Do you ever wonder how closely motor and language development are intertwined in children? Discerning the subtle ties between these two fundamental areas can be profoundly insightful, especially for those of us in the field of pediatric speech-language pathology! I am Denise Stratton, bringing you episode 89 of the Speech Umbrella, as we delve deep into this fascinating correlation, especially concerning children with autism. Drawing from a wealth of research, we underscore the reality that language impairment often goes hand-in-hand with motor skill development issues.

Let’s dive into how motor skills might actually be the first domain where developmental divergence appears in children diagnosed with autism. We bring light to the valuable resource – the 16 actions with objects by 16 months – developed by the First Words Project. This tool has innovatively changed the game for me in my practice, and I can’t wait to share it with you! Understanding and fostering the development of motor skills can lead to future gains in communication. So join me as we celebrate the power of simple therapies and their potential for improving outcomes in our young patients’ lives.

— Useful links —

Spectrum 
16 Action with Objects 
Challenges in Early Intervention

Transcript

Welcome to the Speech Umbrella, the show that explores simple but powerful therapy techniques for optimal outcomes. I’m Denise Stratton, a pediatric speech-language pathologist of 30-plus years. I’m closer to the end of my career than the beginning and along the way I’ve worked long and hard to become a better therapist. Join me as we explore the many topics that fall under our umbrellas as SLPs. I want to make your journey smoother. I found the best therapy comes from employing simple techniques with a generous helping of mindfulness. 

Hello everyone, welcome to episode 89 here on the Speech Umbrella. There are a lot of professionals in our field who work with children. Besides SLPs, there are OT’s, PT’s, developmental specialists and behavior specialists. While we each have our area of specialty, it’s not so easy to separate these areas in real life, nor should it be. There are not clear and distinct lines between a child’s motor, cognitive, social and communication development. What is particularly interesting and concerning to me is research indicating that children with language impairments have poor motor skills, and in children with autism, it may affect as much as 80% of the children with that disorder. Now, that’s probably not groundbreaking news to us, but the question is what can we do as SLPs to promote motor development along with communication, but without getting out of our lane and into the OT’s lane. I have a great resource that has helped me a lot and that’s what I’m going to share today, along with some research on motor development and autism and, as always, some clinical application. Today’s episode is called A Rising Tide Floats All Boats, The Motor Language Connection. With this information I’m going to share today, SLPs can recognize and celebrate progress that doesn’t seem directly related to communication. We know it’s a sign of future communication gains and we can share this exciting news with parents. First, I’m going to go over some research facts, then the motor development research, and wind up with clinical application. All the research I’m citing today comes from the website spectrumnews.org. I’m quoting from three different articles which I’ll link in the show notes, and they have done a great job of writing these articles for the general public. I love it when research is summarized so I can understand it. 

Now let’s dive into the research. Do you wonder when autism can first be recognized? I’ve been around a long time and it used to be that we wouldn’t spot it until language delays made it apparent that something was not developing as we expected. But actually, motor skills may be the domain in which developmental divergence appears first. Infants later diagnosed with autism showed fine and gross motor differences by just six months of age, and large differences were observed by 13 months of age. Early motor difficulties could make it difficult for babies to focus their eyes on objects and that could hinder reaching movements and that makes it harder to get objects and share them with people. And that all cascades into language. So you get this cascading effect across domains. In fact, some of the first communication skills to emerge; facial expressions, joint attention and pointing to requests, are all motor behaviors. 

Rebecca Landa, who is an SLP, and executive director for the Center for Autism and Related Disorders, said this really makes a difference in the way I design early intervention for autism. For example, when teaching toddlers play skills, she says she focuses specifically on improving their motor abilities and some studies show a direct link between communication and motor development. There’s an interesting study that showed reaching for and actively playing with toys can boost young infants’ interest in faces, and there’s another one that shows greater risk for motor impairment is tied to social communication skills and restricted and repetitive behaviors. And that makes me wonder if difficulty playing with toys can contribute to always playing with them the same way and that contributes to repetitive behaviors. That’s just the thought of my own. That was not in the research. 

How can SLPs incorporate motor skills into therapy And where do we even start? I love looking at the sequence of development when I’m wondering where to start in therapy. And that’s what this resource called 16 actions with objects by 16 months does. It lays out the order development of key motor skills from 9 to 16 months. It was developed by the First Words Project at Florida State University. They also developed 16 gestures by 16 months. That’s another fantastic resource. If you want to hear more about that, hop on over to episode 33, challenges in early intervention. Now back to 16 actions on objects. Here’s an overview of all the actions that they have detailed from 9 months to 16 months, and you’ll be able to see how these skills build on each other and also how communication starts to come in. 

At nine months is all about mouthing, banging and dropping. Babies use mouths to explore features, they bang objects with their hand and they also bang objects together. They drop objects by chance and sometimes they drop them on purpose. By the way, dropping objects has a direct connection to developing the gesture of giving, which in turn is connected to back and forth play with objects. At 10 months, babies grab and pull and take things off Like they’ll take their socks and shoes off. They grab and pull to take a blanket off their head and play peek-a-boo with you. They explore objects in an open drawer and they take things out of the drawer Everything out of the drawer. 

At 11 months, babies learn to push. Think of squishing a stuffed animal, pushing buttons on pop-up toys, pushing a tower over. They also learn to turn things like pages in a book, a toy steering wheel or turn a faucet, or they might turn a basket over their head to make you laugh at them. At 12 months, patting and putting in comes along. They can pat themselves off with a towel or they can pat their teddy bear, and pats develop into hugs. When they learn put in, they learn a lot of functional actions. They put a sippy cup in their mouth to drink, they put a spoon in a bowl to scoop and they put the spoon in the mouth to eat. By the way, put is one of my all-time favorite words and actions in therapy. It’s just so functional I use it all the time. 

When 13 months rolls around, they begin to learn by observing others and copying what they do and say. They start to pretend, which is so important to language development. Think of feeding mom with a cup or pretending to feed teddy bear with a bottle. They also open and close objects as they learn to use objects as tools. So toddlers can open and close cupboards and oven doors. It’s interesting to me that opening and closing and copying others emerge together. I do a lot of pretend play with kitchen play and we open and close doors with the pretend oven and we pretend to make food at the same time. So I’m incorporating those two themes when I’m doing kitchen play without even thinking, because we’re imitating what their parents do by cooking and we’re opening and closing a lot of things. And open is another one of my all-time favorite words in therapy. 

At 14 months, toddlers learn to move objects back and forth and up and down. I can really see how these movements contribute to symbolic play, for example, pretending to vacuum and cutting play food, using a rolling pin and cookie cutters. Now Play Doh, rolling pins, and cookie cutters are always within arm’s reach in my therapy room. They are just so awesome. At 15 months, they’re learning to use two objects together with a plan in mind. They can pour from one object to another, such as a liquid from a bottle into a cup. They can pour from a shovel into a bucket and from a watering can onto plants. Playing with two objects together is also a step in symbolic play. At 16 months, we have stacking, cutting out, scribbling and drawing. Now kids are able to make and create things; stacking blocks, creating with Play Doh, drawing, and painting. They are making things that represent other things, which is also critical to language development. This understanding that something can represent another thing is really what verbal and written language is. The actions a child learns vary depending on their family and culture, of course, but having 16 actions with objects by 16 months is a critical milestone for all children because it launches imagination and that fuels language and learning. Now, no doubt you’re already thinking of ways to apply this in your practice if you work with toddlers and preschoolers. 

I want to share a particular case history of how I used 16 actions with objects to spark turn taking. This client was two and on the autism spectrum, and this took place over five months from April to August. I had this plan of how to use the motor skills he had and bring him along in this language with developing motor skills he had yet to develop, and it was so textbook perfect. I mean, he just followed my plan perfectly. I know that doesn’t always happen, but this was awesome. These are my notes. In April, with his mom, I reviewed the 16 actions with objects and we determined that he was functioning around 13 to 15 months, so not too far behind. We brainstormed ideas for incorporating turn taking with actions at that level he was at and things that would be a high interest to him, but nothing really worked for encouraging turn-taking. We brainstormed ideas for how she could incorporate turn-taking with actions for the things he did at home and using things that would be high interest for him, but She reported back to me that nothing was really working for encouraging turn-taking. 

So, in May I was thinking of how to take putting in and pouring, those actions that he had that are around 15 months, and more of it into ball play, and so this is what I did. We took Play Doh and made a ball and rolled it across the table. And I introduced rolling the balls into cups. So I put my cup down on the table so it was really easy that the opening was laying on the table and all he had to do was give it a little push and it rolled into my cup and then I would roll into his. And he wasn’t quite sure what to do, but he went along with it. And the next session he was really engaged. We started tipping the Play Doh balls back and forth between his cup and mine. So now we’re using that pouring in and out, and this was the first sustained back and forth activity he engaged in. Now the next session he again participated in tipping the Play Doh ball back and forth from my cup to his, and then he continued to do it when we changed containers, and he caught the ball and by caught it I mean I loved it to him really soft. I was like two inches away from his hands and kind of threw it. But he caught it. So that was cool. 

And in June he said I want a ball when he had a toy orange. And so we pretended that the orange was a ball and he rolled it and threw it back and forth. And at the end of June he was passing the ball to his mom and to me. In July, he was rolling back and forth with eye contact and starting to engage in other turn taking activities. And in August, he threw a ball back and forth through a basketball hoop, playing basketball just like a typically developing toddler. And it all started with the idea of using pouring back and forth motor movement as described at 15 months. 

In closing I want to hark back to what I said earlier about recognizing and celebrating skills that don’t seem directly related to communication. They don’t seem to be, but they are. When a little client of mine on the spectrum said put in, as he was dropping balls into a tube, it was really exciting. But equally exciting to me was when he calmly and purposefully reached for each piece in a shape sorter toy and worked diligently at fitting the shapes together. It’s exciting because reaching for and actively playing with toys can boost young infant’s interest in faces, as I cited earlier. He’s not an infant now but he still needs to develop that interest in faces. And what he just did with the shape sorter toy is going to support that interest and that’s just as important in my book as him saying put in. 

I called this episode A Rising Tide Floats All Boats for a reason. That’s one of my favorite phrases, because when a child’s motor skills develop and rise, everything else rises too, and we’ve just seen how communication is so tied to how their motor skills develop and how, as SLPs, we can use this resource, this 16 actions with objects by 16 months, to really examine where a child is and to bring them along, following the sequence of development, to build their communication. So here’s a few things to keep in mind from this podcast. Number one motor skills may be the first indication of autism. Number two remember this awesome resource by the first words project, 16 actions with objects by 16 months, it’s fantastic. It’s awesome. Share it with your parents. And number three think about how you can use this resource to look at a child’s motor stage and think about how you can tie language into where they are at and bring them along in their language skills. That wraps things up for today. 

If you want a transcript or the links for today’s and every other episode, you can find them at thespeechumbrella.com/blog. Take a minute to browse around my store and sign up for the free resource library. I know you’ll find something that will help you with your kiddos. Tell your fellow therapist about the podcast, leave me a review and let’s connect on social media. I’m dStrattonSLP on Instagram and The Speech Umbrella on Facebook. Check out my videos on YouTube too. There’s a lot of great stuff under The Speech Umbrella. Thanks for listening. 

Thanks for listening to The Speech Umbrella. We invite you to sign up for the free resource library at thespeechumbrella.com. You’ll get access to some of Denise’s best tracking tools, mindfulness activities and other great resources to take your therapy to the next level. All this is for free at thespeechumbrella.com. If you’ve enjoyed this podcast, subscribe and please leave us a review on Apple Podcasts and other podcast directories.