Interaction and communication development of children with normal

This section will present a short overview of the developmental sequences through which children with normal hearing (NH), ages 0-3 (the children's age in this study), develop communication. It will focus primarily on the first two years of life due to its relevance to the pre-linguistic communicative stage of the children in this study.

The research on this topic is vast (Bates, O'Connell, & Shore, 1987; McLean, 1990, for reviews) and points out that communication development is closely related to social-cognitive development (Prizant & Wetherby, 1990; Prizant & Meyer, 1993).

The social-affective exchange between the infant and the caregiver serves as the basis for the social or pragmatic aspects of communication (McLean, 1990).

In the first few months of life, the infant's readable signs such as facial expressions, vocalizations, body postures, and even the skin color, though not yet deliberately producedon the part of the infant, all serve as communicative functions to the caregiver, who interprets these signals and contingently responds to the behavior to regulate the infant's physiological and emotional needs (Zeanah, 2000).

This is the perlocutionary or the pre-intentional stage (Bates, Camaioni, & Voletra, 1975).

An important social gain at the age of two months is the infant's ability to achieve eye-contact with the caregiver (Wolff, 1966). Stern (1974) refers also to the dyadic structure of social-interactive exchanges between the infant and the caregiver through the establishment of eye-contact and mutual gaze. In addition, Brazelton and Cramer (1990) indicate that the caregiver's tone of voice alerts the infant's attention.

The infant may calmed down on hearing the caregiver's voice and touch and focus on the caregiver's face, thus creating early states of joint attention and transactional⁸ patterns of cycles of affective engagement and disengagement. Trevarthen (1979, 2001) claims that infants are born with the capacity for intersubjectivity- the inherent ability to relate to and communicate with people (primary intersubjectivity), that has to do with shared meanings between individuals, or as Adamson and Bakeman (1982) call it- the phase of affective reciprocity. In this phase, affective information is shared without the infant being aware of the differentiation between self and other.

From 3-8 months of age, infants' communicative skills further develop as well as increased mobility and exploration of the environment. The infant is involved in increased social engagement with the caregivers, expressed in a greater ability to participate in reciprocal vocal and action-based turn-taking sequences, which are precursory to later communicative reciprocity (Bruner, 1981). The shared emotional experiences with the caregiver lead to the infant's awareness that his/her behavior can have an effect others (McLean, 1990). By 6-12 months, the phenomenon of referential look (Newson, 1978) is developed, when the infant shows personal interest for discrete objects by looking at a specific object rather than the earlier global visual scanning in the environment. At this stage, the infant demonstrates the ability to

8 Sameroff (1975) proposed a "transactional model" of infant development, which recognizes the

"continual and progressive interplay between the organism and its environment" (p. 281).

alternate the gaze between an object and the caregiver and vice versa (Masur, 1990).

Thus, joint attention⁹ (or 'joint visual attention') is established between the infant and the adult, which either of them may initiate. This change in behavior is sometimes referred to as secondary intersubjectivity¹⁰ (Trevarthen & Hubley, 1978), where "the topic shifts from two-person communication centered on self to a two person communication regarding a third event" (Kasari, Sigman, Yirmiya, & Mundy, 1993, p. 202). Many times, the caregiver provides a label for the object or event of mutual interest, thus promoting future efficient lexical learning (Bruner, 1975).

A major development in communication occurs in about the last three months of the first year- the development of intentional communication (Zeanah, 2000) or the illocutionary phase (Bates et al., 1975). The infant starts using preverbal gestures and vocalizations¹¹ to communicate intentionally in order to affect other's behaviors.

Bruner (1981) suggested that there are three innate communicative intentions:

(a) Behavior regulation- including signals to regulate another person's behavior in order to request, reject, or protest an object or action;

(b) Social interaction- including signals to draw another person’s attention to oneself for affiliative purposes such as greeting, calling, etc.

(c) Joint attention- including signals used to reference another person’s attention to comment on objects and events.

Bruner (1975) discusses the relation between the emergence of speech and the development of joint attention and joint action, i.e., the concurrent focusing of both caregiver and infant on an object or the collaborative performing of a task, respectively. Bates, Bretherton, Camaioni, and Volterra (1979) state that there are two distinctive communicative functions emerging at the phase of intentional communication: Proto-declarative (pointing and vocalizing) and proto-imperative (manipulating and controlling other's behaviors). Stern (2000) indicates that infants are far more adept at communicating emotions than specific intentions around the end of the first year. In addition, by the age of 12 months and continuing to the second year, the prelinguistic communication of the typically developing child progresses to linguistic communication. This is the most important landmark of the second year-

9 Joint attention is also called 'shared', 'mutual', or 'coordinated attention' by different authors (see Kim, 2006).

10 See also Stern's discussion on intersubjectivity (Stern, 1985, pp. 124-137).

11 See sections 2.2.5~ 2.2.6 on gestures and vocalization.

language acquisition (the locutionary stage). The child's communication dramatically increases in rate and becomes more consistent, explicit, readable, and sophisticated in form (Zeanah, 2000). The early single-word stage occurs between 12 and 18 months and is slow and still unstable. The child begins to connect between permanent vocalizations and their agreed upon meaning in the adults' language. At this stage, the majority of his/her communication signals still include a variety of gestures and vocalization. The child also can decontextualize (free from context) words and this ability is believed to reflect the increasing knowledge of situations and concepts (Barrett, as cited in Wetherby, Reichle, & Pierce, 1998). The acquisition of new words becomes associated with conceptual representations of objects and events (Wetherby et al., 1998). At 18 months, vocabulary dramatically increases. Two or more words are used by the child to express more complex meanings which were initially expressed through nonverbal behavior. Language still primarily refers to immediately observable events. In the second year, language comprehension is greater than its production. By 24 months, there is less need for contextual or environmental support and language comprehension is expanded greatly. In the third year of life, the child moves from semantic or meaning base to sentence grammar and fine-tuned meanings, can communicate about future and past events and emotional states, and finally becomes a conversational partner (Zeanah, 2000).

2.2.3 Interaction and communication development of children with hearing