Waiting to Start Intervention…Is It Ever Too Early?

Waiting to Start Intervention…Is It Ever Too Early?

imageUniversal Newborn Hearing Screenings have been a game changer for children with hearing loss. Rather than late identification, many children are being identified with hearing loss and fit with amplification by just a few months of age. Often, this is well before we would expect speech and language to develop.

Frequently, I hear people (even medical professionals) saying it’s too early to work on listening, speech and language skills. They claim that the child is too young and there is nothing yet to work on, and then suggest waiting until after one year of age.

With the latest technology, such as digital hearing aids and cochlear implants, most children with hearing loss can have excellent access to speech and can ultimately become skilled language users. Therefore, we must set high expectations for our children (or clients) and ensure that all skills are developing within an age appropriate range. So, let’s consider the question…should we wait for the child to get older to start the process of intervention?

The answer is emphatically NO!

There are many pre-language skills that children need to acquire in order to be able to learn to use language. Intervention should begin with working on development of these pre-language skills right from the get-go. As children with hearing loss are at-risk for language delays, ensuring these skills are acquired in a timely manner is critical. Here is a list of some of these important developmental skills.

Smiling: While a baby’s first smiles are reflexive, by 2-3 months this smile becomes purposeful and is made in response to something. This can be seeing something pleasing (a food or object) or seeing the face of a caregiver. Smiling is an important pre-language skill, as it is not only the outward expression of pleasure, but the beginning of development of social connections. Play with your baby face to face, smile as you interact. Before too long, you will see those first smiles emerge.

Visual Tracking: Visual tracking is the ability to use eye gaze to follow an object. Between 2-6 months of age, babies begin to track objects and people across various planes (midline, upward, downward, etc…). The ability to visually track is an important early skill as this promotes awareness of the environment, as well as it is a precursor to some later developing social communication skills. Find toys and objects which interest your child. Once your child looks to the object, move it slowly in different directions and watch your baby’s eyes follow. At first you may only see them tracking in one direction, but over time they should look in any direction.

Object Permanence: Object permanence is the child’s ability to know that objects still exist even when they can’t be seen (or heard) any longer. This is a skill that usually comes in around 7-9 months of age. Object permanence is the beginning of the development of memory skills, as it is the ability to remember that an object exists, even when it is out of sight. This memory leads to other forms of memory development and the ability to talk about what is not actually present. When object permanence is developing, you will begin to see your child dropping objects from the high chair, watching them fall, any finding it amusing. Playing peek-a-boo is a great game to work on object permanence. Prior to developing this skill, your baby may cry when you cover your face. This is because he/she thinks you are gone. Once object permanence develops, your baby will find this activity enjoyable. You can also work on hiding a favored toy under a blanket. At first, only partially hide the toy (allow part of it to be visible).

Cause/Effect: Cause/effect is the child’s ability to understand that the his/her own actions can bring upon a response. This can be as simple as learning that a specific body movement can continue an activity (4-5 months) to understanding that pulling a string can bring a toy closer (9 months). The skill of cause/effect is important not only for understanding how the world works, but for the development of communication. Once the child has developed cause/effect, he/she can begin to learn that others are a means to getting needs met. The child understands if I vocalize, mom will do this favored activity again or if I say “more”, I will get another cookie. There are many cause/effect toys out there. Pop up toys are a great way to work on cause/effect.

Joint Attention: Joint attention is the ability to share focus on an object with another person. Typically, eye gaze and pointing (or other gestures) are used to share simultaneous attention to an object with someone else. It is the ability for the child to follow another person’s focus of attention and also to direct someone else’s attention to an object in which the child is interested. Joint attention typically begins to emerge around 9 months and this skill is solid by 18 mos. This is also a precursor to social communication. Once joint attention is established, your child will gain your attention, not necessarily to get an object, but rather to “show” it. Be a good model for your child. Use pointing, gesturing, and eye gaze to help direct your child’s attention to things in the environment.

Imitation: Imitation is a critical skill for development of language skills. Children begin to use language only after they have developed the ability to imitate. Language is the imitation and generalization of what a child hears. So, in order to begin to use language, the child must learn the skill of imitation. In the very early stages (around 2 months) we see babies begin to imitate sticking out the tongue and other movements of the face. Over time (around 7-8 months), a child begins to imitate more gross motor movements such as clapping and other motor gestures. It is through imitation that we can teach the child many different skills. Play imitation games with your child. In addition to working with your baby on imitating your movements (facial expressions, pointing, clapping, tapping, etc…), imitate your child’s movements and actions sometimes. It’s amazing to see the delight in your child’s face when you become the imitator.

Preferences: The basic desire for something and having preferences is critical to language development. At the initial stages of language use, children begin using language to make their wants and needs known. A child who has not yet developed preferences for objects, people and actions, will likely have difficulty with language development. While having preferences is not something we can “make happen”, finding what those preferences are is important. Once your child’s preferences are known, you can set up situations which will prompt a communicative response.

Understanding the importance of each of the above pre-language skills and beginning to incorporate them into therapeutic interactions with your child is critical to ensuring that your child is ready to talk. Don’t forget to work on the early listening skills, as well. If your child is not developing these skills, even with intervention, it may be an indication of another issue and you might want to consider a full neuro-developmental evaluation.


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