Pairing in ABA

Introduction to ABA:

Applied Behavior Analysis (ABA) is a scientific approach to understanding and improving behavior. It involves using evidence-based techniques to teach new skills, reduce problematic behaviors, and enhance learning. ABA is widely used in various fields, especially in working with individuals with autism spectrum disorder (ASD). Its principles can be applied in any context where behavior change is desired. The focus of ABA is on observable behaviors, and it uses positive reinforcement, prompting, and other strategies to shape behavior in a structured, measurable way. The goal is to promote meaningful and lasting changes that improve an individual's quality of life.

Pairing in ABA

Pairing in ABA therapy refers to connecting (pairing) a therapist with a child's favorite items or activities (reinforcers) to build rapport. It allows them to respond favorably to being in the presence of a therapist, develop a trusting relationship, and increase the chances that they will listen to and comply with the therapist’s instructions. Pairing is done by engaging in the child’s preferred activity or providing favorite items like a toy or a snack without placing any demands. By pairing with an already established (primary) reinforcer, such as an object or an activity, the therapist becomes a conditioned (secondary) reinforcer.

Steps for Pairing in ABA:

Identify Reinforcers:

Before starting the pairing process, identify what the individual finds reinforcing. This could include toys, food, activities, or social praise.

Reinforcers should be something that the child enjoys or values and will willingly engage with.

Associate Yourself with the Reinforcer

Identify potential reinforcers and associate yourself with positive experiences by presenting or delivering the reinforcer. For example, if the child enjoys a game, join in and show that fun times occur when you're present.

Consistent association helps as the therapist to become a source of reinforcement. This strengthens the connection between therapist and positive experiences.

Keep Interactions Positive and Fun:

Ensure that the interaction remains enjoyable and low-pressure. The focus should be on creating positive experiences, not demanding anything from the individual at this stage.

You might want to use playful tones, allow for freedom in choosing activities, and avoid any form of pressure.

Gradually Introduce Demands: Gradually introduce small requests or tasks once the bond is strong, ensuring they are paired with positivity and encouragement. This helps make learning and cooperation feel like a fun and rewarding journey rather than just demands. 

The pairing process is ongoing, not a one-time event. Stay attentive to their evolving interests and preferences, adjusting your reinforcers as needed.

Monitor Progress:

• Continuously assess whether the individual is beginning to respond positively to the previously neutral stimulus.
• If the person continues to engage with or show positive responses to the neutral stimulus, the pairing is progressing well.

Unconditional Pairing (Unconditioned Reinforcers)

Definition:  These are stimuli that are naturally reinforcing without any prior learning. They do not require any pairing to be reinforcing.

Examples: Food, water, sleep, and other biological needs. These are things that naturally satisfy basic needs and will elicit positive responses.

Role in Pairing: Unconditional pairing refers to using naturally reinforcing stimuli to establish initial positive associations with neutral stimuli. For instance, if you are pairing with a child and you give them a favorite snack (unconditioned reinforcer), they will naturally be motivated to interact with you.

Conditional Pairing (Conditioned Reinforcers)

Definition: These are stimuli that have become reinforcing through prior learning and pairing with unconditioned reinforcers or other established reinforcers. In other words, conditional reinforcers require learning to be valuable.

Examples: Praise, tokens, activities, or other stimuli that have gained reinforcing value through association with unconditioned reinforcers.

Role in Pairing: In the context of ABA, once you have successfully paired a neutral stimulus (e.g., a therapist or location) with an unconditioned reinforcer (e.g., a preferred food), that neutral stimulus can become a conditioned reinforcer. For example, praise may become a valuable reward if it is frequently paired with food or play.

Tips for Successful Pairing

Consistency: Consistency is key in pairing. Reinforce the positive associations regularly to build a strong connection between the neutral stimulus and the reinforcer.

Timing: Pairing should be done in short, frequent sessions rather than long, forced interactions. Keep it light and engaging.

Avoid Demands: At this stage, the goal is not to ask the individual to perform any tasks or follow any instructions. Keep it about building positive associations.

Watch for Negative Reactions: If the individual seems overwhelmed, disinterested, or upset, take a step back. The process should feel natural and positive, not stressful.

Use Natural Environment: Pairing can be done in natural settings, which can help the individual generalize their positive experiences to different situations.

Communication in ABA

Importance of Communication in ABA

Effective communication is a cornerstone of child interaction, enabling us to convey thoughts, emotions, and needs. For children with developmental differences, such as autism spectrum disorder (ASD), communication challenges can impact various aspects of their lives. ABA therapy Services offer a structured framework to address these challenges, with a key focus on receptive and expressive language.

The Role of Applied Behavior Analysts in communication:

Applied Behavior Analysts (ABA) work to change individual behavior through evidence-based interventions, focusing on planning, developing, and monitoring treatments for behavioral challenges. Their duties include maintaining client progress records, consulting with and teaching team members, collaborating with families and service providers, and conducting periodic service reviews. Effective communication is key in ABA, as it strengthens relationships and helps analysts understand the unique needs of clients. ABA professionals enhance communication skills, particularly for those with autism spectrum disorder, by assessing behaviors, developing personalized plans, and using techniques like discrete trial training and natural environment teaching. They track progress through data, adjust interventions as needed, and work with families and educators to ensure consistency across environments, while also providing ongoing training and adhering to ethical standards.

Understanding Receptive and Expressive Language:

Receptive Language: refers to the ability to understand and comprehend spoken or written language. It involves processing and interpreting information from others, such as following instructions, identifying objects, comprehending questions, and understanding concepts. Individuals with strong receptive language skills can understand the meanings of words, sentences, and conversations.

Expressive Language: pertains to the ability to communicate thoughts, ideas, emotions, and needs to others. It involves using words, sentences, gestures, and nonverbal cues to convey messages. Expressive language skills encompass speaking, signing, writing, and using communication devices.

Intervention Strategies for receptive and expressive language aim to improve a child’s understanding of language. ABA-based strategies include:

·       Use clear and concise language during instruction.

·       Gradually increasing the complexity of instructions.

·       Incorporating visual support, such as visual schedules and cues.

·       Teaching functional communication skills, such as requesting, rejecting, and commenting.

·       Breaking down complex language into smaller components for teaching.

·       Using prompting and fading techniques to shape appropriate language use.

Types of communication that are commonly used in ABA:

1.     Verbal Communication:

• Mand: A request, such as saying “Cookie,” to ask for a cookie
• Tact: A comment used to share an experience or draw attention, such as “airplane” to point out an airplane
• Intraverbal: A word used to respond or answer a question, such as “Where do you go to school?” “Castle Park Elementary”
• Echoic: A repeated, or echoed, word, such as “Cookie?” “Cookie!” This is important as imitating will help the student learn.

2.     Nonverbal Communication:

Facial Expressions: Emotions such as happiness, sadness, anger, and surprise are often expressed through facial movements.

Gestures: Hand movements, nodding, or shaking the head are common gestures that enhance verbal communication or can stand alone to convey meaning.

Body Language: Posture, stance, and movement can indicate a person’s feelings or attitudes.

Eye Contact: The use of eye contact can regulate interactions, convey interest or disinterest, and express social cues.

What is Augmentative and Alternative Communication (AAC)?

The Autism Society of Wisconsin defines AAC as “any non-vocal form of communication that supplements or replaces vocal speech in learners with communication impairments.” There are two categories of AAC systems: Selection-based (SB) and Topography-based (TB). While SB systems like PECS may be easier for motor impairments to learn, more response effort is required. Conversely, TB systems like speech or writing are closer to vocal skills, but they require extensive systematic instruction to generate a response.

Four Forms of AAC

The Association for Science in Autism Treatment defines PECS as “a methodology that use pictures and other symbols to develop a functional communication system for individuals with autism spectrum disorder (ASD) based upon the principles of applied behavior analysis (ABA).” Another type of AAC, SGDs, are machines that produce voice output. Communication boards and sign language are two other forms of AAC that can help children communicate.

1.     PECS: PECS stands for Picture Exchange Communication System. It's an alternative communication system primarily used by children with autism or other communication disorders who may have difficulty using verbal language. In PECS, individuals use pictures to communicate their needs, wants, or ideas. The system typically begins with teaching the individual to exchange a picture (like a picture of a cookie) for the item they want (the actual cookie). As individuals progress, they can use more complex combinations of pictures to communicate.

PECS starts with a request as opposed to a comment of label. It doesn’t require verbal prompts. It’s also considered useful for transitioning to an SGD. The downside is that the selection of pictures and words used for PECS is limited.

2.     SGDs: SGDs stand for Speech-Generating Devices. These are electronic devices used by individuals with speech or language impairments to communicate. SGDs convert written text or symbols into speech, helping people who have difficulty speaking to express themselves more easily. They are valued for their portability, convenience, and ability to foster social interactions. Known for their portability and convenience, SGDs increase social interactions in natural settings. They also have widespread peer acceptance, which is valuable. However, SGDs typically require additional communication materials.

3.     Communication Boards: Communication boards can be used as a bonding experience between parents and children. The communication method is also fairly simple, and there are high-tech and low-tech options available for use. That being said, expensive high-tech communication tools restrict access to advanced communication.

4.     Sign Language: Sign language is a visual language that uses gestures, facial expressions, body movements, and hand shapes to convey meaning. It is primarily used by the Deaf and hard-of-hearing communities to communicate, but it can also be used by others who might have difficulty with speech or hearing. Sign language works because it facilitates efficient responses, it’s comprehensive, and its topography based. At the same time, it poses its challenges, such as not being universal and requiring a substantial time to learn

Strategies for Enhancing Communication Skills:

1. Pairing and Establishing Motivation: Before addressing language skills, ABA practitioners focus on building rapport and establishing motivation. Pairing involves associating the practitioner with positive experiences, creating a foundation for learning.

2. Building Basic Communication: For individuals with limited or no language, ABA practitioners often start by teaching basic communication skills. This might involve using PECS (Picture Exchange Communication System) or other AAC methods to request desired items or activities.

3. Expanding Language Skills: As individuals progress, ABA practitioners work on expanding their language skills. This includes teaching receptive skills (following instructions, identifying objects) and expressive skills (requesting, labeling, commenting).

4. Generalization and Maintenance: ABA focuses on generalization—ensuring that communication skills are used across various settings and with different communication partners. Maintenance strategies aim to prevent the loss of acquired skills over time.

5. Functional Communication Training (FCT): FCT is a common ABA intervention for individuals with limited language. It involves teaching alternative, socially acceptable ways to communicate needs and wants.

6. Prompting and Prompt Fading: ABA practitioners use prompts to guide individuals toward the correct response. Prompt fading involves gradually reducing prompts to promote independence.

7. Reinforcement and Data Collection: Positive reinforcement is integral to ABA. Providing immediate reinforcement for correct communication encourages individuals to use their language skills. Data collection helps track progress and make informed decisions about intervention adjustments.

8. Collaborative Approach: Effective ABA communication interventions involve collaboration between practitioners, families, educators, and speech therapists. Consistency across environments enhances learning outcomes.

                                                                     الشاشات والتواصل

في عصرنا الرقمي الراهن، أصبحت الشاشات جزءًا لا يتجزأ من الحياة اليومية للأطفال والبالغين على حد سواء. ورغم الفوائد التي تقدمها التكنولوجيا، إلا أن الإفراط في استخدامها يحمل مخاطر كبيرة، خصوصًا للأطفال في سنوات نموهم الحاسمة.

تسلط هذه المقالة الضوء على الآثار السلبية لاستخدام الشاشات على تطور الكلام واللغة لدى الأطفال، مع التركيز على تأثيرها على مجالات التواصل، والتفاعل الاجتماعي، والنمو المعرفي.

تتعدد العوامل التي يجب أخذها بعين الاعتبار عند تقييم تأثير الشاشات على اللغة، مثل مدة استخدام الشاشات، وجود شخص آخر يشاهد مع الطفل، نوع المحتوى المُشاهد، البيئة المحيطة بالطفل، بالإضافة إلى عوامل أخرى قد تؤثر في تطور مهارات اللغة. وفيما يلي، سيتم استعراض بعض الآثار الضارة لاستخدام الشاشات على الأطفال:

التأثير على مهارات التواصل

أحد أكبر التأثيرات السلبية لوقت الشاشات المفرط هو تعطيل تطوير مهارات التواصل عند الأطفال. التواصل اللفظي وغير اللفظي، مثل قراءة تعابير الوجه ولغة الجسد، أمر بالغ الأهمية لتعلم اللغة في السنوات الأولى. عندما يقضي الطفل وقتًا طويلاً أمام الشاشات، مثل مشاهدة التلفزيون أو اللعب بالألعاب الإلكترونية، فإن هذه الأنشطة لا تعزز التفاعل الاجتماعي الفعّال. في الواقع، يمكن أن يؤدي ذلك إلى تأخر في اكتساب المفردات، حيث أن الأطفال الذين لا يتعرضون للتفاعلات اليومية مع الأهل والأقران يفتقرون إلى الفرص الطبيعية لتعلم الكلمات والجمل.

 التأثير على التفاعل الاجتماعي

التفاعل الاجتماعي بين الأطفال والأشخاص المحيطين بهم، سواء كانت الأسرة أو الأصدقاء، يعد أساسيًا لتطوير المهارات الاجتماعية واللغوية. قضاء وقت طويل أمام الشاشات يقلل من هذه التفاعلات ويؤثر سلبًا على قدرة الطفل على فهم الإشارات الاجتماعية والتواصل بشكل فعّال. تشير الدراسات إلى أن الأطفال الذين يتعرضون للكثير من الشاشات في السنوات الأولى من حياتهم قد يواجهون صعوبة في بناء علاقات اجتماعية سليمة ويعانون من مشكلات في التكيف الاجتماعي.

 التأثير على النمو المعرفي

تعتبر السنوات الأولى من حياة الطفل فترة حاسمة لتطور الدماغ. في هذه الفترة، يقوم الطفل بتطوير القدرة على معالجة المعلومات واكتساب المهارات المعرفية مثل التفكير المنطقي وحل المشكلات. تشير الدراسات إلى أن الإفراط في استخدام الشاشات قد يؤثر على قدرة الطفل على التركيز والانتباه، مما يعوق تطور مهارات التفكير النقدي والإبداعي. علاوة على ذلك، فإن العديد من الأنشطة الرقمية لا تتطلب من الطفل التفاعل أو التفكير العميق، مما يؤدي إلى قلة النشاط العقلي مقارنةً بالأنشطة الأخرى مثل القراءة أو اللعب التفاعلي.

التأثير على التطور اللغوي

يعد التواصل الشفهي أحد المكونات الأساسية لتطور اللغة. يمكن أن يعيق وقت الشاشات المفرط اكتساب اللغة، حيث يعتمد الأطفال في هذه الحالة على المحتوى الرقمي بدلاً من المشاركة النشطة في المحادثات. تشير الأبحاث إلى أن الأطفال الذين يشاهدون الكثير من التلفزيون أو يستخدمون الأجهزة الرقمية بشكل مفرط لا يطورون مهارات التواصل بنفس السرعة التي يطورها الأطفال الذين يتفاعلون مع الأشخاص بشكل مستمر. كما أن الوقت المفرط أمام الشاشات قد يؤثر على مهارات القراءة، ما يؤدي إلى تأخر في المهارات الاكاديمية، مثل الكتابة وفهم الكلام المكتوب.

التأثير على النوم
من الآثار السلبية الأخرى لاستخدام الشاشات المفرط تأثيره على النوم. تشير الدراسات إلى أن الأطفال الذين يقضون وقتًا طويلاً أمام الشاشات يعانون من صعوبة في النوم أو جودة النوم، ما يؤثر على صحة الدماغ. لأن قلة النوم تعيق قدرة الدماغ على معالجة المعلومات والتعلم، بما في ذلك اكتساب اللغة والمهارات الاجتماعية، كما يمكن أن يتداخل الضوء الأزرق المنبعث من الشاشات مع إنتاج الميلاتونين، وهو هرمون ينظم النوم. بالتالي تؤدي جودة النوم الرديئة أو قلة النوم إلى صعوبات في التركيز والذاكرة والتعلم، مما يعيق تطور اللغة.

انخفاض جودة التفاعل بين الوالدين والطفل
يعد التفاعل الجيد بين الوالدين والطفل أمرًا بالغ الأهمية لاكتساب اللغة. توفر الأنشطة مثل قراءة الكتب، ورواية القصص، وغناء الأغاني، والمشاركة في المحادثات، مدخلات لغوية غنية ونماذج لاستراتيجيات التواصل الفعالة، يمكن أن يتداخل وقت الشاشات المفرط مع هذه التفاعلات، حيث قد ينشغل كل من الوالدين والأطفال بأجهزتهم، مما يقلل من تكرار وجودة التبادلات اللفظية.
أظهرت دراسة أجرتها جامعة واشنطن، أن حتى التلفاز الذي يعمل في الخلفية يمكن أن يعطل التفاعل بين الوالدين والطفل. عندما يكون التلفاز قيد التشغيل، يميل الوالدان إلى التحدث أقل مع أطفالهم، مما يؤدي إلى انخفاض جودة اللغة المستخدمة، وبالتالي تقل الفرص التي يمكن أن يتعلم فيها الأطفال كلمات جديدة وبُنى لغوية. يمكن أن يعيق هذا التراجع في المحادثات التفاعلية تطور مهارات لغوية هامة، مثل زيادة المفردات، والتركيب اللغوي، واستخدام اللغة في سياقات عملية.

التفاعل الاجتماعي ومهارات اللغة العملية
يمكن أن يعيق وقت الشاشات المفرط أيضًا تطور التفاعل الاجتماعي ومهارات اللغة العملية. تتعلق هذه المهارات بفهم واستخدام اللغة بشكل مناسب في السياقات الاجتماعية، مثل معرفة كيفية التبديل في المحادثات، وتفسير الإشارات غير اللفظية، وتعديل الكلام وفقًا لاحتياجات المستمع. تعلم هذه الجوانب من اللغة يكون بشكل أفضل من خلال التفاعلات الاجتماعية الواقعية، التي تتقلص بشكل كبير عندما يقضي الأطفال وقتًا طويلاً أمام الشاشات.يمكن لوقت الشاشات التفاعلي، مثل مكالمات الفيديو، أن يوفر بعض الفرص للتفاعل الاجتماعي. ومع ذلك، فإنه لا يعد بديلاً للتواصل وجهًا لوجه. توفر التفاعلات الواقعية تجارب غنية ومتعددة الحواس، وهي أساسية لتطوير مهارات اللغة الاجتماعية والعملية. يتعلم الأطفال قراءة تعبيرات الوجه، ولغة الجسد، والإشارات غير اللفظية الأخرى، والتي غالبًا ما تكون مفقودة أو محدودة في التفاعلات المعتمدة على الشاشات.

مدة الإنتباه والتركيز
يرتبط الاستخدام المفرط للشاشات بفترات انتباه أقصر وصعوبة في الحفاظ على التركيز أثناء المهام التي تتطلب انتباهًا مستمرًا. يمكن أن يؤدي ذلك إلى تحديات في فهم اللغة ومهارات التعبير اللغوي، حيث قد يجد الأطفال صعوبة في متابعة المحادثات، والتعليمات، أو السرد القصصي الذي يتطلب انتباهًا واستماعًا مستمرًا.

التأثير على مهارات الانتباه والاستماع
يمكن أن يؤثر وقت الشاشات، خاصة عندما يتضمن محتوى سريع الحركة أو مفرط التحفيز، بشكل سلبي على مهارات الانتباه والاستماع لدى الأطفال، وتعتبر هذه المهارات أساسية لتطور اللغة والنجاح الأكاديمي. الأطفال الذين اعتادوا على التغيرات السريعة والتحفيز العالي قد يجدون صعوبة في التركيز على الأنشطة الأقل ديناميكية ولكنها ضرورية، مثل الاستماع إلى المعلم أو المشاركة في محادثة لكن على الرغم من أن الإفراط في استخدام الشاشات له آثار سلبية واضحة على تطور الكلام واللغة، فمن غير الواقعي القضاء على الشاشات تمامًا من حياة الأطفال. وبدلاً من ذلك، يمكن للآباء ومقدمي الرعاية اتخاذ خطوات للتخفيف من هذه الآثار

   تحديد وقت الشاشة
اتبع الإرشادات مثل تلك الصادرة عن الأكاديمية الأمريكية لطب الأطفال، وحد من وقت استخدام الشاشات للأطفال الصغار، وتأكد من أنها لا تتداخل مع النوم، والنشاط البدني، والانشطة الأساسية الأخرى.

  المحتوى الموجه
يجب أن يكون المحتوى الموجه بعناية تعليميًا ويعزز المهارات المعرفية ومهارات التواصل. من الضروري أيضًا أن يتوافق مع سن الطفل حتى لا يكون مفرطًا أو غير مناسب

  المشاركة في المشاهدة والمناقشة
يجب على شريك التواصل المشاركة في وقت مشاهدة الشاشات مع الطفل، من خلال وصف ما يشاهده بعبارات واضحة وبسيطة، مثل تسمية المفردات، الأفعال، والألوان. يمكن طرح أسئلة بسيطة على الطفل حول المحتوى ومناقشته، وربطه بتجارب الحياة الواقعية لتعزيز الفهم واستخدام اللغة

استغلال الوقت لصالحك
خلال وقت مشاهدة الشاشة، استغل الفرصة لطلب أوامر بسيطة من طفلك، مثل
"أحضر عبوة المناديل"
"أحضر الماء من الثلاجة"
"أغلق الباب"
وذلك لتعزيز قدراته على الاستجابة للأوامر

 استخدم التلفاز للتعزيز
أخبر طفلك أنه عندما ينفذ الأوامر المطلوبة منه خلال اليوم، سيحصل على فرصة لمشاهدة التلفاز لفترة قصيرة. اختر محتوى تعليمي جيد، وابتعد عن الأغاني أو الرسوم المتحركة السريعة

تشجيع اللعب النشط
 يعد اللعب النشط من أهم الأنشطة التي تساهم في تطوير مهارات الطفل، خاصةً في مجالات اللغة والتواصل. عندما يتفاعل الطفل مع الأنشطة التفاعلية، مثل قراءة القصص أو تبادل الأدوار، فإنه يحصل على فرصة لتنمية مفرداته وفهمه للغة بشكل أفضل

Receptive language skills

Receptive language is the “input” of language, the ability to understand and comprehend spoken language that you hear or read. For example, a child’s ability to listen and follow directions (e.g. “put on your coat”) relies on the child’s receptive language skills. In typical development, children are able to understand language before they are able to produce it. Children who are unable to comprehend language may have receptive language difficulties or a receptive language disorder.

Why is receptive language (understanding words and language) important?

Receptive language is important in order to communicate successfully. Children who have understanding difficulties may find it challenging to follow instructions at home or within the educational setting and may not respond appropriately to questions and requests. Within the school setting, difficulties in understanding may lead to attention and listening difficulties and/or behavioural issues. As most activities require a good understanding of language, it may also make it difficult for a child to access the curriculum or engage in the activities and academic tasks required for their year level of school.

Examples of receptive language at different age levels (0-5 years)

·        0-1 years: Respond to their name, follows simple directions, Recognizes a few basic words (e.g., "mama," "dada," "no").

·        1-2 years: Understands up to 50 words, can point to a few body parts when asked (e.g., "Where is your nose?"), recognizes common objects (like "ball" or "cup"), Follows simple two-step directions (e.g., "Pick up the toy and give it to me"). Understands the concept of "more" or "all gone”.

·        2-3 years: Understands around 300 words. Can follow multi-step directions (e.g., "Go to your room, get your book, and bring it here"). Can identify basic colours and shapes when named.

Recognizes and responds to questions about familiar routines or objects (e.g., "What do you eat?").

·        3-4 years: Can follow three-step directions (e.g., "Get your shoes, put them on, and come to the door"). Can answer simple questions about familiar stories and events (e.g., "What did you do today?"). Understands concepts such as "big" vs. "small" and can categorize objects (e.g., "What are you wearing?").

·        4-5 Years: Can understand and respond to more complex instructions and questions. Can follow rules in games (e.g., "If I say 'red,' you have to jump!"). Begins to understand basic why questions (e.g., "Why do we wear coats?"). Can follow longer narratives and understand simple stories or instructions without needing visual aids.

Children who have difficulty understanding language may struggle with the following:

·        Following directions

·        Understanding what gestures mean

·        Answering questions

·        Identifying objects and pictures

·        Reading comprehension

·        Understanding a story

Receptive language development is influenced by a variety of factors, including the amount and quality of language exposure, the richness of the language environment, and individual differences in language processing abilities. Children who grow up in language-rich environments—where adults and caregivers frequently engage in conversation, interact meaningfully, and expose them to a diverse range of vocabulary—are more likely to develop robust receptive language skills.

What are the building blocks necessary to develop receptive language?

·        Attention and concentration

·        Pre-language skills

·        Social skills

·        Play skills

Key aspects of a language-rich environment include:

·        Engagement in Conversations: Frequent interactions that involve listening and responding help children understand language context and nuances.

·        Diverse Language Exposure: Hearing different speakers and varied styles of communication fosters adaptability in understanding language and meaning.

·        Reading Together: Shared reading experiences introduce children to new vocabulary, concepts, and sentence structures, enhancing their ability to comprehend language.

·        Overall, a combination of interactive communication, varied language exposure, and shared reading plays a crucial role in strengthening children's receptive language abilities.

Key Areas of Receptive Language

When discussing receptive language, there are four key areas to consider, which form the foundation for understanding and interpreting communication effectively

• Receptive vocabulary: It is the ability to understand vocabulary. This is a simple but yet very powerful receptive language skill. Vocabulary is like the bricks in the process of learning. Vocabulary is essential for understanding. Children can be able to say what they want to say. Having a large vocabulary enables a child to comprehend and use language. Content makes up a large portion of our communication. It's the foundation upon which your entire understanding of grammar relies. Without a solid grasp of words, there is no way to progress to more complex sentence constructions. The more words a child has, the easier it is to link it with words. The more words, the better the ability to understand things. If we don’t understand words, we can’t follow directions, understand stories, participate in conversations, or express our ideas effectively.

•  Following Directions: For a child to follow a direction (e.g.: “Open the door”) child must know

·        direction words (open)

·        vocabulary (child must know what a door is, in order to open it).

·        child should have adequate attention needed to listen to a direction.

·        child should have adequate short-term memory needed to listen to, comprehend and retain information long enough to carry out a direction.

•  Understanding questions: Understanding questions refers to a child’s ability to answer “WH” questions such as who, where, when, what, what doing, why, and how. This is a CRUCIAL skill necessary to demonstrate academic knowledge, participate in conversations with teachers/peers, socialize, make friends, etc…. This ability depends on many foundational language skills such as

·        Auditory Attention & Listening Comprehension: The child must be able to pay attention to the speaker, hear the question clearly, and understand the spoken words and sentence structure. Difficulty in this area is a major barrier.

·        Vocabulary: A strong vocabulary is essential. The child needs to understand the words within the question (e.g., "Where is ball?" requires knowledge of what a "ball" is) and also be able to formulate an answer using appropriate words.

·        Syntax & Grammar: Understanding the sentence structure of the question helps the child interpret what information is being requested.

·        Memory (Working & Short-Term): The child needs to remember the question while they process it and formulate an answer. Working memory helps in holding information while manipulating it.

·        Executive Functioning (Attention, Inhibition, Flexibility): The child needs to focus on the relevant information, inhibit irrelevant thoughts, and be flexible in their thinking to find the correct answer.

·        Pragmatic Language: Understanding social cues and the context in which the question is asked. This can help narrow down the possible answers.

·        Specific comprehension skills for each “wh” question: Understanding that "who" refers to a person or people, "what" refers to an object, action, event, or idea, "what" refers to an object, action, event, or idea; "where" refers to a location or place; "when" refers to a time; "why" asks for a reason or cause; "how" asks for a manner, method, or process.

·        Problem-Solving & Inferencing

•  Understanding grammar: It is the ability to understand grammatical structures and rules (in word and sentence level). This is crucial for receptive language development, like understanding nouns, pronouns (he, she), verbs and tenses (jumped, jumping, will jump), prepositions, sentence structure (who is doing what in a sentence, understanding word order in a sentence), negation (understanding not in sentences), differentiating yes/no and wh questions. If a child has trouble understanding grammar, they may have:

·        Trouble following directions

·        Answer questions incorrectly

·        Unable to produce grammatically correct sentences

·        Misunderstand stories

·        Limited vocabulary

·        Simplified speech

·        Underutilisation of pronouns

·        Overall communication challenges

                                                                   Activities To Improve Prelinguistic Skills

Pre-linguistic skills are the first form of communication developed prior to the symbolic language, typically from 9-15months. Limited pre-linguistic skills in the early years are an indication of future concerns in the areas of language development, attention, concentration, behaviour, social interaction and play skills.

Prelinguistic skills which should be to make the child communicate better:

•  Gestures

• Eye contact

• Joint attention

• Turn taking

• Imitation

• Name call response

Here are some activities you can try with your child to target each of the key pre-linguistic skills:

Gestures

• Model Gestures: Use gestures when talking to your child, when you wave goodbye, point to objects, or shake your head for “no”, frequently during the daily life routine, then the children will start imitating these actions.

• Respond to Gestures: When your child uses a gesture, respond to it verbally. If they point to a toy, say, “You want the ball?” This reinforces their attempt to communicate and connects the gesture with words.

• Play Games That Involve Gestures: Simple games like “peek-a-boo,” “pat-a-cake,” or action songs like “If You’re Happy and You Know It” involve gestures and help children associate movement with meaning.

• Role playing activities: Act out pretend scenarios (e.g, cooking, shopping) and encourage the child to use gestures to communicate actions.

• Mirror play: Encourage the child to watch their gestures in the mirror. Copy each other’s gestures to reinforce recognition and imitation.

Eye contact

• Peek-a-boo games: Peek-a-boo games can be played anywhere; from behind a curtain, when getting dressed, while having a bath or even when walking your baby in his/her pram. You can encourage your child to look at you by sitting at his/her level or opposite the child.  Hide your face behind your hands and play peek-a-boo games.

• What’s mummy/daddy wearing: You could try putting on and taking off a brightly coloured or interesting hat or gloves, a colourful scarf, sari or piece of material, sunglasses or a home-made paper plate face mask to play peek-a-boo games, encouraging your child to look at you.

• Making faces: Make funny faces or sounds while looking at the mirror together.  Wait for your child to look at you before you continue or wait for your child to copy you.  You could also do this during bath times when sitting at his/her eye level.

• Blowing bubbles: Before you blow bubbles, wait for your child to look at you.  You may have to call out their name, help them anticipate blowing by saying, ‘ready, steady…’ or shake the bottle of bubbles to get their attention. You can encourage your child to look at you by placing the bottle of bubbles close to your face.

• Ready, steady go! : You can play any ball game (i.e. skittles), blowing bubbles, a marble run or a car game with your child.  Say ‘ready, steady’ and pause briefly to get his/her attention before saying ‘go’ and throwing the ball, rolling the car or blowing bubbles

• Hand/glove or finger puppets: Put on a hand/glove puppet or a home-made sock puppet on your hand and wave your hands or wriggle your fingers close to your face to encourage your child to look at you.  Similarly, you can use finger puppets or draw faces on your fingertips with washable paint, paint your nails or use hand paint on your hands.    Place your hand close to your face and wriggle your fingers and hide them, encouraging your child to look at you.

• Use favourite object:  Hold a favourite toy or object close to your eyes and encourage the child to look up when talking or interacting with the object. Exaggerate your facial expressions while having conversation placing the object near to your face. Make sure you are sitting in the same eye level of your child.

• Action songs: Use action songs. Make eye contact a part of fun, make the child do the action by holding the hands.

• Stacking blocks: Make the child to look at your eyes before you hand them the next block. Make it a part of the routine.

• Eye-contact countdown:  Start with brief eye contact and use a countdown. Like say, “Look at me for 3,2,1” and gradually extend the time as the child becomes more comfortable. You can use any reinforcement for the child’s positive responses so the child will be encouraged.

• Look and Tell game:  Hold up a picture or object the child is interested in and say, “Look at me, then tell me what it is”.

• Physical games: Play games the child likes, between say “Anu, Look at me” and then continue. This will also help to improve her response when her name is called. Or, STOP her from doing or playing the activity by calling her name simultaneously. Make her look at you by making her saying “Yes”.

Joint attention

• Use of Interactive story books, give your child books instead of tablets or mobile. Using of interactive story books will enhance the Joint attention, sitting behavior of the child also the bonding with the parents. It will also improve the child’s language skills

• Roll a ball/car down a ramp or throw a ball back and forth

• Do a jigsaw together

• Sing songs with actions, like “Row, Row, Row Your Boat”, and hold hands and dance to your child’s favourite song.

• Hold a sheet or blanket with your child and rock a baby doll.

• Play Hide and Seek with toys which your child is interested with.

• Blow up balloons and letting them go to fly around the room

• Physical games such as chase and tickles, build towers and knocking them down.

• Bubble Play : Blow bubbles and pause to wait for the child to look at you or point. Encourage shared excitement by saying, "Wow, look at the bubbles!"

• Flashlight Games : In a dim room, shine a flashlight on different objects. Encourage the child to look where the light is pointing and label the objects.

• Point and Label : Use books or posters with vibrant images. Point to pictures, label them, and wait for the child to look at the item or your face.

• Toy Surprise : Hide a toy under a blanket or inside a box. Use exaggerated facial expressions and excitement as you reveal it.

• Snack Time Interaction : Hold a snack or favourite item in front of your face. Wait for the child to look at you before giving it to them.

Turn taking

• When playing with your child, make sure you pause and wait and give them an opportunity to respond to you, using specific time limit with counting from 1-10.

• Games that involve passing a toy to each other help to develop turn taking e.g. rolling a ball forwards and backwards, pushing a car to each other etc. You can model language too, “my turn, your turn”

• Try to involve yourself in your child’s play, for example if your child is playing with blocks, you could get your own blocks and play alongside them. If they are ready, you can take a turn to put a block on their tower

• Try playing games without toys; we call these games ‘people games. Your child may enjoy chase, tickles or peek a boo.

• Pause and wait for your child to take their turn, remember their turn might be a look, a smile, a movement or a sound. When they respond then take your next turn.

• Board Games or Simplified Card Games : Play simple games like "Snakes and Ladders" or "Go Fish." Use visual cues like a "turn-taking card" to help the child know when it's their turn.

• Bubble Blowing : Take turns blowing bubbles. Say "Your turn to blow!" and "My turn to pop."

• Pretend Play : Set up a pretend tea party or store where each person takes turns pouring tea or being the cashier.

Imitation

   Imitating sounds:

• Encourage your child to continue making sounds and engage in back-and-forth sound Games.

• Imitate your child’s sounds

• Pause to see if your child repeats the sound. If he does, imitate again to create a back-and-forth imitation game

• Sing familiar songs and rhymes over and over

• Once your child knows a song well, pause before a favourite part to see if your child will fill in the blank

• Copycat Sounds : Sit face-to-face and produce simple sounds like "ah," "oo," "ba," or animal noises. Encourage the child to imitate by making it playful and rewarding their attempts. Exaggerate your facial movements .

• Action Songs : Use songs with repetitive sounds and actions, like "Old MacDonald" or "Wheels on the Bus." Exaggerate sounds like "E-I-E-I-O" and encourage the child to join.

• Silly Sound Games : Make playful sounds during play, such as car noises ("vroom") or pretending to sneeze ("achoo"). Pause and wait for the child to imitate.

• Mirror Play: Sit in front of a mirror and make silly faces paired with sounds. Encourage the child to mimic both the facial expressions and sounds.

• Verbal Imitation Cards : Show picture cards with simple words (like "cat" or "car"). Say the word slowly and clearly and prompt the child to repeat.

• Play-Based Imitation : Use toys that encourage sounds (e.g., animal figurines or vehicles). Say phrases like "moo" for the cow or "beep beep" for the car and prompt the child to copy.

• Imitation Chain: Start with a simple sound and gradually build to two-word phrases (e.g., "ba" → "ba-ba" → "ball"). Reward any attempt to encourage progress.

• Snack Time Sounds : Hold a desired snack and model words like "yum," "more," or "please." Wait for an attempt before giving the snack.

• Rhythm and Sound Games: Tap on a drum or clap while saying a sound or syllable. Pause and wait for the child to imitate the sound or rhythm.

  Imitating actions on objects:

• Use matching sets of objects to play with your child so that you both have the same objects

• Get face-to-face with your child and imitate exactly what he does with the objects once he enjoys this game, try showing him a different action with the object. Pause expectantly to see if he will imitate, if he doesn’t gently help him to.

• Praise your child for imitating your action, whether you helped. Go back to imitating his choice of actions for a while before trying again.

• Keep it fun! Add silly sound effects and label the actions as you go.

  Imitating facial expressions and gestures:

• Pick a gesture in a favourite song. When it gets to that part of the song, begin the gesture, then help your child to imitate by moving her hands. Reward her by continuing the song.

• Each time give your child less and less help, so he is doing it more independently.

• Don’t worry if he doesn’t do it exactly. Give lots of praise and encouragement.

• Use exaggerated facial expressions when playing with your child and in all your daily routines together.

• Try playing in front of a mirror together and making silly faces and sounds.

Name call response

• Find a few of the child's favourite treats or activities (like chips and bubbles). When the child is focused on something else, call his name while standing behind them, then gently touch their shoulder and give them a chip or blow bubbles. Gradually, move a bit further away and wait a second or two before touching their shoulder. This way, the child will learn that good things happen when they hear their name.

• To teach your child to look at you when you call, it's important to limit distractions. Start in a quiet room by turning off the TV and asking siblings to play elsewhere for a few minutes. Remove any toys or clutter that could divert his attention. This calm setting will help him learn to respond better. Once he’s comfortable, you can gradually introduce louder and busier environments, like the living room or toy room.

• Music can be a powerful tool to capture a toddler's attention - two-year-old and preschoolers often love it. If your child responds enthusiastically to music, try incorporating it into your interactions with them. When calling their name, try using a sing-song tone of voice, making it a fun and engaging experience

• Name Calling Hide and Seek : Hide behind furniture and call the child's name. Encourage the child to find you by following your voice. Celebrate when they respond.

• Name Call with Reinforcement: Call the child's name when he is engaged in a preferred activity (playing with toys or watching a video). Reward with positive reinforcement when they respond (clapping, praise, or a small treat).

• Interactive Play with Name Calling: Engage in a game like catch or ball rolling. Call the child's name before throwing the ball and encourage eye contact.

• Bubbles and Name Response: Call the child's name before blowing bubbles. Only blow bubbles when they respond.

• Name Call Freeze Game: Play music and have the child dance. Call their name randomly to prompt them to freeze.

• Snack Time Interaction: Hold up a desired snack and call the child’s name. Wait for eye contact or a response before giving the snack.

The Pre-linguistic skills

The Pre-linguistic stage marks a crucial period in early childhood development when the children communicate and interact without using words. This stage forms the basics for language development, social bonding, and emotional regulation.

Below are some key pre-linguistic skills that children develop during this time:

• Gestures: using hand motions like pointing, reaching, or waving to communicate before they can talk.
• Eye Contact and Social Smiling: making eye contact and smiling in response to others, which helps build social connections.
• Joint attention: the ability to focus on the same object or event as another person, and it's a crucial pre-linguistic skill is a key indicator of social and cognitive development.
• Turn-taking: children learn the back-and-forth flow of conversation by babbling or making sounds and then waiting for a response from others.
• Imitation: children imitate sounds, expressions, or actions they see from caregivers or others around them, which helps them learn how to communicate.
• Attending to Sounds: children begin to focus on the sounds around them, such as voices or environmental noises, which is essential for understanding language.
• Name-call response: It refers to a child’s reaction when they hear their name being called by someone, such as a parent or caregiver. It’s a fundamental step in language development, showing that the child is becoming aware of themselves as an individual and is beginning to respond to social cues.

Occupational therapists see beyond diagnoses and limitations to hopes and aspirations. They look at relationships between the activities you do every day – your occupations – alongside the challenges you face and your environment. Occupational therapy (OT) is largely known to be a creative profession both as a practice and in its use of creative activities for the benefit of clients. Occupational therapists (OTs) offer practical advice and support to help people carry out their daily activities. Their work centers on adapting a person’s environment so that it better suits them and the things they want and need to do. OTs work with people of all ages.

Common examples of what they do include:

• helping people going through physical changes to carry on working
• helping people experiencing changes in how they think or remember things to carry on working
• helping children with disabilities fully participate in school
• helping people with disabilities take part in social situations, hobbies, or sports
• work with the person and their family to identify their goals
• design a custom intervention, or plan, that will help the person perform their everyday activities and reach their goals
• check to see whether the person is meeting their goals and make any necessary changes to the plan

What is the role of an Occupational Therapist with children?

Occupational therapists working with children are trying to determine where delays or limitations are coming from, especially in the areas of fine motor skills, cognitive skills, social development, and establishing self-care routines.

Why Might My Child Need to See an Occupational Therapist?

Children see occupational therapists for a variety of reasons including:

• Delays in fine motor skills
• Help developing visual motor skills – tracking an object, hand-eye coordination
• Cognitive delays including problem-solving skills, memory, and attention
• Children with sensory integration issues
• Delays in play and social interaction skills
• Help with learning basic self-care tasks, such as getting dressed

What is Sensory Integration Therapy?

Sensory integration is the process through which we sense the world around us. We use our sensory organs to receive information and, on a higher level, we organize it so we understand our surroundings and respond appropriately. To sum it all up: we perceive, organize, modulate and interpret sensory information.

Most people don’t realize that breakdowns in sensory processing can affect:

• behavior
• communication
• function
• successful participation in daily life

When we hear the buzz of a bee near our head, we immediately swat in an attempt to avoid being bitten. The smell of burning in the kitchen alerts us to the possibility of a fire and we act in order to prevent danger.

It is important to realize that there are more than just the five senses that most of us are familiar with.

Information is taken in from:

• Touch
• Smell
• Vision
• Hearing
• Taste
• Vestibular
• Internal organs (interoception)
• Proprioceptive receptors

Vestibular receptors are responsible for detecting changes in position in space, balance, and movement.

Interoception involves the internal regulation responses in our body such as hunger, thirst, blood pressure, and even toileting urges.

• Smell
• Vision
• Hearing
• Taste
• Vestibular
• Internal organs (interoception)
• Proprioceptive receptors

Vestibular receptors are responsible for detecting changes in position in space, balance, and movement. Proprioceptive receptors provide information about body awareness, position, and posture. Interoception involves the internal regulation responses in our body such as hunger, thirst, blood pressure, and even toileting urges.

OTs have the clinical knowledge to design sensory experiences specific to the child. It may start with a certain form of sensory stimulation to elicit the desired response. While every session will be different depending on your child’s needs here is an example session with some sensory integration therapy activities.

The OT may begin the treatment session with an obstacle course which the child views as a fun challenge. However, the course was carefully designed to provide sensory input to her joints and calm the pressure on the child’s body. Large motor, and physical activities that are organized to the senses, the OT may include playing in ball pits to target the tactile system. The purpose of this sensory stimulation is to regulate and prepare her system for the next activity.

Next comes a fun puzzle. However, the puzzle pieces may be placed into a sticky or wet substance such as slime or water beads placed into a bin. The child often has so much fun playing the game that he/she forgets she’s placing her hands into the very thing he/she doesn’t like! With this sensory experience, now the child is starting to adapt hyper-responsively to the messy texture.

Common items seen in clinics where occupational therapists use sensory integrative techniques include swings, trampolines, soft brushes, and scooters.

While the room may look like a play place or a gym setting, sensory integration therapy requires training and education that the OT must obtain in order to perform therapy safely and effectively.

“OCCUPATIONAL THERAPY IS WHERE SCIENCE, CREATIVITY, AND COMPASSION COLLIDE.”