Communication is a vital part of livelihood, so these types of expressive language are a huge part of everything we do. It starts at birth and continues until almost our final breath. Infants cry from the moment they are born, signaling some sort of need or distress. Their needs are met based on the type, volume, and intensity of their cry. This is why we as occupational therapy providers, and other readers of this site (parents, educators, other therapy providers, etc.) can use this information in supporting the kids we live with and work with. It’s the social skills aspect that helps to shape the foundation for other areas of development.
We wanted to include examples of how you can document when these different types of communication are used in therapy sessions, so be sure to look at the documentation examples below each communication type.
Having an understanding of communication types is important for occupational therapy and other therapy professionals for documentation purposes. We can use these types of communication with our clients, and it’s important to document that.
When we think about communication, we think about talking. Speech therapy is highly sought after due to the number of people who can not communicate. Talking is just one form of communication. Let’s take a look at all the different types of communication and what we can do to foster them.
TYPES OF COMMUNICATION
How many different types of communication can you think of beyond the spoken word? Since spoken language is one of the highest levels of communication, it is what we consider when thinking about types of communication. This is so important because when there are sensory needs, behaviors, or any type of challenge with daily functional tasks, we can see a lack of meeting specific needs. That’s where the self awareness piece comes in. You’ve seen the behavior iceberg imagery before, right? When we see behaviors, below the iceberg are underlying needs. Those needs are often not communicated and so what we do see is the behaviors or emotional outbursts. Self-awareness plays a major role in self-regulation skills and knowing when and how to implement self regulation strategies that support the individual’s needs.
However, there are many other ways to get our wants and needs met than just using our voice.
There is verbal and non-verbal communication as two broad categories.
- Verbal communication is the way we talk to communicate needs.
- Non-verbal communication is a huge category that needs to be broken down into different subcategories to do it justice. There are eight different types of non-verbal communication.
Related, is receptive language. Together these language types impact auditory processing and attention and play a huge role in overall language in social skills.
NON-VERBAL Communication
Nonverbal communication can be difficult for our therapy kids (and all of us) to understand and recognize. There are several types of nonverbal communication:
- Body language
- Gestures
- Paralinguistics (loudness of voice)
- Proxemics (personal space)
- Eye gaze
- Hepatics
- Appearance
- Artifacts
All of these types of nonverbal communication types require insight and awareness. Autistic individuals in particular and other neurodivergent can really struggle with this awareness. You can support this need with self awareness activities and self awareness games.
This information can help our kids that we work with by using the different types, depending on needs, when it comes to visual schedules and other tools.
These communication types can support social and emotional development skills.
Body Language
Body language is a powerful type of communication. It can help us understand others. It helps us understand how people are feeling. You can use body language to express intention. Research suggests we make certain judgements about a persons’ intelligence based on facial expressions. Having body awareness is part of this. If you’re not sure where your body is in space, then it’s difficult to use it in communicating wants and needs.
Eye contact (or lack of it), crossing your arms, stepping closer or further away, facial expressions (smiling, frowning, surprise), stiffening your body, melting into the floor, and yawning are just some types of body language.
Some lesser-known types of body language signals are; pupil size, blinking, and biting the lips. The absence of body language or facial expressions can signal communication also.
Documentation Example for Body Language:
“During the session, (the student) was engaged in a group activity to encourage social interaction. She used body language and gestures to communicate with peers, such as nodding to show agreement and waving to greet others. She also used her hands to demonstrate actions like “come here” and “stop.”
Gestures
Gestures are like sign language but less precise or formal. Think about the kind of gestures you use daily. This may be intentional, or subconscious. Some gestures are universal, while others might be more cultural or geographic in nature (be careful about using certain gestures when travelling)
- Waving hello or goodbye
- Giving a high five
- Pointing to something
- Nodding or shaking your head
- Stomping your feet
- Clenching your fist to indicate anger
- Thumbs up or down to indicate approval or disapproval
- The “ok” sign to signal everything is alright. In some parts of Europe this signal means you are nothing, and in some South American countries it is a vulgar gesture
- The “V” sign means peace or victory in some countries, but in the United Kingdom and Australia it is takes on an offensive meaning when turned backward (like showing the middle finger in America)
- Showing the middle finger – in the US this is a powerful gesture. It shows clear meaning of unhappiness and is meant to be quite offensive
Check out this article on Cultural Differences in Non-Verbal Communication.
Documentation Example for Gestures as Communication
“The client was guided through an obstacle course designed to improve his balance and coordination. The therapist used gestures and visual cues to direct the client through the course. The client responded to these non-verbal cues effectively, following the therapist’s hand signals to climb, jump, and crawl. He also used gestures to communicate his needs, such as pointing to a water bottle when he was thirsty.”
Paralinguistics
This is the tone of voice or loudness. Not necessarily spoken word. Screaming, grunting, yelling, crying are forms of communication. With language, tone of voice can convey a message.
How to document paralinguistics in therapy sessions
“(The client) participated in a storytelling activity where he was encouraged to adjust the loudness of his voice based on the context. The therapist provided feedback on using a louder voice when calling for attention and a softer voice during one-on-one interactions.”
Proxemics
Proxemics means personal space. Personal space is another type of non-verbal communication. There are different factors that influence how much space we believe belongs to us. Social norms, cultural expectations, situational factors, personality characteristics, sensory perception, and level of familiarity are just some of the factors. COVID had a big effect on personal space. Some people loved the six-foot barrier between people, while others found this difficult to adjust to.
Documentation Example for Proxemics:
“(The student) engaged in role-playing scenarios to learn about personal space. The therapist used visual aids and physical demonstrations to show appropriate distances for different social interactions, such as standing closer for friends and farther for strangers.”
Eye Gaze
People’s eyes can indicate a range of emotions. Steady eye contact can mean someone is being honest. Shifty eyes and avoiding eye contact are of seen as a sign someone is lying or being deceptive.
This can be especially misleading when people who have a social disorder such as autism avoid eye contact. Gaze and eye contact doesn’t need to be a goal, but documenting this can have it’s role.
Documentation example for Eye Gaze:
“(The student) participated in interactive games designed to encourage eye contact, such as peek-a-boo and follow-the-leader. The therapist provided positive reinforcement whenever he made eye contact during interactions.”
Haptics
Haptics are touches. Julia Wood in her book Interpersonal Communication writes that touch is used to communicate status and power. Higher status individuals tend to invade personal space more than that of lower status. Women tend to use touch to convey care, concern, and nurturance. Men tend to use touch for power or control over others. A caregiver’s touch has a strong influence on behavior and social interaction in babies.
Tactile defensiveness plays a major role in this form of communication.
Documenting Example for Hepatics:
“(The student) was involved in activities that incorporated touch, such as high-fives, handshakes, and patting on the back. The therapist modeled appropriate touch and explained its use in different social situations.”
Appearance
Choice of clothing, hair style and other appearance factors are also a type of communication. Appearance can alter judgements, interpretations, and physiological reactions. We make first impressions about how someone looks.
Documenting for appearance as a communication form:
“During the session, (the student) was guided through activities related to personal hygiene and appearance, such as brushing hair and selecting weather-appropriate clothing. The therapist used visual schedules and modeling to teach these skills.”
Artifacts
With the rise of online presence objects and images are types of communication that can communicate without language. You might use an avatar, a meme, or emoji to convey a thought or impression. Wearing a particular uniform or badge says something about you.
Documentation example for artifacts:
“(The student) used various artifacts, such as picture cards and a communication board, to express his needs and preferences. The therapist guided the student in selecting and using these tools during activities.”
Forms of NON-VERBAL COMMUNICATION
There are various forms of communicating through nonverbal communication as well. This is how we relay our needs and wants without speaking. This includes sign language and use of electronic devices, written work, and other means like facial expressions.
SIGN LANGUAGE
Sign language is considered a form of non-verbal communication. It is based on visual cues through the hands, eyes, face, mouth, and body. Sign language combines body language and gestures. Some sign language gestures are universal, however just as there are different types of spoken languages, there are many types of signs.
NON-VERBAL COMMUNICATION THROUGH ELECTRONIC DEVICES
Non-verbal communication in a digital world is becoming more important than ever. Electronic devices combine written communication, pictures, and symbols. There are several types of assistive technology devices that are used for non-verbal communication. These range from low tech output such as a read aloud book or choice board, to a dynamic machine with layers of words and phrases. These can be accessed by tapping on the screen/board, or through eye gaze technology.
If your child could benefit from a speech generating device, there is a process to follow with a specialized therapist and assistive technologist. This includes trials on different types of devices and training. Occupational Therapy and Speech Generating Devices is a helpful article to understand the role of AAC in therapy.
Documentation Example when Using ACC
(“The client) was provided with an AAC device to assist in expressing her needs and choices during therapy. The therapist programmed the device with simple phrases and images relevant to the session activities. The client used the AAC device to indicate her preferences, such as selecting the “play with blocks” icon and saying “more” through the device when she wanted to continue an activity.”
Types of VERBAL COMMUNICATION
There are two types of verbal communication, written and oral. Both convey messages.
WRITTEN WORDS
The written word can be a powerful tool to convey a message. It can be used to write stories, emails, texts, messages, articles, and more. It can be helpful when communicating between people who cannot communicate with spoken language. Pointing to a written item on a choice board or menu is an effective method to get your wants and needs met.
Written words can also include pictures, symbols, picture exchange cards, and photos to convey a message.
With the invention of Google Translate and other language apps, it is now possible to communicate in different languages with each other. This has proved especially helpful in cities where there are many cultures in one area.
Written communication, like any other types of communication can cause misunderstanding. There may be a delay in getting an answer, or difficulty getting the message across. Over written communication there are often difficulties interpreting feelings and meanings behind the text. Without facial expression, gestures, and body language, it can be hard to figure out the meaning of a message.
Documentation example for written communication
“(The client) participated in activities aimed at improving his handwriting skills, such as tracing shapes and writing simple words. The therapist observed and documented client’s progress in forming letters and maintaining proper grip on the pencil. The student also used written communication to express his feelings about the activities, writing words like “fun” and “hard” to describe his experiences.”
ORAL COMMUNICATION
When we think of communication, verbal language is what we often think of. This is a high level of communication and takes years to master. It starts with cries, babbling, and putting words together. Once this is mastered; storytelling, vocabulary, semantics, grammar, and pragmatics are developed. Oral communication can be between two people, to a large group, in a speech or television program, discussion, on the telephone, video conferencing, or a meeting.
While the output is similar in different types of oral communication, non-verbal communication plays a big part in the setting. For example, a phone conversation might not convey much non-verbal language, where a video conference or meeting would. A teacher uses a different volume and tone of voice than a store clerk.
Documentation Example for Verbal Communication
Verbal communication will be used a lot during therapy sessions! Here is an example of how you can document this means of communicating that occurs in therapy sessions:
“During the session, the client was encouraged to verbalize her feelings and choices. She was asked to describe her favorite toys and the activities she wanted to do. The client responded verbally with single words and short phrases, indicating her preferences and emotions. For instance, she said, “I like the red car” and “I feel happy.”
LISTENING IS A FORM OF COMMUNICATION
Is listening a type of communication? Yes. It is often overlooked because we are so busy trying to get our message across. Listening is important for two-way conversation. Being able to listen can be a difficult skill. You may find yourself thinking about what you want to say rather than really listening to the sender. This is not active listening. You may hear what is being said, but are not processing it fully. A good conversationalist is not only a great speaker, but also able to listen. At the same time, the speaker needs to read cues and take breaks to let another person take a turn.
OT TOOLBOX RESOURCES ON TYPES OF COMMUNICATION
- Expressive Language
- Turn Taking
- Communication Disorders Archives
- Receptive Language
- Self Reflection resources
A WRAP UP of THE TYPES OF COMMUNICATION
Take some time to look around you and process all the types of communication happening at once. Just because your child is not verbal, does not mean they are not trying to communicate in some way. Sometimes they are not using the most effective way to communicate like spitting, or hitting, but they are getting some message across. Take time to acknowledge what they are trying to convey and give them tools to make better choices in terms of communication. There are so many options out there, with a lot of trial and error you are bound to find some combination that allows your child to get their wants and needs met.
Victoria Wood, OTR/L is a contributor to The OT Toolbox and has been providing Occupational Therapy treatment in pediatrics for more than 25 years. She has practiced in hospital settings (inpatient, outpatient, NICU, PICU), school systems, and outpatient clinics in several states. She has treated hundreds of children with various sensory processing dysfunction in the areas of behavior, gross/fine motor skills, social skills and self-care. Ms. Wood has also been a featured speaker at seminars, webinars, and school staff development training. She is the author of Seeing your Home and Community with Sensory Eyes.
