The early identification and treatment of communication impairment in infancy

The current study proposes an interactional model of communication where communication is viewed as a multi-dimensional process at the interface of human linguistic, cognitive and social systems, influenced not only by the biological endowments of the child but also the environment in which the child lives. Communication is seen as part of a network of interdependent systems, with the relationship between the systems in a "semi-permanent state of change” (Rutherford, 1987). The interdependence between these component systems is critical to the design of this research study. As Rutherford indicates, "systems do not exist in and of themselves but rather as definable and observable only through their interaction with other systems" (1987, p93). Central to this study is the relationship between prelinguistic communication and later communication via language. This relationship is felt to hold the key to our understanding of the acquisition of language and communication. Early intervention is based on the assumption that there is some continuity between communication in the prelinguistic period and later communication via language. Within an interactional model, communication in the prelinguistic period is primarily achieved through non-verbal means such as eye-contact and gesture. As the infant's cognitive and social systems develop through his interactions with his environment the primary means for communication changes in the second year, with the infant learning to use linguistic forms to express the same intentions already formed in the prelinguistic period. The beliefs and assumptions of the interactional model are tested in a longitudinal study of 137 infants. The principles of the model have been applied to all aspects of the study including identification, assessment and intervention procedures. The current study comprises two sections, a pilot study and the main study. The pilot study involved 38 infants with normal perinatal histories, from which the Early Communication Profile and intervention programme were developed. The remaining 99 subjects were allocated to five experimental groups (Group One: "At risk", follow-up only; Group Two: "Not at risk" follow-up only; Group Three: "At risk" intervention; Group Four: "At risk", no follow-up; Group five: "Not at risk", no follow-up). Groups One, Two and Three were assessed at four, eight and twelve months of age, whereas Groups Four and Five were assessed at twelve months only. The study examines whether it is possible to identify infants who are "at risk" of communication impairment. If this interactional model of communication is to be supported, not only should we find that both environmental and biological factors are useful in our quest to identify infants "at risk" of later communication impairment, we should also find that the interaction between these two factors is useful in identifying infants who are "at risk". This study investigates the effect of perinatal and environmental factors on communication and cognitive development and parent/infant interaction, and whether there is an interactional eflfect of these two variables on development. The assessment proforma used in this study also is based on the interactional model of communication proposed in this thesis. Accordingly, assessments involved not only measures of communication outcomes but also measures of cognitive, and parent/infant interaction outcomes. The study also examines the effectiveness of a minimal intervention programme (involving eleven monthly sessions) based on the principles of the interactional model. The programme, which was developed as part of the research, covers not only communication development but also the component systems identified in the interactional model including early social, cognitive and linguistic development. The major aim of the programme is to provide parents with information and skills which will improve the stimulation provided within the infant's environment. The intervention programme includes lecture material, overheads, six videotapes and parent hand-books covering the first twelve months of development. The results of the study suggest that there are significant differences at both eight and twelve months of age in the communication and cognitive skills of infants with poor perinatal histories and infants with good perinatal histories. There also appears to be differences in the communication and cognitive skills and parent/infant interaction of infants from highly stimulating environments and those infants from less stimulating environments. In addition, there appears to be an interaction effect between these variables such that infants with poor perinatal histories are more susceptible to environmental influences. Intervention and follow-up appear to have a significant impact on aspects of infant communicative and cognitive outcomes at eight and twelve months. In addition, neonatal and family background variables were found to differentially contribute to the prediction of communication and cognitive outcomes at eight and twelve months of age. Finally, the study examines the relationship between communication, cognitive and parent/infant interaction outcomes in light of the interactional model of communication proposed in this thesis.