Relato de Caso
Camila Mayumi Abe1 Andreza Carolina Bretanha1 Amanda Bozza2 Gyovanna Junya Klinke Ferraro2 Simone Aparecida Lopes-Herrera3
Descritores
Fonoaudiologia Linguagem infantil Desenvolvimento da linguagem Comunicação Comportamento verbal
Keywords
Speech,language and hearing sciences Child language Language development Communication Verbal behavior
Correspondence address:
Simone Aparecida Lopes-Herrera Departamento de Fonoaudiologia FOB--USP
Al. Octávio Pinheiro Brisola, 9-75, Bauru (SP), Brasil, CEP: 17012-901. E-mail: lopesimone@gmail.com
Received: 7/12/2011
Accepted 10/15/2012
The current study was conducted at the Department of Speech-Language Pathology and Audiology, Bauru School of Dentistry, Universidade de São Paulo – USP – Bauru (SP), Brazil.
(1) Graduate Program (Master’s degree) in Speech-Language Pathology and Audiology, Bauru School of Dentistry, Universidade de São Paulo – USP – Bauru (SP), Brazil.
(2) Undergraduate Program in Speech-Language Pathology and Audiology, Bauru School of Dentistry, Uni-versidade de São Paulo – USP – Bauru (SP), Brazil.
(3) Department of Speech-Language Pathology and Audiology, Bauru School of Dentistry, Universidade de São Paulo – USP – Bauru (SP), Brazil.
Conflict of interests: None
development: a case series
Habilidades comunicativas verbais no desenvolvimento
típico de linguagem – relato de caso
ABSTRACT
The aim of the current study was to investigate verbal communication skills in children with typical language development and ages between 6 and 8 years. Participants were 10 children of both genders in this age range without language alterations. A 30-minute video of each child’s interaction with an adult (father and/or mother) was recorded, fully transcribed, and analyzed by two trained researchers in order to determine reliability. The recordings were analyzed according to a protocol that categorizes verbal communicative abilities, including dialogic, regulatory, narrative-discursive, and non-interactive skills. The frequency of use of each category of verbal communicative ability was analyzed (in percentage) for each subject. All subjects used more dialogical and regulatory skills, followed by narrative-discursive and non-interactive skills. This suggests that children in this age range are committed to continue dialog, which shows that children with typical language development have more dialogic interactions during spontaneous interactions with a familiar adult.
RESUMO
INTRODUCTION
A pragmatist studies language function, linking practice to theory and employing normative data to describe the in-tentional use of language(1). Communicative skills refer to
the ability of the individual to participate in an interactive sequence of speech acts with communicative intent. Thus, communicative competence refers to the ability to use langua-ge as an effective tool to interact across social contexts. This competence involves the communicative intention, regardless of the means used for communication(2,3).
These skills can be divided into: conversation, narrative, and non-interactive skills. Conversation skills include the ability to respect sequential organization, repair flaws in the conversation, use language to establish and alternate social roles, and also understand and produce a variety of speech acts. Narrative skills are typically characterized by the abili-ty to interpret the meaning of stories as well as storytelling following a basic structure. Non-interactive skills relate to the use of language for thinking and problem solving as well as establishing one’s identity, gameplay, and metalanguage(4,5).
Only recently has the speech pathology literature at-tempted to describe the development of pragmatic commu-nicative abilities in the context of historic studies regarding morphosyntactic, semantic and phonological development(5).
Few studies have taken a pragmatic approach to typical language development, and furthermore, the bulk of this literature describe communication skills in the development of language(6,7) or communication skills in specific age
ran-ges, previously thought to correspond with marked shifts in language ability(7-9).
The importance of studies that characterize pragmatic communicative skills in children with typical development cannot be understated as they provide comparative parameters necessary for identification of deficits and to provide targets for therapeutic intervention. The few studies that focus on typical development of pragmatic language function providing the theoretical basis of the field(4,10), justify this study. When
one wants to characterize the typical development of a skill or linguistic function it should be taken as a criterion that all other functions are present within the established criteria for normality. Thus, were chose to evaluate children with normal acquisition of oral language in order to minimize interfe-rence from processes of language acquisition in the survey of communicative skills. The objective of this study was to characterize the verbal communication skills employed by children 6-8 years of age with typical language development.
CLINICAL CASES PRESENTATION
Ten children (boys and girls) with typical language development between 6 and 8 years old were included in the current study. This age group was selected to minimize interference of language acquisition in verbal communicative skills. Typically, children in this age range are in the final stages of language development and have evolving pragmatic abilities. All subjects were selected by a speech pathologist
who performed screenings, interviews with the parents, and observation of the child, to confirm the absence of deficits in hearing, speech and/or language.
Subjects were selected among children in a mainstream school in a city in the interior of São Paulo. Participation in the current study was voluntary and the parents/guardians were informed regarding the goals and methods of the study with particular emphasis on subject confidentiality; all provi-ded consent. The experimental procedures were approved by the Research Ethics Committee (REC) of the Bauru School of Dentistry, Universidade de São Paulo (FOB-USP), under protocol number 068/2009.
To analyze subject pragmatic profile, a 30-minute re-cording of each child was performed while interacting with either parent. Caregivers were counseled on the maintaining discourse; this model was employed to avoid confounds related to minimize familiarity with the interlocutor. All pro-cedures were performed in the Speech-Language Pathology Outpatient Clinic, FOB-USP. The room was designed for clinical care with minimal external sounds or distractions. In the room, the conversation partners were provided with play materials selected according to age and gender. The selection of play materials was made with the objective of stimulating communicative skills.
A tripod-mounted video camera was used to record the entire interactive situation without distraction. The researcher provided instruction for both the adults and child to remain seated on the mat so that the camera could record the entire interaction, and that the play materials could be used as they wished in order to maintain dialogue for the 30 minute ex-perimental protocol.
The recordings were transcribed verbatim and literally, classifying the verbal communicative skills of communi-cative dyad (parent-child or parent-child), according to the Protocol Verbal Communication Skills – VCS(4,10). This
pro-tocol focuses on verbal communication skills, described in 25 categories, which are divided into four groups: dialogical skills (DS), regulatory skills (RS), narrative-discursive skills (NDS) and non-verbal interactive skills (NIS).
DS are subdivided into early shift (ES) maintenance dialog (MD), insertion of new topics in the dialogue (NT), sequential organization dialogic (SO), repair of faults (RF) range of roles (RR), social routine (SR) and expression of feelings (EF). Sequential organization dialogic (SO) is then subdivided into comments (CM), direct answers (DA), imitation (I) and feedback to the speaker (FS). SR is also then subdivided into self-regulatory (SeR), direc-ting attention (DAT), driving action (DAC), request ob-ject (RO), request for information (RI) and consent (CS). NDS is subclassified as storytelling or event (SE), playing histories (PH), interpretation of stories (IS) and arguments (ARG). Finally, NIS is subcategorized to the use of language to establish its own identity (EOI), symbolic play (SP) and metalanguage (ML).
observers in order to determine independent inter-observers variability, including both the lead researcher and a second trained observer). Inter-observer agreement was analyzed in each session for each child and calculated; every turn was analyzed by observer 1 compared to the corresponding shift analyzed by observer 2 leading to the calculation of percent agreement (performed by dividing the number of agreements plus the disagreements of the number of agreements and mul-tiplying this result by 100). Only interactions which achieved 75% agreement were included.
Calculation of reliability for all the recordings made with ten dyads confirmed that the data were reasonable; all indices were above 75% agreement, with a mean of 97.19% overall agreement. Then, the frequency of productions within each categories included in the VCS was subjected to statistical analysis.
Statistical analysis was based on normality tests of Anderson-Darling and Variance Analysis of Single Factor (ANOVA). In the first test, it was observed that the use of different categories that make up a verbal communication skill possessed a normal distribution between dyads. In other words, each skill category had a normal distribution across the subjects. The normality test indicated that the variation of use of each category among children was in agreement with the standard deviation and therefore can be subjected to ANOVA. The ANOVA was employed to determine agreement among the usage profiles of the verbal communication skills of the ten children. We analyzed the frequency distribution of the categories that comprised a particular verbal communication skill in order to determine whether the profiles of individuals were part of the same group. Thus, p values greater than 0.05 indicated that the children that had the same profile of verbal communication skills employed similar skills.
Descriptive statistical analyses were performed; calcu-lating mean, median, standard deviation and interquartile range for each variable. These values allow us to identify the profile of children with typical language development for each category of verbal communication skills. Likewise, the interquartile ranges showed the frequency distribution for each category. The interval between the first and third quartile showed how often given category was used by five children. The third quartile identified what was expected how 75% of children would perform.
The majority of the skills observed belonged to the cate-gory of dialogical skills (DS), followed by regulatory skills (RS). These data suggest that children presented with recurrent communicative interactive (dialogical) skills throughout the interactions (Table 1).
The children used verbal communication skills (VCS) in similar proportions, which can be seen by comparing the percentage of use of each category (Table 1). The percenta-ges presented are critical variables related to the subjects’ pragmatic profile. These values indicate the frequency with
which each child made use of a specific category within the VCS. This analysis allowed for the comparison between the subjects according to the usage profile of these categories. For example, it was observed that a subject used the dialogic skills 75 times during the interaction, while a second subject employed these skills 50 times. However, the frequency of use of this category with respect to all categories of VCS was the same for both cases (Table 1). Similar findings were observed in the RS category, which was used less by subject 4, while subject 6 used this skill more often. However, both showed similar frequency of use in this category, when considering all categories of VCS. The categories of narrative-discursive skills (NDS) and non-verbal interactive (NIS) were rarely used across all subjects.
Within DS, dialogic-sequential organization (SO) was observed most frequently, followed by the expression of fee-lings (EF). The percentage use of DS was distributed similarly between dyads and between skills. The average difference in the frequency of use of SO was 5.66%, while maintenance dialog (MD) was 3.55%, lower than the others. It should be noted that SO consists of several sub-categories (Table 2).
Within SO there are subcategories, as shown in Table 3. The subcategory most used by the subjects was the commen-tary (CM), followed by direct response (DR). The largest differences were in the number of CM produced by each subject. There was little variability between subjects with regard to the other SO subcategories.
Regarding regulatory skills (RS), request information (RI) was most common followed by driving action (DAC), suggesting that the subjects produced more questions than regulated attention and adult action. The average difference in the use of self-regulation skills (SeR) was 11.45%, while the RI was 11.28%, in directing attention (DAT) was 10.78%, the DAC was 8.80%, on consent (CS) was 5.57% and the request object (RO) was 0.46% (Table 4). Marked variations in SeR productions were observed; note the variation of the standard deviation in Table 4.
Among the ten subjects, only four used narrative-discursi-ve skills (NDS) and the highest occurrence was playing stories (PH), followed by the argument (ARG) (Table 5). Subjects 4 and 6 were the only ones to use the three categories of NDS (PH, SE and ARG). The average difference between the use of PH in children was 35.41% SE was 18.63% and ARG was 8.4%. Non-interactive skills (NIS) were used by eight sub-jects, most of whom had only one occurrence of some skills in this category.
Table 1. Verbal communication skills presented by children of the dyads 1 to 10
Criança HD HR HND HNI Total
n % n % n % n %
1 75 52.08 56 38.89 12 8.33 1 0.69 144
2 107 56.32 81 42.63 0 0 2 1.05 190
3 93 64.14 50 34.48 1 0.69 1 0.69 145
4 50 52.08 34 35.42 10 10.42 2 2.08 96
5 129 59.45 75 34.56 11 5.07 2 0.92 217
6 164 60.07 102 37.36 6 2.2 1 0.37 273
7 84 61.31 49 35.77 0 0 4 2.92 137
8 138 69.00 62 31 0 0 0 0 200
9 179 63.70 91 32.38 0 0 11 3.92 281
10 96 70.59 40 29.41 0 0 0 0 136
Descriptive statistics
Mean 111.50 64.00 4.00 2.40
Median 101.50 59.00 0.50 1.50
SD 40.54 22.48 5.19 3.24
Q1 86.25 49.25 0.00 1.00
Q3 135.75 79.50 9.00 2.00
p-value 0.968
ANOVA (p≤0.05)
Note: DS = dialogical skills; RS = regulatory skills; NDS = narrative-discursive skills; NIS = non-verbal interactive skills; SD = standard deviation; Q1 = 1º quartile; Q3 = 3º quartile
Table 2. Dialogical skills presented by children of the dyads 1 to 10
Child ES MD NT SO RF RR SR EF Total
n % n % n % n % n % n % n % n %
1 0 0.00 7 7.61 6 6.52 59 64.13 2 2.17 0 0.00 0 0.00 18 19.57 92
2 0 0.00 3 2.52 2 1.68 94 78.99 1 0.84 0 0.00 0 0.00 19 15.97 119
3 0 0.00 6 5.40 6 5.40 84 75.68 1 0.90 0 0.00 2 1.80 12 10.81 111
4 1 1.69 4 6.77 5 8.47 35 59.32 6 10.16 0 0.00 0 0.00 8 13.56 59
5 1 0.63 15 9.49 3 1.90 119 75.32 3 1.90 0 0.00 1 0.63 16 10.13 158
6 0 0.00 4 2.07 1 0.52 138 71.50 2 1.04 0 0.00 0 0.00 48 24.87 193
7 1 1.07 1 1.07 5 5.38 66 70.97 0 0.00 0 0.00 0 0.00 20 21.51 93
8 0 0.00 0 0.00 1 0.70 118 82.52 0 0.00 0 0.00 0 0.00 24 16.78 143
9 0 0.00 25 14.37 4 2.30 120 68.96 0 0.00 0 0.00 0 0.00 25 14.37 174
10 0 0.00 2 2.47 1 1.24 64 79.01 0 0.00 0 0.00 0 0.00 14 17.28 81
Descriptive statistics
Mean 0.30 6.70 3.40 89.70 1.50 0.00 0.30 20.40
Median 0.00 4.00 3.50 89.00 1.00 0.00 0.00 18.50
SD 0.48 7.69 2.07 33.53 1.90 0.00 0.67 11.00
Q1 0.00 2.25 1.25 64.50 0.00 0.00 0.00 14.50
Q3 0.75 6.75 5.00 118.75 2.00 0.00 0.00 23.00
p-value 0.991
ANOVA (p≤0.05)
Table 3. Sequential organization dialogic skills presented by children of the dyads 1 to 10
Child CM DA I FS Total
n % n % n % n %
1 23 38.98 24 40.68 1 1.70 11 18.64 59
2 49 52.13 30 31.92 1 1.06 14 14.89 94
3 48 56.47 13 15.29 6 7.06 18 21.18 85
4 27 75.00 6 16.67 0 0.00 3 8.33 36
5 82 68.91 20 16.81 0 0.00 17 14.28 119
6 116 82.27 24 17.02 0 0.00 1 0.71 141
7 55 70.51 23 29.49 0 0.00 0 0.00 78
8 99 89.19 12 10.81 0 0.00 0 0.00 111
9 98 70.00 41 29.29 0 0.00 1 0.71 140
10 83 86.46 13 13.54 0 0.00 0 0.00 96
Descriptive statistics
Mean 68.00 20.60 0.80 6.50
Median 68.50 21.50 0.00 2.00
SD 32.01 10.20 1.87 7.59
Q1 48.25 13.00 0.00 0.25
Q3 94.25 24.00 0.75 13.25
p-value 0.987
ANOVA (p≤0.05)
Note: CM = comments; DA = direct answers; I = imitation; FS = feedback to the speaker; SD = standard deviation; Q1 = 1º quartile; Q3 = 3º quartile
Table 4. Regulatory skills presented by children of the dyads 1 to 10
Child SeR DAT DAC RO RI CS Total
n % n % n % n % n % n %
1 17 34 2 4 4 8 0 0 26 52 1 2 50
2 20 21.98 1 1.1 28 30.77 0 0 38 41.76 4 4.39 91
3 10 16.39 2 3.28 11 18.03 1 1.64 29 47.54 8 13.11 61
4 10 24.39 1 2.44 16 39.02 0 0 4 9.76 10 24.39 41
5 20 25 16 20 19 23.75 1 1.25 22 27.5 2 2.5 80
6 3 2.31 43 33.08 48 36.92 0 0 36 27.69 0 0 130
7 0 0 8 15.1 21 39.62 0 0 24 45.28 0 0 53
8 0 0 17 31.48 13 24.08 0 0 23 42.59 1 1.85 54
9 2 2.47 26 32.1 15 18.52 0 0 38 46.91 0 0 81
10 1 2.44 7 17.07 7 17.07 0 0 26 63.41 0 0 41
Descriptive statistics
Mean 8.30 12.30 18.20 0.20 23.60 2.60
Median 6.50 7.50 15.50 0.00 26.00 1.00
SD 8.26 13.66 12.53 0.42 10.04 3.63
Q1 1.25 2.00 11.50 0.00 23.25 0.00
Q3 15.25 16.75 20.50 0.00 34.25 3.50
p-value 0.656
ANOVA (p≤0.05)
the VCS categories similarly, achieving a reliable pragmatic profile.
DISCUSSION
The children in the current study produced a higher fre-quency of dialogic skills followed by regulatory skills. This profile demonstrates the concern of children to establish dialogic activity and also to regulate the behavior of adults. In the presented dyads, the children used, among dialogical skills of sequential organization, preferably the ability to comment corroborating the results obtained by a recent stu-dy(7) suggesting that, although conducted in a younger subject
population, children with typical development widely used functional comments. In the current study, children aged 6-8 years also used comments extensively, followed by direct response, demonstrating the concern of children in giving their opinion and answering questions asked by an adult, regardless of age.
In addition, increased use of dialogic skills was noted, demonstrating the interactive nature of the communicative scenario in which children were inserted. In the current study, the experimental environment contributed to the occurrence of interactive situations and the children interacted directly
with the adult the majority of the time. These interactions were largely characterized by regulatory or dialogic activities, even in non-directive productions such as telling stories (narrative- discursive skills). Non-interactive skills were observed in only a few dyads. Comparing these data with studies of younger children, younger children, despite using the same range of communication skills as the children in current study, make use of nonverbal turns, which was not observed in the current study. Older children participate in dialogues not only with answers to simple shifts, but also by conducting reviews with compound shifts(6). Children 4-5 years of age with typical
language development had a communicative profile similar to the older children in the current study, widely employing comment skills(7).
In the group of dialogic skills, sequential dialogical or-ganization was most-commonly used by the children. This finding suggests that, for the most part, the subjects continued to interact with the adult, over the insertion of new topics and starting new turns. Similar findings were observed in previous research(5), which highlighted that the theme of conversation
exchange in children is directed by their focus of interest, and these appeared to be substantially consistent in their participation in the dialogue.
In current study, the subjects changed the conversational
Table 5. Narrative-discursive skills presented by children of the dyads 1 to 10
Child
SE PH IS ARG
Total
n % n % n % n %
1 1 8.33 11 91.67 0 0.00 0 0.00 12
2 0 0.00 0 0.00 0 0.00 0 0.00 0
3 1 100.00 0 0.00 0 0.00 0 0.00 1
4 2 20.00 7 70.00 0 0.00 1 10.00 10
5 0 0.00 8 66.77 0 0.00 4 33.33 12
6 1 16.67 4 66.66 0 0.00 1 16.67 6
7 0 0.00 0 0.00 0 0.00 0 0.00 0
8 0 0.00 0 0.00 0 0.00 0 0.00 0
9 0 0.00 0 0.00 0 0.00 0 0.00 0
10 0 0.00 0 0.00 0 0.00 0 0.00 0
Descriptive statistics
Mean 0.50 3.00 0.00 0.60
Median 0.00 0.00 0.00 0.00
SD 0.71 4.22 0.00 1.26
Q1 0.00 0.00 0.00 0.00
Q3 1.00 6.25 0.00 0.75
p-value 0.294
ANOVA (p≤0.05)
subject, giving sequence to the dialogue according to the game they would like to initiate. Among the subcategories that comprise the category of sequential-dialogical organi-zation, the subjects employed comments most frequently, which corroborates previous researcher(7,11-13). Regulatory
skills were the second category of verbal communicative skills commonly used by the subjects. Among them, the most frequent were: request for information and directing action. These data suggest that children were more interested in re-questing information from adults and directing attention and action than regulating themselves. The consent and request skills had low frequency in all dyads, but this may reflect that the interaction was semi-structured, in which the toys were provided to the child, eliminating the need for a direct request. The presence of self-regulation in all dyads suggests that children needed to focus their attention on what they were doing during the interaction.
In only a few instances, the subjects employed narrative--discursive skills. This observation may be related to the narration skills used to tell/report stories. This type of pro-duction is rarely used in playful, spontaneous (undirected) situations. In the current study, the experimental conditions were considered semi-structured; children’s storybooks and other materials were available allowing for narrative activities. Among the narrative-discursive skills, though little-used, we noted a higher incidence of reproduction of stories, which indicates that reproducing stories is more common than re-porting them spontaneously. Non-interactive skills were not common in the dyads since this study as the experimental conditions favored interactions.
In the current study, the subjects presented with a commu-nicative profile by using skills that allowed for establishing and continuing communicative activity in children with typi-cal development when exposed to situations of spontaneous interaction with a familiar adult. The direct contribution of this study was to delineate the verbal communication skills of children with typical language development at an age in which the acquisition of pragmatic abilities is complete. However, it should be noted that the language sample was restricted to playful activities and spontaneous interactions. However, the children’s behavior could be different in everyday situations and furthermore, interactions with unfamiliar adults, child, or group may yield a different profile.
However, there is a substantial void in the literature with regard to typical development, and especially in the age group in the current study. This void necessitated the current analysis and furthermore, studies conducted in populations with di-fferent age groups and profiles are indicated. Future research must address the correlation between verbal communication skills and pragmatic skills discussed in the current study in order to better understand the role of verbal communication skills in on communicative effectiveness.
FINAL COMMENTS
Based on data from the current study, 6-8 year old children with typical language development present with a pragmatic
profile characterized primarily by dialogic and regulatory skills during interactions with a familiar communicative partner.
ACKNOWLEDGEMENTS
The São Paulo Research Foundation (Fundação de
Amparo à Pesquisa do Estado de São Paulo – FAPESP)
provided financial support for this research in the form of undergraduate scientific scholarship #2009/00682-9.
* CMA was responsible for data collection and tabulation, and for writing the manuscript; ACB contributed with literature review, data collection and manuscript elaboration; AB contributed with data collection and manuscript elaboration; GJKF contributed with data analysis and manuscript elaboration; SALH supervised the development of the study and manuscript elaboration.
REFERENCES
1. Acosta VM, Moreno A, Ramos V, Quintana A, Espino O. Avaliação da linguagem: teoria e prática do processo de avaliação infantil do comportamento lingüístico infantil. São Paulo: Santos; 2003. p.279-80. 2. Mayor, A. La pragmática del lenguaje: consideraciones para la
intervención. Leng Comun. 1991;7:17-21.
3. Zorzi JL, Hage SRV. PROC: Protocolo de observação comportamental: avaliação de linguagem e aspectos cognitivos infantis. São José dos Campos (SP): Pulso Editorial, 2004
4. Lopes-Herrera SA. Habilidades comunicativas verbais em autismo de alto funcionamento e síndrome de Asperger. [dissertação]. São Carlos: Universidade Federal de São Carlos - Centro de Educação e Ciências Humanas; 2000.
5. Bretanha AC. A influência da extensão do corpus linguístico no levantamento do perfil comunicativo pragmático infantil [dissertação]. Bauru: Universidade de São Paulo, Faculdade de Odontologia de Bauru; 2011.
6. Hage SRV, Resegue MM, Viveiros DCS, Pacheco EF. Análise do perfil das habilidades pragmáticas em crianças pequenas normais. Pro Fono. 2007 Apr;19(1):49-58.
7. Cervone LM, Fernandes FDM. Análise do perfil comunicativo de crianças de 4 e 5 anos na interação com adulto. Rev Soc Bras Fonoaudiol. 2005;10(2):97-105.
8. Tjus T, Heimann M, Nelson KE. Interaction patterns between children and their teachers when using a specific multimedia and communication strategy: observations from children with autism and mixed intellectual disabilities. Autism. 2001 Jun;5(2):175-87.
9. Miilher LP, Fernandes FDM. Análise das funções comunicativas expressas por terapeutas e pacientes do espectro autístico. Pro Fono. 2006 Dec;18(3):239-48.
10. Lopes-Herrera SA, Almeida MA. O uso de habilidades comunicativas verbais para o aumento da extensão de enunciados no autismo de alto funcionamento e na Síndrome de Asperger. Pro Fono. 2008;20(1):37-42.
12. Brinton B, Fujiki M. A comparison of request-response sequences in the discourse of normal and language-disordered children. J Speech Hear Disord.1982 Feb;47(1):57-62.
