Week 6: Assessment and Intervention in the Prelinguistic Period (ch.6) Flashcards
What is the core of SLP Practice with Infants?
It is family-centered
What document is used for SLP Practice with Infants?
Individual Family Service Plan (IFSP)
What is mandated in an IFSP?
7
Child’s level of performance (physical, cognitive, communicative)
Family resources (priorities and concerns related to development)
Major outcomes and criteria to determine progress
Early intervention services needed (Speech, OT, PT, Respiratory), Frequency, Location, Payments
Other services (Medical, funding, transportation)
Projected initiation date and anticipated duration
Name of service coordinator
_____ of newborns are considered high-risk. (March of Dimes)
12%
What are PRENATAL Factors that may put a child at risk for Communicative Disorders in Infants?
(3)
Prematurity and low birth weight
Mom’s age + health (also toxins, alcohol, drugs)
Genetic and congenital disorders (Down syndrome, William’s, Klinefelter’s, Fragile X)
What are POSTNATAL Factors that may put a child at risk for Communicative Disorders in Infants?
(5)
Hearing Impairment (See Audiology)
Nonspecific ID
ASD (DSM-V)
Language delay
Abuse or neglect
What tests can be used to test language delay in infants?
4
REEL-3
Rosetti
Boehm
PLS-5
How might an infant be referred for a Communication Disorder?
(2)
Physician referral
Child Find
What do we assess in the NICU?
2
Feeding
Oral Motor Development
How do we assess Feeding and Oral Motor Development in the NICU?
(2)
Chart review (gestational age, complications, concerns, etc.)
Bedside evaluation
What are we looking for in a Chart Review when performing assessment of Feeding and Oral Motor Development in the NICU?
(3)
Gestational age
Complications
Other concerns
What are we looking for in a Bedside Review when performing assessment of Feeding and Oral Motor Development in the NICU?
(4)
Suckling
Sucking
Rooting
Phasic Bite Reflex
What is Suckling?
3
Just the motion
Tongue extension and retraction,
Jaw and lip closure
What is Sucking?
3
Change in intraoral pressure
Rhythmic pattern of suck
Swallow + breathe
What is Rooting?
When baby turns to side when check or lip is rubbed (searching for food)
What is Phasic Bite Reflex?
When gums are touched, baby bites then releases
How do SLPs help manage feeding and oral motor development in the NICU?
(7)
Helping families understand why non-oral feeding is needed and its consequences
Providing support to mothers
Assessing infant communication readiness
Assess parent communication and family functioning
Kangaroo care
Help parents observe and identify infant states and emotion
Encourage parents and staff to allow parents to help participate in care (and improve observational skills)
What are three ways of non-oral feeding?
Nasogastric (tube through nose )
Orogastric (tube through mouth)

Gavage
When do SLPs provide support to mothers in NICU?
2
While NON-oral feeding is employed
Once oral feeding begins
What support does an SLP provide mothers in the NICU while NON-oral feeding is employed?
Provide child with opportunities for non-nutritive sucking (pacifier during tube feeding)
What support do SLP provide mothers in the NICU once oral feeding begins?
(4)
Suggestions for interactions and communication with baby
Advise on types of nipples, bottles
Working on feeding pacing
Look for signs of distress
How do SLPs assist in hearing conservation and aural habilitation in NICUs?
(2)
Newborn hearing screenings
Monitor hearing and noise levels in NICU
How do SLPs assess child behavior and development in the NICU?
(3)
Focus on current strengths and needs - not future ones
Evaluate physiological organization and homeostasis
Use specialized newborn questionnaires and checklists
What is the NICU goal for child behavior and development?
Achieve stabilization and homeostasis of physiology and behavior
How do SLPs Provide developmentally supportive care in the NICU?
(6)
Monitoring noise levels
Give child quiet time
Advocate for non-nutritive sucking and oral stimulation
Provide information about early intervention services
Encourage parental interaction with baby (talking to baby, rocking, loving touch, etc.)
Help parents recognize and respond appropriately to infant distress signals (cold/hot, hungry, diaper changes, etc.)
How can SLPs foster staff awareness in the NICU?
4
Ototoxicity
Laryngeal effects of endotracheal tubes
That oral stimulation is reduced with non-oral feeding
Sensory overstimulation and low interactive stimulation
How do SLPs help assess Parent-Child Communication?
2
Infant readiness for communication
Parent communication and family functioning
How do SLPs assess infant readiness for communication?
1+3
By looking at Stages of Readiness
- Turning in
- Coming out
- Reciprocity
What is Turning In?
3
Infant is unavailable for communication due to medical needs (Remember baby is very sick)
Work on maintaining homeostasis
Interaction between baby and parents (talking to baby, holding baby, etc.)
What is Coming Out?
2
Infant begins to respond to environment
Important parents interact during feeding, diaper change, general time, singing, rocking, etc.
What is Reciprocity?
Baby will reciprocate with parents
(if not a development delay - vision, feeding, sensory issues,
hearing)
How do SLPs assess parent communication and family functioning?
(5)
Assessment (adjust for age)
Consider parents (feelings, coping strategies)
Develop development activities (face to face interactions, etc.)
Provide educational information
Make appropriate referrals (if you see a danger, counseling needs, food supply, etc.)
What is Kangaroo Care?
Skin-to-skin contact between mother and child
What do SLPs try to help parents learn to observe in their baby?
(1+4)
Stress Signals
- Gaze aversion
- Turning away
- Spreading fingers
- Arching back
Do we need to allow babies time to relax?
How?
Yes
Rock them gently, talk/sing quietly, swaddle, lower the lights, decrease number of people/sounds
Are parents part of the NICU team?
Yes
How do we assess feeding in Pre-Intentional Infants?
3
Assessment instruments
Informal assessments
Identification of developmental feeding patterns
What are specialized assessments for children with neurological involvement or tracheostomy?
(9)
***Cervical auscultation
***Videofluoroscopic studies
Ultrasound studies
Endoscopy
Upper GI study
Milk scan
Radionuclide imaging
pH Probe
Methylene blue screening
What should we be looking for in Observational Recordings of Pre-Intentional Infants?
(4)
Rate of vocalization (pausing, delays, etc.)
Proportion of consonants (initial bilabials should increase to coordinated sounds 4-6 months)
Multisyllabic babbling (6-10 months)
All should increase over first year
Is development highly variable?
Yes
When should canonical babbling occur?
Around 10 months
What should performance be assessed relatively to?
Gestational age
What are the three stages of Pre-Intentional Infant Feeding?
3
Provide oral stimulation (non-nutritive sucking: pacifier, nuk brush)
Slowly introduce solid foods around 6 months (depends on previous test results - pureed dissolvable starts, puffs)
Teach strategies for improving feeding skills
How should SLPs assess and manage Hearing Conservation and Aural Habilitation in Pre-intentional Infants?
(3)
Continue to monitor hearing; audiological assessments every 3 to 6 months
Alert parents to signs of otitis media - encourage treatment
Provide amplication/CIs for children with hearing impairments (8-12 months)
How should SLPs assess and manage Child Behavior and Development in Pre-intentional Infants?
(2)
Ongoing monitoring of cognitive, motor, and communicative development
Management by multidisciplinary team (often home-based, often transdisciplinary model where SLP consults with other professionals to design plan but not deliver services directly)

How does an SLP assess Parent-Child Communication in Pre-intentional Infants?
(2)
Formal assessments
Informal assessments
How does an SLP INFORMALLY assess Parent-Child Communication in Pre-intentional Infants?
(7)
Pleasure/positive affect
Acceptance of baby’s temperament
Reciprocity and mutuality (how ‘in tune’ are parent and infant)
Appropriateness of objects and activities
Language stimulation (use of ‘baby talk,’ engage in back-and-forth and “choral” babble)
Establishment of joint attention (scaffolding the baby’s participation)
Singing with modeled movements (Itsy Bitsy Spider)
How does an SLP help parents increase Parent-Child Communication in Pre-intentional Infants?
(3)
Teach normal infant communicative patterns
Model interactive behaviors
Develop self-monitoring skills
How can an SLP help make parents aware of normal communicative patterns?
(2)
Print, video, and spoken instruction models
Adapt to infant’s immaturity (start small and build on foundation)
How can an SLP help model interactive behaviors, including?
4
Turn-take with vocalization
Imitate see if child imitates
Establish joint attention (focus on objects, people)
Develop anticipatory sets (peek-a-boo, pop-up, bubbles)
How can an SLP help develop self-monitoring skill?
Review video recordings of baby and parent interactions
How can an SLP help assess the transition to intentionality in Prelinguistic Infants?
(4)
Needs achievement of 9- to 10-month level on cognitive testing)
Observation of play, using play scales
Parent report measures
Informal observation of presence and frequency of intentional communication (child vocalizes to gain attention, react to others, imitate looks and vocalizes - may point too)
What are strategies an SLP can use for at-risk children with age-appropriate communicave developement?
(12)
Encourage parents to scaffold and support communication attempts (respond to vocalizations)
Help parents learn to ‘up the ante’ to more sophisticated forms of communication (add more pauses, require vocalizations)
Prelinguistic milieu teaching has evidence base for this developmental level
Interactive book reading provides contexts for
communication (start with simple books, point out important pictures/people)
Communication temptations can be used to increase frequency of communication
Included activities to develop comprehension
Provide intensified ‘motherese’ input (not baby talk)
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
How do SLPs assess Feeding and Oral Motor Development in Older Prelinguistic Clients?
(11)
Review medical and feeding history
Thorough physical exam
Assess posture, position, oral-motor structure and function
Observe chewing, biting, swallowing
Assess food preferences
Use instrumental study if necessary
Include social and communicative aspects of feeding
Maintain pleasant, positive environment allow for breaks
Provide social opportunities with feeding pause and talk with child
words (more, yummy, yucky -encourage turn taking)
Develop feeding skills as a foundation for speech (be aware feeding is necessary but not sufficient for speech development)
Always address vocal development specifically
How do SLPs assess Hearing Conservation and Aural Habilitation in Older Prelinguistic Clients?
(5)
Continue to assess hearing regularly and communicate with audiology
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
How do SLPs assess Child Behavior and Development in Older Prelinguistic Clients?
(2)
Consider communicative function of challenging behaviors
Provide ongoing assessment of cognitive development to determine when new cognitive skills can support new communication behaviors
How can we consider communicative function of challenging behaviors in Older Prelinguistic Clients?
(3)
Use Functional Behavior Analysis to identify functions
Teach adaptive strategies for expressing functions
Consider differential reinforcement of other behavior
How do SLPs assess Intentionality and Communication in Older Prelinguistic Clients?
(4)
Identify unconventional forms of communication
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

What are some examples of Unconventional Forms of Communication?
(5)
Echolalia has communicative value (may be a sign of frustration, lack of understanding)
Aggression or self-abuse try to decrease by giving a break
Body orientation
Touch
Generalized movements or changes in muscle tone
How can SLPs use Augmentative and Alternative Communication in Older Prelinguistic Clients?
(5)
All children need to communicate regardless of cognitive level
Provide core vocabulary (more, all done, stop, wait, important people)
Choose among pictures, symbols, written words to represent concepts, based on client characteristics

Use easy to transport formats, including smart phones and notepad
Develop transactional support within communicative environment
How does ASD affect communication at the Prelinguistic Level?
(2)
Almost all delayed in communication
Restricted range of communicative intentions
How can SLPs assist with Autism Spectrum Disorders in Older Prelinguistic Clients?
Evidence base for eliciting first communicative behaviors
What are some evidence-based strategies for eliciting first communicative behaviors?
(4)
Prelinguistic milieu teaching
Picture Exchange Communication System
Applied Behavioral Analysis
Parent responsiveness training
What is Low Tech AAC?
Pictures, symbols, written words to represent concepts, based on client charateristics
What is High Tech AAC?
Easy to use technology (smart phones and notepad computers)
