Pediatric Language Intervention Flashcards
What is the continuum of naturalness?
The extent to which the settings and activities in intervention resemble “real life” or the world outside the clinic room
What are the three basic approaches according to Fey
Clinician directed approach
Hybrid
Child-centered
Clinicians specify all aspects of intervention, AKA drill or DTI or discrete trial intervention, increase relevant linguistic stimuli/reduce irrelevant stimuli. This is also less naturalistic as the the clinician controls the environment
Clinician directed approach
Provide an example of clinician-directed approach
“Say “what’s in the picture after me”
The clinician presents picture stimuli and asks, “What is this?”
What are the advantages of a clinician directed approach?
- Maximizes opportunities for the child to produce higher number of target responses
- Effective in eliciting a wide variety of new language forms
This is more of a drill-type and structured approach. What approach is this?
Clinician directed
What is drill play
It has subsequent antecedent
What is modeling?
The child is not expected to imitate immediately
What is the child-centered approach?
Child is in the driver’s seat
Clinician chooses the materials, child directs the activity
“Following the child’s lead”
What is the goal of a child-centered approach?
The goal is to respond to the behavior in a way that models communicative language use
Not trying to elicit specific reaction
We react to the child’s behavior
What are language stimulation techniques?
- Indirect ways to facilitate language growth
- “Tempt” the child to talk more
- Good for younger clients
- High levels of intensity of input
- 1 consequating remark/minute
What kind of LST is this: “Wow. I’m building with blocks and legos. I’m putting one lego here on top!”
Self talk - describing our own actions as we engage in parallel play with the child
What kind of LST is this: “Wow! You’re building a block!”
Parallel talk
What kind of LST is this:
Child: Eat apple
Clinician: The girl is eating the apple
Expansion - take what the child said and add the grammatical markers and semantic details
Sometimes called recasts
What is an extension?
- AKA expatiations
- Add some semantic information
- Child: Doggy house
- Clinician: Doggy went inside or Yes, he got cold.
- Adult extensions → significant increase in children’s sentence length
The clinician not only expands the child’s utterance by making it grammatically correct but also adds new semantic information that wasn’t part of the child’s original sentence.
Extension AKA expatiations
What are consequating behaviors?
- Imitation, expansion, extension
- Decrease amount of info the child has to process
- Applies ZPD
- Gives children more mature linguistic forms for their ideas
What LST is this? Break into several phrase-seized pieces that overlap in content
Build ups and breakdowns
Hybrid approaches
- Target one or a small set of specific language goals
- Maintains a lot of control but does so in a way to tempt the child to make spontaneous use of targets
- Clinician uses linguistic stimuli not just to respond to the child’s communication but to model and highlight targeted forms
What is focused stimulation?
- Carefully arranges the context of interaction so child is tempted to produce utterances
- Clinician provides very high-density models of the target forms in a meaningful communicative context
- Only tempted but not required to say. Respond contingently
- Effective for improving comprehension of a form, and production
What hybrid approach is this:
The clinician repeatedly models a target structure to stimulate the child to use it. This is usually done during a play activity that the clinician designs to focus on a particular language structure (e.g., the plural morpheme -s). The clinician uses various stimulus materials, talks about them, and repeatedly models the plural constructions “Look, here are two pigs. I see two pigs here.” The clinician does not correct the child’s incorrect responses but instead models the correct target.
Focused stimulation
This is a form of expansion used like focused stimulation to highlight target structure but it is less naturalistic than standard LSTs/LFTs, it is a specific nonlinguistic stimulus, and targets a particular form. It is also a naturalistic response from the clinician not requiring imitation. Target is early developing language forms. Child’s incomplete utterance → contingent question
Vertical structuring
A speech-language pathologist is working with a 3-year-old child with a language delay. The child says, “Dog eat.” The clinician uses vertical structuring to facilitate language development. Describe how the clinician might use this technique in this context and evaluate the effectiveness of vertical structuring for promoting the development of early language forms compared to other intervention strategies such as focused stimulation or recasting. In your response, discuss the potential advantages and limitations of vertical structuring in fostering syntactic and grammatical development in young children.
A. The clinician asks a contingent question like, “What is the dog eating?” and after the child’s response, expands on the child’s utterance by saying, “Yes, the dog is eating food.” This method is effective because it encourages imitation of complex sentences, which makes it more beneficial than recasting for promoting sentence complexity in natural conversations. However, vertical structuring may be less engaging for young children because it relies heavily on structured prompts.
B. The clinician uses a more naturalistic approach by modeling the correct utterance, “The dog is eating,” without directly asking a question. Vertical structuring here is advantageous for fostering spontaneous language use, especially when compared to focused stimulation, but it may limit syntactic development because it doesn’t directly prompt the child for a response.
C. The clinician asks, “What is the dog doing?” to prompt the child to elaborate on the utterance. After receiving the child’s response, the clinician models a more complex sentence, such as, “Yes, the dog is eating food.” Vertical structuring is effective for building on incomplete utterances and promoting sentence expansion. However, it may not be as beneficial for encouraging the use of new vocabulary as focused stimulation, which targets specific forms repeatedly.
D. The clinician repeats the child’s utterance exactly, “Dog eat,” and waits for the child to self-correct. Vertical structuring relies on the child’s ability to recognize and self-correct errors. While this method can encourage critical thinking, it may be less effective for younger children who require more direct language input, unlike strategies like recasting or focused stimulation that offer immediate language models.
Answer: C. The clinician asks, “What is the dog doing?” to prompt the child to elaborate on the utterance. After receiving the child’s response, the clinician models a more complex sentence, such as, “Yes, the dog is eating food.” Vertical structuring is effective for building on incomplete utterances and promoting sentence expansion. However, it may not be as beneficial for encouraging the use of new vocabulary as focused stimulation, which targets specific forms repeatedly.
What type of hybrid approach is this:
Material: A picture of kids playing at the park
Clinician: Look at this. What do you see?
Client: Play
Clinician: Yes, there are kids playing. What are they playing?
Client: Tag
Clinician: Yes, they’re playing tag. The kids are playing tag.
Vertical structuring
What is milieu communication training?
- Uses child’s interest and initiation
- Use imitative cues and extrinsic reinforcement
What are the three major concepts of milieu communication training?
- Environmental arrangement
- Responsive interaction
- Conversation-based contexts
→ Implements incidental training: things the client wants or needs to complete a project are visible but out of reach
What is incidental training?
- Things the client wants or needs to complete a project are visible but out of reach
The child is points at the desired object. The clinician responds by focused attention–going to the child. When the child does not respond or say anything, the clinician will ask a question, “What is that?” If the question produces a target response, the clinician will provide a confirmation, which includes a model of the target form
Child: Want cookie
Clinician: Oh, you want the cookie. Here it is.
However, if the question fails to produce the target response a prompt is provided:
Clinician: Say, “I want a cookie” If not, one more attempt to prompt is made. If this fails, the child gets what they want. The clinician then tries again on the child’s next attempt at communication
Incidental teaching
This intervention technique is similar to incidental teaching but the difference is the clinician does not need for the child to initiate communication. The clinician, using attractive stimulus materials, designs a naturalistic interactive situation. The clinician will then say, “Tell me what you want.” If the child gives no or a very limited response, the clinician models the complete, correct response. If the child does not imitate the entire modeled sentence, the clinician prompts (e.g., “Tell me the whole sentence.”). The child is praised for imitating or for responding correctly without modeling and is given the item he or she wanted.
Mand-model
The child initiates the interaction, and the adult waits for this natural occurrence to prompt and expand the child’s language. The adult provides more indirect guidance, such as cues or questions.
Incidental teaching
The adult initiates the interaction and directly prompts the child to use language, often by asking a question. If the child doesn’t respond, the adult models the target language.
Mand-model
This is for children who are not yet using spoken language, developmentally 9-18 months old. The goal is to develop the basic intentional communication skills necessary for early language development by increasing the frequency, maturity, and complexity of nonverbal communicative acts
Prelinguistic milieu teaching
Goals for prelinguistic milieu teaching
- Establish interactive routines to serve as contexts for communication
- Increase frequency of vocalizations
- Increase frequency and spontaneity of coordinated gaze
True or False. Enhanced milieu teaching is effective for children who meet the following criteria:
(1) Produce some verbal imitation
(2) Have at least 10 productive words
(3) Are in the early stages of language development, with MLUs from 1 to 3.5 \
True
Activities used in enhanced milieu teaching
Choose materials of interest to child; arrange environment
Use environmental arrangement to elicit child initiations
Mirror child actions to take a nonverbal turn; pause and wait to give child a chance to take a turn
Recognize and respond to what child communicates verbally or nonverbally
Expand child utterances to those at child’s current zone of proximal development
Use models following child requests to elaborate child form
Use request or questions that give child a limited choice for responses
Use time delay/expectant waiting to elicit child speech
Advantages of milieu teaching
- Lead to better generalization
- Increase children’s frequency of talking both to the teacher and each other
- Broad range of expressive communication targets
- Long term gains
- Useful for small-group or classroom setting
What is script therapy?
- A way to reduce cognitive load of language training by embedding it in the context of a familiar routine
- Develops some routines or scripts with the child in the intervention context
A clinician is working with parents on home language-stimulation activities for their 3-year-old daughter Hannah, who is language delayed. Among other things, Hannah needs to increase her expressive language skills to a level more commensurate with her chronological age. Her mean length of utterance is restricted and her utterances are more typical of a young 2-year-old child. The clinician has recommended that at home, the parents use a technique in which they play with Hannah and describe and comment upon what she is doing and the objects she is interested in. For example, the parents might say, “You are making the car go fast,” or “That pig is pink.” The parents are using the technique of:
Self-talk
Expansion
Expatiation
Parallel talk
Joint reference
Answer: D. Parallel Talk
Maximal prompting: clinician is teaching
- Cues are frequent (80% to 100% of trials) support is full
- Complete imitative model or explicit verbal instruction
- Hand-over-hand or full physical guidance
- Point or show correct target location
- Provide direct, explicit instruction or metalinguistic instruction
Moderate prompting: Client is ___________
- Client is practicing
- Cues are intermittent (25% to 75% of trials) Support is partial
- Provide: a closed set or multiple choice, a category for response, a semantic cue, cloze cues with expectant waiting, phonological cues, point or look in the general area of a correct response
Minimal prompting: client shows use of the skill; may self monitor; clinician is coaching
- Cues are occasional (5% to 20% trials) support is subtle
- Provide a light touch or tap to direct attention or remind
- Provide verbal reminders
- Provide a visual cue (picture schedule)
What are baselines?
Clinician-designed measures that provide multiple opportunities for a client to demonstrate a given communicative behavior
75% accuracy or higher - not in need of remediation
Below 75% accuracy - potential intervention targets
At least 50% accuracy - best potential for improvement
Highest priority
Uses in 10% to 50% of required contexts
High priority
Uses in 0% to 10% of required but understood in receptive tasks
Low priority
Uses in 50% to 90% of required contexts
Does not use at all and does not demonstrate understanding
Number of therapy doses per week
Dose frequency
Number of trials or learning instances provided during a therapy session
Therapy dosage
True or False. Early intervention has a primary emphasis on family involvement and education
True
What is the goal of early intervention?
The development of basic skills thought to be critical to successful speech, language, and communication learning
Age of early intervention
0-3 years old
What are the primary therapy strategies for infants?
- Authentic learning experiences in natural environments
- Modeling/stimulation
What is localization?
Infants ability to demonstrate awareness of sounds in their environment by turning toward and visually searching for the source of a sound
Infants conceptual grasp of cause-effect relations
What is joint/shared attention?
A shared focus underlies successful communication
Relationship between the adult’s utterances and the objects, actions, or concepts they represent
Joint visual attention → prerequisite for all subsequent communication
The clinician placed an attractive or noisy object in front of the infant, looked at it, and commented on it
Joint/shared attention
What is mutual gaze?
- The infant and caregiver look at each other during social interactions
- Attachment/bonding between infant and caregiver
- Later development of the important skill of turn-taking in conversation
- Immediate parental response to the infant’s initiation of eye contact results in more frequent and varied interactions
Adult eye contact is accompanied by smiling and other facial expressions, touching, and novel, or entertaining vocalizations
What is joint action and routines
- Occurs in play sequences known as sound-gesture games or routines such as peekaboo
- A routine is a prepackaged or ritualized exchange
- Clear marked beginning, middle, and end
- Clearly specified positions for vocalizations/verbalization
- Encourages anticipation and predictability
Vocalization
- Increasing the frequency, variety, or quality of the vocalizations produced by the infant
- Singing, humming, cuddling, tickling, or playing sound-gesture games such as peekaboo
- Clinicians may also imitate the infant’s vocalizations in a playful manner to initiate a repetitive imitative exchange
What are communicative intentions?
The meaning that a speaker wishes a message to convey
This is where the infant discovers intentional communication and begins to express their communicative intentions through gesture and vocalization.
9 months
At around this age, infants begin to understand a few familiar words
6-8 months
Production of first true words occurs around the _________________
First birthday
Three main consideration in the selection of target vocabulary are:
(1) words that can be used in different contexts
(2) words that are important to the child
(3) words that represent dynamic rather than static states
This period is characterized by rapid growth in vocabulary.
3-5 years old
How is focused stimulation applied at this age?
Provides concentrated exposure to a target form in a variety of contexts
Clinician preselects a linguistic target and produces it in high concentration throughout natural and meaningful adult-child interactions
The child is not required to produce the linguistic form
Wide variety of targets: vocabulary, grammatical morphemes, and syntax
What is incidental teaching?
This is a naturalistic approach that encourages a child to initiate communication by arranging the environment to increase the likelihood that the child will produce a verbal or nonverbal intervention target
The child’s successful communicative attempts are rewarded through natural consequences such as a requested object or event
The clinician also responded to the child’s communicative attempts with requests for expansion of elaboration
Variations of incidental teaching include milieu and time-delay
Floortime/Developmental, individual difference, relationship-based
Building the foundations of social, emotional, and intellectual capacities in young children rather than targeting isolated behaviors or skills
It encourages socially appropriate child-initiated interactions
With emphasis on developmental milestones, individual differences, and the relationship between the child and others in the environment
A critical component of this model if family engagement
What is the family centered approach?
Trains parents and other caregivers to foster the development of language and communication in naturalistic contexts
The SLP functions in an indirect or educational capacity with family members
Improving the child’s communicative skills and/or improving the adult family members’ ability to engage in mutually reinforcing communicative interactions with their child
What are the 5 main areas to increase child’s print knowledge
- Shared book-reading and sense of story
- Phonological awareness
- Promoting awareness of speech sounds
- Alphabetic letter name and sound knowledge
- Adult modeling of literacy activities
- Experience with writing materials
Shared book-reading and sense of story
Engage in dialogic reading
Ask questions throughout the reading activity about what has been read and what might happen next
Direct the child’s attention to the printed words rather than focusing solely on picture.
Improve the child’s phonological awareness through
- Reciting fingerplays
- Sing songs and chants
- Engage in alliteration and rhyming
- Point out words that begin with the same sound
- Say simple words such as “cat”; have the child think of one or two words that start with the same initial sound
- Encouraged the child to recount familiar experiences that occur routinely in daily life (e.g., scripts) such as grocery shopping or getting dressed
- Encourage the child to recount personal event narratives, which are event sequences experienced by someone else (e.g., Daddy cooking dinner)
Promoting awareness of speech sounds. What is this?
PASS is a structured early reading program designed for preschool children
It follows a consistent lesson format
This can be used with typically developing preschoolers and early elementary aged children with and without disabilities
Three instructional units that are being used would be
rhyming
Blending
Segmentation
True or False. The rhyming lesson demonstrates an expressive task at the level of saying the words.
False. The rhyming lesson demonstrates a receptive task at the level of matching and recognition
Choosing two pictures that rhyme from a set of three
The blending lesson utilizes what kind of task?
A yes/no judgment task
A child is given a word phoneme by phoneme (e.g., b-a-t) and then a whole word
The child is required to indicate whether the whole-word version is the same as or different from the unblended version
What is segmentation?
The child is required to produce a word using its individual sounds
Example: When given the word bat the correct response would be b-a-t
What is alphabetic letter name and sound knowledge?
The following order: letters in which the sound represents the beginning of the letter name, end of the letter name and which the sound is not related to the letter name
Call attention to the way letters are formed /w/ → round lips etc.,
Call attention to the sounds that each letter makes (e.g., letter m makes the /mmm/ sound)
What is adult modeling of literacy activities?
Frequent opportunities for the child to observe adults engaged in reading and writing contexts
Child as a “helper” in everyday activities
Engage the child in interaction with various kinds of written materials
This provide materials that permit children to write by themselves, facilitate all forms of writing, and encouraging the child to dictate a “story” given visual stimuli
Experience with writing materials
What is language for learning (L4L)
It is a framework that emphasizes the role of language in supporting learning and academic success
Understanding and using complex information in academic contexts
What is inter-professional planning?
Therapists and teachers work together to design therapy program
Principle 1: Use curriculum-based instruction.
The SLP must refrain from having their own independent intervention agenda
Based on material drawn from the academic curriculum
Purely developmental or specific deficit model - are less central to the needs
Avoid working on isolated language skill
We want to integrate our language intervention with the demands in the classroom everyday
Principle 2: Integrate oral and written language
Provide both oral and written opportunities for students to practice forms and functions
What is the principle 3?
Principle 3: Go Meta
What are metas?
Activities that direct conscious attention to the language and cognitive skills a student uses in the curriculum
What are the meta-skills
Talking and thinking about thinking
Meta skills would include
Activities for language objective must be done at 2 levels:
(1) Demonstrate through models and practice how particular forms and functions of language work
(2) The client and clinician talk about the language forms and functions being used and state rules and principles explicitly, focusing attention on the structure of language
The client and clinician
→ Language forms and functions
→ Rules and principles explicitly
Principle 4: Collaborate to prevent school failure by participating in RTI
We can work on semantic and syntactic targets in curriculum-based activities
Example: using language from the literacy materials for talking about the words and sentences in the material
True or False. Pragmatic skills are crucial for effective communication and social interaction
True
