Joint Attention, Imitation, Play and Communication Skills, "Oh My"!

heatherR

11/6/2019 1:04 AM

Working in a large, outpatient, pediatric hospital as a speech language pathologist specializing in severe behavior, severe autism and developmental disabilities, I will be honest in that  there have been times I have wondered if my goals are helping this patient/family.  After having my own child, I realized how much bonding and shared enjoyment occurs throughout the day that is embedded with play and/or leisure activities.  One day this idea stuck in my brain and I couldn’t shake it.  As I engaged in pretend play with my daughter during a nature hike (as we pretended to be mountain lions) and talked about what animals we might find, discussed the nature around us and even labeled the way to move through our playscape (run, walk, giant steps) it hit me: many of the families I work with on a daily basis do not get to experience the joy of an afternoon playing with their child.  Without giving due respect to the physical limitations that may make play schemes challenging, I was stuck by how much of the play I was engaging in with my daughter was layered with language.  It was at that moment that I began my personal mission of identifying play activities that could be enjoyed and easily replicated by patients and families.  I am excited to share practical play ideas in a future post. 

My focus for this post is to discuss and define critical play skills.  Just as in any other area of development, the play skills of individuals with severe communication disabilities can be scattered.  However, as in the development of other cognitive skills, it is important that the hierarchy of play skills are being addressed. As research has demonstrated, and continues to demonstrate, play skills have a high correlation to language development.  Research has documented that first word acquisition is associated with the emergence of both symbolic and self-pretend play  (pretending to feed oneself by taking “bite” out of a block) as well as in pretend play with others (feeding a dinosaur a tree).  While the combing of words is associated with combining actions in symbolic play such as taking a bite from a block and then giving the dinosaur a bite from the same block.

To discuss/identify and target the progression of play skills is a complex undertaking.  For this post, the focus will be on core primary play/language skills.  The skill levels discussed will fall within the  Preintentional Behavior, Intentional Behavior, Unconventional Communication  and Conventional Communication levels of the Communication Matrix.

When considering goals for individuals with severe communication impairments, joint attention is often an early and critical target that incorporates play and communication skills.  Joint attention in the simplest form is shared attention between 2 communication partners.  It is through joint attention that individuals begin to communicate (grunting, eye gaze to an object, reaching for an object).  Joint attention skills are critical in early language development. Joint attention skills are also essential in later developing language (social rules, pragmatics of language, and theory of mind). 

When joint attention skills are impacted, it may be helpful to further dissect the concept into more specific domains: protodeclarative joint attention and protoimperative joint attention skills.  Protodeclarative joint attention is a social interaction used for the social intent of sharing attention. This could be communicated in the form of gestures, pointing to objects, through vocalizations, or via shared interest in an outside object (eye gaze shifted from object to communication partner, then eye gaze shifted back to outside object of interest). Protodeclarative joint attention attempts are made with the goal of engaging another communication partner into an exchange. Protodeclarative attention is significant in that it marks a shift in cognitive-linguistic development, usage demonstrates the individual’s conscious intent to initiate social interaction and establish joint attention to an object, action, or communication partner.

Protoimperative joint attention is related to making requests. This type of gesture or vocalization is produced with the intent of the communication partner to obtain a desired object. For example protoimperative joint attention could be noted when an individual guides a communication partners hand to reach a toy which is out of reach. This can be seen as requesting a behavior (for the adult to give the toy to the child). 

After joint attention has been established, the focus of play can turn to imitation. Through imitation, individuals learn about actions and intentions of others’. Deferred imitation is correlated to memory recall and an individual’s ability to produce actions based on stored mental representations of social events and action sequences. It has been theorized that a failure to engage in early social imitative play may directly impact the development of social reciprocity, and later developing theory of mind abilities.

There are specific types of imitation to address, imitation of object use (stacking blocks, hitting a drum), imitation of actions (clapping hands, using hand play in songs), imitation of functional objects (using a cup to give a baby a drink) and imitation of symbolic actions (using a block as phone).  It is important to note that the imitation of functional objects is associated with receptive language development. While imitation of symbolic objects is associated with both expressive and receptive language skills.  Now that critical joint attention and imitation skills have been discussed in depth, the next and final post in this series will discuss practical play schemes and identify potential play materials that can be used with individuals exhibiting severe communication disabilities.

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