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166 ACQ Volume 11, Number 3 2009 ACQuiring knowledge in speech, language and hearing
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communication skills, and the Parent Child Interaction
Teaching Scales, a tool used widely in the United States
of America and the United Kingdom. As per the Teaching
Scales criteria, videoing of a structured teaching task
enables the clinician to assess dyad reciprocity, caregiver
sensitivity to infant cues and the caregiver’s capacity to
provide an environment that is conducive to the development
of social, emotional and cognitive skills. The interaction also
enables assessment of the clarity of the infant’s cues.
Each week caregivers and infants join the clinicians for
an hour and a half of floor time to enjoy a variety of songs
and rhymes. Repetition ensures that mothers and infants
become highly familiar with their favourite songs or rhymes
and learn adaptive use of the material to meet their individual
needs (e.g., to increase alertness, to settle, or to alleviate
distress). The benefits of routine are demonstrated using
key songs to signal program changes. Broad smiles are
elicited when the mums become cognizant that the song
“I’m a little teapot” means they can sit back, sip a cuppa,
chat and be waited upon for 20 minutes. The song “This
is the way we pack away” is soon understood by even the
youngest of infants to signal the end of bubble-and-ball time
and returning to their mothers’ arms. A brief “mothers only”
time is always a challenge to the facilitator left to manage
up to six infants and sometimes toddlers (bubbles are truly
a blessing!) while the second speech pathologist leads a
discussion with the mothers.
First Words Project Home Activities
) introduce early communication development. The
NCAST Baby Cues: A Child’s First Language (http://www.
) flash cards explore the concepts of engagement
and disengagement cues (Givens, 1978). Most parents, adept
in identifying potent engagement cues (moving arms towards
caregiver/ babbling) or equally potent disengagement cues
(back arching/withdrawal from quiet alert to active sleep state),
learn to use songs to facilitate transitions from one state to
another – from active alert where the baby is fussing to quiet
alert where the baby’s eyes are focused .
org/). Recognising more subtle engagement cues (brow
raising/facial brightening) or subtle disengagement cues
(diffuse body movements/tongue showing), and identifying
clusters of cues can be a new experience for some.
Preliminary outcome measures (sample size of 6) have shown
encouraging results. Caregivers improved in their ability to
interpret their child’s communication and foster a sensitive
reciprocal interactional style that promotes cognitive and
emotional development interaction. Caregivers accessed
support for their own mental health concerns and infants were
streamed, where required, into community programs and
ongoing developmental programs at an early age. Feedback
from the mothers has been heartening. Responses included
“I realised that talking to my child is the best thing I can do
for her” and “I can read her body language better”.
Early results thus indicate that the START group provides
caregivers with increased knowledge of early communication
development and the importance of sensitive interaction.
Gwynne, Blick and Duffy (2009) conducted a pilot program
in Sydney, utilising a relationship-based model of care, which
highlighted the benefits of integrated centre-based interventions.
Similarly, the START group is an additional building block in the
development of at risk mother–infant interaction that fosters
attachment, communication skills and global development.
References
Bowlby, J. (1988). A secure base. London: Routledge.
Cantwell, D. P., & Baker, L. (1987). The prevalence
and type of psychiatric disorder and developmental
Lisa Dyer is a speech pathologist who graduated in 1985, and
completed a Master in Counselling in 2007. She has predominantly
worked with a paediatric caseload, in Australia, the UK and
Zimbabwe where she worked for four years as a development
worker with the goal of handing over speech pathology skills to
local health workers. For the past six years Lisa has worked in Child
and Adolescent Mental Health and currently combines this with
community health work and private practice.
Correspondence to:
Lisa Dyer
email: