Week 7 (Ch. 7) Flashcards
Children with known risk factors that are referred during infancy: what 4 common risks?
Down Syndrome
Fetal Alcohol Syndrome
Hearing impairment identified in infancy
Neurological involvement, such as CP or prenatal drug exposure
Children who come to us through Child Find or other referral sources or simply because their parents are concerned about their development: 4 common concerns
Those with hearing impairment not identified earlier
Fetal alcohol effects
Fragile X syndrome
Acquired disorders secondary to encephalitis, trauma, or abuse
For children in the 18- to 36-month range, the decision to intervene should be based on
an accumulation of risk factors
Highest priority for intervention are those with what 6 problems/issues?
- Cognitive deficits
- Hearing impairment or chronic middle ear disease
- Social or preverbal communicative problems
- Dysfunctional families
- Risks associated with their birth histories
- Family history of language and reading problems
4 language predictors of need for intervention
Language production, language comprehension, phonology, imitation
Explain language production as a predictor for intervention
Small vocabulary for age: Few verbs, preponderance of general verbs (make, go, get, do).
More transitive verbs (that take a direct object: hit ball)
Few intransitive verbs (without direct object: lie down) and bitransitive verbs (that take both direct and indirect object: give the ball to me).
Explain language comprehension as a predictor for intervention
Presence of 6 month comprehension delay
Comprehension deficit with large comprehension-production gap
Explain phonology as a predictor for intervention
Few prelinguistic vocalizations, limited number of consonants, limited variety in babbling, reduced rate of babbling, fewer than 50% consonants correct (substitution of glottal consonants and back sounds for front): restricted syllable structure, vowel errors
Explain imitation as a predictor for intervention
Few spontaneous imitations, Reliance on direct modeling and prompting in imitation tasks
3 non-language predictors of need for intervention
play, gestures, social skills
Explain play as a predictor for intervention
Primarily manipulating and grouping, little combinatorial or symbolic play
Explain gestures as a predictor for intervention
Few communicative gestures, symbolic gestural sequences, or supplementary gestures (gestures that add meaning to words produced)
Explain social skills as a predictor for intervention
Reduced rate of communication, reduced range of expression of communication intentions, behavior problems, few conversational initiations, interacts with adults more than peers, difficulty gaining access to peer actviities
4 risk factors for language delay
- males more vulnerable to delay than females
- Otitis media (prolonged periods of untreated OM)
- Family history (members with persistent language, reading, and learning problems)
- Parent characteristics
5 parent characteristics that are risk factors for language delay
low maternal education
low ses
more directive than responsive interactive style
produces less talk contingent on child’s productions
high parental concern
2 considerations when deciding to intervene when a child has no other known risk factors
- Intervention may accomplish facilitation.. hastening development that would eventually happen on its own
- Or it may serve as a secondary preventive function by helping to minimize later effects on learning even when more basic oral language problems resolve
Children who have learning disabilities often have histories of
delayed language development
Late talkers who show normal range skills language and literacy skills at 5-6 years, begin to show ______________ later on.
literacy deficits
Intervention for late talkers not only increased __________________ but also _____________________.
their language skills; improvements in social skills
Guidelines for play assessment: <18 months, symbolic play level 1
pre-symbolic scheme; the child shows understanding of conventional object use or meaning by brief recognitory gestures. There is no pretending. Properties of present object are the stimulus. Child appear serious rather than playful.
Example: picks up something, puts it in proper position to use, then drops it
Guidelines for play assessment: 18-24 months, symbolic play level 2
Autosymbolic scheme: the child pretends at self-related activities. Pretending is present. Symbolism is directly involved with the child’s body. Child appears playful, seems aware of pretending.
Example: pretends to eat or drink from appropriate objects, pretends to sleep (hands and eyes)
Guidelines for play assessment: 24-36 months, symbolic play level 3
Single-scheme symbolic games; the child extends symbolism beyond own actions by including other agents or objects of actions. Pretending at activities of other people or objects such as dogs, vehicles, etc.
Example: pretends to read, sleep, make car sounds when moving a car
Guidelines for play assessment: 24-36 months, symbolic play level 4 (combinatorial symbolic games) A
Single scheme combinations: one pretend scheme is related to several actors or pretend receivers of action
Example: combs own and mother’s hair, toy bottle feeds self and doll, empty spoon to self and others’ mouth
Guidelines for play assessment: 24-36 months, symbolic play level 4 (combinatorial symbolic games) B
Multischeme combinations: several schemes are related to one another in sequence
Example: holds up play telephone and dials, kisses doll and puts it to bed, cooks feeds and cleans dishes for doll
Guidelines for play assessment: 24-36 months, symbolic play level 5 (hierarchical pretend) A and B
A. Planned single-act symbolic games: the child indicates verbally or nonverbally that pretend acts are planned before being executed
B. Planned multi-scheme symbolic acts
Example: finds iron, sets it down, searches for cloth while tossing aside several object, When cloth found, irons it.
Gestures highly related to ____________ in early development.
language
Children often rely on ___________ to express meanings when they are still very limited in their verbal abilities
gestures
____________________ often lead the way to multiword speech
Word-gesture combinations
Gestures are an Important ______________ indicator for children with delayed language
prognostic
2 instruments for assessing gesture
MacArthus-Bates Communicative Development Inventory
Communication and Symbolic Behavior Scales
3 types of gestures
deictic, symbolic, representational
Define: deictic gestures
showing, giving, pointing, ritualized requests such as reaching
Define: symbolic play gestures
play schemes including recognitory gestures; actions carried out on an object to depict the object and its function (e.g. holding telephone to ear)
Define: representational gestures
do not manipulate objects; a form is used to stand for a referent (flapping arms to represent bird)
Deictic gesture progression throughout language stages
10-12 months: emerge for first time, use of pointing predicts first word use
15-16 months: gestures complement spoken forms, children show preference for either gestural or vocal expression
18-20 months: increased pointing in combination with spoken words
Symbolic gesture progression throughout language stages
12-13 months: play schemes emerge, recognitory gestures first, then self-directed symbolic play (e.g. feeding self from empty spoon)
15-16 months: other-directed play schemes emerge (e.g. pretending to feed doll)
18-20 months: transition to play schemes without object (e.g. holding hand to ear instead of toy telephone to pretend talking).
Multi-scheme symbolic play emerges (e.g. stirring then feeding).
Representational gesture progression throughout language stages
12-13 months: emerge for first time (e.g. puts hand to mouth to indicate that they want a bite of moms cookie).
15-16 months: gestures complement spoken forms; children show preference for either gestural or vocal expression
18-20 months: gesture-plus-spoken word combinations emerge; increase in word use; preference for words over gestures
Formal methods of communication assessment
SEE TABLE 7-1
3 Informal methods of communication assessment
Assess communicative intention
Assess comprehension
Assess productive language
Children’s attempt to communicate can take several forms: 2 main categories
verbal (words) or nonverbal (gestures)
Communication assessment should include:
observing the child playing with some interesting toys and a familiar adult
What 3 aspects of communication can be examined as part of this assessment
- Range of communicative functions expressed
- Frequency of communication
- Means by which the child attempts to convey his/her message
Bates (1976) divided early communication into what two basic functions:
Proto-declarative and proto-imperative
Define: protodeclarative functions of communication
preverbal attempts to get an adult to focus on an object or event by such acts as showing off, showing, point out objects, pictures etc.
Define: protoimperative functions of communication. 3 examples
Used to get an adult to do or not do something
Requests for objects
Requests for actions
Rejections or protests
Define: discourse functions of communication: 3 examples
Intentions that refer to previous speech acts
Requests for information, acknowledgments, answers
Expect 18-month-olds to produce about ______ instances of intentional communication/minute
2
Expect 24-month-olds to produce more than ___ /min
5
If less is noted, than child is at risk for _____________________.
development of functional speech
Intervention should focus on what 2 things?
eliciting single-word productions and increasing the frequency of nonverbal communication, particularly proto-declaratives
As children progress through the emerging language period, they increase the _______________ of the forms of communication they use
sophistication
Gestural means of communication are predominant at approximately _______ months of age
8 to 12
Gestures are combined with word-like vocalizations containing consonants at _______ months
12 to 18
Conventional words or word combinations are used with increasing frequency to express a range of intentions at _______ months of age
18 to 24
Prelinguistic children who produced fewer than one vocal communication act every four minutes were significantly less likely to ________________________
develop functional speech one year later
Intervention should attempt to elicit vocalizations for ___________________________.
functions the child is already expressing with gaze and gestures
Parents often claim that their children as young as 12 months of age ___________________
“understand everything”
In actuality, their receptive language is _________________
quite limited
Normal developing children, as well as those with delayed language use a variety of strategies to _____________________. What does this allow the child to do? What do strategies include?
accomplish this “deception”. Allows child to participate in interactions and provides stepping-stones to the next level of development
Strategies include attention paid to nonlinguistic cues such as gaze, gestures, and situation or even probabilities
In assessing comprehension (many, very few) standardized tests are available for children younger than 3 years of age
very few
2 examples of single word level comprehension tests
Peabody Picture Vocabulary Test-Revised-IV
Communication and Social Behavioral Scales-DP
2 examples of verbal and nonverbal auditory stimuli tests
Receptive-Expressive Emergent Language Scale-3
Sequenced Inventory of Communicative Development
First step in comprehension assessment: assess both _____ and ______.
determine whether the child can understand any single words without the support of nonlinguistic cues…
assess both nouns and verbs
Comprehension assessment: If child demonstrates linguistic comprehension of nouns and verbs (12-18 mos level), proceed to ______________________ (Example?).
two-word instructions (18 – 24 mos level): action + object
Comprehension assessment: If child demonstrates comprehension of two-word instruction, move onto ___________________ (Example?).
three-word instructions (24 – 36 mos level): agent + action + object
What is it important to do for children with expressive and receptive deficits?
build a strong input component into the intervention plan
3 important adjuncts to eliciting expressive language
Focused language stimulation, verbal script activities, and child-centered approaches such as Indirect language stimulation
What 2 things should be part of intervention play?
Facilitative play and modeling of play behaviors-using both conventional and symbolic use of objects-along with simple descriptive language
3 ways to assess productive language
Speech-motor development
Phonological Skills
Semantic-syntactic production
Important to know if delays in speech development are related to _____________ or _______________.
deficits or delays in mort speech abilities
Oral-motor exam may be difficult in 18-36 month olds…try to _________________.
make it fun, like a game
Childhood apraxia of speech cannot be diagnosed until _______________________, no earlier than _____________.
child can produce enough speech and can imitate oral motor movements…not earlier than 3-4 years of age
Feeding assessment can be used to gain info about what 3 things?
muscular weakness, paralysis, or dysarthric-like behaviors that might interfere with speech development
Collecting a speech sample is useful for doing what?
getting an idea of the words and sounds the child is producing
Speech sample can be obtained 2 ways in the child who doesn’t talk much
Sample audio-recorded in the home
Parent diary
What 3 aspects of the child’s productions are analyzed from a speech sample
Phonological skills – sounds and syllable types the child produces
Frequency and types of conventional words the child uses
How the child combines words
Typically children who show small expressive vocabularies also show what 2 things?
small phonetic inventories of consonant and a restricted number of syllable shapes in meaningful speech and in nonverbal vocalizations
Strong correlation between __________________ and language outcome in late talkers
the amount of vocalization containing consonants
Assessing phonological production is useful for what 2 things?
prognostic indicator and as an aid in choosing words to be included in the child’s first lexicon
Consonant inventories: Consonants already in the inventory can be used to select what?
words to be included in the first lexicon to be taught to the child
After the child reaches a developmental level of 3 or so and has more cognitive awareness, _______________________ can be targeted
focused work on the acquisition of additional consonant sounds
Number of consonants present in the inventory can be used as what?
an index of severity of phonological delay
Typically developing 18 to 24 month olds produced an average of about ____ different consonants in 10-minute sample; 24-36 month old produced an average of ____.
14, 18
Syllable structure level measure examines what 2 things?
Measure examines both intelligible words and nonconventional vocalizations
Syllable structure level is derived by what?
rating 20 to 50 child vocalizations, each at one of the three levels, in terms of canonical (syllable) structure
3 levels of rating child vocalizations
Level I
Voiced vowel, voiced syllabic consonant, or CV syllable in which the consonant is a glottal stop or glide /ha/, /wi/
Level II
VC or CVC with a single consonant type or a CV syllable
Level III
Syllables with 2 or more different consonant types /pati/ Level III,
/dati/ Level II
6 predictors of long term speech delay in late talkers at 30-35 months
- limited phonetic inventory
- simple syllable structures
- More sound errors
- Greater inconsistency in substitution errors
- Atypical errors
- Slow rate of resolution
Define: limited phonetic inventory
order of acquisition of phonemes is delayed, not deviant; at 30-35 months, late talkers have only 6-9 different consonants
Define: simple syllable structures
Fewer syllables with more than one consonant or consonant clusters
Define: more sound errors
Percent consonants correct <0.45
Define: greater inconsistency in substitution errors
individual phonemes are produced in a variety of ways
Define: atypical errors
unusual substitutions (/d/ –> /h/); vowel errors
Define: slow rate of resolution
little change over the 24-36 month time period
Assessing lexical production: 2 ways to get an idea of the size and range of vocabulary in 18-36 month old children
Screening methods already discussed – MacArthur-Bates Communicative Development Inventory – parent report measure (see Appendix 7-1)
Direct assessments are problematic because of representativeness
Language sampling from observation of a play session, recorded communication samples or parent diary recordings
Children do not begin to combine words until vocabulary size reaches ______ words.
50
Therefore if a client is producing less than 50 words, syntactic intervention is ______________.
inappropriate
In children in the emerging language stage who have productive lexicons larger than 50 words and who are combining words, we need to look at what 2 aspects of their combinations?
Relative frequency of word combinations within a sample
Range of meanings or semantic relations expressed
To look at the relative frequency of single-word versus two-word utterances, we need to do what?
collect a fairly large sample of verbal productions
30% to 40% of late-talking toddlers had moved into the normal range of syntactic production by age _______.
3
How can we assume toddler has moved into normal development?
If an at risk toddler’s MLU exceeds 1.5 at 24 months of age, or if half the utterances contain word combinations
How do we compute the proportion of word combinations
dividing the number of utterances containing more than one word by the total number of interpretable verbal utterances in any speech sample
If the proportion exceeds 50% we can conclude what?
that the client is functioning at least at the 24 month level in terms of syntactic development
If the proportion is less than 50%, we can conclude what?
that the client is functioning below it
Assessment in the emerging language stage involves what?
comparing the child’s functioning in various areas of communicative development and using this information in developing a prognosis that will help in deciding if a child would benefit most from direct intervention or continued monitoring and making up the treatment plan
Does child demonstrate functional or symbolic play behavior that would normally accompany conventional language?
No, intervention should focus on developing communication and modeling the use of objects for conventional and pretend play
Does the child demonstrate symbolic play behavior but the frequency and/or range of communicative behavior is limited?
Yes, use modeling and communication temptations to try to increase the frequency of intentional behavior in addition to heightening the rate of vocal production
Does the child appear to be a good nonverbal communicator but lacks the conventional verbal forms of communication?
Yes, then language comprehension should be assessed
If they are found to be below expected levels then activities to foster receptive language, such as focus stimulation activities and indirect language stimulation should be used
If receptive language is adequate for developmental level then…Children without any other risk factors who are slow to start talking have a good chance of “catching up” with their normally speaking peers by school age if what (3 things)?
their deficits are limited to expressive language
They begin speaking by 30 months
Their cognitive, symbolic, receptive and communication skills are developing normally
Child with only expressive deficits should be monitored closely at _______ years of age…if deficits persist into preschool, ______________.
3-4; intervention should be considered.
Children with expressive deficits and other known developmental disorder and/or other risk factors ____________________.
should get intervention
Intervention will address one or more of the 4 following areas:
- Development of function symbolic play and gesture
- Use of intentional communicative behavior
- Language comprehension
- Production of sounds, words and word combinations
4 types of play behaviors taught in toddler intervention
- Functional play with pretense
- Substitution
- Sequences
- Talk and play
3 pre-linguistic milieu teaching methods
arranging the environment, following the child’s attentional lead, building social routines
4 reasons why Indirect language stimulation is appropriate for 18 – 36 month olds
- Can be used to provide multiple opportunities for the child to observe how language works to map the nonlinguistic context onto words
- Well suited to using parents to administer intervention
- Training of parents should focus on following the child’s lead by imitating actions, sounds and words the child is producing and providing words to match the child’s actions and activities
- ILS techniques including expansion, extension, recasts and open-ended questions – want parents to provide “super normal” levels of these stimuli
Primary goal of phonological intervention is?
the enlargement of the consonant inventory and the range of syllable shapes the child can produce
Imitation of infant’s vocalizations has large effects on _______________…can take place in the context of ________________.
increasing infants’ vocalizations; back-and-forth babbling games
Late-talking toddlers acquire consonants and syllable shapes in (a different, the same) order as normally developing children do, but at (a slower, a different) rate
the same; a slower
By 18-24 mos late talkers produce most (what 3) consonants, but few (what 2?)
stop, nasal and glide; fricatives and liquids
In developing first lexicon, Choose words that are what?
similar to those used first by normally developing children
Nelson (1973) found that 50% of normally developing children’s first words were __________.
nouns
Some examples of first word nouns
Own name, names of pets and family members, names of objects the child acts on directly (spoon, shoe), names of body parts, names of preferred foods, labels for objects that move and change (ball, light), and social games and routines
Other 50%: Most commonly used words in toddlers vocabularies were? 4 examples?
words that can be combined and help the child talk about relations among objects
Examples: pronouns (I, you), function words (that, the), verbs (help, is), and relational words (more, all done).
Words for s first lexicon: 10 communicative functions to be served
- Rejection, nonexistence, or disappearance
- Cessation or prohibition
- Recurrence
- Existence
- Action on objects
- Locative action
- Attribution
- Naming
- Possession, commenting
- Social interaction
Child-centered approaches in procedures for increasing early vocabulary
Play contexts that give opportunities for incorporating words into the interaction would allow the child to learn words for ideas already being expressed through play
Hybrid approaches in procedures for increasing early vocabulary
Milieu teaching, using either the mand-model or incidental teaching format, or script therapy
Clinician-directed approaches in procedures for increasing early vocabulary
Drill, drill-play, modeling with imitation
These techniques are more effective with minimally verbal children with low IQs than more naturalistic approaches, whereas the more naturalistic approaches worked better for children with higher IQs
Developing word combos: Children’s first word combinations are used for what?
to talk about the semantic relations they already have been encoding with single words
Child-centered approaches to developing word combinations
Indirect language stimulation
Hybrid approaches to developing word combinations
Vertical structuring
Script therapy approach
Clinician-directed approaches to developing word combinations
Modeling with imitation
Environmental Language Intervention Strategy
