2. Establishing the pre-linguistic building blocks of language
- Ben Richter
- Dec 8, 2022
- 6 min read
Updated: Mar 22, 2023
"We communicate mostly non-verbally." - Dr. Bob Buckendorf
Image from https://thehellofoundation.com/bob-buckendorf/.
When working with children with significant language difficulties related to autism, a common area of focus in Bob's sessions is working to establish those key pre-linguistic building blocks of language. As mentioned in the previous post, these skills include gestures like pointing, eye gaze, interpretting or making facial expressions, body position, and proxemics - the way we signal how close we are comfortable being in proximity to others. Sometimes referred to as "social relatedness", these pre-linquistic skills reflect key milestones of language and social emotional development.
For typical children, the development of these pre-linguistic skills - and most language development - takes the form of a virtuous cycle, or a "dance" as Bob calls it, between the parent and child. This dance starts with a touch or a sound or a gestural or facial expression which the child quickly learns is stimulating for them, causing the child to respond, which is reinforcing for the parent causing them to continue to engage. Acts as simple as inviting a child to look across the room with a point build skills like eye gaze which reflects developments in joint attention. Telling a child to point to their nose, waiting for them to do so, and then celebrating when they do it help establish a sense of social-emotional reciprocity. Over the course of a day, this dance between child and parent creates hundreds or even thousands of opportunities for the child to build pre-linguistic skills that are foundational for language.
For autistic children, these types of interactions are less naturally stimulating, which causes them not to react in the way typical children do, often causing parents to create fewer of these interactions since they don't seem to be having an effect. This can cause autistic children to miss out on the virtuous dance most children have the opportunity to experience with a caregiver, often resulting in language delays and other effects that make healthy social engagement difficult.
The good news is, we've become much better at identifying early signs for autism in recent decades, often allowing for children with provisional diagnoses of autism to benefit from services as early as 9 to 12 months in age while they're still highly simulable. For Bob, a common goal for sessions with these children to help establish or re-establish that dance.
A session I observed with Bob and a 2 year-old autistic boy by the name of K is illustrative here. K is non-verbal and new to speech therapy with Bob. In the beginning of the session, K is very shy, demonstrating curiosity when Bob begins to share a jack-in-the-box toy but standing back near his mom and also showing an initial lack of persistance in attention.
One form of Bob's brilliance is his ability to meet children like K where they're at. Observing this session, I even began cracking up as a grown-up as Bob reacted with full drama - verbally and non-verbally - after the figure popped out of the jack-in-the-box, and later after his balloons deflated, or bubbles were popped. Within minutes, K had moved past his initial reservations and was fully engaged in these activities like he and Bob were old friends.
I'll describe an exchange from this session as an example.
(Once K had become entranced by the jack-in-the-box.) Bob: "Push it in?"
(As a nonverbal response to this question, K pushes it back in and closes the top shut.)
(Now Bob's turn to reply.) Bob: "Wowww. Good job!"
(Now K's turn. He walks over to the desk, picks up a balloon, and hands it to Bob.)
In Bob's session notes about this moment, he writes, "He eventually finds the balloon, which I have left on the table as a communicative temptation for him." A communicative temptation - I love it!
Bob: "Oh sure! Should I blow this?"
(K responds with a vocalized "duh", indicating his support for the idea.)
(Bob blows up the balloon, lets it deflate and fly across the room, and reacts dramatically.) Bob: "Oh nooo!"
(K giggles, runs across the room to get the balloon, and brings it back to Bob.)
Bob: "Oh thank you very much. [Laughs] Should I blow it again?"
(K is now all smiles and gives an utterance to indicate his position on the matter.)
Bob: "Okay here it comes." (Bob blows up the balloon, lets it fly, and reacts even more dramatically than before.) Bob: "Ohhh nooooo!"
(K's giggle has turned into a full laugh now, as he brings the balloon back to Bob once again.)
(Bob uses his turn in the conversation to slap his knee as he laughs dramatically along with K.)
This exchange continues until K is practically rolling on the floor laughing, feeling included in the activity and expressing many forms of communication.
Amidst to fun, Bob lowers his voice a bit and finds a moment to explain to mom what he's working on and the importance of this kind of nonverbal communication. "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."
Later, he finds another moment to check in with mom, while K waits for Bob to blow up a balloon again, bringing attention to his engagement, persistance, and turn-taking. “He’s engaged with me, he’s eager. He’s waiting to take a turn, he’s waiting and persistent.”
When I first watched this session, it was the first time I had observed Bob. I was immediately struck by his ability to draw K out as though he was a trained children's performer. Admittedly though, I had no idea how intentional every part of Bob's approach was, and how important all the forms of communication he was eliciting from K were. Only after learning more and returning to this video did I notice so many of the techniques involved, like the communication temptation, establishing a sense of turn-taking, and choosing not to prompt to give K time to decide on his own whether to bring to pick up the balloon off the floor and bring it back to Bob the first time.
I'll end this blog with an excerpt from Bob's notes about this portion of the session, with my own emphasis in bold. Note the level of intentionality in every step of this exchange, the degree of reciprocity and joint attention (and shared enjoyment - a new term for me) involved in this activity, and the many forms of non-verbal communication being elicited, including expressive utterances, receptive skills, pointing, and proxemics.
Bob: He eventually finds the balloon, which I have left on the table as a communicative temptation for him. He requests it by vocalizing "duh", and hands it to me. I'm trying to pace this slowly enough to give him time to explore his environment and be available enough to let him communicate in the best way he can. I'm trying not to prompt him more than I have to. He picked the balloon off the floor, handed it to me to request "more" and also vocalized "duh" with a sign after I asked "More?" This increased affect and boisterous laugh when I exaggerate my emotion really helps him stay with me and allows several turns around these toys. The balloon activity provides several instances of shared enjoyment and joint attention, which are important precursors to intentional communication. When asking for me to blow the second balloon, he vocalized, signed, and handed it to me to request blowing the second balloon. The video of K is an excellent example of waiting and pacing, which allows him to initiate communication. When a child is engaged like this, I want the interaction to continue with as many turns as possible. This provides him multiple opportunities to become more and more intentional and reciprocal. (In many of these videos, I have the advantage of having a parent with me and try and explain exactly what I'm doing. One thing I want the family to understand is that there are many nonverbal communications that children need before they say their first meaningful words). I purposefully dropped the balloon and explained the purpose to K's mother. I didn't want play to become a rote routine. I interrupted the play scheme and tried to give him additional opportunities to request the balloon from me and also to help him understand the gesture of "give it to me".
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