Understanding proxemics in multimodal child-clinician interactions: a case of Sturge-Weber Syndrome

Abstract

Aim: Children with complex communication needs (CCN) rely more on multiple communicative resources (e.g., gestures, gaze, communication aids) in everyday interactions (Beukelman & Light, 2020). A growing body of research on children with CCN has adopted a multimodal lens to understand how these children and communication partners utilize and coordinate various modalities for effective and meaningful communication (e.g., Benson-Goldberg et al., 2025). However, limited attention has been drawn to how specific modalities within the broad multimodal framework contribute to the moment-by-moment organization of interaction. Proxemics, the use of space in communication (Hall et al., 1968), is one such critical yet underexamined modality. This study aims to delineate the contributions of proxemics in multimodal aided interactions between one child with CCN and speech-language pathologists (SLPs).

Method: Participants included three SLPs and one child with CCN secondary to Sturge-Weber Syndrome (SWS), a rare neurocutaneous disorder that presents constellations of multifaceted symptoms affecting a child’s overall development (Yeom & Comi, 2022). Video data were collected during the child’s speech-language therapy sessions at a university clinic (ethical approval obtained). Through immersive and repeated review of the dataset, the authors identified interactional episodes where proxemics (among participants, artifacts, and/or the overall environment) was particularly salient or consequential to the interaction dynamics. Two representative episodes were selected for data analysis and transcription following Multimodal Interaction Analysis (MIA; Norris, 2004). This framework sees chains of social actions comprising interactions as its unit of analysis and explores the multiplicity of communicative modes in mediating these actions.

Results: The current study revealed that despite facing multiple communication challenges associated with SWS, the child was able to actively engage in multimodal interactions with support. In addition, findings indicated that in the analyzed child-clinician interactions, the communicative mode of proxemics, while closely intertwined with others, contributed largely to the interactional dynamics in two interconnected forms: child-artifact and child-clinician proxemics. When choreographed properly to match the child’s needs and skills, the proxemic relationship between the child and the communication aid ensured access to communicative resources and supported interaction readiness. Meanwhile, the appropriate child-clinician proxemics established a shared interactional space (Mondada, 2013) that facilitated joint attention, coordinated multimodal actions, and promoted the child’s interactional engagement.

Conclusion: The current study depicts how SWS-related characteristics can shape the child’s interaction and participation and thus adds qualitative evidence to existing limited research on social communication challenges in the context of SWS. Also, through the lens of MIA, this study highlights the essential role(s) of proxemics in multimodal child-SLP interactions and the need for relevant clinical training. SLPs should recognize proxemics as an integral component of multimodal scaffolding and dynamically choreograph client-clinician-artifact proxemics to foster effective communication and participation. However, findings and implications must be interpreted in light of limitations associated with the study’s single-case design and analytic scope.

References:

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Yeom, S., & Comi, A. M. (2022). Updates on sturge-weber syndrome. Stroke, 53(12), 3769–3779. https://doi.org/10.1161/STROKEAHA.122.038585