COMD 5200 Module 3
Assessing Speech-Motor Development
- Attempt standard speech-motor assessment Section in chapter 2 dedicated to Oral Motor Assessment, if it is something you aren't familiar with review pages 30-34. - Be aware of cognitive and imitative difficulties that are common at this developmental level - Be conservative about diagnosis of childhood apraxia of speech before continuous, multiword speech is acquired. In the emerging language stage, we want to be careful of making a diagnosis of apraxia. - Use vocal assessment to complement speech-motor and feeding evaluation.
Semantic Relation Examples
- Attribute-entity: Big shoe - Posessor-possession: Mommy nose - Agent-action: Daddy hit - Action-object: Hit ball - Agent-object: Daddy ball - Demonstrative-entity: This ball - Entity-locative: Daddy chair - Action-locative: Throw chair - Recurrence: More milk -Nonexistence, denial: No cookie -Disappearance: All gone cookie The semantic syntactic production isn't very sophisticated at this point. Gives you an idea of what we would look at during this stage.
Prelinguistic Stage 9-18 months = end of stage
9 months baby's hit another mile stone a) Become intentional communicators b) Learn how to mean ...... Halliday (1975) c) Illocutionary Stage: Express intonations but don't yet use conventional language.
Intervention for Older Clients with Emerging Language
- Include play and gesture - Increase frequency, range, and adaptiveness of expression of communicative intention, for both speech and AAC - Use functional communication training to replace maladaptive behavior with communication - Use indirect and aided language stimulation to increase comprehension - Choose most appropriate mix of AAC and vocal communication for each client - Include family, peers and teachers in AAC system use - Provide emergent literacy opportunities in emerging language stage.
Communication Skills in Typically Developing Toddlers: 18-24 months
- Average expressive vocabulary size at 18 months is 100 words - Multiword utterances increase in frequency - New communicative intentions emerge related to discourse level functions a) Answering questions, acknowledging or requesting information - Understanding of sentences is not far ahead of production - Repertoire of speech sounds increases - CVC and multisyllabic words increase, though many are still single syllable - Average child is 50% intelligible at 24 months -Unfamiliar listener would be able to understand about ½ of what child says —- Early two-word utterances express small range of meanings (doggy eat, mommy hat, baby here) —- Agent, action, object combinations - Possession —- Location —- Attributes —- Meanings related to object permanence - hear babies talking about things not immediately present. —- Word order is consistent within these combinations - usually NOUN FIRST!
Assessment and Mangagement for Preintentional Infants: Hearing Conservation and Aural Habilitation
- Continue to monitor hearing; audiological assessments every 3 to 6 months - Alert parents to signs of otitis media(ear infections); encourage treatment with physician Symptoms: pulling on the ear or jaw, unexplained fever, general fussiness accompanied by a cold. Parents should be encouraged to take a child to the pediatrician when they suspect OM. - For children with hearing impairments a. Encourage consistent use and maintenance of hear aids. b. Provide amplification c. SLP may able to help make a decision about child's candidacy for cochlear implants Page 197: A list of the criteria that professionals look at to decide if a child is a good candidate for cochlear implants. 1. Must be at least 8-12 months of age. 2. Must have profound hearing loss in both ears. 3. Can receive little to no benefit from hearing aids. 4. No other medical conditions making surgery risky. 5. Family understands their role in successful use of cochlear implants and have realistic expectations for cochlear implant use. Willing to be involved in the intensive rehabilitation services. 6. Child must have support from an educational program to emphasize the development of auditory skills.
Assessment & Intervention for Preintentional Infants
- Feeding (not covered in this course) and Oral Motor Development. Feeding is covered in the text in depth but not part of this course. Will discuss: for preintentional stage Oral motor development, Hearing Conservation and Aural Habilitation - Child Behavior and Development
Assessing Phonological Skills
- Given the strong correlation between phonology and lexical development, need to know what sounds child can produce to help choose words the child can learn. a) Collect consonant inventory from communication sample. This is especially important as we are establishing a first lexicon as we want to pick words that contain consonants the child is able to produce so that the words are easy for the child to say. Analysis of phonological skills of child will tell us if the child has a severe speech delay which will impact how we attack therapy. - Use number of consonants in inventory to assess severity of speech delay - Want to know if child is producing an adequate number of syllables for his age. a) Referring to CV patterns discussed earlier, CVC... b) Assess relational phonology (e.g., McIntosh & Dodd, 2008) this is comparing what the child produces with the adult form. Ex: A child at 24 months should be approximately 70% accurate in how they produce consonants in speech.
Older Prelinguistic Clients: Intentionality and Communication
- Identify unconventional forms of communication, such as: - Echolalia - Aggression or self-abuse - Body orientation - Touch - Generalized movements or changes in muscle tone Above might be ways that the client is communicating and we need to be sentsitive to see if these behaviors are consistent with communicating something. As SLPs we want to: - Work to increase the frequency of communication in general - Increase the range of intentions expressed to include joint attention and social interaction - Use 'prompt-free' techniques for children with no intentional communication
Assessing Older Clients with Emerging Language
- Modify assessments to accommodate for motor limitations especially when looking at play and gesture tasks or even when we are asking child to point to something in a Peabody Picture Vocabulary test. a) If the child can't point we need to make accommodations so that the client can fully participate in the assessment. -If we see maladaptive behaviors in clients we want to make sure that we consider any communicative intent that might be present. We are always looking for, are they making requests. Are they making requests by doing some kind of maladaptive behavior. Are they commenting. Are they rejecting. Are they protesting. - We want to consider the concreteness of pictures when assessing the comprehension skills. So, it is probably the best idea to use real objects if you are assessing comprehension rather than pictures since these clients may or may not understand that the picture represents the object. - Continue to assess spontaneous communication for increases in vocal maturity; add vocal communication whenever possible to AAC systems - Consider motor as well as cognitive abilities in choosing AAC systems
Assessment and Management for Preintentional Infants: Child Behavior and Development
-For many high risk infants Assessment involves ongoing monitoring of cognitive, motor, and communicative development This may even be the only component of intervention if the baby is hitting mile stones at the appropriate times. There are many assessment tools available for assessing early development. (Table 6-3) contains a dozen different assessment tools for this age range. - Management provided by multidisciplinary team An SLP will most likely be providing some direct services to the family and infant. a. Often home-based b. Transdisciplinary model may be used in some cases. - SLP consults with other professionals to design plan; may not deliver services directly, but consult to those who do
Assessment Flow Chart of ASD for Toddlers page 268
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Decision Tree page 256
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Assessment and management of babies once they leave the NICU up to 18 mo.
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Chapter 7 Part 2
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Chapter 6 part 2
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When will the IFSP be implemented?
1) Depends, infants who are identified at birth as being high risk might need an IFSP right after they leave the hospital. Other situations may call for a period of waiting to watch to see how child develops before plan implementation. 2) Text gives a couple of scenarios: a. Single teenage mom giving birth in poverty with a drug abuse hx. IFSP may be needed ASAP to provide as much support as possible once the infant goes home from the hospital. b. In contrast infant born to middle class woman with extended family nearby who are willing to help the family's needs as the bring the baby home from hospital. Family may be ok with coping for a while on the own and then do follow-up assessments when external support is needed.
Practice with Infants--Family Centered Guidelines for Practice (appendix 6-1)
1) Encourage support, trust and respect be given to parents and caregivers. 2) Use strengths-based approach: a. Rather than focusing on what infant's weaknesses are, try focusing on strengths infant demonstrates. b. Focus on positives family can bring to the table. 3) Understand and accept parent's perceptions and experiences. a. Starts with being a very good listener. Listen to what the parent is telling us about the infant and about the home environment. b. Very reliant on parents because we don't spend a lot of time assessing infants so we have to listen to what the parents say and ask right questions to elicit the information needed. c. Important that we take seriously how the parents are feeling about the situation and any insight given we want to listen to. 4) Coordination of a professional team: a. A lot of people working with the family. b. SLPs and professionals need to coordinate (can include: medical professionals like doctors, nurses, occupational therapists, SLPs, generally case manager or social worker that takes on coordinating or SLP depending on jop setting.)
Management in the NICU: Child Behavior and Development
1) For babies in the NICU we are not trying to help them meet the same milestones as full-term babies. 2) NICU Goal: Achieves stabilization and homeostasis of physiology and behavior. 3) As members of the NICU team SLPs can ...Provide a unique perspective in terms of early communication and oral motor development. We can also provide developmentally supportive care such as: Monitoring noise levels Foster staff awareness of effects of some ototoxic drugs and other possible negative outcomes: a) Negative effect on hearing that some drugs have. b) Laryngeal effects of endotracheal tubes. c) Reduced oral stimulation from non-oral feeding. d) Sensory over stimulation and low interactive stimulation Advocate for non-nutritive sucking and oral stimulation Provide information about early intervention Encourage parental interaction with baby Help parents recognize and respond appropriately to infant signals
The SLP Role
1) Language disorders are the most common developmental problem that presents in the preschool period. 2) Any infant at risk for a developmental disorder in general is at risk for language deficits. a. Stands to reason that an infant who is at risk for developing a communicative disorder or any developmental disorder is also at risk for language deficits. b. Infants are not born with communicative disorders. 3) Prevention is key a. SLPs role is not to rehabilitate a child. b. SLPs primary role is prevention. 4) Lend expertise on communication acquisition a. SLPs know a lot about how speech develops, how language develops, how hearing impairment affects both of those things. b. Anything that SLPs know about children learning to communicate will help the team of professionals working with the infant and help determine type of intervention needs to put into place. 5) Collaboration with professionals a. Know a lot about language and communication of speech but we need to collaborate with professionals about deficits we don't have knowledge about. b. Ensures that we are doing the best we can for each infant.
Using/Increasing frequency Intentional Communication
1) That means we want to see the child producing more requests, protests, rejections, etc. 2) We want the child to initiate communication. A couple of different Hybrid Approaches are Recommended: —1) Create Communication temptations, these were presented in chapter 6, table 6.5 Ex: Open up a jar of bubbles. Blow the bubbles. Put the lid back on the jar. Hand the jar to the child. By doing this we are hoping that the child will make a request by handing the jar back to the adult or perhaps verbalizing or gesturing a desire for the adult to blow the bubbles again. —- Hybrid approach —- Examples in (Chapter 6-Box 6-5) —2)- Prelinguistic Milieu Teaching Methods (Box 7-4) The prelinguistic Milieu Teaching Methods are also suggested for increasing the frequency of Intentional Communication. These involve: — - Arranging environment — Ex. Placing desired materials in view but out of reach — - Following the child's lead — Ex. Attend to and talk about toys selected by the child — - Building social routines — Ex. Patty-cake, peek-a-boo —- Using specific consequences — Ex. Providing acknowledgement of communication ***Look at Box 7-4 to read more examples in the above categories.
Assessment and Intervention for High Risk Infants and Families (NICU)
3 topics in section: 1) Feeding and Oral Motor Development 2) Hearing Conservation and Aural Habilitation 3) Child Behavior and Development
Transition Planning
Any plan written for a child in the emerging language stage needs to include a transition plan. —- Plans for transition from 0-3 to preschool services are mandated a) IFSP for 0-3 years (Individual Family Service Plan) b) IEP 3 years and up child (Individual Education Plan) —- SLPs can be effective members of transition teams a) Provide families with information and support while in transition planning. b) Set aside time to work with team members both from early intervention and preschool service providers to prepare a timely transition plan c) Share information about adaptations, accommodation, resources, and developmentally appropriate activities with preschool staff. d) Important that we actively help preschool staff prepare necessary services and supports for successful preschool placement.
Prelinguistic Milieu Teaching
Arrange environment Follow the child's attentional lead Wait expectantly for the child make the request Give the child the item
Assessing Semantic-Syntactic Production
As we are assessing symantic -syntactic production, we first want to assess the relative frequency of word combinations vs. single word productions. In other words, we want to see more word combinations than just single words as we are looking over the communication sample. Things we are looking for: - At 24 months, looking for half of the utterances to contain word combinations. - MLU of 1.5 or above ****If the above two are true then you can be confident that the child at 24 months is progressing appropriately. - Examine range of semantic relations expressed in multiword utterances - Using, e.g., Lahey's (1988) content form analysis, or Lee's Developmental Sentence Types (1974) - Or with reference to relations in Table 7-7 shows semantic relations.
Eligibility Decisions for Children with Emerging Language
As we discussed earlier, because services for children birth to 5 are the responsibility of each state, you will need to: —- Refer to local and state eligibility guidelines in making eligibility determinations. —- Use decision tree such as the one found on page 256, Figure 7-5 may be helpful in determining eligibility and in planning for intervention. —- In general, for children with accumulation of risk factors for continued communicative delays, should be considered for speech and language intervention. —- For children with circumscribed delay in expressive language only (means they would be age appropriate in receptive language abilities), consider just monitoring with periodic reevaluations. —- Also follow the family-centered practice guidelines in making all eligibility decisions.
Assessing Play and Gestures
Assessing play skills helps give us a picture of the child's cognitive skills and can give us insight about his conceptual and imaginative abilities. Play assessment will also give us an idea about what the child is interested in so we can plan therapy around the child likes to play and what the child likes to play with. - Certain gestural and play skills appear to be related to the development of intentions, first words, and word combinations - Play assessment: gives us a nonlinguistic comparison to language performance: sample methods Ex: You may assess a child that doesn't verbalize at all but in a play assessment you can see without considering verbal output a child's ideas or capabilities. a) A few different assessments are highlighted in your text. i. CSBPS (Communication and Symbolic Play Scale) will get to know this test well as we'll be completing an assignment on for this unit. ii. Play Scale (1997) - Shown in part on Table 7.1 of text iii. McCune (1995) assessment Table 7.2 iv. Take a moment to look over both table 7.1 & 7.2 in text
What do we assess in the Emerging Language Stage? (pages 293-254)
Assessment in this stage of development is actually very comprehensive. a) Want to evaluate all major aspects of communication to make sure we aren't missing anything. b) Early intervention has proven to be very effective. It is important that we assess across the board to detect delays in development. c) Want any areas of need to be prioritized and appropriately addressed in therapy. An evaluation from a child in the emerging language stage will include. Assessments on: Play and gesture Intentional communication Language Comprehension Speech-Motor Development Phonological Skills Lexical Production Semantic-Syntactic Production
Communication Skills in Typically Developing Toddlers: 24-36 months
Average expressive vocabulary size at 24 months is 300 words (+/-150); word classes include, a lot of variation —- Object, action words —- Kinship terms —- Spatial terms —- Question words —- Color, shape words —- Grammatical morphemes (ing, ed with overgeneralization), verb phrase marking emerges; some overgeneralization —- Grammatical forms for sentences such as questions, negatives are learned —- Sentence length is 3-5 words —- Intelligibility increases from 50% to 70%
Screening and Eligibility for Birth-to-3 Services
Children with risk factors identified at birth are eligible for early intervention services a) Children born prematurely b) Born with a low birth weight c) Those with FAS, drug exposure d) Hearing Impairment e) Genetic disorders f) Cerebral Palsy Others identified later through Child Find, pediatrician referrals (during 18-36 month) a) Include children with fetal alcohol effects and perhaps weren't identified at birth because symptoms not severe enough b) Fragile X syndrome, effects show up later c) Mild or unidentified hearing loss d) Autism spectrum disorders e) Those with delayed language development.
Management of Preintentional Infants: Parent Child Communication
Communication with a baby who is delayed is not as easy as it may seem. a. Human communication is dependent on reciprocity or give and take. b. Parents of typically developing infants are reinforced by their baby's smiles and frequent vocalizations. c. Communicating with infants at risk may not be as rewarding for parents because the baby does not respond as consistently as expected. What does an SLP do: 1) Help parents be aware of normal communicative patterns a. Using print, video, and spoken instruction b. Help them understand need to adapt to infant's immaturity i. Infants have little choice about how to interact and the burden falls on parents. 2) Most important thing parents can do is to enjoy them. a. If parent is enjoying interaction the child will be more apt to interact and communicate. 3) Modeling interactive behaviors for parents, including: - Turn-taking - Imitation - Establishing joint attention - Developing anticipatory sets At the top of page 201 in box 6.4 you will see an acronym TIPS. Love this because it is very easy to remember. Take turns: Coach parents to engage in back and forth interactions through songs, games, and play with toys. Encourage parents to do something the baby enjoys and wait for the child to do something, anything before the adult takes another turn. Imitate: Coach Families to play monkey see and monkey do or copycat by mirroring any actions or sounds. Point things Out: Coach families to engage baby in joint attention routines by bringing things the child likes within view and monitoring that the child is looking at them before making them move, sound, or operate. a. Later when the child is 6-10 months old use gestural pointing to establish joint attention to objects at a distance in addition to brining objects nearer to child. Set the stage: Coach parents to establish anticipatory sets by repeating simple games and songs the child likes. When child has become very familiar with these, encourage parents to stop momentarily in the middle to allow the child to anticipate and request the next part of action. 4) Developing self-monitoring skills as they are working with their infant. a. Achieved by - Having parent videotaped and at the beginning and towards the end. Helps them see how much the baby has progressed and gives them confidence about using new skills they've developed. b. Reviewing video recordings
The Emerging language Period
Defined: Toddlers —- 18 and 36 months of age -Begin speaking - Producing single words - Combining words into two word utterances may even produce simple sentences ***Problems with developing language become evident in this stage.
Preintentional
Definition of phases of preintentional period. - Between 1 mo. -8 months (After newborn stage) Infants called preintentional because ... - Not yet developed cognitive skills to represent ideas in their minds - Cannot pursue goals through planned actions Bates referred to infants in this stage as - Perlocutionary: implies two things.... 1) Babies do not intend a particular outcome 2) Adults act as if they do. a. Example if a child at 8 months old claps their hands and the parents react by saying, "oh you want to do patty cake" and then do patty cake song. b. Child clapped w/o intention but an intention was assumed and acted on by the parents. c. From that point forward the baby may clap again because she wants to do patty cake. d. She was reinforced once for clapping and wants to do the patty cake song again.
Assessment of Communicative Skills in Children with Emerging Language
Discussed typical toddler development & risk factors for language delays Once a child has been through the screening process and it has been determined that the child is not meeting developmental mile stones, it is time to take a closer look at the child's abilities through assessment. Two Primary Assessment Styles for Population: 1) Multidisciplinary Approach: Each professional does independent assessment a. Team come together and discuss findings and plan interventions with parents. 2) Transdisciplinary: Child interacts with one adult: team members suggest assessment activities and observe assessment a. One adult acts as a facilitator while the other professionals observe & take notes. b. Model used initially to decide if client is eligible for services c. Once eligibility is determined the professionals, like SLP, would do more in depth assessments to plan for intervention.
Assessing Language Comprehension
Even if a parent reports that a child understands everything that is said around them very well, it is important to assess receptive language skills or comprehension in the emerging language stage. - Comprehension strategies can mask deficits in receptive language (see Table 7-5) Ex: A mother and a child are on a walk. The mother sees a horse in the pasture and stops to point it out to the child. The mother then says, "Look at the horse." The child looks in the direction the mother is pointing. The mother infers that the child understood the direction. Then say they see a dandelion in the road and the mom stops to pick it up and blows the seeds into the air. Then the mother turns to the child holds the dandelion in front of the child and says, "Your turn, you blow." The child follows the direction. The parent is giving a lot of contextual cues that she may not be considering. The child is able to use many comprehension strategies in order to follow the direction. ***With this in mind you will want to find the linguistic level that the child should be comprehending and then use appropriate strategies for assessing comprehension. Ex: A child who is 12-18 months should be able to identify an object out of a collection of objects. 1) You would give a child 6-7 different objects and without looking at the object ask child, "Hand me the pencil." "Hand me the ball." 2) In the 18-24 month stage you would expect a child to be able to follow agent/action instructions. You could have the same group of items and say, "Kiss the apple." In this example you are using an unexpected combination and that would be better than saying, "Hug the bear." Or "throw the ball." a) A child who is 18-24 months should be able to understand agent/action/object combination. You could say something like, "Have the bear kiss the mom." The child would need to grab the bear and have the bear kiss the mom. -Once the child has reached that level, 18-24 month level and they are able to show they understand agent/action/object combinations, that's an indicator that they are ready to have a standardized test like the Peabody Picture Vocabulary Test or the test of Auditory Comprehension. - Few standardized tests are sufficient to assess comprehension at this stage - Assessment tactic: identify level of linguistic comprehension and strategy use for —- Single nouns, verbs —- Agent-action instructions —- Agent-action-object combinations
What is the point of assessing 9-18 month olds?
Exactly what is looked for in the prelinguistic stage? a)In general we want to see if functional communication is present. b) Want to see if baby is using language to get their needs met. c)Find out if communicative behaviors are present d)Find out what kinds intentions are being expressed. Communicative intents: Requesting (objects, actions, getting adult's attention) Social interactions (greetings) - If we see these types of communicative attempts, we are confident that the child is progressing appropriately. - If not, this could be a red flag that the child is behind developmentally.
Gesture assessment: sample methods
Gestures have been shown to be highly related to language in early development. Most children rely on gestures before their verbal abilities develop. In this regard, gestures can be an important prognostic indicator for children with delayed language. A developmental guideline of gestures is outlined in Table 7.3 of text. List of gestural behaviors and developmental gestures and their behavioral consequences Table 7.4
Assessment and Intervention in the Prelinguistic Period
High Risk Infants: When we are working with high risk infants, we are also working with that infant's family who will hopefully be able to provide the best possible environment for the baby to grow and develop. Appendix 6.1: At the end of the chapter, guidelines for practice for families with infants. a. A great recourse which begins with how to begin your first encounter with the family up to carrying out intervention plans.
Assessment of Prelinguistic Infants
How do we know when an infant has made the transition to intentionality? 1) Complete formal testing. - Assessing the transition to intentionality done by completion of formal testing. - Achievement of 9- to 10-month level on cognitive testing (Appendix 6-3) list of assessment tools including the symbolic play test & CSBS - Communication and Symbolic Behavior Scales a) Formal play scales involve observing a child in a play situation and giving the child scores based on what is observed. b) for assignment 2 you will get a chance to complete a play scale assessment. c) Observation of play, using play scales Observation of play can also be done informally. a) observing a child while he is playing with common objects during conventional and pretend play. Ex: A child pretending to talk on a cell phone or feed a doll a bottle is using objects in a appropriate and meaningful way. b) Indicates a child's readiness to engage in intentional communication. - Informal observation of presence and frequency of intentional communication - Parent report measures: May be useful in determining whether or not a child is demonstrating intentionality. a) These can be helpful if a child is not participating well in the assessment process. b) Parents asked to report on what they have observed their child doing at home. If intentional play is not observed or reported before giving up and moving back to work on the preintentional stage we should model use of conventional objects to see if the child will catch on. i. Feed a baby doll with a bottle and hand the baby doll to the child to see what she would do. ii. Pretend to put ingredients into a bowl and stir them together and wait to see if child follows lead. iii. If child does, great! We know child has turn corner to become intentional. iv. If not we can move back to the interactive behaviors of turn taking, imitation, building and sets, and joint attention activities (back to the tips) Knowing baby is intentional we might want to assess further to determine the frequency and types of communication the baby is demonstrating. Assessment tools for frequency of communication: - CSBS great tool for or can use informal direct observational tools.
Management for Prelinguistic Infants: Vocal Development
How management of vocal development or increased vocalization for the child who is showing a delay. To assess for vocal development: 1) Assess hearing!!!! a. A hearing loss must ALWAYS be the first thing you rule out. b. If hearing is ok you can move forward to encourage vocalization. 2) Encourage vocalization a. Want to encourage entire family to be part of the intervention. Encourage vocalization, siblings, parents, grandparents, everyone to vocalize with the baby. b. Both talk and babble c. Vocal assessment from the last slide can assist you in seeing which vocalizations should be used in therapy. d. Target vocalizations that are age appropriate but aren't being produced. - Involve siblings and others e. Encourage family by playing games, use rattles, games, mirrors to engage in back-and forth babbling games f. Encourage "baby talk" register - higher pitched, exaggerated intonation, and simple words and short phrases. SLPs should be prepared to model this for families. Sometimes parents resist because they feel they have to sacrifice articulation to produce baby register. We're not asking them to make articulation errors. Ex: I see baby. Baby has two eyes. One two. Baby has two ears. One two. Baby has fingers. One, two, three, four, five fingers. Use higher pitch, exaggerated intonation. Simple words. Short phrases. g. Reward infant vocalization with touch, smile, attention Should show excitement and pleasure when babies say something new.
Increasing Vocabulary Production
Increasing vocabulary production is a common goal for children in the Emerging Language Stage. As we are developing a first lexicon we want to choose words based on the childs.....— 1) Select Words (first lexicon) based on phonological and syllable repertoire Ex: If child cannot say the /k/ sound you will want to avoid first words containing /k/ especially in the beginning of the word. —2) Include labels or nouns, verbs, relational words (more, all gone), as well as social interactional words (hi, night-night) —3) Teach words that help the child express a variety of communicative functions rather than simply naming or labeling 4) All the intervention models (CC, Hybrid, CD) can be applied in therapy for increasing vocabulary Ex: Child centered, hybrid, and Clinician directed approaches. Some different ideas under each of these intervention models are described on pages 263-264.
IFSP--What must be included?
IFSP: Focuses on the child within the context of the family. It is similar to an IEP (individual education plan), for 3 and older. It is for children birth to 3 Individual Family Service Plan is mandated to include: 1) Statement of Child's present level of performance: a. Can be in terms of physical, cognitive, social, emotional, communicative, and adaptive development. b. Information has to be based on objective criteria, can't just be the opinion of professional, rather should be based on objective measures that give a picture of the child in comparison to typically developing children. 2) Statement of Family Resources, priorities and concerns: a. Resources- Not a financial statement but resources family has to take care of child in terms of extended family, who can take care of child and how is that going to come into play. 3) Statement of the major outcomes and criteria procedures and timelines used to determine progress: a. What are the goals b. How are we to determine if goals are reached. c. What procedures are going to be used in achieving goals d. What types of timelines for meeting goals and decisions about progress having been met or not. 4) Statement about early intervention services necessary 5) List of other services the child might need such as: a. Medical b. Funding sources that will be used. 6) Projected dates for the initiation of services and their anticipated date of duration. 7) Name and disciple of the service coordinator for service coordinator responsible. 8) Plan of transition to preschool services *Above is on page 184 within text, read more in depth of have questions! IFSP Example: IFSP included in Appendix 6.2 Could have: demographic, med info, committee signatures, developmental hx, current developmental levels, early intervention service dates, and initiation of services.
Developing Play and Gesture
If a child is NOT demonstrating age appropriate play and gesture skills, we will want to target those in therapy. 1) We want to make sure that the child is demonstrating reciprocal behavior. This Includes: - Reciprocal Behavior - Turn-taking - Back and forth babble - Peek-a-boo games - Conventional and symbolic play Once we know that the child is at this level we can begin working on conventional and symbolic play. a) We want to increase a child's ability to participate in play schemes. Ex: Pretending to prepare food in a play kitchen; pretending to drive a car around a city made of blocks. - Pretending/play schemes - Deictic Gestures With regards to gestures, we first want to see deictic gestures such as showing or giving a parent a toy, or pointing/ reaching for a desired object that is out of the child's reach. - Showing, giving, pointing, reaching - Representational gestures - Form is used to stand for a referent Ex: A child who represents eating a cookie by holding his hand up to his mouth. A child who flaps his arms in the air to represent being a bird. a) To increase a child's play and gestures, we need to model what we want them to do. b) Intervention for this area will mostly include teaching the parent to model play and gesture for their child, a parent to reinforce child for those behaviors. c) - Model for child/teach parent to model
Predictors of need for intervention (box 7-1)
In terms of language production, those children in need of language intervention may demonstrate a small vocabulary for their age. Language production - Small vocabulary for age - Language comprehension - Presence of 6-month delay Phonology - Few pre-linguistic vocalizations, limited number of consonants, limited variety of babbling, fewer than 50% of consonants correct Nonlanguage Factors - Little symbolic play - Few communicative gestures - Reduced rate of communication - Reduced range of expression - Behavioral problems
Assessment in NICU: Parent-Child Communication
Interaction between parents and babies in the NICU is somewhat tricky. a) The babies are often very frail and cannot be held for a very long time if at all. b) They may be hooked up to monitors and respirators that inhibit the interaction between PARENTS AND babies. SLPs can be a help to parents by teaching the steps of Infant readiness for communication, helping them recognize when a baby has moved from one stage to another. Stages of readiness 1) Turning in: A very sick child. Child's energy is devoted to staying alive. a. Baby really can't participate in reciprocal interactions during this stage. 2) Coming Out: Baby becomes responsive to environment. a. No longer acutely ill and begins to breathe all right and will begin to gain weight. b. Interactions need to be encouraged at this stage. 3) Reciprocity: This stage is when the infant can respond to parental interaction. a. Infant will respond to parents the typical way newborns would If child is physiologically stable and is not able to achieve the stage of reciprocity it is a sign that developmental deficits may be present. Important to assess Parent communication and family functioning: There are formal tools to assess this. It is probably best to do this informally because most parents and family will be very uncomfortable with being "assessed" Having a baby in NICU is very stressful a) Goal to get an idea of families priorities and concerns. The best way to do this is to just ask family, "What are your priorities and concerns." b) Couple of instruments Paul Nurburry suggested: i. Family Interest Survey ii. How can we help Survey? c) Designed to get information from parents and there is no judgment built into assessments. d) Knowing families priorities and concerns will be key to developing an effective IFSP. How We Can Help Survey? How to use this tool: Found in appendix 6.5 1) Questions are easy to answer. Beginning of survey is open ended. Helps clinician and parent start a nice dialogue Give clinician direction. 2) Page 2 is more of a check list that the parent completes. a. Clinician can hand parent survey or ask questions filling the information in for the parent. b. Can help develop IFSP
Family-Centered Practice
Just like in the prelinguistic stage services and intervention for children in the emerging language stage are family centered. - Learn from the family: - Vision for the child - Expectations - Opinions about the child's ability (family's assessment) - Work with family to: - Make choices about intervention rather than just putting out plan for child. a) We want to get input about what kind of intervention they want to see. - Review progress with family - Involve family when finding out child's interests a) best to have child's buy in or engaged in therapy or intervention. - Enable parents to do what works for their family a) Requires conversation about what family dynamics are, who is able to help with intervention. b) Get as much info from parents so intervention runs as smoothly as possible.
Parent Child Communication: Management in the NICU
Kangaroo care: Skin to skin contact between parent and child. Child is swaddled to the skin of parent for about 30 minutes a day. Practice associated with shorter hospital stays, shorter periods of assisted ventilation, increased periods of alertness, enhanced sense of nurturance of a child. It stands to reason that it would also improve parent/child interactions. You want to encourage this type of care! Help parents observe child and identify infant states and emotions Once an infant is in the coming out stage, our most important job in the NICU is to encourage parent interaction with the baby. Look through infants states in table 6.1 You will see behaviors associated with specific states and the implications for interactions. Parents should also be taught the signs of stress such as: -Stress: Gaze aversion Turning away Spreading fingers Arching back The above signs of stress are not a rejection of the parent's interactions but rather indications that the baby is transitioning from one state to another. -If the baby is showing signs of stress it is best to give them time to reorganize. One idea is that Encourage parents to participate in charting their baby's emotional states to improve observational skills. That way when the baby is taken home the parents are old pros at watching for the best times to interact with the baby.
Assessment in NICU: Hearing Conservation and Aural Habitation
Most states mandate hearing screening for all newborns in the NICU -NICU itself can be harmful to a babies hearing. Machines like cardio respiratory monitors and ventilators can generate noise up to: -NICU noise levels can be higher than 85 dB - At that dB cochlear damage can occur High incidence of hearing loss associated with high-risk population -due to development in auditory structures -especially in children with a genetic or congenital syndrome. -hearing loss is one of the major causes of language disorders seen within children. SLP plays a critical role in hearing conservation. Plays a critical role in making sure that aural habilitation is part of intervention plan once a hearing loss is identified. -SLPs should also teach parents about the signs and symptoms of ear infections and encourage parents to ask for regular hearing screening throughout the early years.
Management of Prelinguistic Infants
Management ideas for children who are at risk, but who are appropriately progressing. - For at-risk children with age-appropriate communicative development First we want to encourage parents to: 1) Encourage parents to scaffold and support communication attempts 2) Help parents learn to 'up the ante' to more sophisticated forms of communication a. Parent responsiveness is an extremely important factor in child development. 3) Prelinguistic milieu teaching has evidence base for this developmental level a. Has proven to be effective with this population. b. Covered under hybrid forms under chapter 3 c. PMT in the prelinguistic period involves arranging the environment by putting things the child would want in sight but out of reach. At this point the child watches for what the child is interested in. As soon as the child shows interest in a particular item that they can't reach the adult looks at the child as if to say, "you want that." Adult waits for the child to give any kind of signal or attempt to give item to child, adult acts on request. This can go along with upping the anti and making the request more sophisticated. d. Communication temptations can also be used to increase the frequency of communication i. A list of communication temptations can be found on p 205. Examples: Eating a desired food item without offering it any to him or her. Activating a wind-up toy, letting it run day and then handing it to the child. - Sabotaging or creating an environment in which child will be highly reinforced to communicate. 4) Offer experiences to a child that will develop their comprehension. Ex: As you are dressing the child pair the referent with the items name. "let's put on your sock." Holding sock you say, "let's put the sock on your foot." Grab the foot and say, "here is the sock I'm going to put it on your foot." You might feel silly or parent might feel silly but you are bombarding child with vocabulary and pairing it with real items that are tangible to child further developing their comprehension. - Interactive book reading provides contexts for communication - Communication temptations can be used to increase frequency of communication - Activities to develop comprehension should be included
Management of Prelinguistic Infants (cont'd)
Management ideas for children who are showing delays in communicative development, not demonstrating intentional use - For at-risk children evidencing delays in communicative development 1) Provide intensified 'motherese' input 2) Focus on fostering comprehension skills 3) Encourage vocalization 4) Following the Child's lead: Make adult communication contingent on what child does/looks at/is interested in 5) Offer interactive story reading if child is interested a) Maybe necessary to go back to books with tactile reinforcement or maybe just one picture per page. 6) Encourage vocal and motor imitation—by imitating child at first. Goes back to vocal development discussed earlier. Above all keep the focus on responding to the child's needs and interests making adults communication contingent on the baby's action making sure the parent and baby are enjoying All of the activities should help the child turn the corner so they can participate in the intervention for intentional communication.
Older prelinguistic Clients: Augmentative and Alternative Communication
Many older prelinguistic clients will benefit from using alternative communication. Will hear this referred to as AAC. AAC is important because: - All children need to communicate regardless of cognitive level -Through AAC we can Provide core vocabulary for the child a) - Involves choice among pictures, symbols, written words to represent concepts, based on client's communication characteristics New technology in regards to AAC: - Use easy to transport formats, including smart phones and notepad computers - Search for new applications that are emerging for these populations - Develop transactional support within communicative environment. Without this the client using AAC will not be successful Box 6.8 outlines how to provide transactional support to enhance communication. Includes: social support, emotional support, providing functional support. Read box 6.8 so you know what is needed in an AAC situation.
Older Prelinguistic Clients: Child Behavior and Development
Many times children in the older prelinguistic stage display undesirable behaviors. • Consider communicative function of challenging or problem behaviors In other words what is the child getting out of exhibiting the undesired behavior? It is our part as part of a team to try and figure out why the child is displaying the behaviors. - Use Functional Behavior Analysis to identify functions (FUBA) Can help SLPs identify the functions of those behaviors. a) Teach adaptive strategies for expressing functions Ex: Instead of screaming you could teach a child to hit a switch, raise a hand, or something that is more socially acceptable. - Consider differential reinforcement of other behavior • Provide ongoing assessment of cognitive development to determine when new cognitive skills can support new communication behaviors -So when new cognitive skills emerge or develop we can be on top of that and help the child so that he or she can communicate as much as possible. a) As soon as child is able to communicate more we want to be there to help them do that.
Assessing Toddlers with Suspected ASD
Now let's talk briefly about a specific population within this developmental range. a) Toddlers with suspected Autism Spectrum Disorders. a. Until recently Autism was diagnosed before age 3. b. Current research however suggests that a diagnosis of Autism or Autism Spectrum Disorder can be made by a team of highly qualified professionals that are specifically trained in assessment of Autism during a child's second year. c. Many screening instruments for ASD are available. Some of those are listed in- Use autism-specific screeners (Box 7-7) d. If a child fails the screen then further testing is needed. If a toddler is suspected of having Autism he will almost always display deficits in communication. a) Table 7-8 lists common communication deficits in toddlers. Deficits Include: Delayed acquisition of spoken language Depressed rate of verbal communicative acts Delayed development of pointing gestures Restricted range of communicative behaviors Deficits in pretend and imaginative play - Assess autism-specific communication symptoms (Box 7-8) - Collaborate with professionals trained in autism-specific diagnostic measures - Autism Diagnostic Observation Schedule (Lord et al., 2000) - Autism Diagnostic Interview-R (Lord et al., 1994) ***The assessment tools that are used for other populations in this age range are also appropriate for the suspected population that has ASD.*** In addition to traditional communication testing, there is assessment tools designed to probe for Autism specific behaviors. Results from tests such as the ADOS (Autism Diagnostic Observation Schedule) or the Autism Diagnostic Interview will provide information that may lead to a diagnosis of Autism. ****Specific training on these tests must be given before a professional can make the diagnosis of Autism. ***
Intervention for Toddlers with ASD
Once a child is diagnosed with Autism intervention needs to begin ASAP. - Address both expressive and receptive language goals; toddlers with ASD often have receptive scales at or below expressive level Receptive language intervention should include: Providing highly engaging joint attention opportunities. a) Can be accomplished by sharing interesting objects with the child. b) Actively attracting their attention and gaze to the object as well as the communicative partner. c) Provide simple, repetitive language to accompany this activity. d) It is important to use real objects and not just pictures of objects since children with ASD sometimes have difficulty understanding that pictures are representations of objects. Several different applied behavioral analysis programs have been designed to elicit early language production. These programs have proven to be successful especially when paired with more naturalistic activities. a) Usually what happens in this type of therapy is the child is taught specific scripts to say during specific interactions or during specific times of the day. When child learns scripts well they are faded and the child's own language can replace the scripts. - Consider clinician-directed ABA approaches for eliciting early language production Many children with ASD use echolalia which is imitating what others say just after they say it or they may repeat something they have heard in the past. Sometimes child will repeat over and over again. a) We need to consider how the child may be using echolalia to communicate. - Consider communicative functions of echolalia (Table 7-12), look at this table! There are several functions of echolalia listed on the table. Approaches to help reduce echolalia include: Using a 3rd person model or a puppet. Ex: We would be teaching the desired language forms by having the puppet demonstrate the language we would want them to use. Then praise or reinforcing the puppet. The child gets to see if I say this, something good will happen. - Address echolalia with: Third person model - Mitigated echolalia: The clinician imitates the client's echolalia but changes it slightly and encourages the client to imitate the change. a) When thinking about the emerging language stage and thinking about this technique it would probably be the most helpful in increasing utterance length. - Script therapy: Take scripts child produces and you change some of the elements in the script. Ex: If a child is repeating a phrase from Sponge Bob you can start by replacing the names from Sponge Bob with names from the child's family. Then you could change out other words and phrases to help you get child to use the language forms you are targeting in therapy. *****The above methods take time so you need to be patient and not expect a lot of results off the bat.***
Intervention Products: Goals for Emerging Language
Once an eligibility decision has been made and it has been determined that a child can benefit from intervention. The next step is to decide WHAT to work on. —- Based on assessment data, we must make decisions about what to focus on in intervention. a) Want to look at each child's strengths and needs as we prioritize what would be the best to help the child communicate in their environment. Potential goals for this Emerging Language Period include: —- Develop play and gestural production —- Increase frequency of intentional and communicative behavior (both preverbal and verbal) —- Develop receptive language —- Increasing vocal and phonological production repertoire (sounds and syllables) —- Increase vocabulary production, based on phonological and syllable repertoire —- Once expressive vocabulary reaches about 50 words, begin encouraging production of word combinations
Intervention for Emerging langauge: Preliteracy
One of the most important and easiest interventions at this stage is teaching parents to provide preliteracy opportunities to their toddlers. Begin this intervention by: — - Provide families access to books: Many early intervention programs have lending libraries where parents can check books out. If this is not available, help families learn about libraries or other community resources that help families gain access to books for their children. —- Encourage families to select books that are developmentally appropriate and attractive to toddlers —- Teach parents routine interactive reading strategies — Ex: Pointing out picture to print connection (If there is a picture of a bear on the page and the word says "Bear" this is bear and point to the word. Using cloze procedure: Ex: After a book has been read a couple of times or if there is a predictive element in the book the parent waits for the child to finish part of the sentence. a) Book Brown Bear, Brown Bear = Can use a Cloze procedure by saying, "Brown Bear, Brown Bear what did you see? I see a red bird looking at _____. Child says, "me." —- Encourage parents to use exaggerated intonation and stress during reading to highlight important elements in the text —- Help parents develop play activities around the themes from storybooks read in the home. —- Help parents begin to expose older toddlers to decontextualized talk relating the stories they have heard.
Chapter 7 Assessment and Intervention for Emerging Language
Part 1
Chapter 7
Part 3
Assessment & Intervention for Preintentional Infants: Vocal Development
Recommends always recording the observation, especially the first several times doing the process. - Observational recording (Fig. 6-1) Developmental vocal assessment form. Non-referenced assessment gives you enough information to determine whether or not the baby is progressing appropriately. a) Which in turn lets you know if goals of vocalizations should be included. Behaviors that should increase over the first year: 1) Rate of vocalization 2) Proportion of consonants 3) Multisyllabic babbling - All should increase over first year 4) Appearance of canonical babble by 10 months Defined: Canonical babbling is the production of well-formed syllables that consist of at least one vowel like element and one consonant like element that are connected in a quick transition and are recognized to contain sounds similar enough to speech to be transcribable. - Performance should be assessed relative to gestational age during first year Premature children, you should adjust for their gestational age by subtracting the number of weeks prematurity from the child's chronological age. Ex: If you are assessing a child who was born 8 weeks early, on his 3 month birthday, you would take 12 weeks for the three months, subtract 8 weeks for the prematurity, and the corrected gestational age would be 4 weeks.
Older Prelinguistic Clients: Hearing Conservation and Aural Habilitation
Some children are much older than the 9-18 month age but they are still functioning at the prelinguistic level. Book provides a lot of detail about working with this population. Key concepts: begin on page 207 • Continue to assess hearing regularly • Treat otitis media aggressively • Provide early identification and amplification of hearing loss • Even children with severe intellectual and motor impairments benefit from amplification • Help parents and teachers manage hearing aids
The Emerging Language Period Continued
States provide 0-3 services to this population Services managed by individual Family Service Plan (IDEA) Eligibility determined by states a) Variability between states exists because individual states determine qualification for services. Children identified later will assessment to determine current strengths and needs a) Assessment is needed with children identified later. i. See if they are eligible ii. Determine strengths and needs Some older children with severe communication disorders may continue to function at this level of communication. a) Some children function at this level and there chronological age is greater but functioning at the Emerging Language Level.
Interactive Book Reading
Suggestions listed in text include: 1) Waiting for the child to initiate interest in something in the book by looking or pointing. a) Adult needs to be aware of what the child is looking at or pointing to, making comments about what the child is interested in. 2) Being face-to-face during book sharing 3) Asking questions a) Even if child is not answering the questions. 4) Verbally inviting children to interact 5) Labeling and talking about the pictures in the book
Assessment in the NICU: Feeding and Oral Motor Development
The text goes into a lot of detail in regards to assessment in feeding for oral development. Does not fit into the context of this course for language disorders! All you need to know is that a bedside feeding evaluation may be necessary to observe a child's readiness to feed. Includes: Chart Review Bedside evaluation to observe Suckling Sucking Rooting Phasic bite reflex Questionnaires and checklists (Appendix 6-4) Can look at for more information. Anything regarding feeding and swallowing will be covered in a graduate class taken in the future.
Assessment for Preintentional Infants: Parent Child Communication
There are several formal assessments designed to evaluate parent communication. - Formal assessment - Informal observation of As was stated in the last lecture, parents of NICU babies may not be comfortable with being assessed. True for this stage as well! -Informal assessment preferred. When observing parents look for: - Pleasure and positive affect, want to see parents enjoying baby and vice versa. - Acceptance of the baby's style and temperament - Reciprocity and mutuality - how 'in tune' parent and infant are - Appropriateness of choice of objects and activities for parent/child interactions; - Language stimulation; use of 'baby talk,' engage in back-and-forth and "choral" babble -Parent showing interest in what the baby is focused on. a. Parent encouraging elaborate responses from the baby about the object of focus. - Establishment of joint attention and scaffolding the baby's participation
Developing Receptive Language
Training parents to use Indirect Language Stimulation is a very common strategy to implement when the target for intervention is developing receptive language. Hopefully, you all recall the video Oh Say What They See from the last unit. This video represents the most common ILS or Indirect Language Stimulation techniques. Indirect Language Stimulation: —- Extremely important for children in the 18-36 month development range —- Gives child an opportunity to observe how language works —- Builds comprehension strategies —- Develops expectations about conversational situations Examples that we are talking about include: — Self-talk, parallel-talk, imitations, expansions, descriptions, recasts, etc
Assessing Lexical Production
We are very reliant on parents as we are assessing the lexical production in the emerging language stage. A couple of tools highlighted within the text are: - Use parent report vocabulary checklists; e.g., LDS (Rescorla, 1989); CDI (Fenson et al., 2007) - Use parent report of general communication skill; e.g., Vineland Adaptive Communication Scale (Sparrow et al., 2005); it is the Language Use Inventory (O'Neill, 2007) *The Rescorla will be posted so that we can see what it looks like since there aren't any within text.
Assessment in NICU: Child Behavior and Development
When SLPs are assessing infants they should consider ---- 1) Assessment in NICU should focus on current strengths and needs. a. First consider what risks an infant faces. b. Will make intervention decisions i. Example in book - A child with Down's Syndrome 1. High risk for speech and language delays 2. Often suffer from middle ear dysfunction 3. Early intervention to boost communication would be warranted, more than a child born prematurely or any additional diagnosis. 2) Includes evaluation of level of physiological organization a. Is the baby able to participate in interactions b. Does he have irregular breathing? c. Is he jaundiced? d. Is he jittery or flaccid? e. Does he have regular periods during the day when he is alert? 3) Makes use of specialized newborn questionnaires and checklists a. Several listed in text b. Help the SLP figure out factors like when the baby functions the best like: i. What causes the baby stress? ii. How much stimulation the baby can tolerate? iii. What kind of supports seem to be helping the baby most?
Assessing Intentional Communication
When toddlers are referred for assessment it is generally because they are not talking. It is our job as SLPs to consider other forms of communication the child might be using. For children with little spoken language it is important to assess intentional communication. We want to first look at a range of communicative functions. Even if the child is not verbalizing in a conventional way are they: - Use primarily for children with little spoken language to assess communicative basis for speech - Look for range of communicative functions -Making Requests and protests/rejections (regulatory functions) (giving cup of milk and then throwing it on the ground) = rejection Other Communicative Functions: - Comments (joint attention functions), Is the child attempting to get the parent to attend to something that she is interested in. - Child using any Higher level discourse functions like answering questions, acknowledging for requesting information. - Look for frequency of communication, generally done in a 15 minute sample observation. - 12 months: 1 intentional act/minute - 18 months: 2 intentional acts/minute - 24 months: more than 5 intentional acts/minute - Look for forms of communication - Gaze - Gesture - Vocalization - Speech, even if it is not in a conventional way. -Gestures are the most common form of communication from about 8-12 months of age. -By 12-18 months gestures are combined with word like vocalizations. -By 18-24 months you'll see conventional words or word combinations beginning to be used. A worksheet such as the one found in Figure 7.2 can provide a summary of a child's performance in terms of intentional communication. The most common mistakes made in using this type of coding system is being too generous in attributing communicative intent. To qualify as a communicative act the child's behavior must satisfy the following criteria: 1) Must be directed primarily by means of gaze to the adult. -The child must look at, refer to, or address the adult directly in some way as part of the act. 2) It must have effect or at least obvious intended effect of influencing the adult's behavior, focus of attention, or state of knowledge. - The child must obviously be trying to get a message across to someone. 3) The child must be consistent in attempt to convey a message if the adult fails to respond or responds in a way that the child has not intended. Look at Figure 7.2 as well!!! To get an idea of what assessing intentional communication is all about.
Risk Factors for Communication Disorders in Infants
Who are we talking about when we say "high risk" infants? Any condition that puts a child's general development in jeopardy also constitutes a risk for a language development 1) 12% of newborns considered high-risk, 2003 March of Dimes statistic Risk factors that put child in category: 2) Prenatal risk factors: Maternal consumption of alcohol or abuse of other drugs. a) Exposure to environmental toxins like lead and mercury b) Prematurity and low birth weight. i. Babies born before 37 weeks and weigh less than 5.5 lbs. 3) Genetic or congenital disorders a. Down's syndrome b. Hurler syndrome c. Metabolic disorder 4) Other risks identified after the newborn period a. Hearing impairment b. Nonspecific Intellectual disability c. Autism spectrum disorder d. Language delay e. Abused & neglected children
Increasing Phonological Skills
—- For children with less than 50 words the first step in increasing phonological skills is to engage them in: — a) back and forth babbling games b) Start by imitating what the child can say — c) Slowly introducing consonants for the child to imitate — i. When selecting which consonants for the child to use you want to keep in mind the order of acquisition by normally developing children. ii. You will want to begin with sounds like nasals /m, n/ or stops like /b, p, d/ —- As the child is developing her phonological skills you want to focus on expanding the repertoire of sounds and syllable shapes rather than correcting errors in the child's speech. —- Shape the child's speech production by rewarding any conventional word approximations rather than correcting. DO NOT correct at this 18-36 month stage!!!!!
Predictors of need for Intervention (box 7-1)
—- Language production —- Small vocabulary for age —- Language comprehension —- Presence of 6-month delay —- Phonology —- Few pre-linguistic vocalizations, limited number of consonants, limited variety of babbling, fewer than 50% of consonants correct —- Nonlanguage —- Little symbolic play —- Few communicative gestures —- Reduced rate of communication —- Reduced range of expression —- Behavioral problems
Risk Factors for Language Delay
—- Males more vulnerable than females —- Significant history of otitis media increases language delay risks —- Family history —- Parental characteristics —a) Low maternal education —b) Low SES c) High parental concern than that is a risk factor because parents are in tune with child's needs but can't put finger on what the problem is. Parents can describe in general what the problem is.
Increasing Production of Word Combinations
—- Once expressive vocabulary reaches approximately 50 words, begin encouraging word combinations. Throughout the section on intervention in this chapter, the authors have outlined how Child Centered, Hybrid, and Clinician Directed approaches may be implemented. ****The section on word productions is particularly good. They describe several of the techniques previously introduced after 3. —- Pages 264-265—Please read about. Not only will you gain and understanding about how to help children combine words. This will also help you get a better idea of the techniques and approaches listed on the slide from chapter 3. —- Indirect Language Stimulation (ILS) techniques (CC approach) —- Vertical structuring (Hybrid approach) —- Script Therapy (Hybrid approach) —- Enhanced Milieu teaching (Hybrid approach) —- Environmental Learning Strategy (CD approach)
Communication Skills in Typically Developing Toddlers: 8-18 months
—- Preverbal intentional communication using gaze, gesture, and vocalization at 8-12 months —- Expressive vocabulary starts slowly —- 12 months: 1-3 words —- 15 months: 10 words —- 18 months (explosion): 50-100 words; first word combinations —- First 50 words include proper (sibling names) and common nouns (dog, cat), adjectives (hot, cold), verbs (run, walk), social terms (hello, goodbye) —- Receptive vocabulary is larger: 50 words at 15 months -child will understand more words than he says - Most words have CV shape, one syllable; some reduplicated words (/baba/, /mama/, /dada/); closed syllables emerge (CVC) = dog, mom, dad —- Sounds used are same as those found in early babble
Early Screening Instruments
—- Used to help identify children without disorders identified at birth, but who show signs of delays in development before 3 years of age —- Screeners focused on communication Name of 3 Screeners: —- Language Development Survey (AKA Rescorla , 1989) —- Communicative Development Inventory (Fenson et al., 2007) —- Communication and Symbolic Behavior Scales Caregiver Questionnaire (Wetherby & Prizant, 2003
