The Responding Game: An Essential Skill for Parents of Children with Language Delay

By Toby Stephan
Hanen Workshop Instructor and US Representative

“What’s One Quick Tip on How to Support Early Language Development?”

A speech-language pathologist friend of mine once shared a story about taking her toddler to the pediatrician for a scheduled check-up. After learning what my friend did for a living, the doctor asked her to give him one quick tip he could share with parents that would best support early language development. My friend was not expecting this question and felt pressured. As would be the case for most of us in this situation, she became flustered when trying to decide on the one best tip she should give. The doctor sensed my friend’s hesitance and filled in the gap by saying that he tells parents to “Talk, talk, talk to their child all day long … do things like describe what they see on their walks to the park together, talk about the colors, the trees, everything that they see happening.”

During the visit, my friend didn’t disagree with this doctor. On the drive home, she was reflecting on this conversation and realized that the doctor’s advice felt right on one level; children are positively affected when they hear a variety of language from those around them. On another level, however, she realized that something was missing from this doctor’s advice. Simply talking to the child isn’t enough. Our talk needs to be meaningful for the child. And in order to be meaningful for the child, our talk needs to start with what is coming from the child. Bronson and Merryman (2009) say that , “the central role of the parent is not to push massive amounts of language into the baby’s ear; rather, the central role of the parent is to notice what’s coming from the baby, and respond accordingly …”. The missing piece from this doctor’s advice was parent responsiveness.

Why is Parent Responsiveness Important?

Intrinsically, being responsive to the child may sound right to us, but what does the literature say? Parent responsiveness has been credited for promoting children’s cognitive skills, emotional attachment and intellectual achievement (Bornstein, Tamil-LeMonda, Hahn & Haynes, 2008). In addition, it has been associated with positive language outcomes such as superior receptive language skills at one year of age (Baumwell, Tamis-LeMonda & Bornstein, 1997; Rollins, 2003) and more advanced expressive language, vocabulary development, and receptive language in the second and third year of life (Olson, Bates, & Bayles, 1986; Rollins, 2003). Bronson & Merryman (2009) indicate that “how often a mother initiated a conversation was not predictive of language outcomes – what mattered was, if the infant initiated, whether the mom responded” (p. 208). The relationship between parent responsiveness and child communication outcomes seems to remain consistent over time. Brown and Woods (2015) conducted a series of three multiple baseline single studies that included children with a variety of conditions, including Down syndrome and autism. These authors concluded that the transactional relationship between parents’ increased use of responsive intervention strategies and children’s increased targeted communication rates align with previous research on parent responsiveness.

How Does Responsiveness Promote Language Development?

So we’ve discussed examples from the literature on why parent responsiveness is important. But a more specific question is how does it promote language development? The literature indicates it has an impact in a variety of ways.

1. If a parent responds contingently to the child’s interests and/or communicative attempts, the child is more likely to be motivated to continue initiating and to remain engaged in the interaction (Ryan & Deci, 2000; Weitzman, Girolometto & Greenberg, 2006). If the child is increasing her or his initiations, that same child is increasing his/her practice in communicating. If a child is increasing the amount of engagement in the interaction, that child is at the same time increasing his/her opportunities to learn from any language input the adult offers.
2. In order for the parent to respond verbally, that parent must pay close attention to their child’s interests, activity, and communication (what we call the strategy of OWL - Observe, Wait, & Listen), which heightens that parent’s ability to match their own words and sentences to the child’s present focus (Baumwell, Tamis-LeMonda & Bornstein, 1997). In other words, parent responsiveness not only increases opportunities for the child to learn from the adult, but it increases the parent’s ability to provide a higher quality language input. If the parent’s language input matches the child’s current focus, the language input will be more meaningful for their child.
3. A parent’s use of responsive language input enables the child to focus his or her cognitive resources on the moment (Girolametto & Weitzman, 2006). If the parent talks about something other than what the child is focused on, the child has to use some of his or her cognitive resources to shift to this new topic; however, if the parent chooses to talk about what the child is interested in, that child will be able to focus more of his or her cognitive resources on the moment, so that child will be in a better position to learn.

How Do We Know if a Parent Is Being ‘Responsive’?

Bornstein, Tamis-LeMonda, Hahn, & Haynes (2008) list three concrete criteria for responsiveness.

1. Prompt (the response is within a 5 second window of the child saying or doing something)
2. Contingent on the child’s interest (e.g. if the child picks up a car, the parent talks about the car rather than the nearby toy train)
3. Appropriate (the parent responds in a positive and sensitive way – e.g. “Oh, you have a car!” rather than “What’s that? Tell me what that is”)

Strategies Parents Can Use

Given that the literature consistently supports parent responsiveness, what are some specific intervention strategies a parent can use?

Step one: Observe Wait Listen

The parent needs to give the child the opportunity to take that first turn, so that the parent has something to respond to.

The Hanen Centre calls this strategy Observe, Wait, and Listen (OWL). We recommend this strategy as an effective starting point for children across developmental stages. Read more about OWL.

Step two: Follow the Child’s Lead

Once the parent OWLs and the child initiates, then the parent should respond by following the child’s lead. The Hanen Centre suggests a variety of strategies that can be used, each of which is described in detail below.

Imitate: Copy what the child says or does

When we imitate the child, the child feels validated and is more likely to continue doing the thing(s) the adult imitated, getting good practice with that action, sound or word.

The strategy of imitate is powerful in a second way. When the child becomes aware that he’s being imitated by his parent, he may pay more attention to what that parent is doing. So, if his parent then models a skill the child finds interesting, he may try to copy it. As a result, he is beginning to learn to imitate others. Once this happens, the learning can really take off.

A third way the strategy of imitate is powerful is the impact it has on children who are hard to engage. When we imitate the hard-to-engage child, that child might just stop and take notice of us, find being imitated fun, and want to keep participating in the interaction.

What do we imitate?

For the children at the earliest stages of communication, imitation could mean imitating a random action, sound or, facial expression. As the child develops intentional communication, we can imitate any intentional action, such as a point or some other gesture, as well as any sounds the child makes. For children at the word or word combination stages, we would imitate the language the child is actually producing, but not exactly as they said it. We would want to remind parents not to imitate less than mature articulation or grammar. So if the child says “wa wa”, the parent can respond by saying “You want water.” If the child says “cow walk” the parent can respond by saying “Yes, the cow is walking.”

We may also need to remind parents that they would only want to imitate the actions or behaviors that they judge to be acceptable, since by imitating the action, the parent is giving the child permission to continue doing it. For example, a parent may choose not to imitate actions like putting objects in the mouth or splashing in the toilet water.

Interpret: Say what the child would say if she could say it (as if interpreting a foreign language)

As with the strategy of imitate, interpret would be a strategy of choice for those children who either are not yet communicating intentionally or who are communicating intentionally, just not yet with words.

• For children who are not yet communicating intentionally - A child might be doing a random action such as patting her belly, and the parent then assigns meaning to this action (interprets) by saying, “Oh, you’re hungry. You want something to eat” and gives her some milk.
  
  When a child does a random rocking motion in a swing, the parent can interpret by saying, “Oh, you want another push on the swing” And then push the swing. If the parent keeps interpreting these random actions and responding to them as if the child asked for something, the child will learn to use the random action intentionally to ask for food or another push on the swing.
  
   
• For children who communicate intentionally – A child purposefully points to the banana on the counter. The parent responds by saying “Oh, you want some banana” and gives her some. The child looks at his or her parent then looks at the bubbles bottle. The parent can respond by saying “Ok, let’s play bubbles” and starts to blow bubbles into the air.
  
  The child’s goal for the intentional communicator is to learn to understand the language that goes with their intentional communications so that, in time, they can use the language themselves.

Comment: Pay attention to what the child is doing and give the child the language that matches it.

This is the “follow the child’s lead” strategy of choice for the child who is at the single word or word combination level. When Tristan slides down the slide and says “down”, the parent can respond by saying “You’re going down the slide.” The goal would be for the child to learn to understand and, in time, say some or all of the words he’s hearing. The closer the language input is in response to the child’s focus of interest, the more meaningful that language will be. Recall that Bornstein, Tamis-LeMonda, Hahn, & Haynes (2008) indicate that a response within 5 seconds is optimal .

We need to mention one further word of caution. The field of language intervention is, for the most part, moving away from using telegraphic speech. So, the optimal response to Tristan’s use of “down” would not be “Marky slide down”. Instead, it could be “You’re going down the slide.” The second model is still short and concrete, but is also grammatical.

Join In the Play

Play like a child. Use fun sounds and words. For some children, the parent may need to start by playing alongside their child, then gradually work into to playing with the child with the same set of toys.

Join in the Play can be a strategy of choice for children at any stage of communication. All young children will be in a better position to learn, whatever the child goal might be, if the parent and child are connected within the same activity. The Join In strategy is often the vehicle for using the other Follow strategies. If the parent or child are connected within an activity, it may be easier for the parent to imitate, or interpret, or comment. The parent’s use of imitate, or interpret, or comment will also be more meaningful for the child.

Play like a child simply means “do with the toys what the child is doing or could be doing”. If the child is using a shovel to dig into the sand, the parent should use a shovel to dig into the sand (and use his own, not the child’s!). This strategy could easily fit onto daily routines. If the child uses a spoon to dig into the cheerios, the parent can also use a spoon to dig into the cheerios. The strategy is that simple and that concrete. When playing with the toys or using the objects that go with routines, the child will often pay even more attention if their parent adds in those fun sounds (oooh, awww) and words (pop, splash). The parent can produce these fun sounds and words with some extra exaggeration and intonation.

The Responding Game: An Essential Skill

I never asked my friend what she shared with her child’s pediatrician on the next scheduled check up, but knowing my friend, I’d bet she suggested to this pediatrician that the research confirms that it is important for the parent to talk to their child. The amount of language a child hears from his or her adult is a good predictor of the amount of language a child will one day use, but an even better predictor is the amount of language a child hears in response to what he or she had said or done first. As for intervention strategies, OWL starts the interaction. The “Follow” strategies of imitate, interpret, comment, and join in help the parent learn to respond to their child so the interaction and the learning can continue.

The Hanen Centre is a Canadian not-for-profit charitable organization with a global reach. Its mission is to provide parents, caregivers, early childhood educators and speech-language pathologists with the knowledge and training they need to help young children develop the best possible language, social and literacy skills. This includes children who have or are at risk for language delays, those with developmental challenges such as autism, and those who are developing typically.