Supporting the development of interactive communication skills

[TODO] This topic offers guidance on how to ..

Interactive communication skills are usually a strength for children and adults with Down syndrome. Most children and adults want to communicate and to participate in social situations. They use and understand the non-verbal communication skills that everyone uses including eye-contact, smiling, facial expressions and gesture to communicate and to support spoken communication, right from infancy. They also use both verbal and non-verbal skills for the same range of communicative functions as everyone else (i.e. asking questions, answering questions, requesting, giving information, commenting, expressing feelings, greeting, drawing attention to self), even though they may not be able to express themselves as fluently in speech as their non-disabled peers.

Interactive communication skills include all the non-verbal skills identified, which are used from the first year of life, and they include the conversational skills that develop later as children become competent talkers, such as telling stories and initiating conversations with visitors.

In infancy, it is important to encourage all forms of communication because early non-verbal skills, including gestures, lead to spoken language and also because children with Down syndrome may rely on non-verbal skills for longer than other children.

It is important to encourage all forms of communication because non-verbal skills, including gestures, lead to spoken language and also because children with Down syndrome may rely on non-verbal skills for longer than other children. The development of communication skills is a gradual progression for all children, and your child can be helped along this developmental pathway - her/his communication skills are not unfolding in a predetermined way on a predetermined timescale, but are influenced by her/his interactions with others.

The Interactive communication and play skills checklist [TODO: tracker] provides some guidance to the progression from gestures to words and also to the social interactive uses of language.

Developing early communication skills - some hints for parents and carers of babies

Encouraging eye-contact, smiling, singing, babbling, using appropriate facial expression and talking to babies from the first month of life will help to develop early communication skills. Respond to your baby’s feelings or emotional states as you would for any other baby, but be aware that your baby may not have such loud or clear communication, so do try to attribute meaning to their movements or efforts, even when you are not really sure what they are trying to express. Show your enjoyment of playing with them, encouraging your baby to watch and listen and enjoy interacting with you.

Follow your baby’s lead as much as possible and talk about what the baby is doing, looking at or playing with. Give your baby time to organise her/his response, as babies with Down syndrome may take a little longer to react than typically developing babies. At first, your baby will look at you and other faces as the main source of interest and entertainment, and then later in the first year of life will show interest in other visual, auditory and moving things - this is the stage when joint attention becomes possible and you can name what the baby is looking at or doing.

Games to encourage attention - listening and looking

Looking and listening are very important skills, which are needed for learning to understand and use language, and should therefore be encouraged.

Games to encourage looking

Attract your baby’s attention by clapping your hands, calling her/his name or shaking a rattle, then praise the baby when they look at you. Once you have your baby’s attention, try and hold it for as long as possible by talking, babbling, (playing with sounds), smiling, pulling faces and praising the baby as they responds. If your baby begins to copy your facial movements or sounds keep encouraging her/him. Feeding and bathing are good times for gaining and maintaining eye contact with your baby. Hang bright objects or mobiles over your baby’s cot and encourage her/him to look at them by shaking them. Then put them near enough so if the baby moves a hand they will touch them and move them.

Gain your baby’s attention by holding a brightly coloured object in front of her/him, then move it slowly to one side and encourage the baby to follow it with her/his eye gaze. Move objects away from the baby and see if they grab for them.

Toys that produce sounds or movement are interesting for infants. Using, for example, a ‘jack in the ball’, or ‘jack in the box’, encourage the child to look at the box or the ball then hold his attention for a few seconds, press the button and the ‘jack pops up’ (a good intrinsic reward). A baby mat on the floor with mirrors, rattles and toys attached may encourage your baby to attend and to begin to explore toys for her/himself.

Play ‘peek-a-boo’ and ‘round and round the garden’ games to help gain attention and eye contact.

[TODO: new pictures (not from S&L sounds) ]

Figure 1. Everyday sounds game

Collect suitable pictures, place the cards face down, make the sound and ask the child to turn the card, saying “What makes this sound? Brrrm.. Brrrm… It’s a bus! Let’s make a bus sound.” End with the balloon card, saying “It’s a balloon and the balloon goes Pop!” as you and the child/children clap hands. (The children enjoy waiting for the balloon pop).

In addition to encouraging eye contact and communication, these games will increase your baby’s attention span. This is important, as your baby needs to be able to attend and concentrate for increasingly long periods of time in order to learn, as they get older. In our experience, this is a problem for some children with Down syndrome, who find it difficult to sit still and attend. We find that children who have been played with from infancy, and expected to attend to games and to books for example, have longer attention spans and are better able to cooperate in learning situations at two or three years of age and later, in the classroom.

Games to encourage listening

A variety of games can be played to encourage listening and sound discrimination. Give your baby a rattle to shake, join in with your own rattle and when the baby shakes her/his, you shake yours, stop when the baby stops and then start again when they do. You could try this the other way round. You start by shaking the rattle and see if your baby joins in. If they do, then continue rattling then stop and see if they stops. Use different noise makers to attract your baby’s attention, squeaky toys or perhaps your own home made ones, e.g. rice or dried peas in different containers. Move the noise makers away and see if the baby reaches for them. Move them slightly to one side and see if the baby follows with her/his eyes. Show your baby a noise maker, shake it then hide it under a rug or in a box still shaking it and see if they look for it. See if your baby turns her/his head as you move the sound maker away to one side.

Draw your baby’s attention particularly to household noises, e.g., a clock ticking, a spoon stirring in a cup, running tap water, telephone ringing, kettle boiling, etc. Show the baby what is making the noise, talk about it, and tell her/him what it is. When your baby can sit, independently or supported, a good game for looking and listening is pushing a ball between yourself and your child. Before you push it to her/him, call your baby’s name and show her/him the ball, telling the baby what it is. Then as the baby looks at you push the ball to her/him. Gain the baby’s attention before they push the ball back to you if possible.

Joint attention - looking and listening together

As well as sharing attention together, looking at and engaging each other, encourage joint attention sessions (where you and your baby both look and listen to the same things, like a rattle, or food, or toy, a person or a picture) and try to keep the baby’s attention on task to build up the length of time they can attend to an activity with interest or enjoyment.

As you play and interact with your baby, your baby’s ability to attend, by listening and looking, increases, as does his/her ability to be flexible in redirecting attention from one thing to another. These skills also develop as your baby manipulates or makes things happen in his/her environment, with early toys or people.

Your baby needs to learn to attend to things long enough to learn from the situation, toy or activity, but not for so long that they misse opportunities for learning about all of the other things and people around her/him. Sharing attention and joint attention will develop the attending skills the baby needs for learning and communicating. The parent with a baby who is easily distracted can help them to look and listen for a little longer, and a parent with a baby that attends to one thing for rather too long (e.g., looking at or playing with own feet) can help them to enjoy and attend to a wider range of activities. It is doing these things together that helps to develop communication skills.

Developing intentional communication

As babies use their skills and understand how their behaviours affect others (by the responses that parents give) they learn to communicate their needs in increasingly specific and effective ways. They communicate by looking, crying, moving parts of their bodies, picking things up, and these develop into gestures, such as offering things, holding out their hand to request something, while also looking, either at you or at the thing or action they want. Then gestures become words as children learn to talk. For children learning to sign, gestures will become signs that enable them to communicate more clearly for a wide range of words, before they are able to say the words.

Understanding how to communicate underpins effective speech and language development and developing intentional communication skills provides the foundation for learning to talk.

Children begin to tell others what to do, using gestures that attract the attention of adults and redirects it towards objects or things they want. They also begin to share aspects of their experiences with adults, with mutual eye-to-eye contact and smiling, or by drawing the adult’s attention to something by looking or pointing. Some of the types of things that young children communicate about are listed in the box (right).

The interactive communication skills checklist will enable you to record which of these intentions your child has and whether they use only early communicative behaviours (e.g., crying, laughing, looking), whether they also use gestures (e.g., moving their bodies, hands, arms, mouth in particular ways, shaking their head, pointing) or also say words (using simple sign and/or speech).

Gestures

As children begin to use more gestures, signs and sounds to communicate successfully, and learn that it is easier and more accurate to convey their needs or wishes using gestures, signs and early words, these will take over from earlier communicative behaviours. As they learn more words (or signs) these will replace the use of some gestures. Sometimes children use negative behaviours to communicate their needs, such as - moving away, throwing a tantrum or even just smiling. These will be replaced by more positive, communicative behaviours if children are shown or taught these more sophisticated skills, by seeing how others use them and copying them, and finally using them spontaneously to communicate their needs.

The development of communication skills is a gradual progression for all children, and your child can be helped along this developmental pathway - her/his communication skills are not unfolding in a predetermined way on a predetermined timescale, but are influenced by her/his interactions with others.

Learning to choose and point

Your child will learn how to become an intentional communicator with gestures by having these shown to them as you communicate together, as well as by the responses that you give to their efforts to communicate with you. Your child will also learn that they can have control over some aspects of daily life by being shown how to choose with encouragement to point, as well as to take items. Offer a choice of two items, for example, toys, activities, or foods, before starting an activity or meal. You will be able to judge from your child’s response (look at, reach, push one away, hold in hand, indicate or touch with hand, point at) which one they prefer and this will motivate the child to use and develop his/her communication skills. If you can’t judge a preference by the way the child looks or behaves, just choose the item they are actually looking towards at a moment in time and ‘pretend’ the child has chosen it, as this will help to develop his/her intentional communication skills. Looking at pictures and the reading of picture books together can also encourage pointing.

Table 3. How communication progresses from gesture to words

             </th>
<th style="width: 30%">
<ol start="3">
 <li>Early skills, gesture and use of words
to communicate
(signed or spoken)    <br /><br /></li>
</ol>
</th>

Imitating

Your child will learn by copying or imitating your actions, sounds or words. This takes time and your baby will watch an action or a sound at first, maybe for several weeks, before they imitate it. Be patient and keep up the games - you will be rewarded and thrilled when your baby begins to copy sounds, then actions and then words. Once your baby begins to actively imitate, they have taken a significant step forward in learning. Singing and action games are often the first stimulus to join in - starting with repeating actions such as ‘clap hands’ or ‘peek-a-boo’ - and then copying the words. One factor helping children to learn from these games may be the amount of repetition they experience, often playing the game everyday, several times a day. The same amount of repetition may be needed to learn ordinary words, which is why games to teach vocabulary are necessary to help children with Down syndrome.