While speech and language are very important tools that can help us effectively communicate, language is not the only type of human communication. Research has determined that 70%-93% of our communication is non-verbal (Mehrabian A. Silent messages: a wealth of information about nonverbal communication (body language) 2016 http://www.kaaj.com/psych/smorder.html). While there is still a debate about exactly how much communication is non-verbal, even at 70% our body gestures, facial gestures, posture, vocal tone, and other nonverbal emotional expressions make up the majority of our expressive and receptive communications.   While many children with developmental challenges like ASD and other developmental delays often exhibit delays in expressive language, the majority of these diagnoses are communication delays, not simply language delays.   Language is only one relatively small part of our full communication process, and should not be the primary focus or goal for these children.

Neurologists have known for years that language is a byproduct of our preverbal communication patterns.  Children engage in exchanges with caregivers called proto-conversations, using their facial gestures, hand movements, body positioning, sounds and tonality, et cetera, to communicate long before they develop language. They also identified that these extended preverbal  gestural communication patterns called ‘Proto-Conversations’ (nonverbal conversations) are a necessary neurological precursor for developing conversational language (https://pubmed.ncbi.nlm.nih.gov/36871582/, and Bruner, J. S. (1974-1975). From communication to language: A psychological perspective. Cognition, 3(3), 255–287. https://doi.org/10.1016/0010-0277(74)90012-2 ).  These pre-verbal gestural communication patterns that extend into long back and forth interactions form the foundations for verbal conversations. Similar to the developmental concept that we can’t run before we walk, or the educational principle that we can’t do algebra before we know arithmetic, it is virtually impossible to become fully conversational and verbal without having mastered the foundational precursors to language, proto-conversations. In the seventies, Dr. Stanley Greenspan identified the existence of these proto-conversations and deemed them a necessary developmental milestone (the 4th) called the Continuous Flow of Interaction. This was a socially interactive preverbal pattern that children, with a caregiver, begin to master by 18 months of age.  He also found in the pre-measurements of his 2002 outcome study that all of the children he assessed with diagnostic difficulties in social, academic, and/or behavioral functioning had delays in this milestone.

During the first year and a half of life, children develop by using their bodies and motor systems to explore their world and to communicate.  These early social communication experiences wire and strengthen parts of our brain that are essential for the development and use of language.  One of those important parts or our brain is our prefrontal cortex. As we begin to plan our body’s movements to solve problems, get needs met, and to interact with our social world, like getting a toy or mommy’s attention, we use and strengthen this part of our brain.  It is the planning of these actions, not the execution of the movements, that stimulates this part of the brain.  Recently neurologists have identified the neurons in our prefrontal cortex that allow us to ‘plan’ and anticipate which words we’re going to use before we express them (https://www.nature.com/articles/s41586-023-06982-w). This finding further confirms the importance of our motor system being used to nonverbally communicate at early ages.  More importantly, it identifies how the prefrontal cortex enables us to use language for communication later in life.   These new findings reinforce Dr. Greenspan’s findings that there are necessary early childhood experiences using the motor system to communicate through actions like pushing, pulling, pointing, nodding, smiling, and frowning as part of long back and forth social exchanges, not just one and done requests.  These adaptive early social-emotional interactions encourage the development of our motor system (and the prefrontal cortex) in tandem with our ability to socially engage, read and respond to nonverbal communications.  They also lead to the integration of certain parts of our brain allowing for the eventual formation of language and other forms of symbolic communication.

Unfortunately, the vast majority of children with communication disorders, like ASD, are being pushed into therapies that specifically target the production of sounds and language, while overlooking the importance of and strengthening the precursors to sound formation and language. As a result, many children who develop the use of language may produce single words and short phrases/sentences, but they never become conversational. They continue to experience difficulty in reading and responding to nonverbal cues and emotional gestures. Based on this understanding of how ‘Full Communication’ develops, the questions we should all be asking are,·      

  • Why is it that doctors and therapists don’t focus on a child’s full range of communication?
  • Are we shortchanging these children by not filling in these ‘developmental holes’ and going back and strengthening communication from the ground up?

According to our current understanding of neurology and child development, the answer is yes. We as a community need to rethink how we are addressing the developmental needs of a child versus simply using a medical model to target the symptoms of a diagnosis.

For most children with developmental delays, the above precursors to language are never mastered.  As a result, many children develop splinter skills using words to get needs met and identify many objects, colors, numbers, etc., but never become flexible and conversational with their language.  While some of this language is used for communication, and professionals hope this growth will continue, the process through which a child learns can inhibit or enable future growth.  Children with delays are often taught language in a manner that separates it from the process and purpose of communication itself.   Children learn to repeat, memorize, and label without fully understanding the concepts behind the communicative process. More importantly, even if children understand the context and definition of the language they’re using, they’re still missing the many subtle nonverbal gestural and emotional elements that give language its full purpose and meaning.  

It is known that children with social and communication deficits struggle at interpreting and expressing nonverbal communications in the form of subtle emotional gestures, facial expressions, and tonality. Why is it not prescriptive to focus on communication as a whole, nonverbal and verbal, for children with Communication Disorders?  Why are we not focusing on the full range of diagnostic challenges ‘from the ground up’ instead of addressing a single symptom in isolation?  Dr. Greenspan identified these issues early in his career. To combat this perception, he created his Greenspan/DIR™ Model to help us understand where a child’s ‘developmental holes’ were.  He also created Floortime, now Greenspan Floortime®, to strengthen these capacities in a child-centered, thinking-based manner from the ground up while respecting each individual’s unique neurological difference and set of needs.

Learn how to apply his version of Floortime, Greenspan Floortime®.  Register for the Professional or Caregiver/Parent Course at www.stanleygreenspan.com. Parents and Professionals can also receive Greenspan Floortime® Expert Tele-Coaching with additional video analysis and feedback.   For in-person Greenspan Floortime® based OT, SLP, Social Group Programs, and coaching contact The Floortime Center®, www.thefloortimecenter.com.