Imagine a child confidently communicating their needs long before producing their first words. Effective pre-verbal, or pre-speaking, skills are the cornerstone of this achievement, accelerating language development and fostering meaningful connections. For speech-language pathologists (SLPs) and families, mastering these foundational abilities transforms therapy into a more engaging and successful journey toward effective communication.
Pre-verbal skills are particularly important for children with communication disorders and delays. Strengthening these abilities through child-led approaches turns therapy sessions into more interactive and effective experiences. Children gain confidence as they take steps toward language, supported by personalized strategies tailored to their unique needs.
This article highlights the 10 essential pre-verbal skills for language development based on this AbleNet session and discusses how they form the foundation for communication. You’ll discover actionable strategies to incorporate into therapy, a guide to implementing the Imitation Hierarchy, and insights into tailoring interventions for children who are diagnosed with autism spectrum disorder or who are Gestalt Language Processors. Additionally, this guide emphasizes multimodal communication, such as the use of Augmentative and Alternative Communication (AAC) devices, gestures, and signs, to ensure inclusive, family-centered therapy that meets every child’s unique needs.
Understanding Pre-Verbal Skills and Language Development
Pre-verbal skills are foundational for a child’s ability to interact with their environment and build connections with others. These skills are essential for language development, whether the child communicates through spoken words, gestures, signs, or a high-tech speech-generating device.
Pre-verbal skills provide children with their first experiences of shared interaction, teaching them that communication is reciprocal. These initial exchanges set the stage for developing symbolic language and enable children to interact with their surroundings and build connections with others. These skills include things like recognizing environmental cues, sustaining attention, making purposeful vocalizations, engaging through gestures, and participating in early social exchanges. Although they precede spoken communication, pre-verbal skills are integral throughout a child’s language development journey, forming the building blocks for more advanced interactions.
For SLPs, focusing on pre-verbal abilities offers insight into a child’s overall development and helps identify specific areas needing support. By nurturing these foundational skills, SLPs can help children build confidence and engagement, creating a pathway for effective communication.
The Importance of Early Intervention
Delays in pre-verbal skills can signal broader communication challenges, making early intervention essential. Responding to environmental stimuli, taking turns, and engaging with others may look different for each child, especially for Autistic children or those with other developmental disorders. Addressing these skills early supports language development and encourages meaningful connections between the child, their caregivers, and their environment.
Tailored therapeutic support bridges developmental gaps and builds strong communicative connections. Through consistent practice and intentional engagement, children can progress from these early building blocks to more advanced language skills with greater ease.
10 Essential Pre-Verbal Skills for Language Development
Developing pre-verbal skills is a foundational step in a child’s communication journey. These skills pave the way for more advanced abilities, helping children connect with their environment and engage with others. Below are 10 key pre-verbal skills, each accompanied by actionable strategies to build and strengthen them during therapy sessions or daily interactions. Note that many of these skills, such as joint attention or eye contact, will look different in autistic children- this variety in development is natural and expected.
1. Reacts to Environmental Stimuli
Recognizing and responding to cues like sounds, lights, or movements demonstrates a child’s growing awareness of the world. This skill lays the groundwork for active engagement and attention.
Strategies to Enhance:
- Introduce Calming Stimuli: Use gentle music or dimmed lights to help refine responses.
- Gradually Increase Sensory Inputs: Incorporate brightly colored toys or a caregiver’s voice and observe the child’s engagement.
2. Responds to People
When a child interacts with their caregiver or therapist by smiling, turning toward a voice, or maintaining eye contact, they begin to understand the social dynamics of communication.
Strategies to Enhance:
- Warm Greetings and Mirroring Actions: Greet the child warmly, allowing time for subtle responses like turning their head or shifting their gaze. Mirror the child’s actions to foster a connection and encourage further interaction.
3. Turn Taking in Vocalizations
Learning to take turns in vocal exchanges—even without structured words—is an essential pre-verbal communication skill. This supports the development of conversational dynamics later on.
Strategies to Enhance:
- Sound Games: Play simple games like making a sound (“ba,” “ma”) and pausing to see if the child imitates or responds. If the child makes a sound or babbles, imitate the sound back to them.
- Interactive Activities: Engage in activities like peekaboo or rolling a ball back and forth to naturally build on turn-taking.
4. Attention Span
Sustained attention helps a child focus long enough to absorb new skills or activities. Use strategies to gently expand the child’s ability to concentrate.
Strategies to Enhance:
- High-Interest Activities: Start with activities the child loves, such as a favorite toy or song, and gradually increase the duration.
- Focused Exercises: Introduce short, targeted exercises that match the child’s developmental level and slowly build their concentration ability.
5. Joint Attention
Joint attention involves focusing on a shared object or event, or looking between the object and the partner, fostering meaningful connection and interaction between child and caregiver. For typically developing children, this skill is a cornerstone of shared communication and intentional engagement. Joint attention fosters shared engagement between a child and their communication partner. Shared engagement may look different for neurodiverse children, such as moving closer to a communication partner without looking at them. Notice the way that your client or child shares joint attention and build on these skills.
Strategies to Enhance:
- Use High-Interest Objects: Position high-interest toys or objects at the child’s eye level to encourage shared focus.
- Pair Labeling with Shared Experiences: Point to or name objects that capture the child’s attention during joint activities.
6. Follows Directions
A child who can follow simple instructions demonstrates growing comprehension and a better grasp of language as a tool for interaction.
Strategies to Enhance:
- One-Step Instructions: Begin with straightforward instructions like “Clap your hands” or “Pick up the toy.” These should be in context to help with understanding.
- Two-Step Directions: Gradually introduce two-step directions to scaffold skill development once the child shows readiness.
7. Purposeful Vocalizations
Purposeful vocalizations are sounds or noises made intentionally, like babbling to gain attention or expressing excitement. These vocalizations act as stepping stones to more structured communication.
Strategies to Enhance:
- Enthusiastic Responses: Respond enthusiastically to any vocalization, reinforcing that sounds can elicit a response.
- Pair with Visuals or Gestures: Combine vocalization exercises with visuals, objects, or gestures to create dynamic engagement.
8. Imitates Actions
Imitation is a powerful learning tool for children, helping them practice communication by mirroring actions, sounds, and gestures.
Strategies to Enhance:
- Playful Games: Use games like clapping hands or waving to introduce imitative actions.
- Positive Feedback: Reinforce successful imitation by imitating the child back to build back and forth communication.
9. Uses Gestures or Signs
Gestures or signs serve as non-verbal communication supports, particularly for children whose sounds are still developing. These tools help children express themselves while building bridges to spoken language.
Strategies to Enhance:
- Teach Basic Gestures: Introduce gestures like pointing to help the child interact with their environment.
- Simple Signs: Teach simple signs (e.g., “more,” “stop”) to provide accessible communication alternatives.
10. Initiates Communication
Initiating communication involves a child making the first move to interact, whether by looking toward an adult, using a gesture, or vocalizing intentionally.
Strategies to Enhance:
- Choice Opportunities: Offer opportunities to choose between two objects or activities, prompting the child to indicate their preference.
- Intentional Pauses: Pause intentionally during interactions, providing space for the child to lead the exchange.
Practical Strategies to Foster Pre-Verbal Skills
Fostering pre-verbal skills requires a flexible, creative, and child-centered approach. By incorporating engaging and developmentally appropriate activities into therapy sessions, SLPs and families can create meaningful learning opportunities. Below are practical strategies to help children build their foundational communication skills:
Play-Based Approaches
Play is the cornerstone of play-based approaches. Through play, children naturally explore, engage, and communicate, making therapy more motivating and enjoyable.
- Choose Favorite Activities: Select activities the child loves—such as stacking blocks, sorting shapes, or pretend play—and embed communication goals within them.
- Back-and-Forth Games: Use games like rolling a ball, playing peekaboo, or building towers to encourage turn-taking, joint attention, and purposeful engagement.
- Follow the Child’s Lead: Let the child direct activities while gently guiding them toward targeted communication goals.
- Empower Choice: Allow the child to lead during activities by choosing between objects or games.
Sensory Activities
Sensory-rich activities allow children to explore their world in ways that stimulate interaction and focus, often helping those who may struggle with attention or engagement.
- Create Sensory Bins: Fill bins with safe items like soft textures, dried food, colorful objects, or noise-making toys to encourage exploration.
- Use Diverse Stimuli: Incorporate visual, auditory, or tactile stimuli—such as bubbles, vibrating toys, or musical instruments—to capture the child’s interest and promote responses to environmental cues.
Visual Supports
Visual aids help children understand and express themselves when verbal communication is not yet established, bridging the gap to more advanced communication skills.
- Pair Visuals with Words or Gestures: Display objects to associate visuals with words or gestures. For example, show up a ball and say, “Ball,” to link meaning to the visual.
- Core Boards and Visual Choice Cards: Incorporate tools like core boards or visual choice cards during activities to encourage the child to gesture or indicate preferences.
Repetition and Predictability
Repetition is crucial when building pre-verbal skills. Familiar patterns and routines provide children with structure, helping them feel confident as they learn new communication strategies. .
- Repetitive Songs and Rhymes: Engage in repetitive songs and rhymes, or actions—such as clapping hands or singing “If You’re Happy and You Know It”—to reinforce skills like imitation and purposeful vocalization.
- Predictable Routines: Establish predictable routines like starting each session with the same welcome song or ending with a specific goodbye gesture, to help the child anticipate and participate.
Celebrate Small Wins
Recognizing every step of a child’s progress builds confidence and motivation.
- Positive Reinforcement: Use enthusiastic responses, praise, and natural reinforcements to acknowledge successful communication efforts.
- Encourage Participation: Reinforce the value of all attempts to communicate, contributing to ongoing development.
Collaborative Engagement
Collaboration between SLPs, caregivers, and the child creates a supportive ecosystem for communication growth, ensuring consistency and reinforcing progress.
- Caregiver Education: Caregiver education involves teaching caregivers to observe and reinforce small communication efforts, like a glance or vocalization, during everyday interactions.
- Integrate Strategies into Daily Routines: Involve families by embedding simple strategies into daily activities, such as encouraging gestures at mealtime or vocalizations during play.
- Continuous Feedback: Maintain open communication with caregivers to refine therapy goals.
Consistency reinforces communication skills across different environments. By integrating play, sensory experiences, repetition, visual aids, and family involvement into therapy, children develop supportive and engaging environments to build pre-verbal skills. These strategies foster foundational abilities and form the building blocks for meaningful communication in everyday life.
Implementing the Imitation Hierarchy Effectively
Imitation is a foundational skill supporting language development and social communication. By encouraging children to observe and replicate actions, sounds, and expressions, SLPs can build a framework for more advanced communication abilities. The imitation hierarchy offers a step-by-step guide to help children progress from basic to complex imitation tasks, ensuring therapy is intentional and effective, with each stage building upon the last.
Steps in the Imitation Hierarchy
1. Actions with Objects
Copying how an object is used during play. For instance, pushing a toy car on the floor helps establish cause and effect while fostering engagement.
Strategies for Teaching:
- Model simple actions, such as stacking blocks or shaking a rattle, and encourage the child to follow.
- Use toys with clear visual or auditory feedback, like a toy drum or wind-up car, to capture interest.
2. Gestures
Imitating symbolic gestures like clapping, waving, or pointing, which are vital for non-verbal communication.
Strategies for Teaching:
- Incorporate gestures into familiar songs like “If You’re Happy and You Know It” to make learning natural and fun.
- Pair gestures with verbal cues, like waving while saying “Bye-bye,” to create multimodal learning opportunities.
3. Facial Expressions
Imitating facial expressions helps children connect emotions with social cues.
Strategies for Teaching:
- Play mirror games where the caregiver or SLP makes a silly face and waits for the child to mimic it.
- Use mirrors or cameras to let children see and compare their facial movements.
4. Intentional Vocalizations
Using purposeful sounds directed toward a person, object, or event demonstrates intent to communicate.
Strategies for Teaching:
- Encourage back-and-forth vocal play, such as repeating sounds the child makes and waiting for them to respond.
- Pair sounds with objects or actions to give meaning to the vocalization (e.g., saying “vroom” while moving a toy car).
5. Sound Words
Onomatopoeias (“moo,” “zoom”) and interjections (“uh-oh,” “yay”) engage children and spark spontaneous vocal experimentation.
Strategies for Teaching:
- Use books with animal sounds or noisy toys to introduce and model sounds in context.
- Reinforce sound words during playtime, such as saying “hop, hop” when moving a stuffed bunny or “boom” when stacking blocks fall.
6. Verbal Routines
Leveraging predictable patterns or phrases to guide children in completing anticipated vocal contributions.
Strategies for Teaching:
- Create engaging routines like counting before pushing a swing (“Ready, set…go!”) to build anticipation and encourage vocal participation.
- Use highly consistent routines across different activities to help the child recognize and predict their role in the exchange.
7. Core Words
Model impactful, functional words, called core words, such as “help,” “more,” or “stop” that allow children to express control over their environment or needs.
Strategies for Teaching:
- Model core words in meaningful contexts, such as saying “help” when assisting with a block tower. Pair this word with gestures and signs.
- Reinforce core words with clear outcomes, ensuring that each successful use results in immediate recognition or action.
8. Single Words
Mastering single words tied to a child’s personal interests or needs is often the final step in the imitation hierarchy.
Strategies for Teaching:
- Choose words that are both meaningful and functional for the child, ensuring frequent opportunities for practice during daily routines.
Pair single words with gestures, visuals, or AAC tools to maximize learning and facilitate carryover into natural settings.
Get a Voice
Get a Voice
Each stage of the imitation hierarchy builds on the progress achieved at earlier steps, creating a natural flow of development as skills evolve. By following this structured approach, SLPs and caregivers can motivate children to engage and practice new forms of communication.
Differentiating Between Averages and Milestones in Language Development
When assessing a child’s language development, understanding the distinction between averages and milestones is essential. Both are important tools for evaluating progress, but they serve different purposes in tailoring therapy goals.
Milestones refer to specific communication skills most children (approximately 90% or more) achieve by certain ages, such as pointing by 12 months or combining two words by 24 months. These benchmarks are often used by pediatricians and specialists to track typical development and identify potential delays.
Averages, on the other hand, provide a broader perspective. They indicate when roughly 50% of children are likely to demonstrate a particular skill. This range allows for more flexibility, acknowledging variability in development while still offering insight into what is generally expected.
By referencing CDC’s child development milestones, SLPs can evaluate each child’s progress in a real-world context, ensuring supportive and responsive interventions.
Practical Application in Therapy
By combining these perspectives, SLPs can create an individualized approach to therapy:
- Prioritize Foundational Skills: If a child has not yet reached a milestone, prioritize foundational skills essential to communication.
- Targeted Interventions: If a child is within average ranges but shows weaknesses in specific areas, implement targeted interventions to build stronger communication abilities.
This nuanced understanding ensures therapy goals are both realistic and tailored to the unique needs of each child, fostering steady progress without undue pressure.
Considerations for Autism Spectrum Disorder
Working with autistic children often requires tailoring strategies to meet their unique needs, strengths, and perspectives. While many foundational principles of language development remain applicable, it is important to understand differences and adopt approaches that are flexible, respectful, and mindful of factors influencing engagement and progress.
Focus on Regulation and Motivation
Establishing a foundation of trust and comfort is vital when working with autistic children. Start by creating a predictable and calming environment that allows the child to feel safe and engaged. To build motivation, observe the child’s interests and incorporate them into therapy sessions. For example, if a child enjoys spinning a wheel or sorting objects, these activities can serve as valuable entry points for building communication skills.
Joining their preferred activities can help form a connection and encourage the child to engage. By showing genuine interest in what excites them, you create a meaningful interaction that lays the groundwork for introducing new skills.
Recognize and Adapt to Existing Strengths
Children on the autism spectrum often develop communication skills in unique ways. Joint attention, for instance, may not involve traditional eye contact but could instead be demonstrated through shared focus on an object or action.
Identifying and building on these strengths allows therapy to enhance existing abilities. Focusing on what they can do, rather than what they cannot, creates a more positive and supportive therapy experience.
Use Multimodal Communication Methods
Autistic children often benefit from multimodal communication approaches that incorporate various tools beyond spoken words. These methods reduce frustration and offer multiple ways for the child to express themselves.
- High-Tech AAC Devices: Advanced options like speech-generating devices provide dynamic and customizable solutions. For example, the QuickTalker Freestyle™ high-tech speech generating device offers tailored communication programs, enabling high-tech speech device users to express themselves effectively.
Building Connection Through a Child-Led Approach
Intervention strategies that follow the child’s lead foster meaningful, productive sessions. Allow the child to direct activities whenever possible and support their interests naturally.
By addressing regulation, embracing strengths, and offering diverse communication methods, you guide autistic children toward achieving communication milestones in authentic and attainable ways.
Considerations for Gestalt Language Processors (GLP)
Gestalt Language Processors (GLPs) approach language acquisition differently than more traditional, analytic learners. Instead of starting with single words, GLP children often use “gestalts” or larger chunks of language, such as phrases or scripts, as their initial form of communication.
Tailoring Strategies for GLP Communication Development
Supporting GLPs requires shifting from traditional language teaching methods to approaches that align with their natural developmental patterns.
Focus on Delayed Echolalia
For GLPs, delayed echolalia—where children repeat chunks of memorized speech from earlier interactions or experiences—is a critical starting point. Recognizing and using these scripts can guide therapy.
Strategies to Support:
- Observe and Document Scripts: Identify common scripts the child uses, noting their context and meaning.
- Bridge with Communicative Tools: Pair these scripts with gestures, visuals, or AAC tools to transition toward more flexible communication.
Use the Natural Language Acquisition (NLA) Framework
The NLA framework provides a roadmap for guiding GLPs through language development stages, emphasizing breaking down gestalts into smaller units.
Strategies to Support:
- Intentional Modeling: Combine gestalts with intentional language modeling, such as rephrasing a child’s script to highlight smaller, meaningful components.
- Layer Multimodal Tools: Encourage comprehension by layering multimodal communication tools alongside spoken language.
Leverage Multimodal Communication Methods
GLPs often rely on various communication methods, so providing access to multimodal tools ensures their communication remains functional.
Effective Tools Include:
- AAC Systems: These can help children with diverse needs express themselves.
- Visual Supports: Include picture boards or core word charts to supplement scripts.
- Manual Signs or Gestures: Integrate simple signs to support language flexibility.
Honor the Child’s Natural Process
GLPs’ scripts often reflect emotional significance or strong connections to past experiences. Respecting the personal meaning behind their communication style is vital.
By building on GLPs’ natural strengths and language-learning processes, therapy fosters communication that feels authentic and achievable.
Multimodal Communication: Tools and Approaches to Support Development
Multimodal communication approaches play an important role in fostering language development, especially for children with limited verbal or speaking skills or those facing communication delays. These methods combine various tools and strategies to provide multiple avenues for effective expression.
Children respond differently to various forms of communication. Offering a variety of modes ensures each child finds a method that works best and builds the tools in their communication toolbox. The goal is to empower children by giving them consistent, reliable ways to communicate in their everyday lives.
Tools for Multimodal Communication
- Low-Tech Strategies: Simple tools such as picture cards, visual schedules, or basic sign language help children convey needs and preferences.
- Mid-Tech Solutions: Devices with recorded speech buttons or static communication boards allow children to connect sounds or phrases to actions.
- High-Tech AAC Devices: Advanced options like speech-generating devices provide dynamic and customizable solutions. For example, the QuickTalker Freestyle™ high-tech speech generating device offers flexibility with communication applications, enabling high-tech speech device users to express themselves effectively.
Try a Device
Try a Device
Approaches to Incorporate Multimodal Communication
- Combine Modalities: Integrate verbal or spoken communication with gestures, visuals, or AAC devices to create a multifaceted communication system.
- Tailor to the Child’s Needs: Select tools based on the child’s unique strengths and preferences.
- Encourage Active Participation: Involve the child in choosing their preferred mode of communication.
- Model Multimodal Communication: Demonstrate the use of different tools during interactions.
- Ensure Consistency Across Settings: Work with families and educators to support communication methods in all environments.
Benefits of Multimodal Communication
- Reduces Frustration: Provides alternative ways to communicate.
- Facilitates Understanding: Enhances connections between the child and their caregivers or peers.
- Promotes Language Acquisition: Encourages children to experiment with different communication modes.
- Fosters Independence and Confidence: Empowers children to communicate effectively.
Adopting a multimodal communication approach ensures that every child, regardless of their speaking abilities, has access to tools that broaden opportunities for engagement and connection.
Unleashing the Power of Pre-Verbal Skills for Empowered Communication
Empowering pre-verbal skills lays the foundation for a child’s successful communication journey. By implementing these essential strategies—such as fostering joint attention, promoting purposeful vocalizations, and utilizing multimodal communication tools—SLPs and families can create a strong framework for language development. These skills act as stepping stones to more advanced and purposeful expression.
The key to fostering these skills lies in creating a personalized, supportive, and child-centered environment. Tailoring strategies to each child’s unique abilities, interests, and needs ensures therapy is both effective and engaging. When families and professionals collaborate, children benefit from a consistent, all-encompassing approach that encourages both progress and confidence.
Are you ready to transform your therapy sessions and support your child’s communication journey? Contact AbleNet’s ableCARE support team today to explore our tailored communication solutions and innovative tools like the QuickTalker Freestyle™ high-tech speech generating device.
Let’s work together to empower every child to discover their voice, build meaningful connections, and engage confidently with the world.
