rules it becomes more loosely tied to immediate contingencies. As a child moves from behavior controlled through solving immediate contingencies to behavior controlled by rules and information provided to them there is a fundamental, almost qualitative difference, in the child’s ability to control their own behavior. The child can now respond to delayed or remote contingencies. The child is more ready for token systems and a focus on working toward getting what they want in a delayed fashion. I mention this shift here because the building of receptive and expressive language ability comes from the ability to respond to information provided in the form of social rules.
Most requesting and labeling will still rely on solving immediate contingencies but we will want to be aware of information provided throughout this time and provide information to the child on a limited basis as the child indicates they will benefit from the information. Before a child is ready for rules and information it is largely just one more distraction. I often see parents bombarding their child with information the child can not understand. This is an attempt at providing information before the child can benefit from the information. The best case scenario when this occurs is that the child can disregard the information. The worst case scenario is that the child becomes overwhelmed and can’t learn from present immediate contingencies because they are being overwhelmed with too much sensory stimulation in the form of information provided to them.
Requesting
Here we are teaching the child to attend to, discriminating between and make verbal requests. The most successful way to elicit verbal requests is through manipulation of the environment and delayed responding. When a child is requesting something all you have to do is provide the requested item and the child will request more often. The therapist is the conduit through which the desired item is attained. At this point the child has learned to discriminate between different vocalizations and to be responsive to verbalizations. They have learned to imitate motor movement as well as vocal and verbal sounds. The child has further developed visual/spatial discrimination skills and the ability to respond to receptive labels.
We begin building on the programs presented earlier of withholding a desired item until the child initiates release of the item through eye contact. Once eye contact is consistently used to control the world and the child has attained all of the skills just describe they are usually ready to begin one word requests. We begin by having an item or activity the child desires available. The therapist controls the desired item or activity and then offers the item or activity freely to build desire. The therapist then stops providing the item or activity freely and adds contingencies to the existing chain of events. The child must first glance at the therapist to get the desired item or activity. Next the child must make eye contact and make a vocalization for the desired item or activity. The vocalizations are then slowly shaped to approximations of the verbal label for the item or activity. It is important to be able to recognize the child’s ability level at this point. The therapist has to be able to carefully gauge the child’s verbal ability and provide the item or activity when the child’s request is slightly more advanced than their typical request.
The child can learn to request food, favorite objects, actions, familiar people, places and/or activities. For example the child could ask for a “baba” for bottle, “zwee” for swing, and dada for dad. Each of these vocalizations could bring the desired object, activity or person. When the child can very clearly and consistently say “baba” for bottle we would want to stop providing the bottle for the “baba” request and wait for a closer approximation like “bada.” We would then offer the bottle for “bada” until that form of response becomes strong. Then we may hold out for “badal” and so on until the full verbalization of bottle is attained.
Once we get 20-30 solid single word verbal requests we will often add the word want before the requested item. For example the child would need to say “want cookie”. Eventual we would want the child to say “I want cookie”, “I want a cookie”, “I would like a cookie”, and eventually “I would like a cookie please” or “can I please have a cookie”. My point here is that the more complex request is built out of simpler requests. Expressive abilities are mainly taught through requesting and extended requesting programs where as receptive language ability is the focus during the receptive and expressive labels programs.
Expressive Labels
A child is ready for expressive labels when they can do receptive labels and word length verbal imitations. Here we are providing the child success for attending to objects or pictures in the environment (discriminative stimuli) and verbally labeling objects. While we are working on receptive labels the child will often start to spontaneously expressively label the items when he/she hands the appropriate picture to the therapist. As the child’s spontaneous verbalizations increase we can start to consider moving on to doing the labels program expressively. We want to be cautious at this point however because as soon as we move on to doing the programs expressively we seriously limit our ability to prompt the child. The child also may not be ready for the pressure of doing the programs expressively. This is a good time to go slowly and cautiously. We will often continue to do the programs receptively but add an expressive component to the receptive programs. For example you may say “give dog” as the child hands you the picture then you may show the picture to the child and say “good job that’s a dog”. Eventually you may say “give dog” and when the child hands you the picture of the dog you may turn the picture to the child and say “what is it?” and then prompt the child to say “dog”.
We usually want to start with already mastered items from the receptive object labels program. We go over objects, body parts, familiar people, shapes, letters, cartoon characters, places, occupations, actions, activities and affects the child has previously learned receptively. We can also focus on expressive categories, plurals, pronouns, and irregular plurals.
The first major focus when teaching a child to expressively label is for the child to label the objects he/she interacts with in the world. The second focus for the therapist during receptive and expressive labels programs is to carefully expand the verbal requests made by the therapist from the use of a single word such as, “match” to using multiple words such as, “give cup” or eventually, “where does a farmer work.” The focus with these programs is two fold, teach labels and expand the child’s receptive language ability. First the child is taught the discrete labels. The child learns the names for objects, actions, subjects and qualifiers and is eventually prepared to integrate and combine the labels descriptively and make receptive conditional discriminations between the stimuli.
After we have taught the child 30-40 object labels (e.g. dog, cow, car, house etc.), multiple action labels (e.g. run, sit, walk, climb, hop etc.), subjects or familiar people (e.g. dad, mom, sister etc), and qualifiers (e.g. green, big, small, fast etc.) the child is ready to begin responding to requests that combine what has been learned. Give mom the big train or give dad the little blue train and mom the big red car. Here the child has to know each of the labels and how they fit together into a complete idea in order to be able to respond. Expressively the child could ask for chocolate milk in a big glass.
Since the focus is two fold we are expanding the child’s ability to label the world at the same time that we are expanding the child’s ability to understand complex language in a mode that is easy to prompt. As we move on from receptive labels to expressive labels we should always be ready to do the programs receptively. It is important for the child to gain breadth of knowledge. The focus with each of these programs is on building receptive language ability even when we are doing an expressive labels program. It is more important for the child to know the label for the object than for the child to be able to verbally label the object at this point. Building expressive ability and verbalizations is the focus during requesting and expanded requesting programs.