quiz 3

Question 1

Practice with Infants

Answer 1

Support, trust and respect parents/caregivers
• Use strengths-based approach
• Understand and accept parent’s perceptions and
experiences
• Coordinate a professional team

Question 2

Individual Family Service Plan is mandated to include

Answer 2

• Child’s present level of performance
• Family resources, priorities, and concerns
• Statement of the major outcomes and criteria, procedures, and
timelines used to determine progress
• Statement of early intervention services necessary to meet the
needs of the child and the family
• List of other services that the child needs
• Projected dates for initiation of the services and their anticipated
duration
• Name of service coordinator
• Plan for transition to preschool services

Question 3

When will the IFSP be implemented?

Answer 3

• That depends…..
• Infants who are identified at birth as being high-risk may need an
IFSP very soon after leaving the hospital
• Other situations may call for a period of waiting to watch how the
child develops before implementing a plan

Question 4

The SLP Role

Answer 4

• Language disorders are the most common developmental
problem that presents in the preschool period.
• Any infant at risk for a developmental disorder in general
is at risk for language deficits.
• Prevention is key
• Lend expertise on communication acquisition
• Collaboration with professionals

Question 5

Risk Factors for Communication Disorders in Infants

Answer 5

• 12% of newborns considered high-risk
• Prenatal risk factors
• Maternal consumption of alcohol or abuse of other drugs
• Exposure to environmental toxins
• Prematurity and low birth weight
• Born before 37 weeks/

Question 6

Assessment and Intervention for High-Risk Infants
and Families (NICU)

Answer 6

• Feeding and Oral Motor Development
• Hearing Conservation and Aural Habilitation
• Child Behavior and Development

Question 7

Assessment in the NICU: Feeding and Oral Motor

Development

Answer 7

• Includes:
• Chart review
• Bedside evaluation to observe
• Suckling
• Sucking
• Rooting
• Phasic bite reflex
• Questionnaires and checklists

Question 8

Assessment in NICU: Hearing Conservation

and Aural Habilitation

Answer 8

Most states mandate hearing screening for all newborns
in the NICU.
• NICU noise levels can be higher than 85dB
• High incidence of hearing loss associated with high-risk
population
• SLP plays a critical role in hearing conservation

Question 9

Assessment in NICU: Child Behavior and

Development-

Answer 9

• Assessment in NICU should focus on current strengths
and needs.
• Includes evaluation of level of physiological organization
• Makes use of specialized newborn questionnaires and
checklists

Question 10

Management in NICU-Child Behavior and

Development

Answer 10

• Goal: achieve stabilization and homeostasis of physiology
and behavior
• Provide developmentally supportive care, such as
– Monitoring noise levels
– Foster staff awareness of ototoxicity, laryngeal effects of
endotracheal tubes, reduced oral stimulation that results from nonoral
feeding, sensory overstimulation 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

Question 11

Assessment in NICU: Parent-Child

Communication

Answer 11

• Infant
readiness
for
communica7on
• Stages
of
readiness
• Turning
in
• Coming
out
• Reciprocity
• Parent
communica7on
and
family
func7oning

Question 12

Parent-Child Communication: Management in

the NICU:

Answer 12

Kangaroo care
• Help parents observe child and identify infant states and
emotions
– Stress
• Gaze aversion
• Turning away
• Spreading fingers
• Arching back
• Encourage parents to participate in charting to improve
observational skills

Question 13

Preintentional

Answer 13

Between 1-8 months
• Not yet developed cognitive skills to represent ideas in
their minds
• Cannot pursue goals through planned actions
• Perlocutionary
• Do not intend a particular outcome
• Adults act as if they do

Question 14

Assessment & Intervention

for Preintentional Infants

Answer 14

Feeding (not covered in this course) and Oral Motor
Development
• Hearing Conservation and Aural Habilitation
• Child Behavior and Development

Question 15

Assessment for Pre-intentional Infants: Vocal

development

Answer 15

• Observational recording (Fig. 6-1)
• Rate of vocalization
• Proportion of consonants
• Multisyllabic babbling
• All should increase over first year
• Appearance of canonical babble by 10 months
• Performance should be assessed relative to gestational
age during first year

Question 16

Management for Pre-intentional Infants: Vocal

Development

Answer 16

Encourage vocalization
• Both talk and babble
• Involve siblings and others
• Use rattles, games, mirrors to engage in back-and-forth babbling
games
• Encourage “baby talk” register
• Reward infant vocalization with touch, smile, attention

Question 17

Assessment and Management for Pre-intentional

Infants: Hearing Conservation and Aural Habilitation

Answer 17

• Continue to monitor hearing; audiological assessments
every 3 to 6 months
• Alert parents to signs of otitis media; encourage treatment
with physician
• For children with hearing impairments
• Provide amplification
• Consider candidacy for cochlear implants

Question 18

Assessment and Management for Pre-intentional

Infants: Child Behavior and Development

Answer 18

• Assessment involves ongoing monitoring of cognitive,
motor, and communicative development (Table 6-3)
• Management provided by multidisciplinary team
• Often home-based
• Transdisciplinary model may be used
• SLP consults with other professionals to design plan; may not deliver
services directly, but consult to those who do

Question 19

Assessment for Pre-intentional Infants: Parent Child

Communication

Answer 19

Formal assessment
• Informal observation of
• Pleasure and positive affect
• 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
interactions;
• Language stimulation; use of ‘baby talk,’ engage in backand-
forth and “choral” babble
• Establishment of joint attention and scaffolding the baby’s
participation

Question 20

Management of Pre-intentional Infants: Parent Child

Communication

Answer 20

• Help parents be aware of normal communicative patterns
– Using print, video, and spoken instruction
– Understanding need to adapt to infant’s immaturity
• Modeling interactive behaviors, including
– Turn-taking
– Imitation
– Establishing joint attention
– Developing anticipatory sets
• Developing self-monitoring skills
– Reviewing video recordings

Question 21

Assessment of Prelinguistic Infants

Answer 21

Assessing the transition to intentionality
• Achievement of 9- to 10-month level on cognitive testing
(Appendix 6-3)
• Observation of play, using play scales
• Parent report measures
• Informal observation of presence and frequency of intentional
communication

Question 22

Management of Prelinguistic Infants

Answer 22

• For at-risk children with age-appropriate communicative
development
• Encourage parents to scaffold and support communication
attempts
• Help parents learn to ‘up the ante’ to more sophisticated forms
of communication
• Prelinguistic milieu teaching has evidence base for this
developmental level
• Interactive book reading provides contexts for communication
• Communication temptations can be used to increase frequency
of communication
• Activities to develop comprehension should be included
development
– Provide intensified ‘motherese’ input
– Focus on fostering comprehension skills
– Encourage vocalization
– Make adult communication contingent on what child does/looks
at/is interested in
– Offer interactive story reading if child is interested
– Encourage vocal and motor imitation—by imitating child at first

Question 23

Older Prelinguistic Clients: Hearing

Conservation and Aural Habilitation

Answer 23

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

Question 24

Older Prelinguistic Clients: Child Behavior and

Development

Answer 24

Consider communicative function of challenging behaviors
– Use Functional Behavior Analysis to identify functions
– Teach adaptive strategies for expressing functions
– Consider differential reinforcement of other behavior
• Provide ongoing assessment of cognitive development to
determine when new cognitive skills can support new
communication behaviors

Question 25

Older Prelinguistic Clients: Intentionality and

Communication

Answer 25

• Identify unconventional forms of communication, such as
• Echolalia
• Aggression or self-abuse
• Body orientation
• Touch
• Generalized movements or changes in muscle tone
• Work to increase the frequency of communication
• Increase the range of intentions expressed to include joint
attention and social interaction
• Use ‘prompt-free’ techniques for children with no
intentional communication

Question 26

Older Prelinguistic Clients: Augmentative and

Alternative Communication

Answer 26

All children need to communicate regardless of cognitive
level
• Provide core vocabulary
• Choose among pictures, symbols, written words to
represent concepts, based on client characteristics
• 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

Question 27

The Emerging Language

Period

Answer 27

18 and 36 months of age !  Part C of IDEA !  States provide 0-3 services !  Services managed by Individual Family Service Plan !  Eligibility determined by states !  Children identified later will require assessment to determine
current strengths and needs
!  Some older children with severe communication disorders may continue to function at this level of communication

Question 28

Screening and Eligibility for Birth-to-Three Services

Answer 28

Children with risk factors identified at birth are eligible for early intervention services
!  Others identified later, through Child Find, pediatrician referrals

Question 29

Early Screening

Instruments

Answer 29

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 !  Language Development Survey (Rescorla, 1989) !  Communicative Development Inventory (Fenson
et al., 2007) !  Communication and Symbolic Behavior Scales Caregiver Questionnaire (Wetherby & Prizant,

Question 30

Transition Planning

Answer 30

Plans for transition from 0-3 to preschool services are mandated
!  SLPs can be effective members of transition teams

Question 31

Family-Centered Practice

Answer 31

  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 !  Review progress !  Involve child’s interests
!  Enable parents to do what works for their family

Question 32

Communication Skills in Typically Developing Toddlers: 8-18 months

Answer 32

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: 50-100 words; first word combinations
!  First 50 words include proper and common nouns, adjectives, verbs, social terms
!  Receptive vocabulary is larger: 50 words at 15 months
!  Most words have CV shape, one syllable; some reduplicated words (/baba/, /mama/, /dada/); closed syllables emerge (CVC)
!  Sounds used are same as those found in early babble

Question 33

Communication Skills in Typically Developing Toddlers: 18-24 months

Answer 33

Average expressive vocabulary size at 18 months is 100 words
!  Multiword utterances increase in frequency
!  New communicative intentions emerge related to discourse level functions
!  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
!  Early two-word utterances express small range of meanings
!  Agent, action, object combinations !  Possession !  Location !  Attributes !  Meanings related to object permanence
!  Word order is consistent within these combinations

Question 34

Communication Skills in Typically Developing Toddlers: 24-36 months

Answer 34

  Average expressive vocabulary size at 24 months is 300 words (+/-150); word classes include
!  Object, action words !  Kinship terms !  Spatial terms !  Question words !  Color, shape words
!  Grammatical morphemes, 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%

Question 35

Predictors of need for intervention Box 7-1

Answer 35

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

Question 36

Risk Factors for Language Delay

Answer 36

Males more vulnerable !  Significant history of otitis media !  Family history !  Parental characteristics
!  Low maternal education !  Low SES !  High parental concern

Question 37

Predictors of need for intervention (Box 7-1)

Answer 37

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

Question 38

Risk Factors for Language Delay

Answer 38

Males more vulnerable !  Significant history of otitis media !  Family history !  Parental characteristics
!  Low maternal education !  Low SES !  High parental concern

Question 39

Assessment of Communicative Skills in Children with Emerging Language

Answer 39

  Multidisciplinary: each professional does independent assessment
!  Transdisciplinary: child interacts with one adult; team members suggest assessment activities and observe assessment

Question 40

Assessing Play and Gesture

Answer 40

Certain gestural and play skills appear to be related to the development of intentions, first words, and word combinations
!  Play assessment: nonlinguistic comparison to language performance: sample methods
!  Gesture assessment: sample methods

Question 41

Assessing Intentional Communication

Answer 41

Use primarily for children with little spoken language to assess communicative basis for speech
!  Look for range of communicative functions !  Requests and protests/rejections (regulatory functions) !  Comments (joint attention functions) !  Higher level discourse functions
!  Look for frequency of communication !  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

Question 42

Assessing Language Comprehension

Answer 42

Comprehension strategies can mask deficits in receptive language (see Table 7-5)
!  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

Question 43

Assessing Speech-Motor Development

Answer 43

Attempt standard speech-motor assessment
!  Be aware of cognitive and imitative difficulties common at this developmental level
!  Be conservative about diagnosis of childhood apraxia of speech before continuous, multiword speech is acquired
!  Use vocal assessment to complement speech-motor and feeding evaluation

Question 44

Assessing Phonological Skills

Answer 44

Given strong correlation between phonology and lexical development, need to know what sounds child can produce to help choose words the child can learn
!  Collect consonant inventory from communication sample
!  Use number of consonants in inventory to assess severity of speech delay
!  Assess syllable structure
!  Assess relational phonology (e.g., McIntosh & Dodd, 2008)

Question 45

Assessing Lexical Production

Answer 45

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); Language Use Inventory (O Neill, 2007)

Question 46

Assessing Semantic-Syntactic Production

Answer 46

Assess relative frequency of word combinations vs. single word production from communication sample
!  Looking for half of the utterances to contain word combinations.
!  MLU of 1.5 or above
!  Examine range of semantic relations expressed in multiword utterances !  Using, e.g., Lahey s (1988) content form analysis,
Lee s Developmental Sentence Types (1974) !  Or with reference to relations in Table 7-7

Question 47

Semantic Relational Categories by Brown (1973)

Answer 47

Semantic Relation Example !  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 Allgone cookie

Question 48

Eligibility Decisions for Children with Emerging Language

Answer 48

Refer to local and state eligibility guidelines !  Use decision tree such as Figure 7-5 !  For children with accumulation of risk factors
for continued communicative delays, consider intervention
!  For children with circumscribed delay in expressive language only, consider monitoring with periodic reevaluations
!  Employ family-centered practices in these decisions

Question 49

Intervention Products: Goals for Emerging Language

Answer 49

Based on assessment data, include goals to
!  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

Question 50

Developing Play and Gesture

Answer 50

Model for child/teach parent to model !  Reciprocal Behavior !  Turn-taking !  Back and forth babble !  Peek-a-boo !  Conventional and symbolic play !  Pretending/play schemes !  Deictic Gestures !  Showing, giving, pointing, reaching !  Representational gestures !  Form is used to stand for a referent t

Question 51

Using/Increasing Frequency Intentional Communication

Answer 51

  Communication temptations !  Hybrid approach !  Examples in (Chapter 6-Box 6-5)
!  Prelinguistic Milieu Teaching Methods (Box 7-4) !  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

Question 52

Developing Receptive Language

Answer 52

Indirect Language Stimulation
!  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 !  Self-talk, parallel-talk, imitations, expansions,
descriptions, recasts

Question 53

Increasing Phonological

Skills

Answer 53

For children with less than 50 words !  Back and forth babbling games !  Slowly introducing consonants for the child to imitate !  Keep in mind the order of acquisition by normally
developing children
!  Expand on the repertoire of sounds and syllable shapes rather than correcting errors
!  Reward any conventional word approximations rather than correcting

Question 54

Increasing Vocabulary Production

Answer 54

Select Words (first lexicon) based on phonological and syllable repertoire
!  Include labels or nouns, verbs, relational words (more, all gone), as well as social interactional words (hi, night-night)
!  Teach words that help the child express a variety of communicative functions rather than simply naming
!  Variety of intervention models (CC, Hybrid, CD) can be used to target vocabulary

Question 55

Increasing Production of Word Combinations

Answer 55

Once expressive vocabulary reaches approximately 50 words, begin encouraging word combinations.
!  Pages 264-265—Please read about
!  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

Question 56

Intervention for Emerging Language: Preliteracy

Answer 56

Provide families access to books
!  Encourage families to select books that are developmentally appropriate and attractive to toddlers
!  Teach parents routine interactive reading strategies !  Pointing out picture to print connection, using cloze procedure
!  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
!  Help parents begin to expose older toddlers to decontextualized talk relating the stories they have heard

Question 57

Assessing Toddlers with Suspected ASD

Answer 57

Use autism-specific screeners (Box 7-7)
!  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)

Question 58

Intervention for Toddlers with ASD

Answer 58

  Address both expressive and receptive language; toddlers with ASD often have receptive scales at or below expressive level
!  Consider clinician-directed ABA approaches for eliciting early language production
!  Consider communicative functions of echolalia (Table 7-12)
!  Address echolalia with !  Third person model !  Mitigated echolalia !  Script therapy

Question 59

Assessing Older Clients with Emerging Language

Answer 59

Modify assessments to
!  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

Question 60

Intervention for Older Clients with Emerging Language

Answer 60

  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