3. Take a turn and wait: the importance of reciprocity for early language development

"When you bring up a topic, I give you a present when I say, ah tell me more about that. What do you mean by that? That’s very interesting. You give a present when you interact with people. And that present is, you give them your presence." - Dr. Bob Buckendorf

Image from "20 Questions: G. Robert Buckendorf, PhD, SLP" on studentdoctor.net.

Reciprocity refers to the back-and-forth that occurs in a balanced conversation. Those who are skilled at knowing when and how to initiate or respond to others in conversation have a strong sense of reciprocity. As we all know, this can be a challenge for many people, regardless of the presence of a disability.

As noted in blog post #1, autistic children often have a difficult time building a number of foundational language skills, such as eye gaze, joint attention, and imitation. For these children, difficulties in these areas are interconnected with a broader challenge with reciprocity.

Put simply, Bob describes reciprocity as "Being sensitive to one another." and "Balanced social interactions." Some of the techniques he uses are as simple as, "take a turn and wait." Especially for clinicians who in a role of feeling responsible for guiding a session forward, it can be hard to just take your turn and wait. But, Bob says, even if the silence feels awkward to us, "those periods of silence have to occur, because it gives your conversational partner, your play partner, a chance to respond or to take a turn."

Across all of the sessions I observed with Bob and clients diagnosed with ASD, building a sense of reciprocity was a commonality in all of them in some form or another.

A session with Bob and an 11 year old autistic boy named L offers several great examples. L has limited language abilities, including receptive and expressive. In addition, L often experiences difficulties regulating his emotions and exhibits impulsive behavior, often resulting in varying degrees of self-injury.

One of the goals for this session was to create as many opportunities for language as possible by keeping him engaged using a number of activities, including a hanging swing in the OT room, a large exercise ball, a game with beanbags, and finally eating together at the end of the session. Each of these activities allowed for a number of turns, with Bob facilitating language and allowing L to be the leader or initiator as much as possible. In some way or another, Bob is taking a turn and waiting for L to respond.

At the beginning of this session, L was entirely non-verbal, but by the second half he's beginning to share some spontanious language. This progression demonstrates the effectiveness of Bob's reciprocal approach, including helpful prompts and binary questions.

I hadn't considered food as an opportunity for language development, but the meal portion about 42 minutes in provides the clearest demonstration of reciprocity (and joint attention) in the session. In Bob's comments on this portion of the session, he shares, "Eating is a wonderful opportunity for language. You can prompt them, do you want it on the plate or on the table? Or, how many do you want, one two or three?"

In Bob's notes for a separate session with a 2 year-old named G, he further expands on this topic. "Food, because it's so motivating, is a great tool to help kids ask for assistance." Describing another communicative temptation technique, he continues, "We often put crackers or other treats in a transparent container that the children cannot open themselves to give them an opportunity to request help from us."

To introduce this meal segment of the session, it began poorly. Shorly after sitting down at the lunch table, L heard a baby crying in the next room which caused him to get very upset. L's response was to go into a corner and begin to cry loudly. Bob picked up a "marshmallow dream bar" (provided by mom), calmly sat down next to L, handed L a piece of the bar (which he ate right away), and said, "Do you think the baby's done crying? I think so."

Back on track with a meltdown averted, Bob then got back to work.

• Bob: "Let's get some more marshmallow dream bar. They're delicious. They seem kinda dreamy. You can have another bite too... Do you want another bite of the marshmallow dream bar?"

• (L vocalizes an utterance to suggest the affirmative. At this point, joint attention on the marshmallow dream bar has been established, though L is still looking mostly down.)

• Bob: "Oh that would be a great idea."

• (Bob breaks off another piece of the bar for L.)

• Bob: "Mmm that was great. Do you want even MORE marshmallow dream bar? What do you think?"

• (L vocalizes in the affirmative again. Now L is looking Bob in the eyes and even smiling a bit.)

• (Bob breaks off another piece for L.)

• Bob: "L loves marshmallow dream bars, I think. Yummy! Have another bite.

• (Bob intentionally doesn't fill the silence, giving L an opportunity to initiate.)

• L: "I want more please." (This is one of his clearest utterances of the session so far.)

• Bob: "You want MORE???"

• L: "I want more please."

• Bob: "Of course." (Breaks off another piece for L to eat.) "Mmm. I'm glad you like it. There's a lot more left." (Bob is making L ask for more on his own.)

• L: "I want more please."

• Bob: "You want some MORE marshmallow dream bar???"

• L: "More dream bar please."

• Bob: "Can I put it on your hand?"

• L: "Do do do do do"

And so on, with Bob using his turns in the conversation to ask questions or add levity to keep L engaged, allowing L to take on as much of a leader or initiator role in the conversation as possible. Moments after a near-meltdown, Bob had steered the session into a relaxed, preferred activity focused on turn-taking, with L engaged and producing the most verbal communication of the entire session.

Link to the next blog post:

Blog Post 4: Using toys to build early language skills