A boy with a problem of delayed speech and language development was seen at the age of 3 years and 7 months. Three years after his first visit, he was diagnosed as having developmental receptive aphasia. This diagnosis was based on the following findings: (1) He did not show any motor disabilities. (2) His mental ability was near normal. (3) He could not follow oral directions but could follow directions with gestures. (4) His hearing level was normal on the audiometer. However, he could not distinguish words auditorily though he could easily identify the same words with Japanese characters. (5) He did not use any gestures or symbolic play. (6) His language and speech delay was severe, which was not commensurate with his general functional level. Language therapy using visual materials was effective to some extent. Now he is 8 years and 9 months old and can understand written words, phrases and simple sentences, but shows no improvement in expressive language.

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This study reports on training for nonverbal exchange behavior in two, three year old children with developmental disorders who have a strong tendency to refuse instruction. The training was developed through a consideration of emotional rhythm and a turn-taking cycle of behavior.
The development of nonverbal exchange behavior in the two children was divided into four steps in the same order. In the first step, the children could agree on an emotional rhythm of tension and relaxation with the trainer. In the second step, the children could obey the trainer's instructions and could ask him the result of action. In the third step, the children could watch while the trainer was acting, and then could take turns suitably. In the fourth step, the children could control themselves, and could cooperate with the trainer in high level bargaining.
These observations suggested that these characteristics of exchange were related to accepting others approaches in daily communication behavior and were helpful to smooth communication.

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