Close Server: KOPWWW05 | Not logged in

Welcome to Health Care POV | sign in | join
Early Intervention Speech Therapy

The Different Paths to Communication

Published March 10, 2009 10:48 AM by Stephanie Bruno-Dowling
When I enter a new home and meet a family for the first time, one of the first questions I am asked by parents usually sounds something like this, "How are you going to get my to child to talk?" After doing this for several years, I have learned that this is not always an easily answered question. Generally speaking, there are four main modes of communication that I discuss with families. I explain the theory and mechanics behind each one, make my recommendations and ask the family for their input and feedback.  The four main methods are the following:
  1. Sign language
  2. Picture communication
  3. Phonemic cueing / Articulation therapy
  4. Augmentative communication

As a therapist, there are many questions I ask myself and the parent(s) before making my recommendations. I feel that it is very important to get a full assessment of the child and their level of development and communication before making a decision. In addition, I often incorporate a mix of the four modes and include oral motor therapy to provide support and stimulation to the physical development of the speech musculature.

Below are some of the questions and points to consider before making a recommendation:

  • How is the child communicating now? What is working at home and what is not?
  • How old is the child? How should the child be communicating at this age level and what is the best way to achieve that goal?
  • Get the family involved—ask them if they have a preference for a communication mode (some will and some won't). You need to assess what the family can handle and the commitment they are willing to make with a communication system on a daily basis. I have met families that are originally opposed to sign language because they fear their child will never talk if they learn how to sign. Therefore, parent education often becomes a big part of recommending a communication system.

Join me Friday, when we continue the discussion about how to choose an appropriate communication system for little ones in early intervention!


Geri - Thanks for your question. Because the child is so young, you really only need to know a few signs to get started. I always start off with the basics - "more", "please", "all done", "eat", etc. and maybe a favorite food or two. I use a book called "Baby Signs" and I share it with families when I first begin with them. I also found the following two websites that should be helpful for you and the parents:  - this one has a sign index  - you can click on specific signs and a person will pop up on the screen and demonstrate how to make the sign.

Good Luck and let me know if you have other questions!!


stephanie bruno, blog author March 18, 2009 5:56 PM

Hi Stephenie,

I would like to introduce sign language to a 14 month old child that I see at home.  I have very limited knowledge of sign language. Are there any websights or programs that you would recommend to give me a basic knowledge.  Unfortunately I don't have alot of time to devote to learning this new skill.  Any recommendatons would be greatfully appreciated.

                                         Thanks so much,


Geri, EI - SLP March 18, 2009 8:32 AM

Great - thank you for the info!

stephanie , blog author March 17, 2009 3:06 PM

To get the material you need to explain and demonstrate Cued Speech (multi-modal phonemic communicaton system), visit these two websites: (National Cued Speech Association) and (bookstore of the National Cued Speech Association).  Both have information about Cued Speech and its applications to multiple language, speech and learning needs. also has a forum focused on sharing instructional ideas.

Pamela Beck March 12, 2009 10:22 PM
Cleveland OH

leave a comment

To prevent comment spam, please type the code you see below into the code field before submitting your comment. If you cannot read the numbers in the image, reload the page to generate a new one.

Enter the security code below:


About this Blog

    Stephanie Bruno Dowling, M.S. CCC-SLP
    Occupation: Speech-Language Pathologist
    Setting: Early Intervention in Delaware County, PA
  • About Blog and Author

Keep Me Updated