This Week’s Podcast

Brookes Barrack is a Speech-Language Pathologist and DIR-Expert Training Leader who has a clinic just outside of Kansas City, Kansas with Occupational Therapist Emily Tritz called Kansas City Developmental Therapies where they offer DIR services. This summer they became an official accredited DIR Organization. She originally trained in Floortime at ‘the Bunker’ with Drs. Greenspan and Wieder in Washington, D.C. and in the PLAY Project with Dr. Rick Solomon back at his home. This episode we are discussing Gestural development : The D, The I, and The R.

Gestural Development: The ‘D’, the ‘I’, and the ‘R’

by Affect Autism

Setting the Stage

I set the stage for this episode by referring to the podcast I did with Gene Christian on Preverbal Affective Signalling and how important it was to Dr. Stanley Greenspan in his teachings of DIRFloortime. Brookes says that gestural communication is something she barely touched on in graduate school. Until she had the gift of Floortime training, especially with her mentor Sherry Cawn, doing video reflections, she truly didn’t understand the importance of gestures.

Brookes’ mentor would always say, “Tell me about his gestures” and she would wonder why it was so important because for years, as a working speech-language pathologist, she would check off the boxes on a standardized assessment during a language assessment talking to families hearing that kids weren’t waving or pointing, but didn’t do anything with that information. It didn’t lead her to further wonderings until Brookes started diving deep into DIRFloortime.

Brookes slowly realized that she was missing so much by excluding gestural communication and even now in her practice, she has a lot of field work graduate students who also say they haven’t learned much about gestural development. A lot of caregivers notice that their neurodivergent or autistic child wasn’t gesturing in the same way as siblings, for instance. Brookes says that looking at gestural development can help us support language because there’s a lot that gestures do for communication, and also to support working memory and long-term memory.

What are gestures and how do they develop?

Brookes explains that a gesture is just a movement of the body or limbs that expresses or exercises a feeling or idea. It’s an image in material form and she wants us to remember that definition for later. In predictive development, Brookes explains, it’s at between around 7 to 9 months when we see babies starting to gesture. Gesturing is easier for the body than the more coordinated motor plan of speech. If they’re representational gestures, we tend to see speech coming about 3 months later for that gesture. 

These gestures also bring in the ‘R’ (Relationship), too, because gestures develop with a caregiver. When a baby wants to be picked up, they reach both arms up and have a lovely back-and-forth with an attuned caregiver who picks up the baby. So the baby starts to learn that they have agency in this world. And so the more we as caregivers are responding to this development of gestures, the more we get the gestures back, Brookes explains. This is in the third Functional Emotional Developmental Capacity (FEDC) in the Developmental, Individual differences, Relationship-based (DIR) model. We always talk about how important this preverbal communication is before speech and language develop, and, of course, some children do not develop speech and language, but communicate in so many different ways.

Individual differences impacting Gestural Development

I shared that when I was getting questionnaires about my autistic son who’s now 15 and they asked if he points to things and look at you to show you what he’s looking at, I said that he did not, and then it must have been 4 or so years later when he started pointing at things. So a lot of times with this developmental model we see development unfold in these ways, but it might take longer in some kids and in my son, it’s been a lot longer of a process. But it still follows this developmental trajectory, even though it might look different. Brookes responded that we want to look at how a person’s ‘I’ (Individual differences) impact the developmental capacities.

Brookes went back to the example of the baby lifting up their arms for their caregiver to pick them up. Some kids might not have the postural control or the ability to sit up. Some may need both hands on the ground to be able to sit up, but you can’t have both hands on the ground and also bring them up. That doesn’t mean the child didn’t have the idea to reach for the parent, but at that time, this individual difference impacted the baby’s ability to do it.

This was a significant shift for Brookes in her thinking as an SLP, she shares. So if you answer on a questionnaire that your child is not pointing, then what do we do with that information? We want to wonder deeper about individual differences, Brookes states. It’s not that a child doesn’t want to communicate, Brookes says. It’s not that they don’t want to be part of a shared world with the rapid back-and-forth interactions. Something might be making that harder for them, so we want to know how to support it as caregivers. 

Relationship impacting Gestural Development

That’s where the ‘R’ comes in. When practitioners see some of these differences early on, then what can we do to support parents? Maybe we can see that the baby moved their eyes, but can’t yet move their whole hand. First, a baby moves their whole hand to point to something and then eventually you get that lovely distal point where it’s just the one finger, Brookes explains. If they can’t do that but they’re sharing some eye gaze, we as parents can then model it for them and interpret for them. So the more we can understand what gestures develop when and why, and for what purpose, then, the more we can help support parents and help support our own kind of therapeutic goals, Brookes states.

In his radio shows and writings, Dr. Greenspan talked a lot about how parents can think that their child isn’t interested because they’re not showing the development as expected, and so you kind of get this snowball effect where the parent stops engaging so much with the child, and then a child doesn’t get that interaction. And that can be like a self-fulfilling prophecy where the child doesn’t interact with you. What Brookes is saying is that we can educate parents and explore and be curious together about what the child is doing or not doing and notice those other cues like their eyes going up because they couldn’t move their arms up.

My little guy was a little butterball of rolls of chubbiness and cuteness. If I look back at old videos of him now maybe I see some signs of having a harder time doing certain things. The Occupational Therapists (OTs) always said he had a weak core because he was W-sitting instead of being able to have that strength to sit up. It’s different than strength because I could hold his feet and he could do a wheelbarrow walk, yet he slouches all the time. There are so many individual differences, Brookes says, that can impact gestural development. We want communication to be easy. Brookes is not looking for perfection.

My goal as a Speech-Language Pathologist is that every kid or team that I see feels like communication is easy and that they’re understood. Those are the primary things we should be working on.

Brookes Barrack, DIR SLP

Brookes is looking for meaning, and thinking about how to support children in their bodies and their ideation, and everything else. Individual differences like motor planning and praxis affect our ability to gesture along with postural control and visual-spatial skills because if we’re not watching others, it’s hard for us to take in that information because we can’t track. But relationship factors also impact gestural development. Think about parent attachment as well. If you have an insecure or avoidant kind of attachment, that child might be gesturing, but the parent might not respond, so the child stops gesturing. There are so many pieces that impact gestural development, and we can help parents understand what it is that the child is doing in a communicative way.

Holding Gestures Longer

Brookes says that if a child isn’t gesturing, we can hold our gestures longer. When playing with the child and you don’t know something, you can hold your hands up and shrug for a long time. Another piece about gestures that goes so well with Floortime is that you have to use affect. You can’t really gesture without using any kind of affect. It all goes together. Brookes says that sometimes people get confused with sign language and gestures and they’re very different, because sign and speech are stored and used in the same part of our brain, whereas gestures are in a different part.

Gestures allow us to fire up more of our brain, Brookes says. She took years of sign language as a student and worked in a deaf hard of hearing classroom. There was a teacher of the deaf who was deaf and one of the best paraprofessionals was a child of deaf adults. They were part of the deaf culture, and signers as their first language and Brookes could sign proficiently with them. When they told a story or read a book, they use more of a gestural type of communication and due to that affect, Brookes didn’t even need to know all the signs because the gestures helped her understand.

It’s not just the child gesturing for communicative intent, Brooke says. When we gesture, it helps the child process language better and process communication better, so we’re supporting their understanding, not just their expression, Brookes declares.

Related Podcasts

The Importance of Preverbal Affective Signalling with Gene Christian

Pre-linguistics are Pre-Social Abilities with SLP Mary Beth Stark

The Building Blocks of Motor Planning with OT Maude Le Roux

All About Praxis Part 1 and Part 2 with OT Joann Fleckenstein and LPC Mike Fields

Physical Therapy Part 1 and Part 2 with PT Mary Beth Crawford

And Interdisciplinary Approach

Brookes is so aware of so many factors as an SLP which speaks to the fact that this is an interdisciplinary approach that really helps parents. As a parent, I commented that not many parents have an education on child development. I have one child and I’ve only ever had one child, so I watched my child develop, and didn’t know if it was different than other kids or not. I could see that my child was fussier than the other kids in my mother’s group.  I knew he needed to move and later learned that his vestibular system really needs that input and his proprioceptive system needs input, so it’s so helpful to have this knowledge through a DIR approach.

DIR practitioners look at the why behind the behavior presuming competence, so wonder what’s preventing someone from doing something like communicating through gestures. Brookes says that often the Speech-Language Pathologist (SLP) is the first therapist who is contacted because parents want their children to speak. Often she will look at what needs to be done first developmentally, and sometimes her clinic takes a lot of Medicaid and insurance families, so they have to justify their therapy to those insurance companies. If families have to choose between therapies, sometimes Brooke will advise that they choose Occupational Therapy or Physical Therapy first.

The other therapist may need to look at what is happening with the motor planning system and the whole body picture. Thinking about what we do to help support parents, Brookes continues, oftentimes depends obviously on individual differences, but as a whole, she wants to look at the deeper why about why she thinks they’re not gesturing.

Supporting Parents

Brookes will educate the family on typical gesturing and have them do bigger, whole body gestures. She’ll get them to do many different kinds of gestures to begin with that grab attention, called deictic gestures. These are simple gestures such as when you look at the light, point to the light, and then label the light, or when you go outside and the dog walks by and we point to the dog and label it. The toddler may then start to point and say “dog” and eventually two-word phrases. 

Those kinds of gestures start first, Brookes explains, and then we go into more representational or symbolic gestures like putting your finger up to your lips and saying, “Shh” or when you change the baby’s diaper you wave your hand in front of your nose and say, “Whoo, it’s stinky!” Those are more symbolic, so we want them understanding how gestures develop what they look like as they develop. Next, Brookes continues, we want them understanding their child better to know what is happening. 

Brookes will also introduce a beat gesture where you’re talking and emphasizing language with your hands. The research on beat gestures says that when children use them, they show better narrative skills later. Watching the child gives Brookes information about where to support the parents whether it’s using more gestures or modelling gestures for them, or holding that gesture for longer. Parents tell her it’s working when they try, but they feel silly going around the room and/or outside pointing and holding a gesture using that affect while waiting. 

Brookes reminds us of the definition she shared earlier about a gesture being an image in material form, because once you speak, it’s gone and you have to mentally picture it. A gesture, on the other hand, can stay, so that’s one way we can support this is by telling families to use gestures more. Also, she helps them interpret what the child is doing with their body to communicate in order to interpret their gestures and make them meaningful to the parent.

Gesturing Supports Academics 

What Brookes finds so interesting about gestures is that they support us across a lifetime and we know this because they also there’s been lots of research that shows gestures can help support working memory and also can support long-term memory. We even know that if teachers are using more gestures when they’re teaching, it can support reading comprehension and even mathematics learning. This is so interesting because by holding the gestures and making the communication more meaningful with the affect, it helps the child make the connection and remember it better.

I’m willing to bet that a lot of kids like the teachers who use a lot of gesturing and affect, especially when they’re younger. Brookes shares that there is research using fMRI that demonstrated a change in the brain after implementing the Visualizing Verbalizing program. Parts of their brains were talking to each other that weren’t before. It’s a reading comprehension approach to help support concept imagery, Brookes explains because when reading, you should be making a movie in your head, which is the concept imagery.

It goes back to meaning making and how we have to have this imagery in our head, and then we get to play around with that imagery. It’s what locks us in and we can be in a different place, yet still remember. One way you can tell if a child is using concept imagery is that they start gesturing, Brookes shares. The research shows we are using a different part of our brain when we’re visualizing information and using a visual motor representation, which is a different part of our brain than speech. We need to activate working memory. A gesture allows us to hold on to the image and that’s what long term memory is, she says.

If we can use more gestures as parents or ask our kids to, we can see it having a role affecting working and long term memory. In fact, there’s research from SLP Sarah Ward in Boston who is an expert in executive functioning. You can tell a child to go upstairs and to put their pajamas on. If you instead ask them to ‘show and tell’ you their plan, they have to gesture it. They need to repeat back that first they are going to take their clothes and throw them in the hamper, then shower, then get their clothes out for the next day, put them on their bed, and get ready for tomorrow. This is different and they’ll probably remember it better because it’s firing up a different part of the brain.

Neurodivergent Parents

I asked Brookes about neurodivergent parents who may not gesture as much and so their children not only don’t have the same predisposition, but also aren’t getting that gesturing from the parent. Is it ableist of us to tell them they need to gesture more or are we just promoting gesturing to support their communication? We know that the neurodiversity movement is so relatively new and evolving since Neurotribes came out, and there’s so much information now on neurodiversity-affirming care, but there’s not a lot of research on autistic development, per se. We hear self-advocates saying that they develop differently. Is development just development for all humans?

In DIR we tend to believe that it can look very different for different individuals, and even so, that we all go through the same developmental process, although this is still to be determined in the research field. We believe it is neurodiversity-affirming in that we are respectful and do not force anybody to look neurotypical, respecting individual differences and wanting to empower everyone to communicate more readily. Brookes says that her goal is communication as an SLP. She will take any communicative effort she is given and say it’s intentional and meaningful.

If she has a child who is nonspeaking using a device, she won’t make them use her conventional gestures. They may struggle with praxis and use gestures of their own. She believes it is up to her to understand the client’s gestures and the meaning behind them through a strong Relationship. She honours that, and in that way she is being neurodiversity-affirming, she says. And when she talks about using gestures for working and long term memory, she can suggest to just try it. Even for caregivers, Brookes continues, she can suggest using more gesturing and just seeing how it feels.

Executive functioning is big now, Brookes continues, and we want to think about how to support that as well, she says. It’s just another modality and another piece of the gestures. The more we can give supports in visual form to everyone, the more we’re supporting their comprehension, which is support for regulation, she says.

Everyone wants to understand what’s going on in the world, and if we don’t, we tend to dysregulate.

Brookes Barrack, DIR SLP

DIR and Gestures

Brookes believes that the best part of DIRFloortime is that the evidence is not just rooted in blind studies, but it’s looking at all the other research that support it. When she looks at therapeutic goals and supporting parents, she examines what she is doing to support imagery throughout development, and supporting it through gestures is just one component. If she uses it in the earlier Functional Emotional Developmental Capacities (FEDCs), it will support her clients in their higher capacities. Holding the gesture longer, and using affect to hold that space is a part of that piece of emotion driving development, she says.

I shared that when I think about holding gestures for a longer time, I think of Dr. Gil Tippy putting his hands out to promote the child coming up with the next thing. Let’s all think developmentally about that deeper why, Brookes says. Thinking about that gestural development helps us chase the why and look at those individual differences and keeps us neurodiversity-affirming since all individuals are so unique and bring different things to us, Brookes says. I added that you you can’t teach developmental capacities as skills. I love how this model pulls so much from different disciplines into a theory that guides how we use all the information. And this podcast episode certainly gave me another way to think about it.

This week’s PRACTICE TIP:

This week let’s practice gesturing with our children using a lot of appropriate affect. 

For example: Let’s try to point to things, gesture getting undressed and dressed, washing our body, and eating by bringing our hands to our mouth like we are putting a spoonful in our mouth. Let’s match our affect to co-regulate appropriately. That is, if our child is too upregulated, let’s exaggerate slow, quiet affect. If our child is not as responsive, let’s get bigger and a bit louder while still being slow and intentional with our gestures.

Thank you to Brookes for covering gestural development with us in such great detail and with such great tips for caregivers! I hope you found it as helpful as I did and will consider sharing this post on social media.

Until next time, here’s to choosing play and experiencing joy everyday!

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