5. The importance of parents in child language development

"Many of the parents we work with are tired, and worried, and frustrated. Frustrated because it isn’t working like it’s supposed to so in their soul they say I must be a bad parent. And one of our responsibilities as a clinician is to say, that’s not the case. You have a child with a challenge but here’s what you can do to help that. People are more important than projects. These are people, not projects, and that’s how we want to interact with people in our clinics. People are worth giving our lives to." - Dr. Bob Buckendorf

Image from "The Lost Art of Communication - G. Robert Buckendorf, PhD" on Vimeo.

Towards the end of a lecture Bob gave in 2010 called "Engagement and Mutual Exchange: Lessons from Autism", he takes a step back and shares "three significant truths" based on all of his work experience over the years. Taken together, they put into perspective the important role speech therapists have for children and their families, and the partnership SLPs should have with parents. It's on this important note that I'd like to focus this last post of my blog.

Bob's "three significant truths":

1. People are more important than projects.

   1. "Many of the parents we work with are tired, and worried, and frustrated. Frustrated because it isn’t working like it’s supposed to so in their soul they say I must be a bad parent. And one of our responsibilities as a clinician is to say, that’s not the case. You have a child with a challenge but here’s what you can do to help that. [...] I've learned through the years that those people that come through the doors - those families and those little kids - are critically important. It's worth my life to work with families and children. [...] These are people, not projects, and that’s how we want to interact with people in our clinics."

2. I need to be an example not a judge for families.

   1. "I had a mom several months ago that said, I am so scared, because I do not know what this means. My child has a disability. I don’t know where this is gunna end up. I need an example, not a judge to those families."

3. Give words of affirmation, not criticism.

   1. "One of the most important things I can do as a clinician, when a family comes in to see me - [once I] ask them how are the things going that we talked about last week, and have them show me that - is for me to say to them, You're doing great. Your child did something and you responded to that. That was terrific. I want you to do that more, but that was terrific. And so my responsibility is to be an affirming clinician that says keep it up, and then to help people specifically to know what to do."

In a separate talk Bob gave that year, Bob draws attention to a finding in the research that highlights the importance of parents in the language outcomes of children. In a 2002 study published in the Journal of Autism and Developmental Disorders, researchers tracked the progress of many different autistic kids over time. At the beginning of the study they measured the extent to which the behavior of each child's caregiver was "synchronized" with that of the child - how in tune they are with their kids. "What that means is", Bob explains, "if the parent walks in and the kid is playing with blocks and the parent sits down next to them and starts playing as well - that’s synchronous. Or one of the kids is telling you about a trip they went on and the parent joins them in that conversation and asks them how it was."

What these researchers found was that children of caregivers who demonstrated higher levels of synchronization developed higher levels of joint attention and language over periods of 1, 10, and 16 years than children of caregivers with lower levels of synchronization (Siller, 2002).

Of course, this concept of "synchronization" at home is similar to the engagement-based approach Bob uses in the clinic described in blog posts 1 through 4. The discovery in this study highlights the importance of bringing parents into these treatment programs, and in particular helping educate parents of autistic children on the importance of engaging with their child to give them all the opportunities to build those critical pre-linguistic skills described in blog post #2 and establish that sense of reciprocity covered in blog post #3.

So when we work with autistic kids, Bob says, "one of the key things we can do is help the parents understand that they need to wait more so they can interpret what Johnny is playing with so they can join him in the play. Or if Johnny is doing something, imitate what he’s doing. This sense of helping parents become more responsive is really important. [...] Because regardless how primitive or ineffective those signals are, if someone is waiting or listening for them and reading and listening to and responding to their signals, like all of us, they will do those things more."

Bob's sessions are filled with examples of him taking the time to check in with parents, to give them affirmation that they're doing great, and to give guidance on strategies to work on at home to help establish the dance between child and parent that's at the heart of language development.

In blog #2, I described an exchange between Bob and a parent during a session with K, a nonverbal 2 year-old autistic boy. Without prompting, K had walked across the room to pick a deflated balloon off the floor and bring it back to Bob for him to blow it up again. To loop mom in on what he was working on, Bob lowered his voice and shared, "Having him give me something is more advanced, is better than for him to hand guide. So when he brings me something and hands it to me it's more complex than taking my hand and putting it on something. Because when he gives me something he's engaging with me, and that's much nicer."

To expand on Bob's point, hand-guiding is considered one of the earlier forms of communications, and one that autistic children often continue to rely on longer than others. When a child takes a parent's hand and puts it on the fridge, this hand-guiding is a form of communication, however it is a primitive one since in a sense they are using the parent's hand as a tool. In this situation, if they were engaging with the parent as a separate person, they may point to the fridge or say "Food" or something to that effect.

In this exchange between Bob and K's mom, he's finding an opportunity to help bring her into the treatment program. He's helping her appreciate how hand-guiding is a great first step towards communication, but once K has mastered that, the next step is to pull back a bit as a parent so he has to be more persistent and find more advanced ways to express what he wants.

In the "Engagement and Mutual Exchange" talk, Bob asks rhetorically, "How do you train parents and grandparents? We [grown-ups] aren't that trainable. If you say do this and this and this and this by next week, it’s overwhelming. But if you say, Okay this week I want you to do this one thing. [...] This week do something and let them take a turn. Let them look at it and wait for them to do something directed back to you."

Bob imagines a session with a child who is only able to glance at a bubble jar and then back to you, the clinician. "I read that as a communication and I say, Oh, more bubbles? And that’s my turn. Then I wait. It’s so hard to wait. But you have to wait. And I need to send that same skill home with parents. If that’s the skill we targeted that week in the clinic. I do something and then need to wait for the child to do something. Parents and grandparents are teachable, but the main thing we as clinicians need to do is help them understand a few strategies and help them understand that they can be effective in these little things that theyre doing."

The clearest example I saw of Bob bringing parents in was during a session with a 2 year-old named G who had a language disorder secondary to ASD and Fragile X Syndrome. In this session, Bob facilitated the activities, but only as much as necessary as he wanted the parents (sitting on the floor next to G) to lead. Bob's main goal of this session was to help teach the parents (dad joined midway through the session as well) how to play and communicate with G in a way that integrates reciprocity techniques and builds skills like joint attention, eye gaze, all manners of verbal and non-verbal communication.

Over the course of the session, Bob introduces a number of sensory-stimulating manipulatives, like bubbles, a jack-in-the-box, and big colorful blocks, and leads songs for G and the parents to take part in together. Parent-child engagement was at the heart of this session, with Bob sitting back but finding opportunities to guide the parents through patient turn-taking, or to model gestural and verbal reactions to things G would do like clapping or exagerated celebrations like "Wowww" and "Woahhh" and "Yayyy!"

In Bob's notes on this session, he writes:

"It's nice to have a parent in the room as we work with children so we can explain our reasoning and the purpose of what we do. This gives us the opportunity to explain what we are doing, not just looking for words but seeking nonverbal communication as well. We also are able to respond to the parents' observations of their child's progress at home as well. We are trying to help him make choices between toys by waiting for a while for him to communicate his desire in some way."

Another session, another masterclass from Bob.