Communication Skills for Children Who Are Blind or Low Vision

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By Carla A. Brooks

Simplifying a Complex Skill

As the parent of a toddler with blindness or low vision, at some point, you will be asked about how their communication skills are developing. As you respond to this question, more than likely, you will think about several different skills.

• Is my child talking yet?
• How big is my child’s vocabulary?
• Does my child follow simple directions?
• How many different sounds does my child say correctly?

In the toddler and preschool years, these are key skills to consider. You may be reading this because your child is older and still not talking or shows delays in understanding and communicating what they want or need. While the following information focuses on early development in the first two years, it might help you talk to others in more detail about your expectations and hopes for your child.

The Impact of Blindness or Low Vision on Developing Communication Skills

Babies use all of their senses to experience and explore their world and to develop new skills. The new areas of development include:

• cognition,
• motor,
• social,
• self-help,
• and communication skills.

When one or more of a child’s senses is impaired, developmental delays or differences tend to be expected. The sense of hearing might be considered the most important for the development of spoken language. However, deaf and hearing impaired children learn to communicate using different methods of “input” and “output.” And, if you have a child with deaf/blindness, there are specific methods of teaching communication using touch.

When a child is born with congenital blindness or is diagnosed with an eye condition within the first two years of life, their communication skills will be closely monitored as along with other developmental skills. It cannot be denied that vision plays an important role in the development of communication skills in sighted children. Recent research, however, suggests that the absence of sight does not automatically mean your child will have language and speech delays. Individual differences are likely, and the patterns of development will also depend upon whether your child is diagnosed with additional disabilities.

What Is Communication?

The purpose of this article is to break down the fairly complex skill of communication into the different “sub-skills.” Communication consists of four different developmental areas or skill sets:

• Receptive language
• Expressive language
• Pragmatic language (social communication)
• Speech

There are other developmental skills that serve as a foundation for the development of communication. These include cognition, motor, and social skills. Your child is building other skill areas, but those three are closely related to communication development.

While we may try to simplify communication by dividing up and defining the separate skills, the reality is that the different skills “blend together” to create successful communication interactions.

Receptive Language

Receptive language is also called language comprehension. The essence of this skill might be described as learning that when speech sounds are combined, they have meaning. The words stand in for, or are symbols for, all the seen and “unseen” entities in our world. Those entities include those we can see (or touch) and include objects, people, animals, and actions. It is easier to just call these entities “things” in our world.

There are also entities in our world that are unseen or abstract. We have thoughts about them and form what are called “concepts” in our mind. Emotions are the most familiar “unseen” labels in our vocabulary. Another example might be a relationship term like “brother.” We learn the concept of a brother, but we can use the word without having a “thing” in front of us. We also create concepts that compare other things such as “big” or “pretty.” These might be a visual concept, but they can also refer to our own experiences and perceptions.

When words are combined, then meaning expands. During the formative language years, children learn many single words and their meanings as separate things. When you use two or more words during daily activities, you are helping your child understand those expanded meanings. Phrases and simple sentences will follow these simple word combinations as your child’s receptive language develops. Typically, a child understands individual words and word combinations before they can produce them themselves. For example:
“Mommy…” “Mommy’s home.”
“Cookie…” “More cookie.”
“Up…” “Pick you up.”
“Coat…” “Put on coat.”
“Go…” “Go to park.”

As a child reaches school age, reading language in print (including braille) is also considered comprehension of meaning. Symbols can provide another form of meaning, including sign language and visual symbols like pictures.

Expressive Language

Once a child understands that words have meaning, they begin to use those words themselves to communicate meaning. The essence of this skill is sharing meaning with others by talking about objects, people, actions, and interactions in their world. They can also begin to talk about things that are not present and about events in the past and future.

Expressive communication actually begins at the nonverbal level and includes non-speech sounds, speech-like sounds (cooing and babbling and jargon), and gestures. Verbal language begins with first words, and then two or more words are combined. Later in the preschool years, words are combined into sentences.

As a child reaches school age, they express meaning through writing (including braille). Meaning can also be expressed through sign language or visual symbols. The reasons for using expressive language fall under the area of pragmatic language, which is described in the next section.

Pragmatic Language

Pragmatic language is also called social communication or language use. The essence of this skill might be considered sharing meaning (expressive language) with another person to accomplish something.

For example, we communicate to let others know what we want or what we need. Communication requires social engagement, or it is just considered “talking.” It initially involves several “steps” that are social in nature. These include:

• Gaining someone’s attention
• Engaging them in an interaction
• Maintaining that interaction until you are finished

A variety of nonverbal behaviors are involved in these steps, including:

• Orienting towards and looking at faces
• Shifting eye gaze
• Using gestures and body language
• Changing facial expression

Communication Development

As adults, we also communicate for a variety of reasons. Sometimes it’s just to pass the time, share experiences, enjoy our friends, or share our feelings. Throughout the day, however, we usually have a purpose in mind. There are different types of what are called communicative functions that children learn and use throughout the day that are similar to having a purpose. They include managing the behavior of others (getting them to do what you want or stop doing something), engaging socially (person to person), and sharing joint attention (person to person and including an object or event).

You might be familiar with the labels of typical communicative functions:

• Requesting
• Protesting
• Rejecting
• Commenting

As a child grows, more complex functions like inviting, negotiating, and disagreeing will develop.

Social skill development was mentioned as one of the core foundational skills related to communication development. It is sometimes difficult to separate out what is a social skill and what is a communication skill when we consider pragmatic language development. The concept of joint attention is one of the most important skills that are required for the development of receptive and expressive and pragmatic language skills:

• Talking about something that is experienced by you and your child at the same time is how meaning is developed.
• Talking about something that you both notice or that your child wants you to notice is how a social commenting is developed.
• And later, talking about an event or an experience that you or your child had in the past or will have in the future is how social conversations develop.

Speech

Speech is often referred to as articulation. Learning to speak combines hearing and processing sounds, imitating and then producing sounds, and combining sounds into words. There are three physical processes that are combined to produce oral speech:

• Articulating sounds (consonants and vowels) using the mouth (lips, teeth, tongue, jaw, and palate)
• Vocalizing by moving air from the lungs and past the vocal chords
• Coordinating sounds and voice to produce words which are then combined and spoken in a rhythmic manner that is referred to as fluency

There are developmental stages for speech just as there are for language. Early forms of expressive language including cooing, babbling, and jargon represent your child’s exploration of sound, voice, and articulation. Once they begin to combine sounds (consonants and vowels) into words, there are age ranges when we expect specific sounds to develop. For example, words with the sounds “m” or “b” will be expected earlier than more complex sounds such as “l” or “r” or “ch,” and sequences of sounds such as “mama” or “uh oh” are easier than “ball,” “cookie,” “banana,” “slide,” or “vegetable.” Young children substitute easier sounds for more difficult sounds and may leave out certain sounds. All of these differences are expected during the first three years of development.

Some children might use nonverbal means of “talking,” including sign language or pictures or even devices that produce the speech after words are selected by touching pictures or a series of pictures. FamilyConnect’s article “Augmentative and Alternative Communication” has more information on nonverbal communication.

Summary

As you can see, communication is a complex set of skills. If your child is developing communication skills, typically, you barely notice the changes that occur. However, if your child’s skills are not advancing, you are more likely going to notice that something is missing. This summary of skills may help you to identify your areas of concern. When other core skills are developing as expected, delayed development of language and/or speech may warrant referral to a specialist called a speech/language pathologist or SLP.