Receptive and Expressive

Communication
The Quickest of Surveys of
the
‘back side of the FEDL’
 The theme: What if?
• For each of these examples on these
lists
• I try to think of what it looks like
• What new ability it reflects for the
child
• And what it looks like if it isn’t there
• And examples of that too
Response to the Sounds, Gestures
and Verbal Communication
(in back and forth reciprocal
interactions for communication)
1. Orient to the auditory source in the environment (auditory figure
ground). (0-2 mo)*
2. Attune to key tones in another’s vocalizations. (0-2 mo)
3. Respond to key gestures in another interaction. (2-4 mo)
4. Respond to key words in another interaction. (4 – 7 mo)
5. Switch auditory attention back and forth between self and others (self
monitor, other monitor & integration) (5-8 mo)
6. Follow directions (record # ___). (simple 8 – 10- mo ‘roll it to me!’; more
and more complex with age)
7. Understand questions (simple 11-15 mo ‘What do you want?’ ‘Ba!’ – ‘Oh,
ok you want the ball!’, complex 18-36 mo)
(how, who, what, where, when, what if, if then).
8.Engage in conversations with abstract ideas (36-48 mo, i.e. symbolic and
logical social problem solving)
 Ages of ‘stages’ disclaimer
• Approximations
• Based on experience
• And reading
• And open to discussion,
correction,and clarification
• (To paraphrase Bone McCoy: I’m a
psychiatrist, not a speech and
language therapist!)
1. Orient to the auditory source
in the environment (auditory
figure ground). (0-2 mo)*
• Babies can do this – mom vs. stranger
• People with ADHD do this constantly –
inability to suppress orienting
• What if you don’t orient?
• What if you can’t discriminate what’s
important?
• What if you can’t organize your head to
move?
 2. Attune to key tones in
another’s vocalizations. (0-2
mo)
• oooooooo….. vs. ooooooooo!
• Think about Chinese, and other
languages, where tone conveys
concrete meaning.
• Now think about the emotional tone
that vocalizations always convey.
• And what if you can’t do this?
 3. Respond to key gestures in
another interaction. (2-4 mo)
• A visual thing
• Or tactile
• Again, there is emotional tone in
these
• And these convey more specific
meaning, over time
• But at this point it is figure-ground
• And if the child can’t do this?...
 4. Respond to key words in
another interaction. (4 – 7 mo,
and beyond)
• Sweetie!
• Here’s daddy!
• No! (Don’t put you finger in the
socket, you crawling baby)
• What does it look like if the child
cannot do this?
 5. Switch auditory attention back and
forth between self and others (self
monitor, other monitor & integration)
(5-8 mo)
• Makes possible anticipatory games such
as back and forth cooing; helpful in peek
a boo too
• When the child cannot do this, there is no
organized reciprocal auditory based
communication
• May need to support development using
more modalities, e.g. tactile
 6. Follow directions (record # ___).
(simple 8 – 10- mo ‘roll it to me!’; more
and more complex with age)

• Processing and comprehending auditory information

• This has a ‘behavioral’ feel to it
• but compliance is important, just not as important as
engagement
• this is about basic comprehension
• Remember that affect plays a key role in comprehension
• And every time is different, because the affect in a situation is
NEVER the same twice
• But the factual comprehension of a command should have
robust cognitive stability
• And you do not have this cognitive stability of auditory
processing, you do not comprehend and you do not do it, and
people become frustrated with you for ailing to comply.
7. Understand questions (simple 11-15
mo ‘What do you want?’ ‘Ba!’ – ‘Oh, ok
you want the ball!’, complex 18-36
mo)
• Critical to supporting a child’s capacity to initiate
• Gives the child the freedom to express desres in a
supportive environment
• What happens if the child cannot understand?
• What happens if the adults do not give the child
an opportunity to initiate?
• Increasing complexity: how, who, what, where,
when, what if, if then.
 8.Engage in conversations with
abstract ideas (36-48 mo, i.e. symbolic
and logical social problem solving)

• Here it is – the holy grail of therapy

• And we have so many people who cannot
do this but can talk ‘at’ us.
• Don’t be fooled.
• Look for the shared meanings of words
early on
• Be careful that you aren’t filling the logic
for the child.
 Use of Vocalizations, Gestures,
Words and Language for
Communication
(in back and forth reciprocal
interactions for communication)
1. Mirror vocalizations with the intention to communicate [2-4 mo]
2. Mirroring gestures with intention to communicate. [2-4 mo]
3. Intentional use of unique non-verbal gestures to convey
intentions. [4-6 mo]
4. Intentional use of affective tones and sounds to convey
intentions. [4-6 mo]
5.Uses single meaningful words to convey intentions, actions and
desires. [8-14 mo]
6. Uses two word phrases meaningfully. [18- 26 mo]
7.Uses sentences meaningfully. [20 – 36 mo] DANGER
8. Uses phrases and sentences in back and forth exchanges with a
logical flow. [26 – 48 mo] DANGER
1. Mirror vocalizations with the
intention to communicate [2-4
mo]
• Coos back while looking
• Babies are only sometimes in a state in
which they can communicate
• But they need to be able to sometimes…
• And if they can’t do this, what do you think
it looks like?
• A mother who’s baby isn’t cooing back…
think about that
• If mother is depressed, will people notice?
• Will the baby have less of this developing if
she is not stimulated?
 2. Mirroring gestures with
intention to communicate. [2-4
mo]
• When is it ‘mirror neurons firing’ e.g. with
sticking out one’s tongue, and when is it
true intent to communicate?
• Does the baby laugh? (multimodal).
• And if the baby can’t gesture?
• Notice, again, the overlap with other areas
– visual, postural, ‘executive function’, etc.
 3. Intentional use of unique non-
verbal gestures to convey
intentions. [4-6 mo]
• Now the baby can make up his own games and
meanings – and he often invents ‘drop the bottle’
• Think about what the absence of this would look
like.
• Could the baby co-create a relationship?
• Will we allow the baby to use these? What if we
don’t because they are not what we expect as
‘appropriate’?
4. Intentional use of affective tones
and sounds to convey intentions.
[4-6 mo]
• Ever hear a baby sing a sigh to get you to do something?
• And if the baby is unable to do this, unable to use her
voice to let you know how she feels?
• Will she feel frustrated? Misunderstood?
• Will her inability to communicate affect and our resultant
inability to understand her rob her of the experience of
feeling understood and thus impede her ability to
develop empathic capacity?
5.Uses single meaningful words to convey
intentions, actions and desires. [8-14 mo]
• Amazing power at a distance
• Will we allow him to express this and
experience that power?
• And, again, what if he is unable to pull
out a word to express himself?
• (Psychiatrist’s note: Topamax and some
other medicines can rob people of word
finding)
• Child development for dummies: 18
words by 18 months
 6. Uses two word phrases
meaningfully. [18- 26 mo]
• Child development for dummies: two words by
two years
• Exponential increase in power: ‘cat bite!’
• Specificity of communication, clarity of
communication, and affective expressiveness
• It is enough for most guys’ communication most
of the time 
• If it isn’t there, if it doesn’t happen, what do you
have?
• Think of your adolescent or adult clients who
have only single words, and how impaired they
are because they cannot put two words together
 7.Uses sentences
meaningfully.
[20 – 36 mo] DANGER
• The ability to participate in fantasy in a more robust,
symbolic manner – you can be a princess, or a
superhero
• And when it isn’t there, it is very hard to engage in
symbolic solutions to problems
• Sentences, even if present, aren’t always meaningful
• They might have been trained
• They could be perseverating at you, without it serving
a reciprocal purpose per se (COMMON ERROR)
8. Uses phrases and sentences in back
and forth exchanges with a logical
flow. [26 – 48 mo] DANGER

• The sine qua non of social problem solving capacity

– makes true negotiation of issues possible
• Such abilities are not always present – it is a
dynamic ability – all people lose this ability at times,
e.g, when under stress (think about when you have
been irrational even in adult life)
• Failure to develop leaves a person unable to truly
deal with reality in a manner that allows a person to
step back, solve the problem, and take reasoned
action
 DMIC 400.
Language Disorders with Compromises
in….
401. Self Regulation and Interest in the World (0-3 months)
401.1 In Comprehension
401.2 In Production
401.3 In Both
402. Forming Relationships: Affective Vocal Synchrony (2-7 months)
402.1 In Comprehension
402.2 In Production
402.3 In Both
403. Intentional Two Way Communication (8-12 months)
403.1 In Comprehension
403.2 In Production
403.3 In Both
404. First Words: Shared meaning in Gestures and Words (12-18 months)
404.1 In Comprehension
404.2 In Production
404.3 In Both
405. Word Combinations - Sharing Experiences Symbolically (18-24 months)
405.1 In Comprehension
405.2 In Production
405.3 In Both
406. Early Discourse - Reciprocal Symbolic Interactions with Others (24-36 months and beyond)
406.1 In Comprehension
406.2 In Production
406.3 In Both
 
each characterized by seven modalities:
shared attention; affective engagement; reciprocity; shared intentions; shared forms and meanings; sensory processing and
audition; motor planning, including oral-motor functioning