Early Communication Intervention Flashcards
Early Communication Intervention (Owens, 2014)
◉ Developmental Disability (DD)
Developmental Disability (DD)
○ Severe, chronic disability that
■ Manifested before 22 years old
■ Likely to continue indefinitely
■ Attributed to mental/physical impairments or combination
■ Substantial limitations in 3 or more areas of activity
● Receptive/expressive language
● Self-care
● Mobility
● Self direction
● Independent learning capacity
● Economic self sufficiency
■ Need supports/services–individual→ lifelong
1986: Early Intervention (EI)/Early Communication Intervention (ECI)
1986: Early Intervention (EI)/Early Communication Intervention (ECI)
○ Legal Basis: Public Law PL 99-457 ‘Education of the Handicapped Act
Amendments’
■ Comprehensive service infants/toddlers with DD
■ Multidisciplinary team assess/intervene as necessary
■ Assess child/family’s strengths/weaknesses
■ EI services appropriate for family
○ Educational approach for young children, birth→3
○ Remediation/prevention of difficulties
○ Focus on child AND family
○ ECI: primary focus on speech, language, or feeding
1990: Individuals with Disabilities Education Act (IDEA) passed by Congress
1990: Individuals with Disabilities Education Act (IDEA) passed by Congress
○ “Free and appropriate public education” for children with DD
◉ 1997: PL 105-17 Reauthorized IDEA: services within family context
◉ 2004: IDEA reauthorized: ‘Individuals with Disabilities Education Improvement
Act (IDEIA)
○ Individualized programs in natural environment
○ ‘Least restrictive environment’ (LRE)
◉ Some principles of intervention (see p. 67 for more)
○ Individualized–child/family
○ Family-centered, including culture, values, language, priorities etc.
○ Developmentally appropriate/goal of participation functionally, naturalistic
environment; highest quality intervention
○ Comprehensive, coordinated, team-based to optimize participation
Various Team Approaches
Multidisciplinary
Multidisciplinary:
a. Separate evaluations–different professionals
b. Information gathered; little coordination overall
c. Families may not be full members–overwhelmed by variety of
professionals
d. Problems: gaps in services, overlap
Various Team Approaches
Interdisciplinary
Interdisciplinary:
a. More cohesive team; family included as a member
b. Constant lines of communication between professionals
c. Assessed separately; cohesive report
d. Serviced separately, but plan together, coordinate services
Various Team Approaches & Families
Transdisciplinary
Transdisciplinary:
a. More cohesive team; family and professionals fully integrated
b. Parents/professionals join to create plans/interventions
c. Assessment: ‘Arena assessment’; team members observe child
interacting with family/natural environment
d. Integrated service plan –consensus/collaboration with family
Various Team Approaches & Families
Transdisciplinary
Transdisciplinary:
a. More cohesive team; family and professionals fully integrated
b. Parents/professionals join to create plans/interventions
c. Assessment: ‘Arena assessment’; team members observe child
interacting with family/natural environment
d. Integrated service plan –consensus/collaboration with family
◉ EI: Family-centered!
○
◉ EI: Family-centered!
○ Parent as partner
○ Positive effects for physical, emotional, cognitive, and language skills
○ Quality relationships/goals
○ Family histories/rationales/circumstances
○ Research shows greater gains in studies with parent participation
Families and Cultural Differences
Successful early intervention depends on quality relationships between all
parties, children, parents, and intervention facilitators. These relationships have a
direct impact on the parent-child relationship” (Owens, 2014, 68).
◉ EI: respect for culture, diversity, individuality
○ Materials in native language
○ Procedures-nondiscriminatory
○ Multiple methods of assessment
○ Understanding ethnic and cultural groups
○ SLP: understand/respect cultural beliefs/values to increase ECI
participation, collaboration, service delivery
Child & Parents/Caregivers
Child & Parents/Caregivers (Owens, 2014)
◉ Dyad interaction: context for ECI
○ Beginning earlier, often less intervention needed (Jacoby, Lee, & Kummer,
2002)
◉ Individualized!
◉ SLP→ Parent
○ Child’s current speech/language skills
○ Rationale for intervention
○ Role of SLP and other providers
○ SLP helping child to interact with family
○ Time/effort needed for success
○ Family: carryover and generalize
◉ SLP: Assisting parent as communication partner
○ Competent, confident in partnership
○ Integrate knowledge of child’s skills with adult education→guide
caregivers
IFSP: Child & Parents/Caregivers
IFSP: Individualized Family Service Plan (IFSP): Based on IEP
school-age
○ Both child and family needs impact development of the child
◉ Needs to include:
○ Child and family’s current status
○ Recommended services/expected outcomes
○ Projection of duration of service delivery
ECI Programs: early communication
Early communication:
◉ TD children learn their behavior affects others in environment
○ Important connection for establishing communication intent
○ LT: language delays can affect social development
■ More withdrawn, limited social-emotional skills (Irwin, Carter,
& Briggs-Gowan, 2002)
■ Preschool: Language problems associated with
behavioral/emotional problems later in life (Owens, 2014)
◉ LLE: Late Language Emergence: Possible Contributing Factors (Owens, 2014)
○ Low birth weight, premature birth
○ Family history of LLE
○ Early neuro-biological growth
○ Male Gender
LT: Outcomes
● ‘Watch and See’ (Paul, 1997, 1996)
● Early intervention assessment:
○ Training/modeling for parent not receiving services
○ Follow-up for services
● LT—> SLI? (Rescorla, 2009; Leonard, 2000)
● Late talkers: Risk for Specific Language Impairment (SLI; DLD)
○ “Greater risk than children who hit the early milestones of language
development on schedule” (Leonard, 2000, 183, emphasis added)
ECI Programs: Different Groups of Children
◉ 2 broad categories of children serviced:
○ Established risk
○ At risk
◉ ‘Established risk’: “strong relationship between the condition and developmental
difficulties” (Owens, 2014, 72)
○ Early intervention programs: very beneficial
○ Easier to identify
○ Strong link with developmental disabilities
◉ ‘At risk’: “potential to interfere with a child’s ability to interact in a typical way
with the environment and to develop typically” (Owens, 2014, 72)
○ Early intervention programs: very beneficial
○ Biological/Environmental in nature
Children: Established risk
○ CP: Cerebral Palsy
Established risk’ “strong relationship between the condition and developmental
difficulties” (Owens, 2014, 72)
○ ID: Intellectual disability
○ ASD: Autism Spectrum Disorder
○ CP: Cerebral Palsy
■ Group of chronic brain disorders–neurological damage
■ Affects movement, muscle tone/coordination
■ Risk factors: low birth weight, preterm birth, rubella and other maternal
infections during pregnancy, prolonged loss of oxygen, bleeding in brain
etc.
■ Different types: (can have mixed)
● Spastic: rigidity, jerky, labored movements
● Athetoid: slow, uncoordinated movements; difficulty with control
● Ataxic: uncoordinated, poor balance/walking
● Hypotonic (‘floppy’): poor muscle tone, floppy posture
Children: Established Risk (cont.) (Owens, 2014)
◉ Sensory Impairments:
Sensory Impairments: *Impacting child AND family
○ Deafness: hearing impairment (HI)
○ Severity of HI measured by intensity level; degree of loudness, measured
in decibels (dB)
○ *Spoken language acquisition—depends on hearing auditory input
○ Access to spoken communication from birth and onward
○ Identifying younger is so important!
■ Six months or less→greater chance of better language dev.
■ All infants in U.S. –hearing screening
○ Total Blindness:Complete lack of form/visual light perception
○ ‘Light perception’ can tell difference dark/light
○ ‘Legal blindness’-visual acuity with best possible correction of 20/200
(where 20/20 is typical vision)
Children ‘At Risk
At risk’ “potential to interfere with a child’s ability to interact in a typical way with
the environment and to develop typically” (Owens, 2014, 72)
○ International Adoptions & language acquisition
■ Language/culture differences
■ First weeks, months etc. of life–institution
■ Possible delays in growth/overall development
○ Socioeconomic Status (SES)–Risk factors may/may not be associated
■ Economic deprivation–lack of nutrition, medicine…
■ Birth complications
■ Physical/mental health problems
■ Neglect/abuse
○ Maltreatment/Neglect
○ Preterm/Low Birth Weight
■ Preterm (22-27 weeks): possible continual health problems
Importance of ECI Assessment
Different kind of assessment
○ Cooperation?
○ Indicative of child’s true language skills?
○ Unreliable responding
◉ **Compare child’s current skills across different developmental domains
○ Identify child’s strengths/challenges
○ Foundation of prelinguisitic skills
■ Vocalic play
■ Vocalizations
■ Gesture use
■ Symbolic play
■ Initiating/responding to joint attention
■ Parental interactions–input
■ Family History of language/learning impairments etc.
ECI Assessment
Two step assessment:
◉ Evaluation: Must be conducted to determine child’s eligibility for services
○ Evaluations: structured, formal, standardized testing (norms)
○ 1) Global evaluation: overall skills
○ 2) Specific evaluation: i.e. communication
◉ Assessment:
○ Assessment: “Ongoing process of identifying a child’s unique needs; the
family’s priorities, concerns, and resources, and the nature and extent of
the EI services needed by both” (Owens, 2014, 79)
○ Less formal
○ Use multiple tools/methods to assess
○ Cooperation with family, other professionals
○ Not just identifying challenges, but identifying what can be done to
help–Step 1 of intervention!!
ECI Assessment (cont.) (Owens, 2014)
◉ Arena Assessment
Arena Assessment: Transdisciplinary team
○ Common sample of child’s behavior, language etc. collected
○ All observe process for assessment
○ Not observed separately by different professionals
○ **Family-centered assessment; parent collaboration is key!
■ Priorities, resources, concerns, supports
○ Play based assessment:
■ Naturalistic
■ Context based
■ Child centered
■ **Not a free-for-all! Structured play!
■ “Process of interaction takes precedence over the product or result”
(Owens, 2014, 79)
Informal Communication Assessment
Early Communication Development—Child behaviors earlier have important impact on later
communication
1. DESCRIPTION OF COMMUNICATION: (use by child/interpreted by caregiver)
a. Descriptive forms/means of communication: Intentional and unintentional
behaviors performed by a child in front of caregiver
i. Physical (non-vocal): eye contact, facial expressions,
communication distance, gestures, body contact/movements,
aggression to self/others
ii. Vocal: sounds, crying, screaming
**Important to include all observed, as early behaviors are
connected to later language disorder diagnoses
b. **Communication Success:
i. Communication goal obtained?
ii. Environment–response to child is important
Informal Communication Assessment (cont.) (Owens, 2014)
2. CAREGIVER-CHILD INTERACTIONS:
CAREGIVER-CHILD INTERACTIONS:
◉ Sensitivity, responsiveness, and interpretation of intent by caregivers
◉ Responses by caregivers encourage/discourage behaviors (Owens, 2014, 81)
○ Relatedness of the response to child’s behavior
○ Consistency of adult response
○ Timeliness (how quickly) adult responds
Informal Communication Assessment (cont.) (Owens, 2014)
3. PRESYMBOLIC BEHAVIORS:
- PRESYMBOLIC BEHAVIORS:
◉ Joint attention/attention following (gazing/pointing)
◉ Variety/complexity in symbolic play
◉ Gestures and vocalizations: intentional communication
○ Gestures correlate with later receptive language skills AND can serve as a bridge
to language expression, from language comprehension
◉ Complexity of presymbolic vocalizations (various consonant, syllable structures)
◉ Motor Imitation
◉ Receptive language/comprehension of words
○ Significant predictor of language expression at later stage
*Communicative intent: Observe child: - Performing a signal/behavior
- Signal/behavior directed at/toward another person
- Appears to indicate communicative function (hard to identify)
Informal Communication Assessment (cont.) (Owens, 2014)
4.. SYMBOLIC ASSESSMENT:
SYMBOLIC ASSESSMENT:
◉ Words, signs, AAC communication
◉ Produced for purpose of communicating a message
◉ Functional: frequent, flexible, purposeful
◉ SLP must observe/report:
○ Phonotactic abilities: production sounds, sound combinations, syllable
structures
○ Imitation abilities
○ Expressive vocabulary
○ Multi-word combinations
○ Pragmatic functions:
Informal Assessment: Word Combinations (
Report basic multi-word utterances: constructionist patterns
(Constructionist Linguistic Theory)
● Word Combinations: words state an experience; successive one
word utterances
○ Ex. Drink cup, Wave bye
● Pivot Schemes: Determines intent; several words can fill ‘slot’
○ Ex. Want doll. Want milk. More cookie.
● Item-Based Constructions: Seem to follow word order constructions
○ Ex. Daddy driving. Mommy throw.
Semantic rules: (Semantic Analysis Method)
● Demonstrative + Entity→ Ex. This doggie.
● Possessor + Possessed→ Ex, My cup.
● Agent + Action→ Ex. Boy eat
Formal Communication Assessment
Formal: Standardized testing: Difficulty to use before age of 3
◉ Parent completed: Checklists
○ MacArthur Bates Communicative Development Inventory (CDI-2)
◉ Standardized tests for young children:
○ Scales: Developmental norms
■ Ex. Bayley Scales of Infant Development, Fourth Edition
■ Rossetti Infant-Toddler Language Scale
■ Preschool Language Scale, Fifth Edition (PLS-5)
Informal & Formal Communication Assessment
Screening
SLP: Responsible for selection & development of screening and assessment
procedures
◉ Screening: first step to determine if deficits are exhibited in
communication/feeding
○ Deficits→ complete evaluation
○ Screening includes direct observation/assessment and parental report on
standardized instrument
○ Interview process/questionnaires with parent: priorities, concerns…
○ Screening: performance at one point in time
○ Continued monitoring of child’s performance over time
○ Several sources of information–most beneficial for SLP
○ *Culturally, linguistically appropriate
Assessment: Overall Steps (
Preplanning
◉ Gathering preliminary data (i.e. teacher, other professionals)
◉ Questionnaire
◉ Interview with parent, other professionals
◉ Interactional observation (settings, situations, frequency of communication)
◉ Formulating hypotheses
◉ Play-based interactional assessment–use ‘communication temptations’; informal
◉ Structured Probes and testing—-including dynamic assessment
○ Dynamic assessment: clinician-mediated strategy to determine
‘teachability’ (Owens, 2014, 87)–stimulability to learn skill
○ Test-teach-test form; determine different prompts that may be beneficial
○ SLP introduces/withdraws prompts (Chapter 5); small changes noted!
○ Sampling: Language sample (babbling, vocalizations, words, combinations)
Analysis of data
◉ Decision making; recommendations (mandates)
○ Team members–intervention options, individual basis
○ Collaboration with family
**Collaboration is KEY!
Assessment: Collaboration with families→more likely to collaborate
with treatment planning etc.
Intervention: Overall
Language: Multiple shared experiences
○ Jointly focused; joint attention on events/objects (i.e.
attention allocation)
○ Communication: nonsymbolic→symbolic
○ Gestural and vocal→verbal
○ Intervention: mapping symbolic forms onto existing
prelingustics functions/intentions = functional therapy!
◉ Daily Routines/activities–unique
○ Embedding intervention: crucial to success!
Intervention Strategies
EI
Specific Intervention Strategies: EI
◉ Responsive Interaction
◉ Directive Interaction
◉ Blended
Responsive: (Owens, 2014, 89)
◉ Following child’s attentional/conversational lead with response
◉ Natural consequences (from verbal/nonverbal initiations)
◉ Extending child’s topic in reply (extensions)
◉ Self-talk/parallel-talk describing an action
◉ Meaningful feedback to child
◉ Expansions: expanding child’s utterance with more mature (more syntactically
correct model)–powerful strategy
Intervention Strategies (Owens, 2014)
Responsive:
Responsive: (Owens, 2014, 89)
◉ Following child’s attentional/conversational lead with response
◉ Natural consequences (from verbal/nonverbal initiations)
◉ Extending child’s topic in reply (extensions)
◉ Self-talk/parallel-talk describing an action
◉ Meaningful feedback to child
◉ Expansions: expanding child’s utterance with more mature (more syntactically
correct model)–powerful strategy
Incidental teaching: naturalistic **child-directed intervention
◉ Child shows interest, clinician goes along with interest
◉ Interacting based on child’s interest
◉ Naturalistic intervention!
Intervention Strategies (Owens, 2014)
Directive Interaction
Directive Interaction: behavioral teaching (antecedents and consequences)
◉ Adults alter cues/prompts to get desired behavior
◉ A: “Say Cookie”
◉ B. Child–”Cookie”
◉ C. “I like the way you said cookie! Here it is!”
◉ *Problem with generalization
◉ Work with different populations
Intervention Strategies
Blended Approaches
Blended Approaches: Natural environments
◉ Modeling language responding to children’s communication from typical
mother-child dyad interaction
Intervention: Overall (Owens, 2014)
◉ Including parents in intervention
Including parents in intervention–Parent implemented intervention
○ Inclusion as language facilitators
○ Teaching how to expand language
○ Parent learning one thing at a time, modeled and practiced
○ Feedback from SLP on consistent basis
○ SLP: building parental confidence
○ Inclusion of other family members into therapy goals
◉ Hybrid model of individualized therapy and working with parents
◉ SLP: Modeling/teaching parents with their children (dyads)
○ Modeling, parent imitates, SLP assistance
○ Deciding targets together, various methods
○ Consultation/education of other family members, professionals
Augmentative & Alternative Communication (AAC)
(Owens, 2014)
AT: Assistive Technology
Adaptations/devices for children to enable more independent functioning
Augmentative & Alternative Communication (AAC)
AAC Augmentative & Alternative Communication definition
Augmentative & Alternative Communication
Form of AT; “An intervention approach that uses other speech means to
complement or supplement an individual’s communication abilities and may include a
combination of existing speech or vocalizations, gestures, manual signs,
communication boards and speech-output communication devices” (Owens, 2014,
Augmentative & Alternative Communication (AAC)
(cont.)(Owens, 2014)
◉ Speech is not ignored
Speech is not ignored!
◉ Enhance communication overall–both input and output
◉ Replaces social unacceptable behaviors–more appropriate, more conventional
means of communication
◉ Facilitates a young child’s ability to more fully participate in daily
activities/routines
◉ Output important–but not just for output!
AAC vocabulary:
◉ Unaided AAC: no equipment; uses body to relay information
◉ Aided AAC: uses communication devices to augment one’s own body
◉ Communication Boards: visual graphic symbols for communication
○ Photographs, line drawings, symbols, printed words
○ Portable, readily accessible, adaptable
■ Non-electronic boards–communicate selection via pointing (also
can be done by eye gaze etc.)
Augmentative & Alternative Communication (AAC)
AAC vocabulary:
Unaided AAC: no equipment; uses body to relay information
◉ Aided AAC: uses communication devices to augment one’s own body
◉ Communication Boards: visual graphic symbols for communication
○ Photographs, line drawings, symbols, printed words
○ Portable, readily accessible, adaptable
■ Non-electronic boards–communicate selection via pointing (also
can be done by eye gaze etc.)
■ Scanning: Child going through the message elements, presented in
sequence
● Child scans to make choice of a certain element (icon)
● Varied organizational designs
○ Schematic grid: Vocabulary on different pages (categories)
○ Schematic scene: integrated scenes with vocabulary in scene
Augmentative & Alternative Communication (AAC)
AAC vocabulary:
AAC vocabulary:
◉ Core vocabulary: Words commonly used in any situation (want, all done, more)
◉ Fringe vocabulary: words specific to a certain setting, situation (paint, dance)
SLPs:
◉ Survey environments/activities specific to child
◉ Communication diary to record child’s attention interactions
◉ Compiling lists of words for variety of settings
◉ Caregiver vocabulary–use questionnaires
SLPs: Motivate:
◉ Integrate play into AAC design/intervention
◉ Meaningful, fun contexts
◉ Expand output voice
◉ Personalization/options for child
Augmentative & Alternative Communication (AAC)
Research Evidence in Literature:
Research Evidence in Literature:
◉ Less evidence-based therapy information, but research shows that AAC very
beneficial
◉ AAC plays important role in communicative development
◉ Must be introduced before communication failure!
◉ AAC appropriate for language development/communication skills
◉ Enhances development of spoken communication–does not deter from using
verbal language!
◉ ***”A systematic review of the professional literature for over thirty years of AAC
research reported that none of the studies demonstrated decreases in speech
production as a result of AAC intervention (Millar et al., 2006). Research data
clearly suggest that the introduction of AAC will neither cause a child to abandon
speech he or she may be using nor prevent acquisition of new spoken words”
(Owens, 2014, 95).
Augmentative & Alternative Communication (AAC) (cont.)
AAC Assessment
AAC Assessment: Assess motor skills, visual perception, sign and symbol recognition
◉ Special type of assessment—SLP knowledgeable in AAC
◉ Problem–many apps, devices provided without proper assessment
AAC System: versatile, appealing, easy to learn, dynamic, (with family consensus)
Aided AAC: Goal accuracy and efficiency of selection! Child needs to locate, select, and
functionally use the AAC:
◉ Symbol system selection
◉ Method and rate of symbol selection
◉ Organization of symbols
◉ Grouping/arrangement
◉ Border, colored background,
