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This article is the third in a series about helping your child with a visual impairment who has delays in the development of communication skills. This article focuses on the transition from single words to the use of word combinations.

Different categories of meaning are represented in a child’s first 50 words. The following are examples of meaning represented by single words. These single words will be combined in this stage of development to represent more complex information.

  • People’s names: Mama, Mary, Mickey
  • Food and drinks: Banana, juice
  • Social words: Hi, bye-bye, thank you
  • Animals: Doggy, kitty
  • Toys: Ball, swing
  • Vehicles: Car, trike
  • A daily living activity: Bath, eat
  • Clothing: Shoe, hat
  • Body parts: Head, tummy
  • Descriptive word: Hot, big, outside
  • Actions: Go, up

Another way to think about these words is to place them into categories based on their meaning. These categories are the foundation for word combinations. Young children use categories of meaning to build their phrases before they use sentences and grammar rules. Here are some examples of groupings using the categories above and other common categories:

  • Agents: People, animals, toy characters
  • Actions: Verbs including daily living activities and play
  • Objects: Food and drinks, vehicles, furniture, clothing, body parts, toys
  • Locations: Some descriptive words like “out” or “outside,” furniture, places
  • Descriptors or modifiers: Descriptive words like “hot” or “big”
  • Social words: Greetings and other social ritual words like “thank you”

The words in these categories of meaning can be combined to create new and expanded meaning. In other words, a single word like “cookie” expresses meaning that is different from “more cookie” or “my cookie” or “all gone cookie.” There are simple rules about how we combine words. The rules here are based on English word combinations, though other languages often have similar combinations at this phrase level. Here are some of the common rules with the addition of some new semantic categories.

  • Agent + Action: Daddy go; dog bark; Mickey sing
  • Action + Object: Throw ball; eat cookie; get shoe
  • Object + Location: Dolly bed; cat chair; (garbage) truck outside
  • Action + Location: Put couch; go outside; ride (to) park
  • Modifier + Object: Hot soup; big ball; noisy toy
  • Recurrence + Object or Action: More cereal; more swing; tickle again
  • Negation + Agent, Object or Action: No juice; no Daddy (Daddy’s not home); no bath
  • Social Words + Name: Hi, Mary; Bye-bye, Grandma; Thank you (teacher)

There are also rules or patterns for combining three words. Here are a few examples:

  • Agent + Action + Object: Mary throw ball
  • Action + Modifier + Object: Throw big ball
  • Action + Object + Location: Put pillow bed
  • Negative + Action + Location: No go school
  • Action + Recurrence + Object: Want more juice

The development of language skills from a single-word vocabulary to word combinations helps to expand meaning. Using word combinations, your child can learn to describe an experience in more detail and share stories with others by having “mini-conversations.” Just imagine how you and your child might feel when she tells Grandma and Grandpa about her trip to the park using new word combinations: “Go [to] park. Big slide! Go fast.”

Using Expanded Meaning to Communicate More Specific Messages

When words are combined to express meaning, your child will describe more of what she experiences and will demonstrate increased understanding of her world. The same word combinations that describe or identify objects also can be used to communicate needs and wants, seek attention, and increase social engagement. Word combinations also allow your child to comment about items, activities, and experiences that they notice and enjoy in social contexts.

Here are examples of word combinations that follow the patterns described above that you can model when you support your child’s ability to communicate a variety of intentions (messages):

  • Gain attention: “Look, Mom,” “Daddy look,” “Come Mary”
  • Tell what she wants or needs: “Want juice,” “more cereal,” “want big ball,” “big bubble,” “want bubble bath,” “blankie bed”
  • Tell what she wants to do: “Wash hands,” “go play outside,” “watch movie,” “find music ball,” “push again”
  • Tell what she doesn’t want: “No juice,” “no go,” “all done snack,” “no wash face”
  • Socially engage with people: “Hi, Mary,” “Bye-bye, Grandpa,” “Thank you, Terry”
  • Tell how she or someone else feels: “Jane mad,” “Dora sad,” “Jane happy”
  • Tell what hurts: “Owie hurt,” “tummy hurt,” “ouch head”

Tips for Supporting the Development of Word Combinations in Children Who Are Blind or Visually Impaired

If your child has begun to combine words from her expressive vocabulary, you can help support the development of new word combinations by understanding the different semantic categories and combinations that are developmentally appropriate. You can also continue to support your child’s communication of her intentions by modeling word combinations that also express her needs and wants and help her engage socially. There are usually three main goals for the development of word combinations:

  • Teach new word combinations (increase the number of two- and three-word combinations she uses).
  • Support the message or intent of the word combinations (teach word combinations that communicate wants and needs).
  • Teach the use of the word combinations in different settings and activities and with different people (to help the skill generalize).

Here are some tips for helping your child meet these goals:

  • As you observe and interact with your child, continue to use word combinations to label or describe the social and non-social aspects of her experience and context. Pairing the word combinations with the experience helps establish expanded meaning and prepares your child to use the combinations to communicate her intent.
  • Anticipate your child’s needs by reading her nonverbal behaviors and modeling words that might express those needs: “You want more X” or “You want to (action) outside” or “You don’t want more Y” or “You want the big Z”.
  • Create daily routines where the same vocabulary can be modeled multiple times a day. You can also create or use action routines in play. For example, if you have a tickle or chase game, you can use words such as “tickle again” or “ready or not” and “here I come.” There are also word combinations in songs and rhymes. You can pause in the middle or at the end so your child might “fill in the blank” or initiate the routine again. Share the typical word combinations and the routines you’ve developed with friends, family, caretakers, and teachers so your child can experience them in different settings and with different people.
  • When modeling a word combination that you want your child to learn, be sure to say the words at the moment your child seems to be attending to you or the object while they are touching or listening or experiencing an activity in other ways.
  • There are two ways you can teach word combinations:
    • Provide a model and wait for your child to spontaneously imitate the words: Say the words, then pause and allow your child time to process the meaning. If your child does not imitate the words right away, repeat the words and then add more language.
      Example 1: “More juice” [pause/wait] “More juice. You want more apple juice.”
      Example 2: “Roll ball” [pause/wait] “Roll ball. Here comes the ball.”
    • Direct your child to repeat the words following your model: Give a direction, asking her to imitate your model.
      Example 1: “More juice. Say ‘more juice.’”
      Example 2: “Roll ball. Say ‘roll ball.’”
  • You can also model the first word of the combination and then pause and expect your child to fill in the rest. For example, “You want to swing some more? More ______. ”
  • As you may have done with single words, you can offer the first sound or syllable of the word you are modeling. “More…sw…Yes! More swing.”
  • Reinforce all your child’s attempts at imitating the word combinations you have modeled. Example 1: “Yes. More juice. You want more apple juice!” Example 2: “Good. Roll ball. Here comes the ball.”
  • Choose the word combinations that help your child meet her communication needs. For example, model word combinations that would allow your child to request a specific object/item (“apple juice” or “big ball”) or an action (“go out” or “jump up”) or assistance doing something (“help open”). Learning word combinations that communicate intent (needs, wants, social interaction) is more powerful than learning to label or describe (“It’s a blue ball. Blue ball.” Or “There are three blocks. Three blocks.”)

As your child develops her first word combinations, you will most likely feel more connected with your child and feel like you can meet her needs more easily. Combined words will provide additional and more specific information. Once a child learns to combine words, she can talk about her world and her needs and wants in a more complex manner. There are so many possible word combinations that new phrases can develop every day. This skill helps build the foundation for true sentences, the next step in development.