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Reply To: Non verbal 2 year old

Gillian Bolton

So interesting to hear about different approaches, thanks all for sharing.

I agree re an integrated approach, looking at all areas, including AAC options, and supporting development through her everyday natural interactions with her parents rather than teaching discrete skills – like Gail I have also shifted in this respect in the last 3 years. Supporting parents to achieve a clearer understanding of where she is at developmentally, and confidence to support her devt through everyday interaction is so important – which is what you have been doing by the sound of it through showing them intensive interaction etc

It sounds like she has responded really well to what you have done so far Joanna , and is now taking more notice of you and others and establishing joint attention. When you mentioned the CHAT were you asking for suggestions re what/how to d/w mum i.e. referring on for further assessment etc? Or just therapy ideas?

If you like/use a means/reasons/opportunities approach to Ax and therapy you may be interested in CATHS. As an assessment framework I like CATHS (2021) because it still contains the communication and cognition framework which one of the current authors developed and published with Clare Latham (SLT) back in 1997 (Assessing Communication) and in 2001 (communication curriculum and classroom practice). Underpinned by psycholinguistic and sociolinguistic theory, the assessment framework looks at mode of communication (means), functions (reasons), cognition (play & learning) through 6 stages – from pre-intentional, through emerging intentional, intentional, first meanings, and through to the use of phrases, and then complex sentences for higher level functions (reasoning predicting negotiating etc) . It takes a MDT approach – typically the SLT collating information from parents/teachers/TAs/other practitioners to build a picture of the child’s unique and often idiosyncratic comm skills (like that excited shudder you described Joanna!) but sets that in a clear developmental framework. Great for identifying the child’s stage of devt – and helping parents and other practitioners understand this – esp for the earlier stages of devt, and enables them to see the link between play and lang devt. During some training I did recently with a colleague in Lancashire we heard several therapists say they were less confident about assessing preverbal communication and they liked the CATHS framework for this reason.

I like the fact that the focus is then on the interaction with, role of, and skills of, the communication partner in facilitating and maintaining successful communi/interaction. The authors recommend Intensive Interaction for the earlier stages. I have trained in and used Intensive Interaction but, like Gail I now prefer VERVE, having seen the impact of mutual face watching, and the focus on regulation, with so many clients including those who present with poor eye contact initially). CATHS highlights best practice for individuals at each stage with lots of clear examples for targets and activities. Although it was designed in, and for, the special school setting I use it as my assessment framework for preschoolers too as well as for older students with DLD associated with SEN.


Hope that’s helpful Joanna.