Assessment and Intervention for Emerging Language

1. Assessment and Intervention for Emerging Language Paul R. (2001). Language Disorders from Infancy through adolescence. Chapter 8

2. What is emerging language stage (EL)? • For normally developing children, corresponds to toddler age range • Approx - 18 - 36 months

3. Who might be at the EL stage? • Children between 18-36 mos with no known risks but parents or others are concerned • Children between 18-36 mos with known risks • Older children with severe disabilities

4. To see them or not to see them…that is the question. • Children under 3 with intact cognitive, preverbal communicative, and sensory capacities with no risk factors - low priority • Children with cognitive deficits, hearing impairment or chronic OM, preverbal communication problems, risks pre or perinatally - should be seen

5. But remember... • Therapy may facilitate development in “normal” slow talkers • Children with later language disabilities often have histories of delayed language development

6. Normal Development

7. Assessment of Communication in EL • Multidisciplinary and Transdisciplinary assessment • Play assessment • Communication assessment

8. Play Assessment • Want to ensure child is at a developmental level consistent with communication development • Relationships exist between play and language development • Provides a more holistic picture of the child

9. Assessing Play • Communication and Symbolic Behavior Scales (Wetherby & Prizant, 1990) • Play Scale (Carpenter, 1987) • parent plays with the child • see Table 8-1, 8-2 p 251 • McCune (1985) • child is given a set of toys and behaviours are analysed (see Table 8-2) • Symbolic Play Test (Lowe & Costello, ‘76)

10. Communication Assessment • Rating Scales • see Table 8-3, p. 253-254 • Communication and Symbolic Behavior Scales (Wetherby & Prizant, 1990) • observe parent and child in various interactions • rates performance in five areas • Informal examination of communication functioning

11. Informal Examination of Communication Function • Assessing Communicative Intention • Assessing comprehension • Assessing Production

12. Assessing Communicative Intention • Range of communicative functions • Proto-imperatives • Requests for objects • Requests for actions • Rejections or protests • Proto-declaratives • Discourse functions • Requests for Information • Acknowledgements • Answers

13. Assessing Communicative Intention (cont’d) • Frequency of expression of intentions • Forms of communication (e.g. gestural, vocal)

14. Assessing Communicative Intent: Worksheet • Table 8-4, page 256 • Communicative Act: • Must be directed at adult. Child must look at or address the adult directly in some way. • Must have an effect on influencing the adults’ behaviour/focus of attn or knowledge. • Child must be persistent in the attempt to convey the message if the adult does not respond

15. Assessing Comprehension • Standardized language tests/scales • PPVT-III, Sequenced Inventory of Communicative Development (SICD), Receptive Expressive Emergent Lang Scale (REEL).

16. Comprehension Activities:Understanding Single Words • A collection of six to eight items • Give me… or Where’s… • Can assess body parts • Assess verbs • Comprehension of single words is normal for 12-18 mos. • What if they don’t?

17. Comprehension activities: Two word comb’s (18-24m) • Action-object (use words understood at single-word stage) • choose unusual combinations such as “kiss the apple” “hug the shoe”

18. Comprehension Activities:Beyond 2-words (24-36 m) • Agent-action-object instructions • Rely on probability • Start with vocabulary from earlier stages and then move on • see Table 8-6

19. Comprehension beyond 36 months • Can be tested using formal comprehension measures such as PPVT-III, TACL-R, Miller-Yoder Test of Grammatical Comprehension, CELF-P

20. Comprehension Findings:What do they mean? • If comprehension is superior to production • better outcomes • If comprehension is poor: • need to include comprehension component in therapy as well as expressive component

21. Assessing Espressive Language • Speech motor development • Speech sample/phonetic repertoire • Phonological skills • Lexical production/Vocabulary • Semantic-syntactic production

22. Vocabulary(Lexical Production) • Expect a child to have at least 50 words and some two-word combinations in the 24-36 month stage • Rating scales • MacArthur Communicative Development Inventories (Fenson et al., 1993) • Language Development Survey (Rescorla, 1989)

23. Semantic syntacticproduction • Children don’t begin to combine words until vocabulary size is approx 50 words • To assess semantic-syntactic production: • Determine the relative frequency of word combinations • Evaluate semantic relations expressed • Table 8-7 (Browns Semantic Relations) • Variety of relations • Advanced relations • Normal toddlers express 8-11 different semantic relations

24. Decision making based on assessment information • See Paul’s decision tree on p. 253 (Fig. 8.2)

25. Intervention: Goals, Procedures & Context • Four main areas that may be targeted: • Functional and symbolic play skills • Using intentional communication • Language comprehension • Production of sounds, words, and word combinations

26. Functional and Symbolic Play Skills • Step1: Establish reciprocal behaviour and anticipatory sets (e.g. peek-a-boo) • Step 2: Model early forms of symbolic play and encourage imitation • Step 3: Model play routines like pretending to give the doll a bath, meal time, store games

27. Developing Intentional Communicative Behaviours • Want children to initiate communication • #1: Communication temptations • can model first with the parents (e.g. hand Mum a container and she hands it back to therapist and indicates ““take the lid off” or says “help”. Then hand container to the child) • #2: Milieu model • place things out of reach and get the child to ask for it or draw the child’s attention to it and wait for a response

28. Developing Intentional Communication (cont’d) • #3 : Use routines or script therapy and then violate the routines • #4 : Respond as though the child is showing intent • #5: If range of intent is limited, increase use of proto-imperatives and declaratives • model the behaviour • pretend not to notice something that the child is interested in and wait for them to get your attention

29. Developing Intentional Communication (cont’d) • If child has adequate intentions but is only using gesture -->increase vocalising • Model the target response • Withold response or pretend not to notice until some vocal behaviour produced

30. Developing Intentional Communication (cont’d) • If the child is using maladaptive behaviour: • immediately provide an alternative form of communication (e.g. I see you want it. Point to it and I’ll give it to you.) • might need to actually take the child’s hands and demonstrate the action

31. Developing Receptive Language • Indirect Language Stimulation (parent training) • self-talk/parallel talk • imitations • expansions • extentions • build-ups and breakdowns • recast sentences • labelling • see box 8-3

32. Developing sounds, words, and word combinations • Increasing phonological skills • expand the repertoire of sounds • use developmental information • Developing a first lexicon • choose words based on normative data • some words should be nouns for labeling • other words should be chosen for expressing other functions • see Table 8-10

33. Developing sounds, words, and word combos (cont’d) • Developing a first lexicon (cont’d) • MacDonald suggested choosing words that are within the child’s interests • Consider the child’s phonetic repertoire • choose words with sounds in the child’s repertoire • early words may be limited to CV and CVC shapes

34. How should we teach first words? • Child centered approach • clinician provides many models • use play contexts and don’t require response • Hybrid approach • milieu teaching • place objects out of child’s reach • script therapy • engage in a verbal routine, once it is overlearned, either violate it or use a cloze technique

35. How should we teach first words? • Hybrid approaches • focussed stimulation • set up the situation so that you are modeling the specific vocabulary you want to teach • provide lots of opportunities for the child to produce it • use recasts, expansions, extensions, etc. • Clinician-directed • may be suitable for older children

36. Developing word combinations • Word combinations express semantic relationships • Client-centered • play situation-when the child produces a one-word utterance, the clinician expands it to a two-word phrase

37. Developing word combinations • Hybrid approaches • Schwartz et al.(‘85) - vertical structuring • Whitehurst et al.(‘91) - see box 8-5 • milieu approaches • put something out of child’s reach - “get X” • focussed stimulation • script therapy • perhaps use a book or song-play that has two words

38. Developing word combinations (cont’d) • Clinician-directed approaches • Leonard (‘75) • use a puppet and the puppet describes what’s happening in the picture • get the child to tell the puppet what’s happening and to “talk like” the puppet • MacDonald et al. (‘74) - Environmental Language Intervention (ELI) • parent works on goal for 5 min in 3 conditions • sessions are three times/week • see Box 8-6