How Can Caregivers Best Support Their Infant’s Needs Through Natural Interactions?

I’m the mother of two boys, Chris and Michael. Chris, my oldest, is 4 and he recently received an autism diagnosis. Michael is my baby at only 8 months. Are there ways that I can work with Michael to help support his development in these early months?

Carolyn Crysdale MS, BCBA, LBA & Eilís O’Connell-Sussman MA, BCBA, LBA-NY
Institute of Applied Behavioral Science, Endicott College

Photographed by Wedding Fog (pexels.com)

Many foundational skills emerge and build off each other throughout the first year of life, which leads to expressive and receptive language. This period can be exciting for caregivers because learning occurs at a rapid rate; however, the first year of life is also when caregivers might notice delays in developmental milestones, which can lead to stress or uncertainty. Although some children may receive a diagnosis during the prenatal period, birth, or shortly after birth (i.e., Down syndrome; CDC, 2023), other families do not receive a diagnosis of a disability for their child until later in early childhood (e.g., autism diagnosis; Hyman et al., 2019). In fact, it has been established that having a sibling with autism increases the likelihood of receiving a diagnosis at some point in their life (Ozonoff et al., 2024). Whereas social communication and interaction deficits are among the first signs of autism (CDC, 2024; Downey & Mawby, 2023), caregivers may want to engage in proactive interactions to foster skill development typically absent in early childhood for children with autism. As will be described below, caregivers can be empowered to use different natural interactions with their baby that work best for their family to support their child’s language development.

Caregivers can foster healthy relationships and their baby’s development through numerous everyday interactions. For example, a growing body of research shows the importance of a caregiver’s response to their infant’s eye gaze, head lifting and turning, kicking, vocalizing, visual and auditory tracking, high amplitude sucking, grasping, touching, and more (Athari 2021; Gazdag & Warren, 2000; Gros-Louis & Miller, 2018; Kaplan et al., 2007; Kuhl & Meltzoff, 1996; Neimy et al., 2017; Neimy et al., 2020; Peleaz et al., 1997; Pelaez et al., 2011a; Pelaez et al., 2011b). In much of this research, parents and other caregivers respond to their infant’s behavior to foster language development. These responses are based on behavioral principles that involve the three-term contingency. This contingency involves something that occurs before the infant behaves (antecedents); what the infant does (behavior); and what happens after the infant behaves (consequences). Caregivers can utilize the three-term contingency within their social interactions with their infants to encourage and increase important behaviors related to language development. For example, caregivers can engage in a preferred activity with their baby (antecedent), and when their baby vocalizes (behavior), they provide a contingent response to that vocalization (consequence).

Eye gaze (e.g., an infant looking towards a caregiver) and babbling (e.g., “baba” or “mama”) are foundational for later language development and some of the first behaviors that caregivers can interact with to foster their infant’s skills. Using a three-term contingency within an infant’s preferred social interactions can increase the likelihood of the infant engaging in these behaviors again in the future. Families can use these simple strategies with their infants to ensure they support the development of foundational language skills. While developmental milestones may be reached at different age ranges depending on culture and disability (Friesen et al., 2014), these interactions can be differentiated by family preference, style, and timeline.

Increasing Eye Gaze

Photographed by Polina Tankilevitch (pexels.com)

Eye gaze typically develops in the first few months of an infant’s life and is an important building block for language skills. Eye gaze (also referred to as eye contact) is defined as a social interaction within a face-to-face context in which the infant’s eyes look at the adult’s eyes for at least one second. Eye gaze starts as direct eye contact towards caregivers and progresses to visually tracking items and people (Neimy et al., 2017). Deficits in eye gaze can potentially halt further learning in later social communication skills, such as joint attention (e.g., an infant shifting their gaze from an object to you) and social referencing (e.g., an infant shifting their gaze to you to gather information about the social context). Particularly, eye gaze is one of the first skill deficits to be identified when an infant has a disability, such as autism (CDC, 2023).

Caregivers’ responses to infants can lead to greater eye gaze (Kaplan et al., 2007; Pelaez-Nogueras et al.,1996). For example, research has found that caregivers can increase their infant’s eye gaze during face-to-face interactions by rhythmically rubbing the infant’s feet and legs while smiling and cooing at their infant when they look toward them. This interaction is done for as long as the infant is making eye gaze with the caregiver (see Pelaez et al., 1997). One simple strategy caregivers can use to increase their infant’s eye gaze is to simply smile, coo, and stroke their infant whenever they gaze toward them (see more in Table 1). An individualized approach is essential as infants vary in how they respond to these caregiver reactions. If eye gaze does not improve, caregivers might also try other interactions (e.g., smiling and cooing with no touch) until they find an interaction approach that increases their infant’s eye gaze. Caregivers can initiate this strategy during their natural, everyday interactions when they are face-to-face with their baby to ensure comfort for all. The timeline and relevance of working on this skill may differ depending on your family’s cultural beliefs and practices.

Increasing Cooing and Babbling

Many caregivers get excited when their baby first vocalizes. Infants begin to coo around four months of age which includes well-formed vowels and consonant-vowel sounds that do not yet resemble words. These sounds are labeled non canonical babbling and can include vocalizations such as “aaa.” Around seven months of age, cooing transitions to something called canonical babbling. These would include vocalizations with more well-formed vocalizations such as “baba” and “mama.” Around 10 months of age, infants typically begin to mix both babbling and meaningful speech to produce “long intonated utterances” such as “buh-bah” (Kuhl & Meltzoff,1996, pp. 1-2). These early vocal sounds are a crucial developmental milestone for later speech in children. Fasolo et al. (2008) demonstrated that the sounds produced in infants’ babbling stages closely resembled the consonants in their first words.

Caregivers can influence the transition from cooing to canonical babbling as well as the quantity and quality of speech sounds produced. An intervention known as contingent vocal imitation (CVI) involves simply imitating infants’ vocalizations, which has been shown to have the greatest effect on increasing infants’ vocalizations et al., 2010; Neimy et al., 2020). For example, the infant says “aaah” and the parent says “aaah;” the infant says “boo” and the parent says “boo.” Neimy et al. (2020) demonstrated that infants with a higher likelihood of receiving an autism diagnosis would repeat the sounds their parents had copied, and it increased the amount their infant vocalized. Such findings support that copying your baby can lead to greater caregiver-infant engagement and create further opportunities for language development.

Another strategy caregivers can use when responding to their infants’ vocalizations is using “motherese” or “parentese.” Parentese consists of infant-directed speech in the form of words and sentences with high-pitched sounds and songlike prosody (Neimy et al. 2020). For example, “Hell-OH sweet BAY-bee!” This type of speech has been shown to increase the number of infants’ vocalizations when provided after an infant vocalizes (Pelaez et al., 2011b).

Figure 1

Infant Behaviors and Types of Contingent Adult Attention

Infant Behavior	Suggested Caregiver Response to Increase Infant Behavior
Eye Gaze	Provide strokes to infant’s body (i.e., face, feet, or legs) and vocal coos (i.e., oooooohhh) whenever infant gazes towards you Provide smiles, strokes, and coos when the infant looks towards you Provide strokes when the infant looks towards you
Babbling (non-canonical and canonical)	Contingent vocal imitation (CVI) of speech sounds (baby says “buh”, caregiver says “buh”) Parentese responses to speech sounds (baby speaks, caregiver says, “Are YOU talking to MOM-ma?”)

During daily practice periods, a caregiver can copy the infant’s sound or use parentese (see more in Figure 1 above). For example, the baby utters “ahh ah!” and the caregiver can look towards the baby and say “ahh! ah!” right after them. The caregiver can also use parentese when their baby vocalizes. For example, the baby says, “ahh! ah!” and the caregiver says, “OHH, my sweet BaaBBByy!” Caregivers may find that their baby prefers parentese over contingent vocal imitation or vice versa and that one will lead to greater vocalizations in their infants (to determine preference see Figure 2 below). Families should also be encouraged to utilize these strategies within their native languages and with phrases they use regularly within their home (see Deliperi et al., 2020 for more information on bilingualism).

The first year of an infant’s life is a critical period for language development. Caregivers can use easy and simple strategies to foster their infant’s pre-language skills to further their language development. For infants with developmental disabilities or infants with an increased likelihood of a later diagnosis of autism, these skill developments are crucial. Behavioral science has demonstrated that eye gaze can be improved by simply stroking their infant’s face, smiling, and using parentese when eye contact or eye gaze is observed (Dunst et al., 2010). Behavioral science has also demonstrated that imitating an infant’s sounds and following them with parentese can increase their infant’s cooing and vocalizations and speed the transition from non-canonical to canonical babbling (Fiani et al., 2021; Neimy et al., 2020; Pelaez et al., 2011a; Pelaez et al., 2011b). Caregivers can be empowered to use these simple strategies in their everyday interactions with their infants to increase the critical skills of eye gaze and babbling to lay the foundation for later language development.

Figure 2

Steps to Determining Your Baby’s Preference for Adult Attention

Interact as you typically would with your baby for a specific amount of time (i.e., 5-10 minutes) and tally how many times they engage in the behavior.

Interact with your baby for the same amount of time but provide the specific response (i.e., parentese, stroking/smiling/cooing) each time they engage in the desired behavior; tally how many times they engage in the behavior.

Compare the tallies from your typical interaction to the new interaction and see if there was an increase in your baby’s behavior. If so, continue during your everyday routine. If not, go back to step 1 and use a different type of interaction.

References

Athari, P. (2021). Infant speech development in the context of mother-infant interaction in transition from the precanonical to the canonical babbling stage (Order No. 29274693). Available from ProQuest Central; ProQuest Dissertations & Theses Global. (2700377325).

Centers for Disease Control and Prevention. (2023, October 10). Facts about Down syndrome. Centers for Disease Control and Prevention; U.S. Department of Health & Human Services.

Downey, J. M., & Mawby, I. (2023). Clinical Corner: Assisting pediatricians to recognize deficits in their infants and toddlers that may indicate a diagnosis of ASD. Science in Autism Treatment, 20(7).

Dunst, C. J., Gorman, E., & Hamby, D. W. (2010). Effects of adult verbal and vocal contingent responsiveness on increases in infant vocalizations. Center for Early Literacy Learning, 3(1), 1-11.

Fasolo, M., Majorano, M., & D’Odorico, L. (2008). Babbling and first words in children with slow expressive development. Clinical Linguistics & Phonetics, 22(2), 83-94.

Fiani, T., Izquierdo, S. M., & Jones, E. A. (2021). Effects of mother’s imitation on speech sounds in infants with Down syndrome. Research in Developmental Disabilities, 119, 104118.

Friesen, A., Hanson, M., & Martin, K. (2014). In the eyes of the beholder. Young Exceptional Children, 18(4), 19–30.

Gazdag, G., & Warren, S. F. (2000). Effects of adult contingent imitation on development of young children’s vocal imitation. Journal of Early Intervention, 23(1), 24–35.

Goulet, C., Frappier, J.-Y., Fortin, S., Déziel, L., Lampron, A., & Boulanger, M. (2009). Development and evaluation of a shaken baby syndrome prevention program. Journal of Obstetric, Gynecologic & Neonatal Nursing, 38(1), 7–21.

Gros-Louis, J., & Miller, J. (2018). From ‘ah’ to ‘bah’: Social feedback loops for speech sounds at key points of developmental transition. Journal of Child Language, 45(3), 807-825.

Hyman, S. L., Levy, S. E., & Myers, S. M. (2020). Identification, evaluation, and management of children with autism spectrum disorder. Pediatrics, 145(1).

Kaplan, P. S., Sliter, J. K., & Burgess, A. P. (2007). Infant-directed speech produced by fathers with symptoms of depression: Effects on infant associative learning in a conditioned attention paradigm. Infant Behavior and Development, 30(4), 535–545.

Kuhl, P. K., & Meltzoff, A. N. (1996). Infant vocalizations in response to speech: Vocal imitation and developmental change. The journal of the Acoustical Society of America, 100(4), 2425-2438.

Neimy, H., Pelaez, M., Carrow, J., Monlux, K., & Tarbox, J. (2017). Infants at risk of autism and developmental disorders: Establishing early social skills. Behavioral Development Bulletin, 22(1), 6.

Neimy, H., Pelaez, M., Monlux, K., Carrow, J., Tarbox, J., & Weiss, M. J. (2020). Increasing vocalizations and echoics in infants at risk of autism spectrum disorder. Behavior Analysis in Practice, 13, 467-472.

Ozonoff, S., Gangi, D., Corona, L., Foster, T., Hill, M. M., Honaker, M., Maqbool, S., Ni, R., Nicholson, A., Parikh, C., Stone, C., Spitler, A. K., Swanson, A., Vehorn, A., Wagner, L., Weitlauf, A., & Warren, Z. (2024). Measuring developmental delays: Comparison of parent report and direct testing. Journal of Autism and Developmental Disorders, 1-7.

Peláez-Nogueras, M., Field, T., Gewirtz, J. L., Cigales, M., Gonzalez, A.Sanchez, A., & Richardson, S. C. (1997). The effects of systematic stroking versus tickling and poking on infant behavior. Journal of Applied Developmental Psychology, 18(2), 169–178.

Pelaez, M., Virués-Ortega, J., & Gewirtz, J. L. (2011a). Contingent and noncontingent reinforcement with maternal vocal imitation and motherese speech: Effects on infant vocalizations. European Journal of Behavior Analysis, 12(1), 277-287.

Pelaez, M., Virues‐Ortega, J., & Gewirtz, J. L. (2011b). Reinforcement of vocalizations through contingent vocal imitation. Journal of Applied Behavior Analysis, 44(1), 33-40.

Reference for this article:

Crysdale, C. & O’Connell-Sussman, E. (2025). How can caregivers best support their infant’s needs through natural interactions? Science in Autism Treatment, (22)3.

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