Learning to speak:
A manual for parents

1. OVERVIEW

INTRODUCTION

It is not surprising that the child's first steps and first words are celebrated events in the minds of parents and treated as major developmental land-marks by professionals. The ability to walk upright and to use speech to communicate distinguishes humans from other species. The potential for acquiring these skills is part of the biological heritage that accompanies the child's entry into the world. The age at which the underlying capacity for these skills emerges is relatively constant for children in most societies. However, the age at which this capacity is expressed with sufficient skill to allow the child to explore the environment and com-municate with parents and others varies greatly. An increasing number of' researchers are acknowledging that the underlying competence appears to be dictated, in part, by a maturing mental ability. The expression of the underlying central processing ability appears to be influenced to a greater extent by environmental opportunities than the maturation of the mental ability itself. This need for a supportive environment to complement a biological readiness appears to be true for speech. Whereas I-year-old children may be -biologically ready- to produce single words, not all children announce their first birthday by demonstrating this uniquely hu-man characteristic. For most, the delay, if any, is minimal. Single words appear, are soon joined by others words, and speech emerges as the child's primary vehicle for communicating thoughts, feelings, and a grow-ing understanding of the environment. But for others, the delay may be prolonged. When the normal course of speech development is disrupted or delayed, the delay becomes a source of growing concern in the minds of parents. To compound matters, delayed speech is often viewed as evidence of potential intellectual impairment by the professional community.

Facility with talking, the ability to comprehend and carry out verbal instructions, and/or the size of a child's spoken vocabulary are not necessarily valid measures of the young child's intellect. However, the fact remains that in our society and in much of the Western world, by the time children reach the age of 3, and increasingly thereafter, they are judged by their capacity to use language to express their thoughts and needs. The truth of this generally held impression is confirmed by the assumptions underlying the majority of standard tests used to measure the intellectual and social abilities of young children. By age 3, tests of children's mental development become heavily laden with items that require the ability to speak, to understand language, and to comply with verbal instructions. Moreover, the ability to talk appears to make the onset of reading more likely, less problematic, and easier. Not only is language of monumental significance in its own right, but in our society it is usually a natural prerequisite to the acquisition of reading and writing. Speech delays may diminish spontaneously as the child approaches school age, but nonetheless, they place the child at risk for delayed reading readiness. The problem may change its complexion, but it does not disappear, for tests given to older children rely on reading and writing facility. Thus, productive language often serves directly or indirectly as a measure of the child's underlying intellectual abilities. Despite logical limitations, problems with productive language continue to forecast problems in the elementary school years.

Productive language, roughly equivalent to a child's speech, can be distinguished from what a child knows or comprehends about language. Just because a child does not say something does not mean that he or she does not know that word, grammatical structure, or function. Moreover, comprehension often appears to develop more rapidly than production. Frequently children who are learning to talk seem to know more than they can say. Nonetheless, what a child says is one way to learn what a child knows about language. There is a limit to what we can learn about a child's language knowledge from simply observing his or her behavior when there is no speech. Clearly productive language is important on many levels.

The importance of productive language for normal development cannot be overemphasized. The judgment that speech-delayed children are at risk for general developmental delays has some validity. A child who is not talking is at a real disadvantage relative to normally speaking peers, not only in preschool, but at home. It is no great revelation that the ability to talk can make interaction with adults and children easier and more productive. Asking questions, clarifying thoughts, and articulating one's own understanding can produce intellectual growth even at the preschool and toddler levels. This growth is a direct result of the ability to express oneself verbally.

In addition, there are social consequences to productive language de-lays. The speech-delayed child is often ignored by peers and, if accepted momentarily, often does not appreciate the rules of peer interaction. Fre-quently, either rejection or aggression is produced. If the developmental delays that often accompany speech delays continue, subsequent social experiences will bring even greater problems. Isolation, embarrassment, shyness, and lack of confidence can occur on one extreme, and unruly, unmanageable, hyperactive behavior on the other. Paradoxically, some developmentally delayed children express both these extremes.

An accomplishment of such importance as the acquisition of productive language deserves special attention, and those factors that influence this critical aspect of early development should not be left to chance alone. Both parents and professionals go to great lengths to protect and promote children's physical growth and development. They use their knowledge of nutrition, immunization, and physical exercise to insure that the underly-ing capacity for normal physical and motor development will be realized. Parents encourage their children to reach, grasp, crawl, walk, run, skip, climb, and explore the world. Parents and professionals also pay close attention to children's diets to insure that they receive proper nutrition. It is equally appropriate to use our knowledge of language, cognitive, and behavioral development to stimulate the development of talking directly and, through greater facility with productive language, to promote chil-dren's intellectual development indirectly.

There are facts about the development of productive language that can be used to facilitate talking among speech-delayed children. Some condi-tions carry a higher probability for eliciting speech from a child than do others. For example, there are times during the child's acquisition of productive language when one form of speech is more likely to occur spontaneously than another. There are particular reactions to a child's early efforts to produce sounds that render the development of words more likely. There is knowledge about the natural course of language learning that makes it possible to identify a child's current level of lan-guage development, anticipate the next level, and facilitate its achieve-ment.

The material presented in this manual sets forth a simple program that we have developed, based on research, that combines both the naturally occurring biological and behavioral factors that contribute to the onset and facilitate the development of talking. The program described in this manual approaches this naturally occurring process from the child's view and sets conditions that are more likely to make speech, rather than nonverbal behaviors, the dominant mode of communication. Once a cer-tain level of speech complexity has been achieved by the child, the ability to communicate is in itself such a satisfying experience for the child that the acquisition of increasingly sophisticated language is virtually assured. It is during the early stages of learning to speak that special emphasis may be needed either to insure that this critical facet of development gets off to a good start or to overcome delays and redirect the child back to a verbal means of language development.

The suggestion that both biological and behavioral factors may in-fluence language acquisition can be illustrated by the acquisition of the child's first words. There is evidence that toward the end of the first year of life the infant undergoes a major maturational change in intellectual ability that makes many new developments possible. This change is illus-trated clearly in the quality of children's play. An 8-month-old infant uses toys in a stereotyped manner-mouthing, waving, and banging them in-discriminately. However, a 12-month-old infant knows the uses for these same objects and may put a telephone to his or her ear and babble, or roll a car on its wheels. It appears that the same change in mental ability that makes functional play possible sets the stage for the child's first words. It is not appropriate to encourage first words before there is evidence of this change in mental ability.

Thus, most children begin to produce their first spoken words within a month or so of their first birthday. Similarly, it is probably not by accident that mama and dada are often among the first words spoken. They are easy sounds that children produce spontaneously and that parents model, repeat, and reward with smiles, hugs, and unrestrained enthusiasm. The effect of this immediate positive response (reward) by the parent for a sound (word approximation) that the child produced (a contingent reac-tion) increases the chance that the child will say the word again. This naturally occurring sequence of events illustrates how the environment interacts with the child's biological readiness to encourage words and facilitate the further acquisition of spoken language.

In addition to the maturational change at 1 year that influences a child's readiness for the onset of his or her first words, there are other broad developmental influences. Later, there is a clear development from sim-ple to complex spoken language, which is described in this chapter, that guides the progression of targeted language throughout this program. There is a recognition that parents have much more influence Y as attached persons in the child's life than do strangers and, as such, have greater leverage as teachers during the second and third years of life. Similarly, there is an appreciation for the fact that a speech-delayed child who has begun to talk will require some time and exposure before talking comfort-ably to strangers, or to preschool teachers. Generalization of the child's newly acquired language from the "teaching sessions" to daily activities in the home and from the home to less familiar situations will play a central role in this program. Broadly speaking, generalization and children's shy-ness in strange situations are developmental phenomena that influence productive language acquisition, particularly for speech-delayed children.

However, one of the most important biological or maturational con-siderations that guides this program is the recognition that the child is an active contributor to the language acquisition process. Children develop rules about language acquisition and use those rules creatively. For exam-ple, a child may say "foots" rather than "feet," even though he or she may not have heard "foots" used before. Instead, the child generalized a rule about regular plural formation to an irregular case where it does not apply.

The primary implication of this biological contribution for this program is that children are treated as active participants who do not have to be taught each step along the way. For example, if children have the underly-ing competence to support speech, no separate time is spent teaching language comprehension or understanding. Comprehension is expected to come in the time needed to learn to say the word. Similarly, if word approximations are possible and the child has a small spoken vocabulary, words rather than babbling are encouraged. Initially, meaningful word approximations even with poor articulation, are encouraged. Thus, if a child with a six-word vocabulary reliably says ar for car, it is acceptable during the initial stages. In our view, the gains resulting from the use of an intelligible word approximation for a meaningful object far exceed the disadvantages of a misarticulation at this point in development. Improved articulation is encouraged later.

Knowledge of the principles of behavior that are used with this program increase the probability that a child will use verbal rather than nonverbal means to communicate. There is a vast amount of literature in psychology demonstrating that the use of rewards can increase the likelihood that one behavior rather than another will occur. The procedures described in this manual rely on the biological foundations that establish the patterns and limits for normal language acquisition as well as the use of rewards. Contingent rewards provide the incentive that is essential for promoting the normal sequences for productive language among speech-delayed children. The rewards act to change the child's reliance on one habit, such as crying, which may prove counterproductive to speech ac4uisition, to another response, such as saying drink, which may promote a normal pattern of development.

Table 1.1

Months	Years	Nonlinguistic Development	Linguistic Development	Vocabulary
1	Reflexive crying and noncry comfort sounds
2	Private and social babbling
5-6	Vocal play
10	Echolalia (imitating self and others)
12		First words - holophrastic speech
	1 ½	Jargon (practicing fluency)		10-20 words
	2		Telegraphic speech - joining 2 words	50-250 words
	2 ½		3-word utterances, inflection appears	All vowels
	3		Complete simple sentences with pronouns	450 words
	3 ½		Compound sentences - 3-4 word utterances	800 words p, b, m, h, w, n, ng
	4		Mastery of inflections - 5-word Utterances
	4 ½			k, j, g, f, d
	5		Articulation 90% intelligible
	5 ½		Articulation 90% intelligible
	5 ½			t, r, sh, v, l, s
	6		Compound-complex sentences
	8		Occasional misarticulation of: tw, dw, bl, kl, fl, gl, pl, sl, br, kr, dr, fr, gr, pr, tr, thr, sk, sm, sn, st, kw

Adapted from: Wilkinson, L. C., & Saywitz, K. Theoretical bases of language and communication development in preschool children. In M. Lewis and L. T. Taft (Eds.), Developmental Disabilities: Theory, Assessment, and Intervention, New York: S.P. Medical & Scientific Books, 1982.

In the case of a child whose overall development is proceeding nor-mally, knowledge of the biological and behavioral bases for the acquisi-tion of productive language can remove the element of chance from the process and make success more likely with greater ease. Thus, knowledge of the normal sequence of language development, shown in Table 1. 1, can allow parents of normal children to take advantage of the child's natural readiness for talking by encouraging the appropriate kinds of production at various levels of development. Moreover, this knowledge can increase the likelihood that parents will provide a language environment that will establish an early and rich foundation for subsequent language de-velopment.

The language sequence and milestones listed in Table 1.1 are only approximations; there is substantial variability in language development among children. Exceptions will occur. Some children may develop sev-eral two or even three word utterances well before two years of age, for example. Some children may have only five words, whereas others may have 50 words by 18 months. However, in general, the sequence outlined in Table 1. 1 provides a reasonable approximation of the ages and order of language acquisition.

FOR WHOM IS THE MANUAL INTENDED?

This manual is intended to provide parents with an effective, efficient method for increasing the young child's disposition to use words and sentences to communicate. It is designed for use with intellectually nor- mal children whose speech delays are not a valid indication of mental retardation. In our own research, this determination was made by estab-lishing age-appropriate information-processing ability for specifically de-signed visual and auditory events despite delays on traditional tests of infant-toddler development. We have shown that this program works most effectively with children whose delayed language may depress their scores on conventional tests and mask their normal intellectual potential.

This manual is not appropriate for children with physical disorders such as a serious, uncorrectable hearing loss that may be accompanied by impaired language learning. Normal or corrected hearing is a necessary prerequisite for this productive language program. Many of the children that we studied experienced recurrent ear infections that resulted in tem-porary periods of impaired hearing. Our procedures were highly effective with these children when their infections were resolved.

This manual is not suited for children whose mental age, as determined by a qualified clinical psychologist, is less than 12 months. Also, it is advisable that parents of children whose delays in mental age exceed 10 months should seek the assistance and supervision of a qualified speech pathologist, psychologist, or early educator for their use of the procedures described in this manual. Children with delays in excess of 10 months may present too great a challenge to their parents, who may need the advice and assistance of a professional to guide them with this manual.

Intellectually Normal Children with Speech Delays

Parents often describe the speech-delayed child as one who understands much of what is said but fails to speak. Such children can frequently communicate by using nonverbal behaviors such as gesturing without words, grabbing, crying, and having tantrums to indicate their needs, wants, likes, and dislikes. Pointing and gesturing are normal occurrences during early language learning, but the child who relies totally on nonver-bal behaviors soon becomes limited in his or her communications. The exclusive reliance on nonverbal behaviors may, in fact, impede the learn-ing of productive language. Such children have a limited number of words at their command. It is not unusual for an 18-month-old child to have no spoken words and the 32-month-old to have a limited usable vocabulary of a dozen poorly articulated words. In addition to the limited vocabulary, the children for whom this manual is intended frequently resist their par-ents' attempts to elicit speech. This resistance, either actively expressed, as in tantrums, or passively conveyed, as in quietly turning away, often makes important contributions to the child's overall delay in learning to speak.

We believe, on the basis of our research and clinical experience, the delays in learning to speak may place the child at considerable risk for further developmental complications. This concern is shared by speech pathologists who caution that the 30-month-old who has not acquired normal level of productive language may subsequently have difficulties, in such language-related skills as reading.

At least three factors contribute to this shared concern. First, the standard developmental tests used to estimate the young child's intellectual competence rely heavily on the words that a child understands and uses. Thus, failure to pass language items on developmental tests may cast doubt on a child's intellectual ability. Second, the longer children persist (and are successful) in using nonverbal means to communicate, the more difficult it becomes to "unlearn" nonverbal behaviors and to redirect the child back to a verbal mode of language expression. Third, speech-delayed children do not always spontaneously overcome their language deficit. Rather, the weight of evidence indicates that with increasing age, failure to acquire normal patterns of speech and language results in a further separation between speech-delayed children and their normal peers. This tendency to fall further behind may extend into other areas and skills essential for successful school performance, such as reading and writing, even after talking begins.

Children from Disrupted Environments

There are several categories of children who may not be exposed to normal opportunities for language stimulation. Research has shown that, on the average, some environments may increase the likelihood that difficulties with language development will occur. Children in these environments are at risk for productive language delays and articulation problems because of inopportune or unfavorable circumstances. There are many ways that the chances for delays with speech and language development can increase, , including multiple births, extremely large families, prolonged hospitalizations, recurrent ear infections during the period when talking emerges, and a host of other medical difficulties. These environmental factors may result in parents unintentionally altering the demands that they normally place on their children. Circumstances that expose parents to periodic or continuing stress may seriously disrupt the home environment. For example, marital discord, loss of income, or a death in the family, can temporarily strain parental ability to cope with the demands of daily living and may impair a child's opportunity to learn to speak. However, in each instance, only the probability or chance for difficulty with language acquisition is increased; a speech delay is not an automatic outcome. Two children from apparently similar environments with identical presenting problems may turn out differently: One may develop delays, whereas the other may not. Research is beginning to show that the environment that aids or impedes language acquisition is highly specific. Increasingly, it appears that not only must there be a cognitive readiness, but that contingent responsiveness by the child's caregivers may also influence the onset of talking.

Psychologists are beginning to discover that environments for indi-vidual children within the same family can be markedly different. A re-cent study of adopted children illustrates the kinds of differences between children within the same family that may lead to sharp differences in language development. Of the numerous environmental factors that could possibly influence language development by 1 year of age, only two proved to be important in a study of 50 adopted children. The mother's imitation of infant vocalization and her contingent responsiveness to her child's vocalizations and verbalizations were the only environmental vari-ables that correlated with the rate of the child's communicative de-velopment. These two maternal behaviors are similar and illustrate the benefit of responding positively (with reward) and continently (im-mediately) to the child's efforts at speech. They also illustrate one way that parent-child interactions within the same family can differ. It is possi-ble to develop a pattern of responding to verbalizations by one child and a different pattern of responding to gesturing and crying by another. These different patterns can unintentionally encourage two different communi-cation styles. It is important to emphasize that parents are not at fault here; rather, they are victims of circumstances that were previously un-discovered. On the positive side, there is something that can be done to reverse the difficulty.

Multiple Births and Large Families.

The demands for feeding, bath-ing, diapering, and day-to-day supervision are increased with multiple births such as twins. For example, physical caregiving responsibilities are doubled with twins, but there is only a limited amount of time and energy available to parents each day. Thus, the total amount of time available for playing games, stimulating verbal interaction, and encouraging the child's achievements is further divided by a factor of 2 because parent-child interaction is a one-to-one experience. Relative to a single-born infant, each twin may have only ¼ the time available for one-to-one parent-child interaction. The situation is more difficult for parents of triplets or quad-ruplets. Of course, parents manage to compensate; somehow they find the time to encourage normal psychological development. The main point is that the demands on parents of twins are much greater. Procedures to help them carry out their responsibilities more efficiently are usually wel-comed.

Time becomes a precious commodity for parents of large families as well as for those with multiple births, and there is a tremendous need to be effective and efficient in meeting both the physical and psychological needs of the children growing up within such a family environment. Lan-guage delays are more likely among children of multiple births than sin-gletons and are not infrequent among the younger children in large families. In some cases, the delays associated with multiple births may be related to other problems, such as prematurely, which often accompanies multiple births. However, the majority of delays in productive language found in such children often appear to be related to experience rather than to any underlying medical or neurological deficit.

Similar to multiple births, children in large families who share parental time and energy with older siblings may not have access to the amount of attention available to the first- and second-born children. In addition, older siblings frequently talk for the "baby" and by so doing decrease the need for the younger child to learn to use words and acquire the basic language skills that emerge during the early years. It is important to emphasize that it is not simply the size of the family that places an indi-vidual child at risk for delays in speech. Most children from large families show normal development. Rather, it is the specific circumstances that surround a particular child during the time of early language learning that may interfere with the acquisition of speech. The procedures described in this manual allow parents to create a language learning environment that makes the most of opportunities to encourage speech systematically, con-sistently, and efficiently.

Prolonged Interruption of Normal Environments.

Children afflicted with long-term physical disorders or those requiring repeated hospitaliza-tion frequently encounter significant disruptions in their contact with par-ents. An 18-month-old child who develops dehydration from a prolonged gastrointestinal illness, possibly with complications, may require a dis-ruptive and threatening hospitalization. Even a 2-week stay may induce a temporary developmental setback, including a regression in language de-velopment. The child's vulnerability to unfamiliar situations at this age can result in a frightening experience that may lead to withdrawal. Moreover, despite attempts of nurses and other hospital staff to lessen the impact of such unavoidable separations, the unfamiliar hospital staff is at a disadvantage with the child who has a fear of strangers. In addition, the hospital staff does not always provide contingent responsiveness for the child's verbalizations. The medical or surgical problem that caused the hospitalization may impose major caregiving demands on both parents and professionals. In these instances, there is often little time for attention to such "non-life-threatening matters" as learning to speak. It is difficult for parents to impose the same level of demand for age--appropriate performance on a child with a major physical disorder as they would with a physically normal child. The development of productive language appears to be particularly vulnerable to this tendency to lower demands and expectations in the face of serious and continuing medical problems. Divorce or unexpected loss of a parent or sibling may result in a more prolonged interruption of what may have been a normal and nur-turant environment. Once again, the need is for an efficient method for stimulating and sustaining the early phases of language development. Contingent positive responsiveness to the child's speech appears to be one efficient procedure.