FamilyConnect

This article is the first in an series about helping your child with a visual impairment who has delays in the development of communication skills. This article focuses on the transition from nonverbal behavior to the use of single words.

If your child has not started using words to communicate, then you may sometimes feel at a loss as you continue to anticipate his needs and respond to vocal and physical behaviors that don’t always clearly communicate a message. Under these circumstances, you must be a good guesser. The good news is that the foundation for verbal communication skills develops before a child learns to say words. Before words emerge, your child with a visual impairment can develop a rich set of nonverbal behaviors to communicate her needs and socialize.  

Nonverbal Communication Behaviors

Nonverbal communication is the first stage of communication development and progresses from crying and moving arms and legs, to more specific body movements like reaching and touching, to more specific motor movements like taking your hand and placing it on an object, leading you across a space by holding your hand, or giving you something so you can manipulate it for the child (open a box, activate a toy). These motor actions describe the development of communicative gestures using hands and arms. The development of these gestures in children with visual impairments and blindness will vary in some ways from the gestures used by a sighted child. While research has addressed the potential limits in gestural development in the absence of vision, there is also good evidence that new gestures can be taught to children who are not yet using words. Nonverbal communication also includes sound-making or vocalizations that are not spoken words. These sounds range from crying and fussing to babbling (example: “babada”) or jargon, which has the rhythm of a sentence but doesn’t consist of real words yet.

Sending Messages Using Nonverbal Communication

Before words are used to communicate your child’s wants or needs, her nonverbal behaviors will transition from those that communicate an unclear message to those that communicate a more specific message. Your role is to first anticipate what your child needs, and then make educated guesses about what message is being communicated nonverbally. Sometimes the message is called the “communicative intent.” In other words, the nonverbal behaviors suggest or communicate what your child wants you to do. There are four phases in this development.

The First Phase of Nonverbal Communication Development

During the first few months of your baby’s life, you spent your days and nights responding to her cries and guessing her needs. You monitored changes in her behavior that helped you understand what she needed (feeding or diaper change), her mood or emotional state (happy or upset), and her physical state (tummy ache or tired). The sounds she made, her facial expressions, and her body language told you almost everything you needed to know. As you set a daily routine, you could anticipate the times of day when your child would be hungry or need a new diaper. You also learned when she would probably be awake and when you could cuddle or play and which toy or activity she enjoyed. At this early stage, you were the primary communicator; your child was not yet a communication partner. As you went about your day, you talked to your baby and described what you thought she needed and what you were going to do to help. Your baby probably answered you by cooing and moving her body towards your voice or changing her position and facial expression. These movements were automatic and a natural part of her response to her environment and your interaction. She wasn’t really thinking about communicating her needs to you, but the behaviors helped you understand what your child needed. This type of movement—crying, fussing, and moving arms and legs—is considered pre-intentional behavior because the child isn’t intentionally communicating her needs yet. If your older child has multiple disabilities, there may be times when she uses these same behaviors.

The Second Phase of Nonverbal Communication Development

Gradually, your responses to your baby’s behaviors help her to understand that she can get your attention and then get you to do what she wants. Her cries change and begin to have meaning related to different needs (wet diaper, tummy ache, a lost pacifier). Body language or motor movements begin to have meaning in the routines you have created, especially in play. For example, when you play pat-a-cake or tickle games, your child may signal a desire to continue playing by repeating one of the actions. Babies with visual impairments and blindness develop simple motor actions or early gestures without seeing them; these actions and gestures reflect natural movements. As she grows, your visually impaired baby will also begin to use sounds and movements that are more consistent, more refined, and that will seem to have a clearer message. For example, she may say “bah” instead of fussing. She wants something, but she doesn’t know yet that she can direct that message to you. Your role is to respond to the behaviors as if she is sending you a message. The more you do this, the more your child will repeat the behavior when she has other opportunities.

During this phase, the nonverbal behaviors you might observe in your visually impaired child include the following:

• Repeating a motor action that is part of a movement activity with or without an object
• Pushing your hand or an object away
• Showing off (repeating a motor or vocal behavior that previously got your attention)

These behaviors may indicate that your child’s wants and needs include the following:

• Gain your attention
• Let you know she wants you to do something again or that she wants some more of what you’ve been giving her
• Let you know what she doesn’t want

The Third Phase of Nonverbal Communication Development

During this phase, your child’s nonverbal behaviors are goal-directed, with you as the intended recipient of the message. In the second stage of development, your child was goal-directed (I want it, and I’m going to get it). In the third stage, your child begins to realize that you are handy to have around, and she can get you to do the work for her. Her behaviors begin to show recognizable intent (the beginning of sending a message), and you can begin to respond to the specific behavior to meet her needs. The behaviors in this phase still require you to do some guessing of the message based on context.

Nonverbal behaviors you might observe in your child during this phase include the following:

Moving another person’s body:

• Touching a person or an object
• Pulling a hand towards her
• Taking a hand and placing it on an object
• Pushing an object or a hand away
• Tugging on a leg

Using her own body in space:

• Reaching toward someone or the place where an object is/has been in the past
• Holding her arm(s) or hand(s) up

These behaviors may indicate that your child’s wants and needs include the following:

• Requesting objects and actions (needs and wants)
• Requesting help or assistance
• Requesting “more”
• Commenting (social sharing)
• Rejecting an object or action; protesting
• Greeting or taking leave (saying “goodbye”)

The Fourth Phase of Nonverbal Communication Development: Intentional Pre-symbolic Communication

During the fourth phase of nonverbal development, before words emerge (pre-symbolic), gestures and vocalizations are clearly intentional. The development of intention is a sign that your child is building one of the four main parts of communication skills called pragmatic language (or social communication). At this stage, the form of communication is still nonverbal (gestural or vocal), but your child’s messages are becoming clearer and more conventional (understood by others). In the context of daily living and play, most anyone should be able to understand what your child wants or needs, or if she wants social attention or to interact socially. If you have an older child whose first words continue to be delayed, supporting this stage of intentional nonverbal communication is very important.

Nonverbal behaviors you might observe in your child include the following:

Note: Some of the gestures from the earlier nonverbal stages will continue to be used during this stage as well. A common gesture that develops in sighted children at this stage is pointing, as in extending the index finger and touching an object up close or pointing across a distance. Pointing is thought to be a rare gesture in children who do not have visual input.

• Lifting arms or hands up or out
• Extending an object (showing), which may be a rare gesture, but may naturally occur
• Giving or handing an object to someone
• Waving (hello/bye-bye)
• Shaking head (no); nodding head (yes)

These behaviors may indicate that your child’s wants and needs include the following:

• Requesting objects and actions (needs and wants)
• Requesting help or assistance
• Requesting “more”
• Commenting (social sharing)
• Rejecting an object or action; protesting
• Greeting and taking leave

Identifying Intentional Behavior in Children with Visual Impairments or Blindness

With a child who has sight, the use of eye gaze—looking from an object she wants or from something she’s noticed to the parent and back again—is one of the primary signs of intentional communication. In the absence of vision, shared attention (when both parent and child are paying attention to the same object, action, or sound) and evidence of intent may be seen when your child comes close to you, turns towards you, or touches you before or as she gestures or vocalizes. Your child may have other ways to show she is communicating intentionally that you can identify. She may vocalize in a certain way as well. Here are some other signs of intent you may observe in your child:

• Uses the behavior only when someone is in the area
• Directs the behavior to you or another person (doesn’t gesture when no one is around)
• Waits for a response
• Persists or repeats the behavior until she gets a response
• May be upset if the response isn’t what she expected

Tips for Supporting Nonverbal Intentional Communication in Children Who Are Blind or Visually Impaired

No matter the stage of nonverbal communication your child demonstrates, you can help to support her development. As a parent, you ultimately want your child to begin talking so she can tell you what she needs and wants and let you know how she feels. Until she reaches that developmental level or until other means of communication are established, nonverbal behaviors are very important. There are usually three main goals for developing nonverbal communication:

• Teach new gestures
• Improve current gestures so they are consistent and clearly produced
• Support the message or function of the gesture by responding consistently

As you observe and respond to your child’s nonverbal behaviors, let her know what you think she needs, wants, or doesn’t want. Even if your child does not yet understand language, she understands the sound and rhythm of your voice. Later the words you use will be her first words and will answer the question, “What do you want?” Your response and the language you use help bring meaning to your child’s nonverbal behaviors. 

Phase 1: Observe your child’s behaviors (cries and body movements) and continue to meet her needs, finding ways to soothe and engage with her. If you need support at this stage, talk with your child’s team. 

Phase 2: Respond to your child’s motor movements and vocalizations in a consistent manner. Create routines as you introduce sensory activities. Holding, bouncing, tickling, singing, saying rhymes, and pausing in the middle of an activity or waiting at the end of an activity will allow your child to signal whether she wants you to continue. She will learn to anticipate the action sequence and may request “again” or “more.” If her behavior seems to indicate “I don’t want it” or “I don’t want to do it again,” then stop or take a break from the activity. If she repeats an action or sound that got your attention and you laughed, watch for her to do it again. She might be showing off. 

Phase 3: At this stage, you can help your child by not only responding to her motor movements and vocalizations but by modeling or shaping her behaviors. You can gently guide your child’s hand to touch an object or person or, if she is toddling or walking, ask her to take you to what she wants (for example, to the door to request going outside, or to the toy box to request opening it up and getting a toy), and model putting your hand on an object (door handle or toy box lid). You can also tell her what you think she wants or doesn’t want as she reaches out or up and vocalizes. 

Phase 4: At this stage, your child’s nonverbal behaviors may be clearly functional, and most people will understand the messages being communicated. Some of the gestures available to a sighted child (such as looking at an object the child wants, pointing to a desired object, and looking back and forth between a desired object and a person the child expects to bring the desired object) may not be used by a child with a visual impairment or blindness. However, your child might be able to learn that when she extends her arm in the direction of a toy that has been moved beyond her reach, she can communicate “get the toy for me” or “help me find my toy.” Your child may be able to learn that extending both arms up when she hears a parent come home from work can communicate a greeting and “come and get me.” The “give for help” gesture (offering an object to an adult so the adult can provide assistance with the object) can be taught by offering your child snacks in a container she can’t open or a wind-up toy that she can’t work herself, then prompting her to extend the container or the toy towards you and then release it so you can open the container or wind-up the toy. You can then return the open container to her so she can help herself to snacks or release the toy on a surface. If your child learns this gesture and then refuses the object upon its return, you can say: “Oh, you don’t want to play ball anymore—all done.” Gestures like shaking your head “no” or nodding “yes” sometimes develop naturally, but you might let your child feel your head move as you say “no, no, no” or “yes, yes, yes” with rhythm and emotion. 

Nonverbal communication is an important developmental skill. The motor actions or gestures and vocalizations that a child with a visual impairment or blindness uses before her first words emerge have the potential to help you understand her needs and wishes, how she is feeling physically and emotionally, and whether she wants to engage with you socially. First words will be an exciting stage of development too.