Establishing a basic speech repertoire without using NSOME: means, motive, and opportunity.

Children who are performing at a prelinguistic level of vocal communication present unique issues related to successful intervention relative to the general population of children with speech disorders. These children do not consistently use meaning-based vocalizations to communicate with those around them. General goals for this group of children include stimulating more mature vocalization types and connecting these vocalizations to meanings that can be used to communicate consistently with persons in their environment. We propose a means, motive, and opportunity conceptual framework for assessing and intervening with these children. This framework is centered on stimulation of meaningful vocalizations for functional communication. It is based on a broad body of literature describing the nature of early language development. In contrast, nonspeech oral motor exercise (NSOME) protocols require decontextualized practice of repetitive nonspeech movements that are not related to functional communication with respect to means, motive, or opportunity for communicating. Successful intervention with NSOME activities requires adoption of the concept that the child, operating at a prelinguistic communication level, will generalize from repetitive nonspeech movements that are not intended to communicate with anyone to speech-based movements that will be intelligible enough to allow responsiveness to the child's wants and needs from people in the environment. No evidence from the research literature on the course of speech and language acquisition suggests that this conceptualization is valid.