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.”