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Early Intervention Activities To Promote Language Development - featured April 30, 2010

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Early Intervention Activities To Promote Language Development

By: Alicia Fox, M.A. CCC-SLP

On the floor: early intervention activities to promote language development

Much of what we do in early intervention is parent education. Direct education, instructing parents to "do this," as well as indirect education when activities are demonstrated and parents can imitate. Early on, motor development is the obvious focus as parents can see improvement from the activities they perform. Since babies aren't yet talking, language is not as prominent a therapeutic focus. Yet easy activities can facilitate parents' interaction with young children, helping the child acquire language. Here are five activities to incorporate into home visits, as parent friendly ways to promote a child's language development. I always want to help parents connect with their child and feel successful.

Research has proven repeatedly that interacting with others is the key for young children developing effective communication skills. Active, face to face interaction with caregivers is what boosts a child's language skills. By embedding these strategies into every home visit, I have the chance to demonstrate ways to interact with a young child and show that the interaction is language therapy.


Offering Choices to help a child make a request
When a child is not yet efficiently communicating his wants and needs, often the only communication tool he knows is to cry or scream. The caregiver’s role at this point is to predict and guess what the child wants or needs. If a caregiver can instead engineer a situation for the child to purposely indicate his wants, then the child is doing the communicative work. For early communicators, learning this power of intentional communication is an important step.

It can be easy to know when a child desires a specific toy - the child gazes at it, reaches for it, but it if it's out of reach he can't get it himself. Rather than giving the child the toy, but before the situation turns into a tantrum, we can offer a choice involving this desired toy. Even if we know the child wants the ball, we can play dumb and present a choice "want truck or ball?" Now the child can do something intentional to indicate which offered toy he wants. Early on this intentional behavior may be an eye-gaze to the ball. It may be reaching toward the ball or it may be an attempt to imitate the word “ball.” Instead of the adult initially interpreting the child's desire and giving him the ball, the adult sets up an opportunity for the child to actively communicate his desire in some way. This can be repeated to shape the child's response, i.e. shaping "ah" while reaching toward the ball into putting his lips together for "ba." Using a choice-making strategy, the child experiences the confidence of a successful communication interaction.

This approach works to build language skills as well. For a child communicating at the one word stage, the choice offered might be “want truck or want ball” to model two word utterances for him to imitate "want ball." We can incorporate descriptions “blue truck or red ball?” and further expand phrases “I want truck or I want ball please.”

When offering choices to encourage imitation, it's helpful to name the target toy last, so it is easier for the child to imitate what he just heard, i.e. "want water or milk?" Typically the child wants the item being offered, so his motivation is high. When the child is motivated to obtain something he wants, the language lessons are more powerful than when a child is asked to parrot "say juice." Offering a choice continues the flow of an interaction and feels more natural than dictating "say ___" to the child. As noted above, that social interaction is the core of communication and language development.


Early Gestures/Baby Signs
"Babysign" has gained popularity over the past few years. There are a plethora of resources, websites, fan pages and many of people using signs and gestures with babies. Research has shown exposure to signs at an early age help a child build his verbal language skills. Often, for preverbal young children it can be easier to imitate simple signs or gestures than imitate words. The signs then give children the power of communicating their wants and needs, while they figure out how to make their mouth say the words they want to say. For children experiencing oral motor difficulties or other developmental delays, gestures and signs can be an early way for parents to connect with their child.

Some frequently used early signs include: more, help, eat, drink, please, want, up, mine, all done, go. Many early signs make sense, so they're easy to remember. For example the sign for “want” is to put both hands out in front of you, palms up, curling fingers up as if to pull something towards you. I’ll describe a few more signs but it is easy to go to the ASL online video dictionary (click on “ASL for Babies” so the word list won’t be overwhelming) http://www.aslpro.com/cgi-bin/aslpro/aslpro.cgi to see video examples of signs.
  • "more": both hands come together in front of you touching fingertips, as if one hand is giving "more" to the other
  • "eat": put fingertips to mouth as if feeding yourself
  • "drink": shape your hand into a "C" as if holding a cup, hold up to your mouth
  • "help": make a fist with your right hand, left palm below your right fist and raise it up, as if your left palm is "helping" your right fist up.
  • “mine" or "my turn": bring an open hand to your chest
  • “please”: open hand to your chest moving in a circle
  • "Thank you": fingers of an open hand to your mouth and then move it away.

For very young children or kids with motor limitations, these signs are modified and approximated as needed. The signs for ‘more’ and ‘help’ sometimes look quite similar since they involve both hands together. Obviously the listener/caregiver is interpreting and giving voice to the child’s message, but the child is actively communicating, rather than waiting for the caregiver to figure out what he wants. We make sure to say the words while signing so the child hears the verbal words while learning the signs.

Therapy play activities are an idea opportunity to model and physically practice a new sign. Once familiar with the sign, parents can then continue to teach the sign in different situations. To start, if the child is working on a puzzle or building with blocks, set the materials out of reach, or in a container with a lid so the child cannot independently get them. Model the 'more' sign stating "want more" when the child is looking for more blocks/puzzle pieces. If a child is not yet imitating signs, provide hand over hand assistance to produce the sign. When establishing any new skills, the child needs to repeat that skill a number of times in order to learn it. So, we can work with a toy that has multiple parts in order to practice multiple requests. Encourage parents to work on the gesture during a snack, giving the child only a few crackers or small piece of string cheese at a time, with more of the snack visible, so the child can request "more." In this same way we can teach the sign for "help," "open" or "my turn."

As the sign/request is established and the child is requesting 'more', language development is further promoted by verbally modeling a two-word utterance, "more crackers" and then "want more crackers” so the child can receptively learn early phrase structure. Use of early signs can empower a toddler as a communicator, allowing him successful communicative interactions.

Often parents are concerned that using signs will delay the development of words. Multiple studies have confirmed that use of signs, as well as other alternative or augmentative communication methods, help to develop verbal language. One such study is "Impact of Symbolic Gesturing on Early Language Development," Susan W. Goodwyn, Linda P. Acredolo and Cathering A. Brown, (2000), Journal of Nonverbal Behavior 24, 81-103.

There are many sign language resources online. A few sites to suggest to parents include:
Sing Songs and Fingerplays
Children often love music. Some children may have an aversion to music and songs due to a sensory sensitivity, but we can still use rhymes and rhythm activities. Songs and fingerplays encourage motor imitation of hand or body movements which often leads to vocal or verbal imitation. Eventually, children are able to sing some words of the song. For early communicators, learning to use intonation or the melody of speech can help their communication efficiency. One little girl I worked with was not yet using words, but her mother knew she was finished with an activity when the girl started humming the "clean up" song. Rhythmically, some children with severe speech impairments can get their message across using intonation features. For example, a child who said "ha-a-a" with intonation was understood to be "hamburger" even though he had no other consonants in his utterance. His awareness of rhythm enabled him to mark each syllable which helped communicate his message. Intonation, rhythm, melody are strong nonverbal aspects of communication. Singing songs and rhymes help children become aware of these other aspects of communication besides specific sounds and words.

There are many songs and fingerplays for children. Well known songs, such as "Old McDonald." Fingerplays, refers to hand movements, such as holding your hand up for “Five little pumpkins” story and putting down a finger as each pumpkin “rolls out of sight.” My favorites include: Wheels on the bus, Itsy bitsy spider, Old McDonald, I'm a little teapot, Alphabet song, Five Little Monkeys. If you're unfamiliar with songs or hand movements that go along with them, there are many fun videos online. There is a huge variety of simple kids songs, for just about any topic, but feel free to stick to the ones most people know. I always ask parents if there are any songs they like. Here are a few sites to explore:
As described in the gestures/sign section, if a child is interested in the song but not imitating the hand movements, provide hand over hand assistance to make the physical movements. Usually children imitate the finger movements first and the words afterwards. Again, this is a great activity to promote imitation, a valuable learning strategy.

Songs are also a great way to incorporate help from a siblings. It's an easy activity to ask a brother or sister to join, which provides them some responsibility and success interacting with their sibling. More positive interactions, building those language skills.

Reading Books
Reading a story is a powerful language teaching tool. We like to make sure children see and interact with books to promote literacy development, but reading also boosts vocabulary. It's common knowledge that young children enjoy stories, but sometimes people are not as comfortable "reading" with babies and toddlers. I once attended a training conference about early literacy and the presenter joked she wanted to write a text called "let them eat books." Good advice to give to parents. Young children typically mouth objects in exploration and we want them to explore books, so let them eat books. Cloth books, squishy books, board books are designed to be sturdy enough for toddlers. Reading at this age does not mean reading every word or each page. For book reading to be positive for a child, he interacts with the adult and the book. Flip pages and point out pictures for the child. As the child points to pictures, caregivers name them.

Vocabulary-wise, start using basic names, but once kids are familiar with them, branch out to object functions or descriptions (i.e. "big bear" "ride bike") Feel free to talk about colors and show other descriptive details. Often I think parents feel the desire to show off what their child can do, asking "what's that" over and over, which then feels like testing. A more shared experience would be an adult talking about pictures, responding to the child's verbalizations or nonverbal pointing. Set up a turn-taking routine, each pointing to something and 'talking' about it. Babbling and jargon at this point are great. If the child is babbling, respond back using vocabulary terms for that picture which will help the child learn those words.

Reading a whole story is not necessarily the goal. The shared language experience is the goal. Young children are busy and often don't sit still for an entire book. In that case, choose a few pages from a story with interesting pictures. Pop up books or open the tab books may help corral fleeting interest. Another enticing strategy can be to use the child's name instead of a character's name. Sometimes I use picture books, but close the book together each time we turn a page and focus on the child helping me say "ready, set, open" or sign 'open' or 'more' to see what's on that page. Is it a typical sit down story book reading? No, but the child is engaged and communicating to continue the activity. We're interacting with each other and the book and once again, interaction promotes language development.

Books with repetitive lines are wonderful for early language stimulation. Children experience the predictability of the story and the rhythm of the verse. After a few pages, they may be able to start filling in some words. My 'favorites' book list includes: The Hungry Caterpillar, The Very Busy Spider, Brown Bear Brown Bear, Good Night Gorilla and The Three Pigs. The local library is a fabulous resource for parents to ask for input on repetitive/predictive stories.

After reading a book, we can ask simple questions. Since my goal is usually vocabulary and communication not necessarily memory, I'll open the book to a page so the child has a picture as a cue, and ask "Who did the bear see?"

After seeing interactive book reading, parents will often imitate it, turning a passive enjoyable experience into an interactive growth activity. By asking questions, leaving off words, encouraging the child to turn the page, creating some excitement by asking "what do you think will happen?" the child has more interaction with the adult and ... social interaction promotes language.

Here are two sites with good information for parents about reading books with their child:
http://www.pbs.org/parents/readinglangua...ddler.html
http://www.readingrockets.org/content/pd...ddlers.pdf

Asking Simple Questions
We adults typically ask kids alot of questions. Answering questions is a skill that can be difficult for some children, so I like to talk about it with parents.

The easiest questions to answer are yes/no, “Do you want” type questions. Typically, children develop a way to say "no" first, to be able to protest. Protesting is one of the earliest communicative intents because it gives the child control of what they will and won’t do. This is why so many two year olds practice their use of "no" so much. If a child does not say or indicate 'no,' we want to teach that first. It's much easier for the child to work on one response at a time, either ‘no’ or ‘yes.’ If a child is having difficulty answering yes/no questions, working on both ‘yes’ and ‘no’ is confusing.

Once we know of something the child does not want, we can work on "no." If he has pushed a puzzle away, to indicate he does not want it, we can abandon the activity for a moment to work on protesting/using "no." Ask "want puzzle?" while shaking your head ‘no.’ This way the answer is modeled for the child while asking the question. If the child can imitate your head shake, verbally say “no” and throw the puzzle piece into a bag/box to put it away. If the child is not able to imitate the ‘no’ head shake, provide physical assistance to help him shake his head ‘no.’ Repeat w/next piece, again modeling head shake while asking question. Another good time to practice imitating ‘no’ is at the end of a snack or meal, when the child has indicated they're finished. Pull the trash can over and ask "want more?" again the child imitates a head shake or physically assist him to shake head 'no' and throw spoonful in the trash. Another spoonful and ask again. This way the child can have 4-5 incidents of practicing "no" in that one activity. Once a child is consistently indicating ‘no,’ we can work on ‘yes.’ Using the same types of activities, just change our question: when the puzzle is finished, instead of “want puzzle” we ask “finished?” while nodding our head ‘yes.’

The other type of questions we ask are "wh" questions. “What” and “who” are the easiest “wh” questions for kids to answer. Early on caregivers want to avoid teaching questions by quizzing, so focus on giving kids the answers just before we ask the question. For example, if it's a daily routine to greet Dad every day when he comes home, talk about it first: "Daddy's coming home. Oh Daddy is here, let's go see Daddy.” Then ask “Who is here?" This way, the child heard "Daddy" several times, so he has the answer and can successfully respond to the question. During stories, it’s easy to talk about a picture or action then ask the question, i.e. “The spider is spinning her web. What is she making?”

If it is still difficult for a child to come up with a person or object name, to answer a question, we can use choice-making strategy to help. "Who is coming home, Mommy or Daddy?" This provides more support to the child, so he can imitate the last thing he heard, and successfully answer a "wh" question. “Who” and “what” questions can keep us busy for awhile and then “where” is the next question we throw into our repertoire. Often we start to work on early location terms in conjunction with "where." Early locations such as in, on, up, down, i.e. "Ball goes up - where's the ball?" Answering questions provides a verbal back and forth interaction for the child, expanding his language skills.


You'll notice there is overlap in my description of these activities. I use fingerplays to promote gestures or signs, ask questions while reading a story and I use the choicemaking strategy in all of the activities. Communication is a multifaceted life skill. All of this overlap is why it's so easy to incorporate a few of these strategies into other skill focused activities during a home visit. While a child is working hard on fine motor skills to complete a puzzle, he can sing a song as a reward when finished. While focusing on standing skills, he can interact reading a story and name pictures to improve his vocabulary.

I know many early interventionists already incorporate these activities into their visits. My goal here is to add ideas of ways to include a new level to some activities, or to add discussion points with parents. It’s been heartbreaking when I’ve seen parents that struggle and don’t feel comfortable playing with their child to promote their language development. By pointing parents toward simple interactive activities, I hope to empower them. By focusing on fun interaction, they can know what they are doing is helping their child’s language growth. Interaction is the key.

I’d love to hear feedback about your personal 'must do' session goals and experiences. Favorite kids songs and books you use. Feel free to share comments on Facebook at “Central Oregon Speech Associates”

This Month's Featured Author: Alicia Fox, M.A. CCC-SLP

Alicia Fox, M.A. CCC-SLP is a Speech-Language Pathologist providing home based therapy through Central Oregon Speech Associates in Bend, Oregon. She also works for the KidTalk program, by The Oregon Scottish Rite Clinics. Please follow "Central Oregon Speech Associates" on Facebook or "Bendspeech" on Twitter and visit http://Bendspeech.com.

Tags: SLP Article Early Intervention 30 April 2010 Newsletter