Week 6 (Ch. 6) Flashcards
6 steps to developing family-centered clinical practice
- First encounter with family
- Gathering client and family data
- Involving family in the assessment process
- Reporting assessment information to the family
- Planning intervention program with the family
- Throughout all contacts
Individual Family Service Plan (IFSP) developed as a result of ____________.
legislation
What 2 pieces of legislation resulted in the establishment of IFSP’s?
- PL 99-457 Education of the Handicapped Amendments
2. Individuals with Disabilities Education Act (2004)
Leglislation requires and IFSP for children in what age range?
birth-3
IFSP must include skills to maximize ___________ and optimize __________.
- the development of the child
2. optimize the family’s capacity to address the child’s special needs
8 Requirements of the IFSP
- Info about the child’s present level of physical, cognitive, social, emotional, communicative, and adaptive developments
- Statement of the family’s resources, priorities, and concerns
- Statement of the major outcomes expected to be achieved by the child and the family
- Statement of the specific early intervention services necessary to meet the needs of the child and the family
- A list of services and funding sources
- Projected dates for initiation of the services as soon as possible after the IFSP meeting and expected duration of those services
- The name and discipline of the service coordinator who will be responsible for implementation of the IFSP.
- A plan for transition to preschool services
4 risk factors for communication disorders
- prenatal factors
- Prematurity and low birth weight
- Genetic and congenital disorders
- Other risks identified after the newborn period
3 prenatal factors
- Maternal consumption of alcohol and other drugs
- Exposure to environmental toxins (Lead, mercury, heavy metals)
- In-utero infections (rubella, cytomegalovirus, toxoplasmosis)
Define: prematurity
Birth prior to 37 weeks’ gestation with low birth weight
Low vs. very low birth weight
Low = < 2500 grams or 5.5 pounds
Very low = < 1500 grams or 3.3 pounds
Prematurity and low birth weight can constitute both _______ and _______ risks.
medical and developmental
Premature infants are susceptible to a range of illnesses and conditions that produce ________.
developmental disabilities
Treatment of the premature child may also have ______.
negative consequences.
3 impacts of being in NICU
- Ototoxic drugs and the loudness in the NICU can cause hearing loss- over-stimulating environment
- Painful medical procedures- intubation can result in damage to larynx which can later impact swallowing; food aversion; trauma to tissue.
- Parents can’t spend as much time with infant in NICU- bond weakened. Baby is frail and fragile so parents may be afraid, bond is not as strong so they hold and play with baby less.
Priority in the NICU is _______, your role as the SLP is to _______.
survival; consult with parents/nurses to make sure child is getting other necessary precursors for language development.
Survival rates have (increased, decreased in the last 30 years. Explain.
increased
1960- 50% survival rate
2002- 55% for 501-750 gm, 88% for 751-1000 gm, 94% for 1001-1250 gm, 96% for 1251-1500 gm
3 empirical facts that prove that early intervention works
- Low-birth weight babies who receive intervention show benefits over untreated infants in IQ
- Preterm infants treated after discharge did better than untreated peers through preschool age, although long-term data suggests those with birth weights above 2,000 gm did the best
- Intervention had the most benefits on infants whose mothers had less than a high-school education
Explain gestational age
Used throughout the first years of life- how long the baby was in gestation (LMP date to date of birth)
Role of SLP for families with high-risk infants in NICU
- Provide family with resources/educate them
- Give them long-term info- what are the steps and what do you watch for?
- Work with the interdisciplinary team
Approximately ____% of infants begin life in the NICU
12%
High-risk infants in NICU typically have complex medical issues and very often _______ are secondary to _______.
therapy goals; keeping infant physiologically stable
SLP’s 2 responsibilities for high-risk infants in NICU
- Assist families
2. Consult on the management plan
4 basic areas to consider for high-risk infants with NICU
- Feeding and oral motor development
- Hearing conservation and aural habilitation
- Infant behavior and development
- Parent-child communication
7 considerations for readiness for oral feeding
- Gestational age (at least 35-37 weeks)
- Severity of medical condition (delays due to respiratory disorders)
- Respiratory/cardiovascular stability (oxygen support, apnea, periodic breathing cause delays)
- Motoric stability (oral tone, posture, movement quality)
- Coordination of sucking, swallowing, and breathing (10 or more sucking bursts with breathing interspersed with suck/swallow)
- Behavioral state organization (maintain alert state)
- Demonstration of hunger (rooting, non-nutritive sucking, crying may be weak)
_______ states mandate newborn hearing screenings in NICU
44 (many)
NICU itself may be _____ to baby’s hearing
detrimental
Risk of hearing loss is in addition to _________.
the high incidence of hearing loss associated with many of the syndromes/conditions baby has.
SLP’s play a crucial role in conserving the hearing of high-risk newborns by __________.
making sure aural habilitation is part of their plan if screening indicates loss
Encourage parents to ____________.
have child’s hearing periodically tested by an audiologist
Consideration about hearing screening follow-up
Follow-up not 100% because up to parent to make the appointment with the audiologist
Goal of child behavior development assessment should be? Should NOT be?
to determine the infant’s current strengths and needs, NOT to predict future behavior
2 considerations in child behavior development assessment
- Want to know as much as possible about what risks the infant faces
- Need to evaluate the infant’s level of physiological organization
Why do you want to know as much as possible about what risks the infant faces?
Helps us decide how much and what kind of intervention to propose
2 reasons that we need to evaluate the infant’s level of physiological organization
- Premature infants experience experience irregular respiration, bodily instability, disorganized patterns of alertness
- Infant’s level of homeostasis will determine the ability to participate in interactions
Goal of child behavior and development management. Goal is NOT:
Best way to do this:
Goal is to achieve stabilization and homeostasis of physiological and behavioral states and to prevent or minimize any secondary disorders that might be associated with the child’s condition
Goal is NOT to attain milestones appropriate for full-term babies
Best way to do this is to become a member of the NICU team
2 functions of parent-child communication assessment
- assessing infant readiness for communication
2. Assessing parent communication and family functioning
Assessing infant readiness for communication: 2 important considerations
- Help to identify the level of interactive, motor, and organizational development that the infant in the NICU is showing
- Crucial for deciding whether the infant is ready to take advantage of communication interaction
Assessing parent communication and family functioning: 2 important considerations
- Use instruments to assess parent-child communication
- Parent Behavior Progression (1981) provides guidelines for observing parent’s behavior with the infant to assess what the parent needs in order to improve or maximize interactions
Parent-child interaction management for babies who can interact with their parents: 2 important considerations
- Kangaroo care techniques involves skin-to-skin contact between parent and child during NICU stay
- Method has been shown to be associated with decreased length of hospital stay, shorter periods of assisted ventilation, increased periods of alertness, and enhanced sense of nurturance of the child by the parent
Parent-child interaction management for babies who CANNOT interact with their parents: 2 important considerations
- Help parents to observe their baby’s state and identify states of the baby is exhibiting
- This will be useful when it comes time to begin communicative interactions with the baby
6 infant states
- Deep sleep
- Light sleep
- Drowsy
- Quiet alert
- Active alert
- Crying
Define: deep-sleep
body still, eyes closed, breathing smooth
Define: light sleep
some body movement, eyes flutter, may smile
Define: drowsy
variable activity, eyes open and close, breathing irregular
Define: quiet alert
light bodily movement, attends to environmental stimuli
Define: active alert
much bodily movement, facial movement, eyes open and bright
Define: crying
facial grimaces, eyes may be tightly closed or open, breathing irregular
Pre-intentional infants include what age group
1-8 months
Why is it considered “pre-intentional” phase?
Considered pre-intentional phase because infants have not yet developed the cognitive skills to represent ideas in their minds and to pursue goals through planned actions
Why does Bates refer to pre-intentional phase as the perlocutionary stage?
- Infants do not intend any particular outcomes by their behavior
- Adults act as if infants do
When collecting a sample, aim for __________.
comfort-state vocalizations
2 ways to aim for “comfort state” vocalizations when collecting a sample
- Includes sounds that the infant makes when in an alert and contented state and are typically heard during familiar caretaking routines, such as changing, feeding, bathing or playing
- Vocalizations include vowel-like and/or consonant-like elements produced with an egressive air stream
Define: canonical babbling. Examples
Production of well-formed syllables that consist of at least one vowel-like element and one consonant-like element that are connected in quick transition
/baba/, /didi/, /iba/, /ta/
Failure to produce these syllables by 10 mos of age predicts
delays in the acquisition of words and word combinations in the second year of life
________ is an important benchmark to look for in determining vocal development and whether or not intervention needs to include _______.
Canonical babbling, vocalization stimulation
3 other important features to note when determining vocal development
- Rate of vocalization
- Proportion of consonants
- Multi-syllabic babbling
Define: rate of vocalization
- Computed by counting the number of vocalizations (not syllables) and dividing by the number of minutes the sample includes
- No norms for babies younger than 6 months, but in general the rate should increase with age
Define: proportion of consonants
- Ratio of consonants to vowels should also increase during first year 2. By 16 months, sample should include more consonants than vowels
Define: multi-syllabic babbling
Babbling that contains more than one syllable should increase in first year
If vocal development is delayed, ________ should always be assessed.
hearing
5 things to do to encourage vocalization
- All family member should be encouraged to talk to and babble to the baby: parents, siblings
- Clinician should demonstrate the kinds of vocalizations that the infant is ready to learn to produce 3. Using Figure 6-1, choose vocal behaviors produced rarely or not at all but at the stage into which the child is emerging
- If baby produces very few comfort vocalizations, encourage family to imitate any comfort vocalizations that the baby produces, anytime…anywhere
- Encourage all family members to use baby talk to infant
How to use baby talk to infant
High pitched speech, exaggerated intonation, simple words, short repetitive sentences
Hearing should be monitored every ________ in high risk infants
3-6 months
Parents should be counseled to be aware of signs of ___________.
Otitis media
3 signs of otitis media
Pulling on the ear or jaw, fever, unexpected fussiness accompanying a cold
For children with hearing impairment, ___________ is crucial to optimal communication development
use and maintenance of hearing aids
Some children will be candidates for ________.
cochlear implants
Cochlear implantation before __________ promotes efficient acquisition of expressive and receptive language
2 years of age
5 qualities for good candidates for cochlear implant
- At least 8 to 12 months of age
- profound hearing loss in both ears
- Receive little or no benefit from hearing aids
- Have no other medical conditions that make surgery risky
- Have families who Understand their roles in successful use of CI Have realistic expectations for CI use Willing to be involved in intensive rehabilitation services
For many high risk infants, ___________ is the sole component of the intervention
ongoing assessment
Goal of assessment is to
identify current strengths and needs
2 instruments available to assess early behavior
- Bayley Scales of Infant Development-II
2. Mullen scales of Early Learning
Define: BSID-II
Cognition, language, motor, social-emotional, and adaptive behavior
Define: MSEL
Verbal, non-verbal, and motor
Child behavior and development management is a _________ focused on __________.
team effort, the family and child
Define: center-based infant stimulation programs
Programs provide general motor and cognitive stimulation as well as fine and gross motor and oral-motor behavio
3 facts about home-based services in CBDM
- Associated with highly positive outcomes
- SLP provides counseling and advice to parents
- SLP can serve as the coordinator on the team and parent advocate
Formal assessments of parent-child communication to look at what?
how parents are interacting with their baby who is not yet initiating much communication but is beginning to be able to consistently respond
3 examples of formal assessments of parent-child communication
- Parent-Infant Relationships Global Assessment Scale
2, Parent Behavior Progression - Observation of Communicative Interaction
Informal assessments of parent-child communication include
observations by the SLP of parents interacting with their high risk infant
7 things to look for during your observations of high-risk infants
- Pleasure and positive affect
- Responsiveness to the child’s cues of readiness and unreadiness to interact
- Acceptance of the baby’s overall style and temperament
- Reciprocity and mutuality
- Appropriateness of choice of objects and activities for interactions
- Language stimulation and responsiveness
- Encouragement of joint attention and scaffolding
3 most important aspects of parent-child communication management
- Awareness of infant communication patterns
- Modeling interactive behaviors
- Developing self-monitoring skills
Communication between mother and parent may need to be __________.
Reinvigorated
3 things to teach parents when teaching them about how babies communicate
- Baby has very little choice in how they interact
- The most important thing they can do for their baby is to enjoy them
- Communication between parent and baby needs to be enriching and responsive
First parents must be sensitive to ____________
their infant’s readiness to interact
What 4 types of interactive behaviors should be encouraged in parents to foster communication in their infants
TIPS
Turn-taking
Imitation
Point things out (Establishing joint attention)
Set the stage (Developing anticipatory sets)
Explain tips for working with parents of pre-intentional infants to optimize TURN TAKING
Coach parents to engage in back and forth interactions with babies through songs, games such as peek-a-boo, and play with toys. Encourage parents to do something the baby enjoys, then wait for the child to do something (anything) before the adult takes another turn
Explain tips for working with parents of pre-intentional infants to optimize IMITATION
Coach families to play “monkey-see, monkey-do” or “copy cat” by mirroring any infant actions or sounds
Explain tips for working with parents of pre-intentional infants to optimize POINTING THINGS OUT
coach families to engage the 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, make sound, or operate. Later, when the child is 6-10 months old, use gestural pointing to establish joint attention to objects at a distance in addition to bringing objects near the child
Explain tips for working with parents of pre-intentional infants to optimize SETTING THE STAGE
Coach parents to establish anticipatory sets by repeating simple games and songs the child likes. When the 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 the action.
In order to develop self-monitoring skills, parents need to
Parents need to develop confidence in their own ability to communicate with their baby
Use ______ to allow parent to self-monitor
video recording
MUST establish an atmosphere in which ________________ rather than ________________.
both the clinician and parent are attempting to learn about what works best with the infant,
one in which the clinician is dictating
Pre-linguistic infants include what age group?
9-18 months
During pre-linguistic phase most infants go from being ________ to being ________.
participants in interactions to being intentional communicators
Pre-linguistic phase refers to Bates Illocutionary stage. Define Bates Illocutionary stage
baby’s express intentions through signals to others but do not yet use conventional language
3 types of pre-linguistic phase assessment
Formal, Informal, parent-report instrument
Explain formal assessment of pre-linguistic infants
Using a formal play assessment
Communication and Symbolic Behavior Scales (Wetherby & Prizant, 2003)
When a child achieves a developmental level of 9 – 10 months or more on one of these assessments, readiness for intentional behavior is inferred
Explain informal assessment of pre-linguistic infants
Observe child’s conventional and pretend play
Used to determine whether the child is demonstrating some recognition of common objects and their uses and can engage in simple pretend play schemes
Example of a parent-report instrument for parents of pre-linguistic infants
Vineland Adaptive Behavioral Scales-II (Sparrow et al., 2005)
If intentional behaviors are neither observed nor reported the clinician can attempt to elicit them by doing what?
modeling and observe whether the child can use these behaviors in his/her own play
If the infant can produce intentional behaviors in response to a model, what does this mean?
some intentionality is likely to be present and the infant could benefit from intervention focusing on eliciting intentional communication
If repeated attempts to elicit conventional and early pretend play do not succeed, the clinician may do what?
postpone targeting intentional communication and instead encourage parents on TIPS
What should assessment of pre-linguistic infants tell us?
Assessment should tell us whether a play interaction with a familiar adult elicits any communicative behaviors…gestural, verbal or vocal
Typical functions expressed at the pre-linguistic age (9-18 months) include
- Requesting objects and actions
- Attempting to get the adult’s attention on what the child is interested in
- Initiating social interactions through greeting, calling or showing off
For the at-risk child at a 9 to 18 month developmental level who is expressing some communicative intent, we need to do what?
encourage parents to learn how to scaffold or support the child’s move toward more conventional communication
4 ways to scaffold or support the child’s move toward more conventional communication
- Parents need to “up the ante” – techniques to elicit higher level responses from the child, once a response of some kind has been evoked
- Pre-linguistic Milieu Teaching
- Techniques using prompts: time delay, verbal and gaze interactions
- Communication temptation (box 6-5, page 205)
Book reading Has been shown to be effective in fostering both ______ and ________.
language and literacy development
Parents of at-risk children should begin to __________ as soon as the child can ________.
engage babies in looking at simple picture books
sit up
5 behaviors that facilitate communication in book-reading
- Waiting for child to initiate interest in book by looking/pointing
- Being face to face
- Asking questions
- Verbally inviting children to interact
- Labeling and talking about pictures in the book
For children in 9 – 18 month level who are noncommunicators (not intentional), intervention should focus on what 3 things?
- Providing intensified input using a “motherese” speech style
- Encouraging vocalizations
- making the child’s communication contingent on what the child does, rather than on eliciting communication
Populations of older pre-linguistic children and those with ASD include what 5 groups?
- Severely or profoundly impaired individuals with cognitive deficits that limit their ability to develop symbolic communication skills
- Older children with autism
- Young hearing impaired children who were not identified or amplified early and who did not receive early introduction to sign language
- Children with severe speech impairments who have not been provided with alternative forms of communication
- Children with severe or profound acquired brain damage through trauma or disease
_________ regularly and be aggressive in __________.
Assess hearing
identifying and treating otitis media
What 2 things are important for good outcomes?
Early identification and amplification
Assistive listening devices, such as auditory trainers, are beneficial to ___________ and ____________.
improve signal to noise ratio
maximize the benefit the child can receive from the auditory environment
Older prelinguistic children may become frustrated when ____________. Such frustration may lead to ____________.
they have difficulty getting their message across to others
Maladaptive behaviors such as aggression and self-abuse
These maladaptive behaviors in older pre-linguistic children can be understood as _______________ for children who _______________.
a form of communication
do not have more conventional, comprehensible means to communicate
Goal in intervention for older pre-linguistic children is to do what?
provide them with more acceptable means of expressing their intentions
Although clients in prelinguistic stage may not _____________, they do ______________.
communicate by conventional means; communicate
We need to search for and identify any such unconventional forms, including the following 6 unconventional forms:
- Echolalia
- Aggressive or self-abusive behaviors
- Touching or manipulating others
- Bodily orientation
- Generalized movements
- Changes in muscle tone
Goal is to teach older pre-linguistic children _______________.
acceptable means to communicate their intentions
5 ways to teach children acceptable means to communicate their intentions
- Expand the frequency and range of their intentions
- Use a prompt-free approach
- Milieu Communication Training
- AAC devices (Book with pictures, iPads and iPhones)
- Help create more transactional support in their environment and their communication partners for their communication attempts
