Assessment and Intervention in the Prelinguistic Period

1. Assessment and Intervention in the Prelinguistic Period Paul, R. (1995). Language disorders from infancy through adolescence. Chapter 7

2. What is the prelinguistic stage? • Newborn Period • Preintentional period (1-8 months) • Prelinguistic communication (9-18 months)

3. Risk factors for infants • Prenatal Factors • maternal drug or alcohol abuse • exposure to toxins or in utero infections • Prematurity • low birth weight associated with developmental delay • susceptibility to illness • respiratory difficulties • less interaction early on

4. Risk factors (continued) • Genetic and congenital disorders • number of syndromes that can occur • autosomal chromosomal abnormalities (Down syndrome) • sex chromosome disorders (Kleinfelter’s syndrome) • craniofacial disorders • metabolic disorders

5. Risks after the newborn period • Hearing Impairment • Autism • Developmental delay • Abuse/neglect

6. Assessment and Intervention for Newborns at Risk • Feeding and oral motor development • Hearing conservation and aural rehab • Infant behaviour and development • Parent-child communication

7. Feeding and oral motor development • Observe feeding and oral behaviour • Interview parents and staff regarding feeding and oral behaviour

8. Assessing Feeding/Oral Behaviour • Reflexes • suckling • sucking • rooting • phasic-bite reflex • Formal assessments • Informal interview (see Box 7-1, p. 197)

9. Management of Feeding • Tube feeding • nasogastric • orogastric • gastrostomy • Stimulate oral motor development • Educate parents about feeding

10. Management of Feeding (contd) • Specific Techniques for Facilitating Feeding • Positioning • Jaw stabilisation • Oral stimulation in feeding • Nonfeeding oral stimulation

11. Hearing Conservation and Aural Rehab • Advocate for early audiological screening • Advocate for hearing testing in child’s early years

12. Child Behavior and Development • Assessment should be to determine the current strengths and needs • Identify what risks the infant faces • Evaluate level of infant’s physiological organization i.e. How much stimulation and handling can the child tolerate? What is the most comfortable position for stimulation?

13. Management of Behaviour & Development • Suggest ways to counteract low levels of language and interactive stimulation in ICU • Advocate oral development and stimulation

14. Assessment of Parent-Child Communication • Assessing infant readiness for communication • Educate parents about stages - Turning in, coming out, reciprocity • Assessing parent communication and family functioning • Discuss the parents concerns

15. Management of Parent-Child Communication • Inform parent about different states the infant may be exhibiting (see Table 7-3) • Encourage parental interaction when the infant is ready • look at, handle, talk to the baby • Help parent identify end of interaction • wait for signals of interaction like eye gaze • watch for signals of distress

16. Preintentional Infants - 1-8 mos • Preintentional - infants have not yet developed cognitive skills to represent ideas in their mind and pursue goals • Perlocutionary (Bates, 1976) • infants do not intend any particular outcome by their behaviour • adults act as if they do (normal and impt for communication development)

17. Assessment and Intervention for Preintentional Infants • Feeding and oral motor development • Hearing conservation and aural rehab • Infant behaviour and development • Parent-child communication

18. Assessment of feeding and oral motor development • Feeding assessment - observe new feeding patterns • integrating sucking with jaw movements • chewing • rotary jaw movements • tongue lateralization • sustained bite

19. Assessment of feeding and oral motor development • Vocal assessment (see Table 7-4, p 205) • observe child and ask parent about vocal behaviours • use corrected gestational age - age -weeks premature = CGA • observe sound play, consonants, intonational changes, babbling

20. Management of feeding and oral motor behaviour (1-8 mos) • Feeding • continue oral stimulation • introduce solid foods • see Box 7-2, p 207 • Vocal Development • talk and babble to baby • imitate any non-cry vocalization • use “baby-talk” • use toys

21. Hearing in preintentional period • Encourage assessment by audiologist • Counsel regarding otitis media and signs of otitis media such as pulling on ear, fussing

22. Child Beh’r & Dev’t (1-8 mos) • Assessment • Involves general assessment of development • Instruments available include: • Bayley Scales of Infant Development • Vineland Adaptive Behavior Scales • Receptive-Expressive Emergent Language Scale • Sequenced Inventory of Communication Development (SICD) • Rossetti Infant-Toddler Language Scale

23. Child Beh’r & Dev’t - Management • General motor and cognitive stimulation • Home-Based Programs • activities should be performed in communicative manner • parent advocate

24. Parent-Child Communication • Assessment • Formal instruments • Informal observation • responsiveness to child’s cues of readiness and unreadiness to interact • choice of objects and activities • language stimulation and responsiveness (cooing, babbling, responding • encouragement of joint attention

25. Communication - Management • Act as a support and encourage parent • Paul suggests three main aspects: • Increase awareness of infant communication patterns • Provide Instruction and modeling of adult-infant communication • Help parents self-monitor

26. Awareness of comm. patterns • Explain that it may be difficult to interact with an unresponsive infant • Make communication enriching and responsive • provide visual, auditory, tactile cues to engage baby • allow infant to explore novel stimuli • Explain interactive pattern of infants • educational videos

27. Modeling Interactive Beh’s • Turn-taking and imitation • ensure baby is ready to interact • use smiles and vocalisations to elicit infant behaviour • wait for the infant to initiate • imitate it and then wait for infant to do something else • vocalization and imitation of vocalization should be especially encouraged

28. Interactive Behaviours • Joint Attention Routines • identify the infant’s focus and share attention to that • make a comment or gesture about what the baby is looking at or doing • peekaboo • choral vocalization

29. Interactive Behaviours • Establishing anticipatory sets • Playing baby games • provide the baby with predictable series of sounds and actions • basis for script development • use baby games that the family have used before and/or are culturally appropriate

30. Interactive Behaviours • Self-monitoring skills • video-taping sessions • ensure a non threatening environment for the parents

31. Assess’t and Treatment at Prelinguistic Comm. Stage (9-18) • Infants become intentional communicators • Illocutionary stage (Bates, 1976) - child expresses intention through signals

32. Assessment • Play assessment (eg. Symbolic Play test) • Observe play • recognition of common objects (brush, phone) • engages in simple play schemes • Is any functional communication present • attempts to request objects or actions • eliciting attention

33. Management • If child is expressing some communicative intent- • scaffold (e.g. break routines) • vocalise the child’s demands • shared book-reading • joint attention to pages • stop and wait for child to respond • Communication temptations (see box 7-3)

34. Management (cont’d) • Facilitate comprehension • baby games (e.g. show me your nose, ears, etc)

35. Management (cont’d) • If the child is not showing intentionality- • provide intensified input (book reading, lots of parallel talk, joint attention activities) • improve comprehension skills • encourage vocalization • respond to the child’s actions and initiations

36. Considerations for older prelinguistic children • Feeding and oral motor development • Hearing conservation and aural rehabilitation • Intentionality and communication • symbolic systems of communication