Our Model

Express Yourself Therapy- ModelWe are proud to use a developmental-based language model derived from the work of Lahey, Bloom, and Tinker. Please read the following description of this model. (Article by Michele Ricamato M.S.)

For children who are typically developing, parents observe their child’s budding language system develop effortlessly. Somewhere between 12-18 months they hear their child’s first words, expressing with intention (and gusto!) their needs, ideas and understanding of their world and their experiences. When language is either delayed or developing in an unusual fashion, parents are concerned. Knowing how, where, and why to intervene and design appropriate interventions can be challenging.

The natural integration of the DIR® (Developmental, Individualized and Relationship-Based) model with contemporary developmental language models can help us in our assessment and intervention for children with language delays and disorders of relating and communicating. The purpose of this article is to provide a brief overview of the precursors and components of language and ways to support its development.

Let’s begin with the question: “what is language?” Lois Bloom and Margaret Lahey, describe language, “as a means to communicate and express ideas, representing objects, events and relationships in a systematic way where rules govern the combination of words and sentences.” 1 Language further represents the shared knowledge of a community, or culture, and will vary based on the speakers within a region. 2

I. Important Precursors to Language: In order to develop language, there are many critical precursors that emerge between 0-12 months of age, prior to the expression of first words. According to the ICDL-DMIC, in the first year of life the child is developing a foundation for communication based on developing capacities for: intentionality, shared attention, affective engagement through sound making and reciprocity. 3 These are developed in the context of playful interaction with caring parents and caregivers, either through gestural, non-verbal affective exchanges or pre-verbal sound making, as in the context of Floortime™ interactions.

How can we support the ability for these capacities?

1. Building intentionality: Intentionality is a cornerstone for language development. This means supporting your child’s ability to experience themselves as competent communicators. As parents, we want to accept any communication as intentional (eye gaze, gaze shifts between people or objects, facial expressions, body proximity, gestures – reaching, pointing, showing, vocalizations, and approximations of words) and give meaning to their early communication, by responding and encouraging more of the same.

2. Supporting Shared Attention: Shared attention happens when the baby or child, bring something to your attention with curiosity and delight, as if to say, “Look mom!” Early on, children appeal for shared attention with another through gaze, gestures and sounds. You respond and together are sharing interest around the same idea, demonstrating “mutual engagement.” In Floortime™ we join the child around their interests (“following their lead”), and thus we are able to validate their experience and intention. As we support and sustain shared attention with the child, they in turn can share and expand on their interests further.

3. Support sound making and social communication: Mirror back, imitate with joy and variation of rhythm, their tone and volume, the many sounds that your child creates. 4 As you establish sound imitation, begin to vary your sound making and see if your child will imitate your sounds within the interaction. Aim for a continuous flow of back and forth playful sound making between you and your baby or young child.

4. Support Reciprocity: When an infant gazes lovingly at a parent, coos with enthusiasm, reaches out their hands and pedals their little feet in rhythm to the affectionate sounds their parents respond with they are engaged in the dance of reciprocity. Relationship formation and early communication development depends on reciprocity. Many early games are helpful in establishing this: peek-a-boo, early song games where you and your child can each take a role, and hiding and finding objects/toys. With the older child encourage playful back and forth exchanges. Your response to your children’s first stages of communication and intent gives meaning to sound production, shared experience and lays the foundation for their very first “circles of communication.” 5

II. Essential Components of Language Formation: Lois Bloom and Margaret Lahey define the elements of language through the intersection of “Form, Content, and Use.” 6 Lois Bloom and Erin Tinker further add “Effort and Engagement,” as factors influencing language development. 7

1. Form:

(a) The sounds of a language
(b) The smallest speech sound that carries meaning (plural /s/, -ing, past tense -ed)
(c) The way we say words within a certain order to express meaning. 8

2.) Content is the meaning that is expressed through words. There are many categories of meaning that are expressed as we communicate with others (objects, actions, relations between things). 9

3.) Use:

(a) The reasons why we talk (to comment, to get another to do what we want, to protest)
(b) How we consider another as we communicate with them (what information do they already know, what do they need to know, how do we adapt to different partners?)
(d) How we start, maintain and end communicative exchanges with another. 10

4.) Effort can be defined as the resources (cognitive process) that a child brings to any language learning exchange and the work it takes to acquire language. 11

5.) Engagement can be defined as the child’s social and emotional development and its impact on determining what is meaningful and relevant to learn when acquiring language. 12

III. How can we support the child’s growth in these areas?

1. Support the development and progression of FORM: Children can imitate sounds and words, even sentences without comprehending the meaning behind what they are saying. It is critical to remember that working on sounds alone does not support the development of language. Therefore, always working on sound production and combinations of words together with content that is at the appropriate level of development for the child is essential. Modeling the words within the communicative exchange allows the child an opportunity to attempt to say it, with success if they are able. Simultaneously, you are building comprehension because the child is introduced to the word in context, at the exact time that they are experiencing the concept. Responding to the child’s intent is far more important than expecting multiple or more accurate sound/word productions, which does not build meaning and can lead to frustration in communication.

2. Support and develop meaning around a range of CONTENT categories. Content categories (the meaning expressed through communication) include but are not limited to the following: recurrence (more, again), existence (events and nouns in the environment that you would share an interest in), non-existence (all gone), actions (open, stop, jump), locative actions (up, in), possession (my, mommy’s), attribution (wet, dirty, broken, hot), quantity (two, plural –s), temporal (and then, then), and causal (because, so). 13

Create opportunities in the environment where there can be lots of experiences around these content categories. Expand meaning and support comprehension growth by helping a child make connections in their environment. Avoid a focus on labels and instead focus on the relations between things in the child’s natural environment and their experience. A child learns about a ball by feeling it, holding it, experiencing its roundness and its ability to bounce. Pictures are unable to convey these important salient cues and may lack meaning for a child when used in isolation.

3. Support and develop the USE of language. Communication should express a range of functions. Too often, we promote in our children the ability to label objects or request needs and wants. By treating language as something to be “taught” rather than “experienced” in the context of relationship and interaction with others, children are not able to develop a full range of functions within communication.

We want to support a child’s ability to comment, to regulate another’s behavior, to negate, to question, to inform, to pretend, and to engage in extended conversation (discourse). Shared experience is how this starts. We can help children to comment in the context of shared experience by asking fewer questions, waiting longer for their initiation, and commenting more ourselves in conjunction with affect cues. It is also helpful to communicate by taking turns naturally in communication rather than specifically telling a child when to take their turn or focusing on the teaching of rules for social communication. Communication is best when it occurs in natural contexts where the rewards of communication are natural consequences of the exchange rather than extrinsic motivators or rewards. 14

4. Support and understand the EFFORT that the child is exerting in any communicative exchange. We want to send the message to our children that communicating is meaningful. Messages are received and things happen. Communication is power. The more effort the child has to put forth within the communicative exchange, the less the child will want to communicate in the future. Finding the “just right” challenge for any child is a critical piece.

In addition, we must remember that a child only has a certain amount of resources to devote to language acquisition at any given time in their development. 15 Because language development doesn’t exist within a vacuum, the development and effort that a child is devoting to the motor system, sensory system, visual and spatial systems, auditory system, emotional and cognitive systems needs to be acknowledged and accounted for within every therapeutic session.

5. Support the child’s ENGAGEMENT in the communicative exchange. The DIR® model works to support the child’s ability to engage with parents/caregivers/therapists. This is critical for language development because once a child can be responsive to another, he is available to try and understand another’s actions and another’s words/sentences. Through engagement the child is available to the social world where language can be explored and interpreted with the help of significant others. 16

IV. How the DIR® Model supports communication and language development:

Together, DIR® and contemporary thinking about language acquisition support an understanding of how language typically develops, and therefore provides an essential developmental roadmap for supporting children with language disorders. When we understand the child’s functional emotional developmental level (FEDL) and the child’s current language functioning, we know where to begin.

The “D” (Development) is our road map to understanding a child’s developmental level. Where does the child exhibit constrictions in their development of a language system? What are their strengths? Are they able to use verbalizations to express wants/needs but lack the capacity to use eye gaze and gestures to augment sharing experience? Are they able to engage for brief exchanges but unable to sustain long chains of reciprocal communication?

When we understand a child’s strengths and weaknesses through the assessment of their individual-differences and their unique language profile, we know how to intervene. The “I” (Individualized) is our guide to supporting each child’s unique capacities and challenges. How does the visual- spatial system of a child impact their ability for eye gaze and complex referential gaze? How does the reactivity of one’s sensory system impact their ability to remain calm and available for shared attention? How does the motor planning capacity of a child impact the ability to understand the rhythm and timing of communicative exchanges?

When we understand the importance of the relationship that the child has with his communicative partner we know why we intervene. The “R” (Relationship) is our guide to supporting communication that occurs in the context of a socially and emotionally developing child. Taking the component parts or skills of language and working on those in isolated and discrete ways does little to develop robust linguistic systems. Why do we communicate? Why do we attempt to share our ideas and experiences with those important communicative partners around us? We develop language and we communicate with others because we desire to become part of a social world and to make connections with others. Let us begin there.