## Building Preverbal Communication & Engagement

### Triadic Gaze Intervention for Young Children With Disabilities and Their Families

by **Lesley B. Olswang, Ph.D., CCC-SLP**, University of Washington Seattle **Julie L. Feuerstein, Ph.D., CCC-SLP**, University of Central Florida Orlando and **Gay Lloyd Pinder, Ph.D., CCC-SLP, C/NDT**, Children’s Therapy Center Kent, Washington

### About the Authors

#### Lesley B. Olswang, Ph.D.
Professor Emeritus, Department of Speech and Hearing Sciences at the University of Washington, Seattle.

#### Julie L. Feuerstein, Ph.D., CCC-SLP
Assistant Professor, School of Communication Sciences and Disorders, University of Central Florida, Orlando.

#### Gay Lloyd Pinder, Ph.D., CCC-SLP, C/NDT
Founder and past Therapist at Children’s Therapy Center in Kent, Washington, and a Certified Neurodevelopmental Treatment (NDT) Speech Instructor.

---

## SECTION I
### Understanding Early Communication Development and Triadic Gaze Intervention

#### CHAPTER 1
### The Child–Adult Dance and the Gift of Engagement and Communication

The first year of life is instinctively dominated by nurturing moments between babies and families, filled with holding, feeding, and socializing. Imagine the beautiful dance that takes place between adult and child as they become finely tuned partners learning to engage and communicate with each other. Children grow and thrive in the context of close and dependable relationships that provide a safe and predictable environment and encourage exploration. Research has overwhelmingly demonstrated the importance of these first relationships to build a strong foundation for children’s future social-emotional, language, and cognitive learning.

The connection established between the adult and child sets the stage for all kinds of future learning. Regardless of the child’s age, these types of interactions capture the gift of engagement. This chapter briefly describes the natural emergence of engagement and the development of early communication during the first year of life, as well as how child–adult interactions form the context for early learning.

### Understanding TGI

Early engagement begins with the infant’s first cries and whimpers, which serve to immediately engage the adult. Gradually, the adult begins to give meaning to the infant’s behaviors of crying, cooing, gazing, and early smiling, responding to them consistently.

### Preintentional Communication
**Single Focus**: Looking and sustaining gaze to a person OR an object.
- Gaze alone
- Gaze + gestures OR vocalizations
- Gaze + gestures AND vocalizations

**Dual Focus**: Looking from an object to a person OR a person to an object.
- Gaze alone
- Gaze + gestures OR vocalizations
- Gaze + gestures AND vocalizations

**Triadic Focus**: Looking back and forth between an object and a person.
- Gaze alone
- Gaze + gestures OR vocalizations
- Gaze + gestures AND vocalizations

### Intentional Communication

Some time around 9–10 months of age, a dramatic milestone is observed when the child begins shifting their gaze back and forth between an adult and an object or event of interest, called triadic focus. This behavioral indication links the adult to an action or object for the purpose of getting the adult to act in some way. Triadic Gaze Intervention (TGI) acknowledges the significance of this early prelinguistic milestone and the importance of an intervention designed to facilitate its accomplishment.

### Communicative Intentions

Children express intentions prior to first words, moving from simple preverbal behaviors to more complex ones. Table 1.1 provides examples of these early communicative intentions:

| Common communicative intentions | Example of preverbal behaviors | Apparent meaning |
|------------------------------|-----------------------------|------------------|
| Protesting | Child looks away, pushes bottle away, and fusses. | “I don’t want that.” |
| Requesting | Child looks and points to a book, vocalizes until mother gives it. | “Give me that book.” |
| Commenting | Child smiles and squeals at brother doing somersaults. | “Look at that!” |
| Answering | Child looks at mother and vocalizes “ah ah.” | “Yes, I want to swing.” |

---

### Conclusion
A lot happens in communication development prior to first words. The interactions during the first 12 months of life reflect children’s gradual development of behaviors recognized and interpreted as early forms of communication. Triadic Gaze Intervention is designed to address breakdowns in the child-adult dance and provide strategies for synchronizing engagement.