Nov 9 2020

Infant-Directed Speech in Non-Westernized Nations

Photo Credit courtesy of Dr. P. K. Abdul Kader

Written By: Donna Sperandio, MEd (HI), LSLS Cert AVT and Ellen A. Rhoades, Ed.S., LSLS Cert AVT

Infant-directed speech (IDS), also referred to as caregiver talk, baby talk, or parentese, is the way many adults around the world typically talk to infants and young children. In addition to using simpler words, caregivers tend to repeat those words in a slower rate of speech that is higher pitched with an exaggerated melody and pitch.

IDS includes engagement in social reciprocity on visual, gestural, emotional, and physical levels; this includes taking turns and making positive eye contact. When we use IDS, we easily capture the attention of infants and young children as well as promote their pattern recognition and auditory memory skills. Caregivers typically talk to infants and young children about what they are seeing, hearing, and feeling—what they are experiencing in the moment. By improving infants’ ability to predict spoken language, we can also improve their ability to efficiently learn more complex language (for reviews, see Rhoades 2020a,b). The use of IDS is central within Auditory-Verbal (AV) practices for facilitating listening and language (LSL) skills.

Non-Westernized Nations and Cultural Considerations

For the purposes of this article, the non-westernized world refers to Asia, Africa, India, Latin America, and the Middle East. Culture is defined by each family’s languages, socioeconomic status, and ethnicity as well as each family’s values and belief system.

Differences in cultural practices exist between nations and within nations. For the non-westernized nations, concepts such as extended family systems, extended family-based decision-making processes, as well as different child rearing practices and roles need to be carefully considered in AV practices.

For example, Samoan infants are raised as members of an extended community rather than by one set of parents. Siblings and cousins do much of the physical caretaking of the child (Ochs, 1988). In this case, a wide range of extended family members will need to be involved in therapy.

In some cultures, eye contact patterns differ from those in westernized nations. In certain parts of Africa, Asia, and Latin America, averting eye-contact and looking at the ground is a sign of respect for a person in authority (e.g., Uono & Hietanen, 2015). Identifying and understanding such differences is essential for the effective delivery of AV practices.

In addition to systemic differences across families, the relative wealth of nations also directly influences each family’s community. Income inequality and health disparities within some nations are vastly more pronounced than in other nations. For example, poverty is relatively insignificant among Kuwaitis yet affects nearly all Kenyans residing outside of Nairobi (e.g., Mesman et al, 2020). Poverty and its concomitant stressors can significantly influence how children and their caregivers will learn (e.g., Blair & Raver, 2016).

Linguistic Considerations

Language is the cornerstone of national identity (Pew Research Center, 2017). Other than English, the most widely spoken languages in the world are used primarily in non-westernized countries. These include, in descending order, Mandarin Chinese, Hindi, Spanish and standard Arabic. Languages in non-westernized countries are diverse in both features and number.

The linguistic features of languages in non-westernized countries can differ dramatically from English in phonology, syntax, morphology, semantics, and pragmatics. The current cohort of approximately 900 certified AV practitioners speak and understand English, with a few also speaking other languages such as Danish, Spanish, Italian, Arabic, Korean, and Indonesian. Some languages are vastly different from those typically spoken by the current cohort of certified LSLS. Working with languages which include lexical tones, clicks, or whistles delivers significant challenges. Grammatical aspects such as the use or non-use of tenses and plurals can also be difficult for AV practitioners. Yet, the characteristics unique to IDS need to reflect those features defined by each child’s languages.

Many non-westernized countries include a plethora of spoken languages. India, for example, has 122 major languages, and approximately 1,600 other languages spoken within its borders. Most children in non-westernized nations are exposed to a minimum of two languages in their early years, and many will use still another language if they access formal schooling. For example, Zimbabwe has 16 official languages. Children might be exposed to Shona or Ndbele as a home language, but English is used in government to conduct business and is the main medium of teaching in educational settings. Research pertaining to typical developmental stages in these languages is often sparse or missing (e.g., Kornilov et al, 2016). This further increases the need for AV practitioners to develop a good understanding of those characteristics essential to IDS, so that adaptations can be made across different languages.

Considerations Specific to Auditory-Verbal (AV) Practices

Given that AV practices were developed in western countries, practitioners in non-westernized areas who want to implement them must learn English. Currently, there are very few professional development opportunities through text, training, or mentoring in languages other than English. This is a significant barrier for the widespread implementation of AV practices. Professionals unable to understand English or Spanish face significant language challenges in obtaining LSL credentials. Hence, there is general misunderstanding among the global community as to the importance of appropriately delivered IDS.

Financial considerations also influence information accessibility for both parents and practitioners in non-westernized nations. Even for AV practitioners from western nations working in non-westernized nations, challenges remain. For example, bilingual interpreters and jargon-free printed materials in languages other than English or Spanish are needed for both AV trainees and mentees as well as families of children with hearing loss (Nicholson et al, 2016).

The availability and quality of hearing technology, as well as appropriate and timely fitting are affected by economic constraints. There is no mandatory newborn hearing screening in most non-westernized nations. Consequently, many children from non-westernized nations are late to hearing technology; they do not have access to sound until at least three years of age, beyond the period of optimal auditory learning (Cardon, Campbell & Sharma, 2012). Even then, some are unable to have hearing technology that allows sufficient auditory access for quite some time. Therefore, AV practitioners may need to modify IDS depending on the child’s circumstances. For example, features of IDS would vary significantly when working with a newly implanted 7-year-old, as opposed to a newly implanted 1-year-old.

Cross-Cultural Implementation of IDS

Research studies as to how IDS is used and can be effectively modified across different languages and cultures are needed.

Meanwhile, to obtain useful information, AV practitioners can ask caregivers and local practitioners to demonstrate how they might highlight an aspect of IDS so as to help the child better hear it. For example, when asked this, local Vietnamese practitioners demonstrated how they exaggerated specific tonal features within IDS. This allowed insight into what is, and what is not, an acceptable way to highlight a lexical tone in Vietnamese. Once agreed on, these learnings can be integrated into AV practice and discussions around IDS.

Practitioners can support caregivers’ understanding of IDS by observing how they perform everyday routine activities, such as bathing and feeding their child. Together, they can then discuss opportunities to use IDS to facilitate sound-object associations and to develop the auditory feedback loop.

Nearly all currently certified AV practitioners are either from westernized nations or have received training from westernized nations. Of the 10 AV principles, six include the word “parent.” As noted earlier, caregivers can be siblings, grandparents, and others beyond the child’s immediate nuclear family. Culturally savvy AV practitioners need to develop hyper-awareness of such issues, recognizing that all caregivers should be included in AV practices.

Important life events include cultural and religious celebrations, family events and local festivals-all of which are conduits for the discussion and demonstration of IDS within appropriate linguistic and cultural contexts. For example, in India putting mehndi (also known as henna) on the hands before various occasions such as Rakshabandhan and the teej festival is common. Young children are excited to see how these designs are prepared and used in celebrations. This provides many opportunities for AV practitioners to describe and demonstrate IDS in a way that will easily carry over into the child’s daily environment.

Late-implanted children in non-westernized nations often come to AV therapy sessions having previously learned to produce speech based on visual and tactile cues. Children who are new to using hearing will benefit from the use of IDS to create the auditory feedback loop that will connect their speech and hearing. Similarly, children who were taught to produce speech through visual means can correct their speech patterns through the use of acoustic highlighting, a feature of IDS.

Contributing authors:

Louise Ashton, MA, LSLS Cert. AVT,

Hilda Furmanski, Fga., LSLS Cert. AVT,

Mary D. McGinnis, Cand PhD, LSLS Cert. AVT,

Ritu Nakra, BEd (HI), LSLS Cert. AVT,

Writer Bios:

Donna Sperandio is a senior rehabilitation manager for MED-EL, which she established in 2013. In this capacity, she trains therapists working with children and adults across Asia. She has worked in cochlear implant programs in New Zealand, Australia, and the U.K. and has presented numerous lectures and workshops worldwide. She can be reached at

Ellen Rhoades is an international consultant, mentor, researcher, and practitioner with 50 years of experience who has founded and/or established four auditory-verbal programs.  Ms. Rhoades has co-authored/edited several books and has contributed to many book chapters and articles. She currently serves on review committees for six professional journals. She can be reached at


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