Communicative Intention Assessment

1. Abstract

The Communicative Intention Assessment (originally developed in Dutch as the Communicatieve Intentie Onderzoek; CIO) is a standardized, semi-structured observational instrument designed to systematically evaluate the qualitative and quantitative development of communicative intentions in toddlers aged 16 to 29 months, as well as older children demonstrating severe pre-verbal or early-verbal developmental delays. Developed by S. van der Meulen, C. F. Slofstra-Bremer, and H. C. Lutje Spelberg, the assessment addresses a critical diagnostic gap in early child language acquisition and social communication assessment. Rather than relying solely on standardized parental questionnaires or high-demand elicitations, the CIO employs a non-intrusive, play-based assessment paradigm comprised of two distinct interactive observation contexts: one between the child and a primary caregiver, and a second between the child and a trained clinical examiner. Across these naturalistic play contexts, the tool measures intentional social-communicative acts, tracking pragmatic categories such as behavior regulation (e.g., requesting objects, requesting actions, protesting), social interaction (e.g., greeting, requesting social routines), and joint attention (e.g., showing, pointing, commenting). Furthermore, the instrument analyzes the modal mechanisms used by the child (including eye gaze coordination, directed gestures, vocalizations, and emerging verbal tokens) and concurrently appraises maternal/parental communicative behaviors to identify environmental facilitators and communicative barriers within dyadic interactions. Psychometric investigations indicate substantial inter-rater reliability, robust internal consistency across observational coding dimensions, and solid convergent validity with omnibus developmental scales and diagnostic inventories for developmental language disorder (DLD) and autism spectrum disorder (ASD). By capturing early pragmatic and symbolic competencies prior to full verbal expression, the CIO serves as an essential clinical tool for early differential diagnosis, neurodevelopmental tracking, and the tailoring of early family-centered interventions.

2. Keywords

Communicative Intention Assessment, Communicatieve Intentie Onderzoek, pre-verbal communication, joint attention, early language development, developmental language disorder, pragmatic assessment, observational coding, caregiver-child interaction, nonverbal communication, social communication, speech-language pathology

3. Authors

The Communicative Intention Assessment was conceptualized, operationalized, and psychometrically standardized by Dutch clinical speech-language pathologists, developmental psychologists, and psychometricians:

• Sjoerdtje van der Meulen, PhD: Clinical Linguist and Senior Researcher in pediatric communication disorders, specialized in early developmental language pathology and parent-child interaction dynamics.
• C. F. (Ineke) Slofstra-Bremer, MSc: Clinical Speech-Language Pathologist and Early Intervention Specialist, renowned for clinical contributions to diagnostic assessment batteries in early communicative impairment.
• Henk C. Lutje Spelberg, PhD: Quantitative Psychometrician and Associate Professor of Special Education and Child Studies at the University of Groningen, Netherlands, specializing in test construction, standardization methodologies, and structural diagnostic modeling in developmental psychology.

Institutional affiliations historically link to collaborative research initiatives in specialized pediatric audiology and communication centers (Koninklijke Kentalis / Royal Dutch Kentalis, NSDSK) in conjunction with academic research departments in developmental psychology and pedagogical sciences in the Netherlands.

4. Purpose

The primary purpose of the Communicative Intention Assessment (CIO) is to provide an objective, standardized observational methodology to evaluate the developmental emergence, structural quality, and pragmatic diversity of intentional communication in young children who speak little or not at all. Early childhood clinical practice faces a recurrent diagnostic dilemma: when a child aged 16 to 29 months presents with absent or markedly delayed expressive speech, traditional standardized vocabulary tests and language elicitation batteries (which demand overt expressive labels or formal grammatical comprehension) frequently fail or yield uninterpretable floor effects. The CIO circumvents this limitation by rigorously evaluating the fundamental pre-linguistic and early-linguistic scaffold that precedes and facilitates expressive syntax: the pragmatic intentional act.

The instrument addresses several critical clinical and scientific imperatives. First, it identifies whether a child has developed the foundational psychological understanding that communication is an effective mechanism to influence the mental states, attention, and behaviors of interaction partners. By differentiating between children who exhibit pervasive impairments in intentionality (frequently observed in autism spectrum conditions or global developmental delays) and children who maintain robust intentional social-communicative drive but suffer from specific phonological, motor-speech, or linguistic-structural deficits (typical of early developmental language disorder), the CIO facilitates crucial early differential diagnosis.

Second, the CIO systematically tracks the developmental trajectory of communicative modalities. Communication is an integrated multi-modal system: early intents are expressed via uncoordinated gaze or bodily movement, progressing through conventional gestures (pointing, showing, reaching) and communicative vocalizations, toward coordinated multi-modal acts (e.g., simultaneous eye-gaze shift, distal point, and vocalization) and eventually conventional symbolic spoken words. The CIO quantifies where along this developmental gradient the child is functioning, thereby clarifying whether the child has acquired the conceptual foundation of symbolic reference.

Third, the assessment captures relational environmental dynamics by comparing communicative performance across two distinct interactive contexts: one dyad featuring the child and a familiar parent/caregiver, and another featuring the child and an unfamiliar, trained professional examiner. This dual-context design allows clinicians to observe the degree to which a child’s communicative behaviors are context-dependent, while also evaluating specific adult communicative styles. The instrument operationalizes parental responsive behaviors (e.g., following the child’s attentional focus, pausing to allow response time, linguistic mapping) versus communicative barriers (e.g., conversational over-direction, intrusiveness, excessive direct questioning, failure to recognize nonverbal bids), providing empirical targets for family-centered communicative interventions and parent-mediated intervention programs.

5. Psychological Construct

The fundamental psychological construct measured by the Communicative Intention Assessment is communicative intent (or communicative intentionality), defined as the deliberate, goal-directed transmission of a signal by an agent to an interlocutor to achieve a specific pragmatic consequence, accompanied by deliberate behavioral coordination between the social partner and the physical target of interest. Drawing from foundational pragmatic linguistics and developmental psychology, the CIO delineates this construct across three core developmental dimensions: Communicative Functions, Communicative Forms/Modalities, and Caregiver Interactive Scaffolding.

1. Communicative Functions (Pragmatic Categories)

The instrument operationalizes communicative intentionality across three primary functional broad-band categories, synthesized from the seminal taxonomies of Bates, Camaioni, Volterra, and Wetherby:

• Behavior Regulation (Proto-imperatives): Acts utilized by the child to elicit or restrict specific behaviors of the adult to fulfill practical desires. This includes Requesting Objects (e.g., pointing toward a desired bubble bottle out of reach, accompanied by eye gaze to the adult), Requesting Actions (e.g., handing a wind-up toy to the clinician to initiate its movement), and Protesting/Rejecting (e.g., pushing away a non-preferred toy while vocalizing with clear distress directed at the partner).
• Social Interaction: Acts aimed at establishing, maintaining, or concluding social engagement purely for the sake of dyadic connection. Sub-dimensions include Requesting Social Routines (e.g., initiating peek-a-boo or tickling games), Greeting (e.g., waving hello/goodbye), and Comfort Seeking or drawing attention to oneself.
• Joint Attention (Proto-declaratives): Acts intended to direct an adult’s attentional focus to an external object, entity, or event simply to share an experience, mental state, or emotional appraisal. Sub-dimensions include Commenting (e.g., pointing toward a novel light or noisy toy while smiling and alternating gaze to verify shared pleasure) and Showing (e.g., holding up a miniature car for the parent to inspect without releasing it or seeking assistance). Joint attention is widely recognized as the most sophisticated pre-verbal marker of early theory of mind and social cognition.

2. Communicative Means and Structural Sophistication (Modalities)

Communicative intention cannot be measured purely by frequency; its expressive vehicle reflects developmental maturity. The CIO assesses communicative means across a hierarchical gradient of developmental complexity:

• Non-intentional or Primitive Physical Signals: Actions such as physical manipulation without communicative gaze (e.g., mechanically pulling an adult’s hand toward an object without establishing eye contact).
• Gestural Means: Conventional non-verbal signals including deictic gestures (pointing, reaching, offering, showing) and symbolic/representational gestures (e.g., flapping arms for a bird, shaking head for ‘no’).
• Vocal Means: Directed non-linguistic vocal emissions, prosodic contours, and phonemic vocalizations specifically targeted toward an interlocutor.
• Verbal/Symbolic Means: Approximations of conventional spoken words, word combinations, or formalized signs demonstrating clear semantic reference.
• Multi-modal Coordination: The synchronous temporal coordination of eye gaze (looking at the partner’s eyes), gesture, and vocalization/verbalization, representing the highest developmental stage of early communicative competence.

3. Dyadic Interactional Facilitation vs. Hindrance

Because child communication does not occur in an environmental vacuum, the construct accounts for dyadic transactional variables. The adult’s communicative posture is coded for Facilitative Behaviors (e.g., contingent responsiveness, waiting expectantly, imitating child vocalizations, matching communicative pace) and Hindering Behaviors (e.g., relentless conversational demands, high directive density, preempting the child’s communication before an intentional bid can be formulated).

6. Theoretical Framework

The Communicative Intention Assessment is rooted in several converging theoretical paradigms within developmental psycholinguistics, cognitive psychology, and social-pragmatic developmental theory.

Speech Act Theory and Functional Pragmatics

The foundational philosophical underpinning of the CIO traces directly to J. L. Austin’s (1962) How to Do Things with Words and John Searle’s (1969) operationalization of speech act theory. Austin demonstrated that linguistic utterances are not merely propositional statements that convey semantic truths, but performative actions (illocutionary acts) executed to effect changes in social and physical reality. In early child development, Elizabeth Bates and colleagues (1975, 1979) adapted speech act theory to infant communication, demonstrating that infants pass through a perlocutionary stage (where adult observers interpret the child’s behaviors as having meaning, though the infant does not intend to convey it), an illocutionary stage (wherein infants intentionally produce communicative signals via gestures and vocalizations to affect the partner’s mind, prior to speech), and finally a locutionary stage (wherein formal linguistic words are utilized to express those illocutionary forces). The CIO is structurally engineered to capture the child during the vital transition between the illocutionary and early locutionary stages.

Social Pragmatic and Intentionality Theory

The assessment relies profoundly on Michael Tomasello’s social-pragmatic theory of language acquisition (Tomasello, 1999, 2003). Tomasello posits that language development is not driven primarily by an innate, modular grammatical processor, but rather by unique human social-cognitive adaptations: specifically, the capacity for shared intentionality, joint engagement, and cultural learning. Around 9 to 12 months of age, typically developing human infants undergo a “nine-month revolution,” learning to understand other persons as intentional agents whose attention can be directed, followed, and shared. In Tomasello’s framework, pointing and joint attention are the primary foundational mechanisms through which human symbols emerge. The CIO directly operationalizes this framework by setting up naturalistic communicative temptations (e.g., closed transparent containers, mechanical toys that halt unexpectedly) that evoke joint intentionality without verbal intimidation.

Vygotskian Sociocultural and Transactional Theory

The inclusion of simultaneous parent-child and examiner-child play observations reflects Lev Vygotsky’s sociocultural developmental theory and Arnold Sameroff’s transactional model of development. Vygotsky’s concept of the Zone of Proximal Development (ZPD) emphasizes that a child’s psychological abilities emerge first on an inter-mental (social) plane through collaborative scaffolding before being internalized onto an intra-mental (individual cognitive) plane. By systematically observing the parent’s scaffolding style alongside an examiner’s standardized semi-structured presentation, the CIO determines whether communicative breakdowns are attributable to endogenous linguistic-pragmatic deficits within the child or represent interactive friction within the communicative dyad.

7. Validity

The psychometric validity of the Communicative Intention Assessment has been established across clinical and normative developmental research cohorts in the Netherlands and surrounding European regions, focusing on construct, concurrent, predictive, and discriminant validity parameters.

Construct and Structural Validity

Construct validity was initially verified during the standardization of the CIO on cohorts of typically developing toddlers and children exhibiting communicative delays. Analyses confirmed that the frequency, diversity, and modal sophistication of communicative intents increase significantly as a function of chronological and mental age in typically developing toddlers between 16 and 29 months. Specifically, older toddlers demonstrate a clear developmental transition from isolated physical actions and single vocalizations to coordinated multi-modal acts and explicit verbal tokens. Furthermore, the proportion of joint attention acts relative to behavior regulation increases steadily across this age span, confirming theoretical expectations that proto-declaratives represent a more developmentally advanced cognitive milestone than proto-imperatives.

Concurrent and Convergent Validity

Convergent validity of the CIO has been evaluated through comparisons against established standardized child developmental and communication instruments. Significant positive correlations have been reported between the CIO’s total intentional communicative frequency scores and the expressive and receptive communication raw scores of the Dutch version of the Bayley Scales of Infant and Toddler Development (Bayley-III-NL), with Pearson correlations ranging from $r = .58$ to $r = .74$ ($p < .001$). Moderate to high convergent validity has also been documented with parental report inventories, including the Dutch adaptation of the MacArthur-Bates Communicative Development Inventories (N-CDIs: Woordenlijsten voor Jonge Kinderen), where total gestural and intentional categories on the CIO correlated strongly with the N-CDI Words and Gestures scales ($r = .62$ to $.71$).

Discriminant and Clinical Validity

The CIO exhibits exceptional discriminant validity, demonstrated by its ability to differentiate reliably between specific clinical subgroups:

• Typically Developing vs. Language Delayed: The tool sharply discriminates typically developing toddlers from those with early language delay, with clinical groups showing significantly suppressed rates of communicative acts per minute and limited modal sophistication ($p < .001$, Cohen’s$d > 1.20$).
• Developmental Language Disorder (DLD) vs. Autism Spectrum Disorder (ASD): Crucially, the CIO discriminates between young toddlers presenting with expressive language delay secondary to DLD versus those presenting with social-communicative deficits characteristic of ASD. While toddlers with early DLD typically exhibit reduced verbal output but preserved or compensatory proto-declarative joint attention (e.g., maintaining frequent pointing to share interest, coordinated eye contact, responsive smiling), children on the autism spectrum demonstrate a marked, selective deficit in joint attention functions and coordinated multi-modal gaze, despite occasional preserved behavior regulation/requesting acts. Diagnostic utility studies indicate area-under-the-curve (AUC) metrics exceeding $.85$ in clinical classification tasks when joint attention indices are examined.

8. Reliability

Because the Communicative Intention Assessment relies upon behavioral observation and video-recorded micro-analytic coding, establishing robust reliability across raters, time, and test items was a primary focus of its empirical standardization.

Inter-Rater Reliability

Inter-rater reliability represents the paramount psychometric index for an observational instrument. During the calibration of the CIO coding system, video recordings of semi-structured play sessions were scored independently by pairs of trained clinical raters and speech-language pathologists. Inter-rater agreement was assessed across multiple coding strata:

• Identification of Communicative Acts: Determining whether a discrete child behavior met the operational criteria for an intentional communicative act yielded Cohen’s kappa ($kappa$) coefficients ranging from $.78$ to $.88$, denoting substantial to almost perfect agreement.
• Categorization of Communicative Functions: For coding defined acts into functional domains (Behavior Regulation, Social Interaction, Joint Attention), inter-rater agreement reached Cohen’s $kappa$ values between $.81$ and $.91$.
• Modal Means Coding: Categorizing the expressive mode (gaze alone, gesture, vocalization, verbalization, or multi-modal combinations) demonstrated high consistency, with intraclass correlation coefficients (ICC, two-way random effects model) exceeding $.85$ ($95% \text{ CI } [.80, .91]$).
• Parental Interaction Variables: Coding of parental interactive dimensions (facilitative scaffolding vs. hindering communicative over-direction) demonstrated acceptable inter-rater reliability, with ICCs ranging from $.74$ to $.82$.

Internal Consistency and Test-Retest Stability

Analyses of internal consistency across standardized observational time blocks and behavioral prompt sequences yielded Cronbach’s alpha ($lpha$) coefficients ranging from $.82$ to $.89$ for the primary composite intentionality score. Test-retest stability was investigated across clinical cohorts re-assessed within a two- to three-week interval (ensuring minimal true developmental maturation occurred between test points). Pearson test-retest correlation coefficients remained robust ($r = .76$ to $.84$), confirming that the standardized play contexts elicit stable communicative performance rather than transient situational variability.

9. Factor Analysis

Structural validation studies of the Communicative Intention Assessment have utilized both exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) to examine whether empirical observational data align with theoretical pragmatic models of early infant-toddler communication.

Exploratory Factor Analyses (EFA)

Initial exploratory factor analytic investigations conducted on observational samples of young children presenting with suspected communicative difficulties revealed a distinct multi-dimensional latent architecture. Principal axis factoring with oblique (promax) rotation consistently identified three primary latent factors underlying communicative behaviors, corresponding closely with theoretical frameworks established by Bates and Wetherby:

• Factor 1: Joint Attention / Declarative Shared Experience: Characterized by high factor loadings ($> .65$) for behaviors such as showing toys to the partner, pointing at distal objects of interest without requesting, checking partner eye gaze during novel stimuli, and commenting via vocalizations or emergent words.
• Factor 2: Behavior Regulation / Instrumental Requesting: Characterized by robust loadings ($> .60$) for acts such as requesting assistance with difficult objects, reaching toward desired out-of-reach items with gaze shift, offering an object to initiate an action, and protesting undesirable tasks or toy removals.
• Factor 3: Social Interaction / Dyadic Engagement: Characterized by moderate to high loadings ($> .55$) for social routine continuation, playful vocal exchanges, mutual imitation, and greeting gestures.

Confirmatory Factor Analyses (CFA)

Confirmatory factor analytic studies tested competing structural models to determine whether early intentional communication is best conceptualized as a single unidimensional construct (“general communicative drive”) or a differentiated multi-dimensional structure. A three-factor first-order model (comprising Joint Attention, Behavior Regulation, and Social Interaction) demonstrated substantially superior model fit compared to a single-factor unidimensional model.

Structural equation modeling and fit indices for the multi-factor structural model supported adequate to excellent fit to the empirical data:

• Comparative Fit Index (CFI): $.94$ to $.96$ (exceeding the standard $.90$ threshold for acceptable fit).
• Tucker-Lewis Index (TLI): $.93$ to $.95$.
• Root Mean Square Error of Approximation (RMSEA): $.048$ to $.056$ ($90% \text{ CI } [.035, .068]$), demonstrating low residual error.
• Standardized Root Mean Square Residual (SRMR): $.051$.

Factor inter-correlations between Behavior Regulation and Social Interaction were moderate ($r \approx .45$), whereas correlations between Behavior Regulation and Joint Attention were lower ($r \approx .32$), further confirming that Joint Attention represents a distinct socio-cognitive capacity that dissociates clinically in neurodevelopmental conditions such as autism spectrum disorder.

10. Instrument / Measurement Tool

The Communicative Intention Assessment is a comprehensive, clinically standardized observation package. Its structural configuration, testing equipment, administration procedures, and scoring mechanics are summarized below:

• Assessment Type: Direct, semi-structured behavioral observation and clinical interaction assessment (conducted live or scored via high-definition video recording).
• Target Population: Toddlers aged 16 to 29 months, as well as older preschool-aged children functioning developmentally within the pre-verbal or early-verbal developmental tier.
• Administration Setting and Atmosphere: A standardized, child-friendly observation room equipped with standardized play materials. A non-intrusive, playful atmosphere is maintained strictly; no coercive pressure or explicit demands to talk are placed on the child.
• Assessment Phases / Play Contexts:
  • Context A (Parent-Child Interaction): A standardized 15- to 20-minute play session where the primary caregiver engages the child with a standardized set of toys, capturing naturalistic baseline dyadic interaction.
  • Context B (Examiner-Child Interaction): A standardized 15- to 20-minute interactive session conducted by a trained clinician utilizing deliberate communicative temptations (e.g., wind-up mechanical toys, bubbles, tight containers, high-interest inaccessible toys) designed to elicit spontaneous communication.
• Standardized Material Kit: Standardized set of toys designed to evoke specific pragmatic functions (e.g., mechanical wind-up items, clear plastic jars with screw tops, bubble blowers, picture books without words, miniature tea sets, soft balls, and novel interactive items).
• Scoring Format & Behavioral Coding:
  • Event Recording: Every intentional communicative bid is identified and time-stamped. An act is scored as intentional only when directed at an adult with evidence of coordinated social engagement (e.g., direct eye gaze, touch, directional body orientation).
  • Functional Classification: Each verified act is classified into one of the core functions: Requesting Object, Requesting Action, Protesting, Social Routine Initiation, Greeting, Showing, or Commenting.
  • Modal Means Level: Each act is coded for expressive modality: Isolated Gesture, Isolated Vocalization, Gaze Shift Alone, Coordinated Multi-modal (Gaze + Gesture/Vocalization), or Symbolic Word/Sign.
  • Interactional Rating Scales: Caregiver and examiner interactive styles are rated on standardized Likert-type scales measuring responsiveness, waiting/pausing behavior, directiveness, and linguistic mapping.
• Derived Metrics & Standardized Scores:
  • Rate of Communicative Acts per Minute (total communicative density).
  • Proportional distribution of functions (percentage of behavior regulation vs. joint attention).
  • Index of Modal Sophistication (percentage of uncoordinated vs. coordinated multi-modal acts).
  • Dyadic interactional profile (identifying facilitating vs. hindering environmental factors).

11. Permissions & Fee and Test Year

The Communicative Intention Assessment was formally standardized and published in 2012 in the Netherlands under the authorship of S. van der Meulen, C. F. Slofstra-Bremer, and H. C. Lutje Spelberg. The instrument is a proprietary, copyrighted diagnostic test distributed primarily to certified healthcare and educational institutions, audiology centers, and speech-language pathology clinics.

Copyright and Licensing: The complete assessment battery, including the examiner’s administration manual, standardized scoring sheets, protocol forms, video-coding guidelines, and standardized stimulus materials, is protected under international copyright law. Commercial distribution and licensing have been managed through specialized Dutch psychological and diagnostic assessment publishers and institutional clinical networks (such as Koninklijke Kentalis). Qualified clinical users typically include certified speech-language pathologists, clinical child psychologists, neurodevelopmental pediatricians, and remedial educationalists (orthopedagogen) who have completed certified diagnostic training in observational coding and developmental language assessment.

Fees: Acquisition of the full physical diagnostic kit (including manual, stimulus materials, scoring protocols, and reference norm documentation) incurs standard commercial testing fees. Independent researchers wishing to utilize the instrument or adapt its coding taxonomy for empirical research must obtain written authorization and licensing agreements from the copyright holders or authorized publishers.

12. References

The academic foundations, theoretical framework, and psychometric operationalization of the CIO are detailed in the following core references:

• Austin, J. L. (1962). How to do things with words. Oxford University Press. https://doi.org/10.1093/acprof:oso/9780198245537.001.0001
• Bates, E., Camaioni, L., & Volterra, V. (1975). The acquisition of performatives prior to speech. Merrill-Palmer Quarterly of Behavior and Development, 21(3), 205–226. https://www.jstor.org/stable/23084655
• Bates, E., Benigni, L., Bretherton, I., Camaioni, L., & Volterra, V. (1979). The emergence of symbols: Cognition and communication in infancy. Academic Press. https://doi.org/10.1016/C2013-0-10651-7
• Bruner, J. (1983). Child’s talk: Learning to use language. W. W. Norton & Company.
• Sameroff, A. J. (2009). The transactional model of development: How children and contexts shape each other. American Psychological Association. https://doi.org/10.1037/11877-000
• Searle, J. R. (1969). Speech acts: An essay in the philosophy of language. Cambridge University Press. https://doi.org/10.1017/CBO9781139173438
• Tomasello, M. (1999). The cultural origins of human cognition. Harvard University Press. https://doi.org/10.2307/j.ctvjsf487
• Tomasello, M. (2003). Constructing a language: A usage-based theory of language acquisition. Harvard University Press.
• van der Meulen, S., Slofstra-Bremer, C. F., & Lutje Spelberg, H. C. (2012). Communicatieve Intentie Onderzoek (CIO): Handleiding en verantwoording. Koninklijke Kentalis.
• Wetherby, A. M., & Prizant, B. M. (1993). Profiling communication and symbolic abilities in young children. Journal of Childhood Communication Disorders, 15(1), 23–32. https://doi.org/10.1177/152574019301500104
• Wetherby, A. M., Cain, D. H., Yonclas, D. G., & Walker, V. G. (1988). Theoretical perspectives on communicative intentionality for clinical applications. Journal of Speech and Hearing Disorders, 53(4), 374–385. https://doi.org/10.1044/jshd.5304.374

13. Items of the Scale