Research by Spence & DeCasper in 1986 indicates that, before birth, babies can hear and recognise their mother’s voice. During pregnancy when mothers repeatedly recited stories aloud, following birth their neonatal sucking pattern changed on recognition of their mother’s voice demonstrating their ability to differentiate their mother’s voice from two other story tellers (Zigler & Stevenson 1993).

Several studies in the 1970s demonstrate that neonatal imitation is a ‘robust phenomenon’ that can be observed from birth (Heimann 1998). This is believed to be due to their innate social motivation to interact, especially in a face-to-face position (Heimann 1998), which takes place within what Kugiumutzakis(1998) describes as the neonatal–maternal ‘intersubjective companion space’.

The speed and complexity with which infants combine words varies and is generally based on their need to get things done, to involve others or to comment. Emphasis in first sentences is usually placed on the main object requested, e.g. ‘book ma ma read’. Communication increasingly becomes a means of exploration and development of personality. Children then use language to share their new experiences with us. Language enables children to think in a symbolic way, which is the principle underpinning learning words using pictures in books and surroundings. Symbolic language is very important for children who have communication difficulties associated with deafness or blindness (Whitehead 2000). Sign language and touch are essentially symbolic, enabling children who are hearing or sight impaired to make sense of their experiences, observations and feelings as they interact socially with others.

By the age of two, children have become talkers or signers and communication enables infants to explore who they are (Bruce 2001) and where they fit in the bigger picture. Between 2 and 4 years of age children start to improve their grammar, sorting out singular and pleural differences and past tense by adding ‘s’ and ‘ed’ (Williams, 2003 and Zubrick, 2007). Whitehead (2000) states that spontaneous errors created as the child tries to correct early words, e.g. mouses and goed, are evidence of the ability of a child’s mind to process and produce the rules of language.

In the preschool years, children start to use joining words (‘because’, ‘and’, ‘if’) as they begin to understand cause and effect, sequencing of events, trial and error (Whitehead 2000). Their increasing ability to use words like ‘why’, ‘how’, ‘where’, ‘who’ and ‘what’ is essential to their cognitive development.

Edwards (1998) emphasises that other ‘relational motivations’, which develop from an early stage, take interaction beyond the boundaries of attachment as the child begins to engage in meaningful reciprocal communication within small groups. The child’s vocabulary increases to include words that enable him or her to share feelings and to explore how others are feeling. Dunn (1998) conducted longitudal research, which measured the child’s ability to correctly interpret emotions (happiness, anger, fear, sadness) related to various situations. This evidence, outlined below, is vital to the promotion of child and family attachment.

The results suggest that personal experience and interest in how parents interact with siblings plays a key role in the development of emotional understanding. Further observation of the children over the next few years revealed that, between 33 and 47 months, talk about feeling to siblings quadrupled while talking to mothers declined. This study reflects the speed at which children develop the capacity to interact with others who, unlike a mother, may not always respond sensitively to them.

Zubrick et al (2007) undertook research to identify factors associated with Late Language Emergence (LLE) beyond 24 months. In a large longitudinal study 1880 (85% of the 2224 participants) returned completed questionnaires providing information on family, maternal, child characteristics and social/economic data. They also answered specific information on the infant’s language development. The results suggest the following factors may significantly increase the likelihood of LLE in an infant:

• a family history of LLE

• being born into a larger family

• neonatal low birth weight or born before 37 weeks gestation.

Surprisingly maternal characteristics (age at childbirth, employment, education, smoking, level of stress or depression) or family functioning demonstrated no statistical significance. Zubrick et al (2007) conclude that neurobiological and genetic factors are stronger determinants of LLE than maternal and family psycho-socioeconomic factors.

Once the child starts school, language development is increasingly influenced by the wider social, cultural experience and literacy. Increasing diversity of experience influences social and moral development characterised by the child’s attitude and behaviour towards others. Studies by Braten (1998) support the theory that children who, when distressed, have been recipients of affective care will respond caringly to others in distress. Studies show that children who have been victims of neglect or physical abuse are more likely to demonstrate indifference, fear or aggression (George & Main 1979, Main & George 1985, Klimes-Dogan & Kistner 1990; all cited by Edwards 1998). Childhood influences are not always positive and as a result children learn to use swear words, foul language and give verbal abuse, presenting a challenge to their families, teachers and healthcare providers. A study by Wilson et al (2003) showed that children between 2 and 4 years commonly told lies to cover up wrong-doing or to control another person’s behaviour (Wilson et al 2003). Some children lie about their health to avoid going to school or undertaking daily chores. They may lie to conceal an illness or injury due to fear of painful interventions, e.g. tetanus injection, which could have serious implications.

The prevailing characteristics and attitudes in the family become the basis of unwritten rules, which are part of the child’s primary socialisation. The child can learn dysfunctional values and ways of communicating with others, which negatively affect the development of all members of the family (Friedman 1992). Dysfunctional communication in families is likely to influence how the child and family communicate with health professionals. Families who have closed dysfunctional patterns of communicating will have more difficulty coping, which may delay psychosocial recovery (Townley & Welton 2000).

The ‘company-they-keep’ hypothesis emphasises that adults who engage with children from an early age must recognise that they play a part in the development of prosocial or antisocial behaviour towards peers, which may continue throughout life (Edwards 1998). Modelling positive behaviour for the developing child is the responsibility of all those who work with children.

The ongoing development of good communication skills throughout the adolescent years is problematic if the acquisition of language and literacy are not well established at this point. David Bell, Her Majesty’s Chief Inspector of Schools, stated:

The maturity of the adolescent is closely related to communication. Problems with self-esteem may be the result of a whole range of issues related to schooling and family life. General lack of confidence and unhappiness about the onset of puberty also impacts on the quality of interaction with some teenagers.

Family communication patterns will either exacerbate or buffer adolescent stressors (Collins & Russell 1991). Saetermoe et al (1999) refer to several research studies that demonstrate that communication problems within the family affect health and well-being. Aggressive behaviour in children emerged as strongly linked to parental conflict (Davis et al 1998). Lanz et al (1999) conducted a large study that revealed that children from separated or divorced families had more problems communicating with their parents and peer groups than adopted adolescents from intact families. Lanz et al (1999) concluded that male and female adolescent self-esteem is related to how well parents interact with each other. Brown et al’s (2007) research findings indicate that parents who talk supportively to their children about parental conflict promote healthy adaptation as the child feels more emotionally secure. According to Morrison & Anders (2001) there is little evidence to support the myth of adolescence as an emotional storm and challenge for parents. Most adolescents maintain close and supportive relations with their parents and ‘embody parental values rather than oppose them’ (Morrison & Anders 2001 p 69).

It would appear that adults are too quick to label the ‘terrible’ teenager (Fig. 10.5). If adults consider challenging behaviour in teenage years as the norm can young people be blamed for this? Adolescent transition to adulthood is synonymous with vulnerability and this may present challenges for those who work with young people. The philosophical belief underpinning work with children should be respect for their values, and human rights (Jennings & Hickson 2002). Health professionals need to remember that adolescent physical and emotional transitional stress can be exacerbated by traumatic experiences that impact on the young person’s maturity, beliefs, attitudes, health, behaviour and communication. Competent use of age- appropriate communication tools is essential.