Nancy Brady University of Kansas nbrady@ku

1. Facilitating Early Communication Development in Children with Intellectual and Developmental Disabilities:Focus on Down syndrome and fragile X syndrome Nancy Brady University of Kansas nbrady@ku.edu http://www2.ku.edu/~lsi/research/profiles/brady_nancy.shtml Presented to Illinois Speech Language Hearing AssociationApril 1, 2011

2. Presentation Overview • Part 1: Overview of Prelinguistic development • Why focus on stages of prelinguistic development? • Typical and atypical developments • Part 2: Assessment Strategies • Part 3: Interventions • Specific considerations for Down syndrome and FXS • Part 4: Working with communication partners

3. What are prelinguistic gestures and vocalizations and when do they occur in typical development? Gestures and vocalizations that precede speech in typically developing children Occur in a developmental order

4. Why??? Why focus on describing, assessing and teaching these types of behaviors?

5. Stages of Prelinguistic Development There is great variability in the communication skills of prelinguistic children Prelinguistic = before children are speaking or signing or using another formal language system

6. Some Examples “Perlocutionary” = children communicate by crying or acting on objects. Others assign meaning to these behaviors.

7. Prelinguistic communication • Next sections: • Vocalizations • Coordinated attention • Gestures

8. Early Vocalizations Crying and experimental sounds

9. Early Vocalizations Crying and experimental sounds continued –“Raspberries”

10. Later Vocalizations Canonical babbling (reduplicated consonant vowel babbling)

11. Later Vocalizations Variegated babbling (jargon babble)

12. http://www.youtube.com/watch?v=-5yIiGF8WGk.

13. Summary of Vocal Development Crying Experimental Sounds (e.g., raspberries, noncanonical babbling) Canonical Babbling Variegated Babbling Speech

14. Vocalizations in children with disabilities Do we hear similar vocalizations in older children and adults with disabilities? Should we continue to encourage vocal development in older children and adults with disabilities?

15. Vocalizations in Down syndrome 3 month old: http://www.youtube.com/watch?v=KMbKlOL8q5s 9 month old:http://www.youtube.com/watch?v=Lr_CmHq2vog How old?http://www.youtube.com/watch?v=0r_H2kHREig

16. Why differences in vocal qualities? • Anatomical differences • Vocal folds • High palatal vault • Larger than typical tongue in relation to the oral cavity • Weak facial muscles • General hypotonicity • Is babbling delayed in DS? • Not much!

17. Quantitative differences in vocalizations by children with DS Recent study by Thiemann-Bourque, Warren and Brady: How do children with Down syndrome differ from an age and SES matched sample of typically-developing children in regards to their home language environments (i.e., adult words, child vocalizations, and adult-child conversational turns)?

22. Vocal summary Differences in prelinguistic quality and quantity of vocalizations in children with Down syndrome

23. Vocalizations in autism Discriminative vocal characteristics could be used to help identify children at risk for ASD Automated vocal analysis of naturalistic recordings from children with autism, language delay, and typical development Oller, Niyogic, Grayd, Richards, Gilkerson, Xud, Yapaneld, and Warren (2-10)

24. Children with FXS Lots of variability

25. Coordinated Attention Aka…joint visual attention, line of visual regard, What is it and why is it important?

26. Why is eye gaze important?

27. Strategies for increasing eye gaze Within routine, child is looking at object, then, intersect gaze

28. Increasing eye gaze continued Verbally prompt for eye gaze Specifically acknowledge the eye gaze Provide the desired object contingent on the eye gaze

29. Increasing eye gaze continued Bring toys up to face

30. Eye gaze shift Step 1. obtain the child’s attention (e.g., move face in front or call their name) Step 2. Look in direction of a “target even” (e.g., remote control car or fan) Step 3. Activate the target event -repeat Steps 1-3 many times- Step 4. Gradually increase the time interval between the shift in the gaze and activation of the event. (This creates opportunities for the child to anticipate and look in direction that interventionist is looking) Activity: practice teaching eye gaze shift with a friend

31. Gestures • Illocutionary or purposeful gestures • What is the function? • Behavior regulation = imperative • Joint attention = declarative • Social interaction

32. Crais et al. (2004) study • Deictic vs. representaitonal • Different functions • What’s the developmental sequence?

33. Contact Gesture Communication Contact gestures = gives, leading by the hand, showing. Gestures that are in direct contact with an object or person.

34. Examples of Contact Gestures Example of a contact gesture

35. Distal Gestures Distal gestures = points. The index finger is extended and other fingers are pulled back. The gesturer is not in direct contact with the referent.

37. Examples of Distal Gestures Example of a distal gesture

38. Other Conventional Gestures Head nod and shake, shoulder shrug, open palm request Depictive gestures such as pantomimes

39. Gesture combinations • Sometimes people combine gestures to convey complex meanings • Gesture + vocal combinations • Gesture + gesture combinations • Gesture + word combinations

40. Examples of Gesture Combinations Examples of children combining 2 or more gestures

41. A Continuum of Prelinguistic Development

42. Activity Work in pairs or groups One person act out the title of the song from the paper Partner guesses the title Discuss the types of gestures you used to convey the title What titles seemed easier and why?

43. Why is it important toknow about prelinguistic stages? Other child behaviors correlate with these stages Intervention strategies may differ for children at various stages Stages are like “milestones” that indicate to parents and teachers that children are progressing

44. Correlates of Prelinguistic Stages • Form and function • Individuals with intellectual disabilities who only communicate with contact gestures rarely communicate “joint attention” (comments).

45. Form and Function Lack of joint attention- example of boy with autism

46. Persons who communicate with contact gestures and distal points frequently communicate joint attention • Significant differences between contact and distal gesture users reported in: • Brady, Marquis, Fleming & McLean, 2005; Brady, McLean, McLean & Johnston, 1995; McLean, Brady, McLean and Behrens, 1999; McLean, McLean, Brady & Etter, 1991)

47. Joint attention Example of person pointing in a joint attention task.

48. Differences in children with Down syndrome?Legerstee and Fisher (2008)

49. Frequency of communication Individuals who communicate with only contact gestures communicate significantly less often than children who communicate with more advanced gestures Findings reported in Brady et al.,2008; Brady et al., 2001; 2004; McLean et al., 1999)

50. Low Rate of Communication Example of low rate communicator