Presentation on theme: "Facilitating Early Communication Development in Children with Intellectual and Developmental Disabilities: Focus on Down syndrome and fragile X syndrome."— Presentation transcript:
1 Facilitating Early Communication Development in Children with Intellectual and Developmental Disabilities: Focus on Down syndrome and fragile X syndromeNancy BradyUniversity of KansasPresented to Illinois Speech Language Hearing Association April 1, 2011Ask questions.Do you like video examples? I’ve got a ton of them.
2 Presentation Overview Part 1: Overview of Prelinguistic developmentWhy focus on stages of prelinguistic development?Typical and atypical developmentsPart 2: Assessment StrategiesPart 3: InterventionsSpecific considerations for Down syndrome and FXSPart 4: Working with communication partners
3 Occur in a developmental order What are prelinguistic gestures and vocalizations and when do they occur in typical development?Gestures and vocalizations that precede speech in typically developing childrenOccur in a developmental order
4 Why???Why focus on describing, assessing and teaching these types of behaviors?Show clip from old Diane Ping tape
5 Stages of Prelinguistic Development There is great variability in the communication skills of prelinguistic childrenPrelinguistic = 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:VocalizationsCoordinated attentionGestures
8 Early VocalizationsCrying and experimental sounds
9 Early VocalizationsCrying and experimental sounds continued –“Raspberries”
10 Later VocalizationsCanonical babbling (reduplicated consonant vowel babbling)Who remembers about what age in typical development we expect to see canonical babbling?
11 Later VocalizationsVariegated babbling (jargon babble)
12 Three different people sent this link to me the last two days, so I’m sure I’m meant to share with you all.Who needs words??
13 Summary of Vocal Development CryingExperimental Sounds(e.g., raspberries, noncanonical babbling)Canonical BabblingVariegated BabblingSpeechRemember that babbling is important because it is highly correlated with first words.
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:9 month old:How old?Comment about best assessment contexts. When I was looking for some video examples, ones with the child engaged in object play had less vocs.What differences in vocal qualities do you notice?
16 Why differences in vocal qualities? Anatomical differencesVocal foldsHigh palatal vaultLarger than typical tongue in relation to the oral cavityWeak facial musclesGeneral hypotonicityIs 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 summaryDifferences 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 ASDAutomated vocal analysis of naturalistic recordings from children with autism, language delay, and typical developmentOller, Niyogic, Grayd, Richards, Gilkerson, Xud, Yapaneld, and Warren (2-10)Differences in vocalizations were detected in children as young as 16 months that were later identified as having autismDifferences in pitch, prosody, tone and phones.
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 gazeSpecifically acknowledge the eye gazeProvide the desired object contingent on the eye gaze
29 Increasing eye gaze continued Bring toys up to face
30 Eye gaze shiftStep 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 friendFrom upcoming chpt by Reichle and Brady
31 Gestures Illocutionary or purposeful gestures What is the function? Behavior regulation = imperativeJoint attention = declarativeSocial interaction
32 Crais et al. (2004) study Deictic vs. representaitonal Different functionsWhat’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 GesturesDistal 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 requestDepictive gestures such as pantomimes
39 Gesture combinationsSometimes people combine gestures to convey complex meaningsGesture + vocal combinationsGesture + gesture combinationsGesture + word combinations
40 Examples of Gesture Combinations Examples of children combining 2 or more gestures
41 A Continuum of Prelinguistic Development Prelinguistic StagesPerlocutionaryContact gesture+Distal gesture+Other conventional+A Continuum of Prelinguistic Development
42 Activity Work in pairs or groups One person act out the title of the song from the paperPartner guesses the titleDiscuss the types of gestures you used to convey the titleWhat titles seemed easier and why?
43 Why is it important to know about prelinguistic stages? Other child behaviors correlate with these stagesIntervention strategies may differ for children at various stagesStages are like “milestones” that indicate to parents and teachers that children are progressing
44 Correlates of Prelinguistic Stages Form and functionIndividuals with intellectual disabilities who only communicate with contact gestures rarely communicate “joint attention” (comments).
45 Form and FunctionLack of joint attention- example of boy with autism
46 Persons who communicate with contact gestures and distal points frequently communicate joint attentionSignificant 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 attentionExample of person pointing in a joint attention task.
48 Differences in children with Down syndrome? Legerstee and Fisher (2008) Get reference
49 Frequency of communication Individuals who communicate with only contact gestures communicate significantly less often than children who communicate with more advanced gesturesFindings 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
51 High Rate of Communication Example of high rate communicator
52 Differences in Repairs of Communication Breakdowns Children who use only contact gestures try to repair communication breakdown less often than children who use more advanced gestures
53 Gesture comprehension InputHow do children respond to gestures?Respond to joint attentionDisambiguate messages
54 Gaze following plus pointing Brooks and Meltzoff, 2008 JCLGaze following, as measured by length of looking at object adult looked at, significantly predicted vocabulary11 month olds who pointed had an additional words/month…or 167 word advantage by age 2Here’s the paradigm, experimenter facing infant and something is in the perifery. Experimenter turns to look at the something. Will infants follow that gaze?Infants that did so and looked longer had greater vocabulary growth, and infants that did this and also pointed had an even greater effect on their vocabulary growth.Share story about human spark from PBS
55 Summary Differences in gesture type associated with differences in: Communication functions (requests, comments)Frequency of communicationRepairs of communication breakdowns
56 Looking ahead at implications for Intervention Strategies Are different intervention strategies better for children at different stages of prelinguistic development?ExamplesTeaching children to use natural gesturesOutcomes from teaching words or other symbols to individuals at different stages of communication development
57 MilestonesIndividuals progress in communication even if they have not yet begun using words or symbolsProgress in:Frequency of prelinguistic communicationUse of points and other advanced gesturesDiversity of communication functionsRepairs of communication breakdowns
58 Preview of Upcoming Sections Assessment strategies for prelinguistic individualsIntervention strategies for prelinguistic individualsIncreasing parent and peer responsivityTeaching joint attention
59 Assessment Strategies Standardized assessments are not very helpfulNeed to determine how a child is communicating across environmentsStandardized assessments may be helpful if you need to use them to qualify a child for services or to receive a particular diagnosis, however they are not very useful for determining intervention goals
60 Why is it important to assess prelinguistic behaviors? Early identification of a language problemEarly identification of a developmental disorderPredictive value for later languageProvides information for identifying intervention goals, monitoring progressResponsiveness to prelinguistic behaviors provides linguistic input
61 How to assess prelinguistic communication? Parent/Caregiver QuestionnairesDirect ObservationAssessment ProtocolsThe CSBS Parent/Caregiver Questionnaire is a good one.
62 Parent/Caregiver Questionnaires Characteristics of a good parent questionnaireQuestions about here and nowUse recognition memory (vs recall)“What does your child do when he or she needs help (e.g., opening a container or getting a toy to work)?”How to use information from parent questionnaire
63 Examples of Questionnaires What do you use?Inventory of potential communicative actsThe caregiver questionnaire from the CSBS
64 Direct Observation Good contexts to observe in Contexts indicated by the questionnaire as showing high probability of communicationMeal or snack timeContexts for vocalizations?Story of Lena issues with shirt on backwards,
65 For our research….Also using Lena to narrow in on the most vocal contexts to listen too.
66 Activity1. list student characteristics-age, setting, likes, dislikes, sensory abilities2. list two or three good activities/contexts to observe and why3. Describe what communication behaviors to record and how.How could you summarize your observation?
67 Assessment ProtocolsTests designed to see if the individual will communicate with whatever means available in order to request, comment, etc.If no communication noted in Direct Observation, need to see if they will do it when provided a specific opportunity to do soExample from Cottonwood- young man who only said a few phrases and we wanted to measure his intelligibility for a reading project and we went in with a picture book and he blew us away….Similar example of boy at Parsons who demonstrated elaborate play when given a chance, the materials etc.Also in dynamic assessment type paradigm
68 Examples from Assessment Protocols Adaptations for older participants
69 Assessment protocols continued Assessment protocols have been used in research by Dr. Brady and colleagues to studyInitiationsRequests and CommentsResponses to Communication Breakdowns
70 Examples of protocols used in research Example of child initiation
71 Examples of protocols used in research Example of repair protocol item
72 Activity: Construct assessment activities Case 1, boy with fragile X syndromeAssess two things-rejecting (or protesting) and repairCase 2, girl with Down syndromeAssess indicating preference of different itemsCase 3, boy with autism:Assess use of PECS and gestures to indicate joint attention (commenting) functions)Case 4, individual your group previously “created”
73 How to Score Protocols? The Communication Complexity Scale = CCS Example from current research by Brady & Thiemann-Bourque
74 12 Scripted Interaction Tasks I. Behavior RegulationTask 1: 2 wind-up toys (1 broken)Task 2: Food items placed in a container (with tight lid)Task 3: 2 battery-operated hammer toys (1 toy switched off)Task 4: Train tracks and toy trains (child has only one track)Task 5: Sealed bubbles (2 bottles, one sealed)Task 6: Bumble ball (examiner switches off)II. Joint AttentionTask 1: Ball chute toy (one ball is too big to fit)Task 2: Spider mixed in with blocks in a containerTask 3: Musical instrumentsTask 4: Pretend hot dog placed in a marker boxTask 5: Book with altered pages (e.g., upside down, marked, ripped)Task 6: Foot controlled switch toy (in child’s line of vision)
76 Items 1-5 Pre-intentional 1 - single orientation only– toward an object, event or person2 - single orientation only + 1 other PCB3 - single orientation only + more than 1 PCB4 - Scanning- eye gaze shift between objects5 - dual focus– shift in focus between person and an object
77 Items 6-8 Intentional non-symbolic 6a- triadic eye gaze6b- dual focus + 1 PCB7- triadic eye gaze + 1 PCB8- triadic plus more than 1 PCB
78 Items 9-12 Intentional symbolic 9- one-word verbalization, sign or AAC symbol10- two word verbalization, sign or AAC symbol11- three-word verbalization, sign or AAC symbol12- four-word or more verbalization, sign or AAC symbol
79 Activity How would you score the following example: Example for a boy that uses lots of different forms!!
80 Proposed Scoring Average of the three highest forms observed Can average within each function (joint attention; behavior regulation)
81 SummaryAssessments are designed to determine how and why a prelinguistic child communicatesGather information from interviews, direct observation, and assessment protocolsAssessment protocols can be constructed to provide opportunities for particular behaviors of interestRepairs, communication with peers, use of AAC
82 Summarize information regarding: Communication formsFunctionsFrequency/rate of communicationStage of prelinguistic developmentInitiations/responses/repairsContextsMotivation
83 Interventions aimed at… Increasing prelinguistic communicationGesturesVocalizationsEye gazeIncreasing communication across multiple contexts and with multiple peopleFacilitating transition into symbolic communicationSpeech, sign language, pictures
84 Operational Principles Create contexts where children communicate naturallyFollow the child’s lead but address specific communicative targetsUse the least intrusive prompts necessary to promote communication targets
85 Goal of InterventionIncrease the frequency and complexity of requests and commentsFor both of these goals the first step is to build routines
86 Why teach natural gestures? Theoretical reasonsOccur developmentally before symbolic communicationThought to pave the way for symbolic communicationProvide opportunities for linguistic inputGestures occur developmentally before symbolic communication and often it’s easier to learn developmentally earlier behaviors, like crawling before you walk or run etc.,Thought to pave the way for symbolic communication. In fact there is a chapter by Butterworth in a book all about pointing titled “pointing is the royal road to language.’ I like this because it’s not the only way to language but many folks who are engaged in theoretical discussions of early communication and language development contend that gestures convey the early thoughts that are later mapped by langugeGestures also provide opportunities for linguistic input, so when a child points at something we almost always label it and we know from Tomasello’s work and others that children learn words best when they are jointly engaged with the referent and person and this is clearly the case when they are gesturing, in fact if you work with kids who are entering that vocabulary burst period, they seem to be activiely recruiting that input in activities like joint book reading by pointing to the pictures and waiting for you to name them.
87 Why teach natural gestures? Practical reasonsMay be easier to teach than some forms of symbolic communicationNo extra equipment neededGestures are readily understood by members of communityCan be used across many different contextsEasier to teach: I’ll show you examples of physically prompting gestures and fading these prompts and I can tell you it’s a lot easier to prompt a gesture than a speech sound– could mention PROMPTAnother practical reason is that you don’t need extra equipment, now I’ll continuously make a point that we want kids to communicate symbolically with AAC systems as much as they can, but there are many many times when equipment isn’t available or vocabulary doesn’t match a ontext, and the child needs to have a means to communicate when they can’t access their equipment,Another selling point for gestures is that they are readily understood by members of a community. It’s obvious that this guy want help with the bubble jar. Now if he walked up to you and went “sign bubbles.” unless you are familiar with signs, you aren’t going to know what means. I have a brother who communicates primarily with sign language and he has a pretty big vocabulary, combines into sentences etc. but he can only use it with people who know sign and he relies heavily on his gestures when he’s out and aboutSo, he can use his gestures across many different contexts and with different partners, unlike his signs.
88 When to teach gestures?Gestures as one part of communication interventionEarly phase of expressive communicationAs augmentative forms when other forms of communication are not available or are not workinge.g., SGD not availablee.g., communication partner doesn’t know signAs I said, gestures should be targeted as PART of a communication system. For some learners who don’t have any discernable expressive communication, it would be the primary focus, for others, gestures may be a back up when those other systems aren’t available, or to bridge into more complex communications.
89 How to Teach Natural Gestures Principles described in Prelinguistic Milieu Teaching (PMT), see Warren et al., (2006)Warren, S., Bredin-Oja, S., Fairchild Escalante, M., Finestack, L., Fey, M., & Brady, N. (2006). Responsivity education/ Prelinguistic milieu teaching. In R. McCauley & M. Fey (Eds.), Treatment of language disorders in children (pp ). Baltimore, MD: Brookes Publishing Co.I’m going to go over the main steps and show you some examples. More information is available in a recent chapter by Warren,, Bredin-Oja, Fairchild Escalante, Finestack, Fey & Brady Book also includes a cd with more video clips of these and other procedures
90 Step 1: Find objects/activities/people that participant will be motivated to communicate about Different for every individualPreference assessments or questionnairesExamples of activities: toy box, snack activities, motor activities like swinging,Range to match development and interestsThe first step is common to all interventions aimed at teaching children to ask for things but is absolutely essential for kids with severe disabilities and for using this approach. You have to find thinks they like, a lot. Differ for every child. I bet many of you already have systematic ways to find what will drive a kid to communicate. What are the?observations’Preference interview with family and teachers, a great thing to do at initial meetings or IEPs. Best 30 seconds of the meeting.Direct assessment procedures like forced choice procedures.Whatever means you use, you need to identify a range of activities the kids really enjoy and reassess this frequently throughout intervention.If something’s not working any more, time to think, OK is this activity still motivating. And for some kids this changes frequently so you got to rotate and change things up often.
91 How to Teach Natural Gestures Step 2. Develop turn taking routine(s) involving activities identified in step 1Examples:Rolling a ballPutting colored discs on a light boxPretend cutting foodTurning on and playing with any battery operated toyMore elaborate routines can be used with children who have advanced play skillsNext, you need to figure out some back and forth turn-taking activities involving the objects and activities that the individual really likes. You have to think of an activity that can take the form of first I do something then you do something etc. Almost any toy or activity can be made into a turn taking activity. Some thing have obvious turns associated with them, like a ball, where you roll the ball back and forth. But there are other fun things you can do with a ball too, like little bounces and big bounces, and roll it zig zag etc.Some of the activities are going to vary by child’s sensory status too. We’re finishing up a study with children with hearing and vision losses in addition to intellectual disabilities, and for a couple kids with limited vision, they loved the light box, and you might wonder well what kind of turn taking routine could you do with a light box but he loved putting different colored discs on the light box so he and the interveentionist took turns putting different discs on to create an interesting pattern.These are very easy, basic activities.For children with more complex play skills, you can use pretend play, like cutting up pretend fruit, velcroed together.
92 Other types of routines Meal timesGetting ready to go outsidePlay with a certain toy or objectSongs with repetitive lines and actionsThe type of routines will vary with the child’s play skills
93 How to Teach Natural Gestures Step 3 (for teaching requests)Interrupt the routine in order to provide an opportunity for the child to requestFor example: hold on to the ball, or pause the swing, or turn off the battery operated toy….May add an expectant lookSo we’ve identified some awesome activities and turn taking routines involving those activities/objects and you’ve already seen the rest of these components but I’ll highlight them with some more examples.The third step, at least for teaching requests, is to interrupt that routine that you’ve just established in order to provide an opportunity for the child to ask for more. So in the peg board routine, how did Susan do this?The light ball, does this on it’s own, it turns itself off, and in the amazing barrel rolling routine, when was the interruption? 1 before he starts rolling her, and also before she flips.For kids with good vision, in the beginning stage an “expectant” look can often help. I call this the confused or dumb look and it can be an extra cue for the child that you’re waiting for something.
94 How to Teach Natural Gestures Step 4: waitStep 5: if necessary prompt the targeted responsePhysical, hand over hand promptsModel promptsVerbal promptsFade prompts as quickly as possibleClip from Super NannyAlong with the interruption and the expectant look, there’s a wait. And the length of that wait time is going to depend on the child’s motor skills and motivation and you the interventionists familiarity with the child’s communication repertoire. If a child has a slow response time in general you will have to wait longer. If you know that she has the response of searching out and tapping your hand strongly in her repertoire, you’re more likely to hold out and wait for that response. However, if it’s pretty new and fragile, you might only wait a few seconds before the next step which is prompting. But I want to emphasize how important the wait time is. When your first starting to use these procedures it may be helpful to even do a silent count in your head just to make sure you’ve given enough time. So, offer the pegs or the ball and then count 5-10 seconds or so. If you wait too long, you’ll know because they’ll lose interest and give up or tantrum. Next time shorten it a bit. But if you don’t wait, they don’t have a chance to show you what they can do.If you don’t get the response you’re looking for during that pause—and you should always have a response in mind– then you need to use a prompt and we rely on physical prompts for our learners with hearing and vision losses, but I think they are best for all beginning communicators. They are easier to fade out than verbal prompts and the kids are more likely to become initiators rather than responders quicker with physical prompts. You can model gestures like points, although it’s hard to model giving for help or open palm requesting unless you’re completely double jointed.You want to fade the prompts as quickly as you can so the child doesn’t become prompt dependent, but, in my experience, you often have to give little booster prompt sessions, maybe at the beginning of each session for awhile. So if you’ve faded a prompt it doesn’t mean it’s gone for good for a long time.
95 How to Teach Natural Gestures Step 6: continue the routine/activity. This reinforces the child’s behavior.General pointersShorter routines provide more opportunities for communicationChange activities when child just begins to lose interestThis last step may seem like a “no brainer” but you need to finish up a turn with the activity so they get to experience the fruits of their labor. Sometimes this can be just a few seconds of the ball light or hearing music, for some kids and some activities they need more time but I try to always be conscious of the fact that the longer they are getting to to experience to reward, the less time they have to ask for it again. So you want to make it worth their while, but not too long.This gets to the first general pointer– shorter routines provide more opportunities. So the examples you’ve seen so far provide lots of turns, lots of opportunities, in contrast, if you had a routine like dress up and teach the child to ask for the box of clothes then spend 10min. Putting on the clothes, that’s only one response in 10 minutes and that’s not enough teaching opportunities. During this skill acquisition period, you need more dense opportunities.We work with the kids for a long time, 45 min. to an hour and so we go through a number of activities and if you are having to do more prompting than usual or the child is getting whiny or falling asleep then you have probably stayed with a particular activity too long. Learn to read subtle signs that they are just beginning to lose interest and change at this time. “Leave em wanting more.” is what we strive for.Change up some motor, some sensory toys, some snack activities, keep it interesting for the child and you. If you’re bored it’s not a good sign either. Try to keep up a good energentic but not frenetic pace.
96 Intervention: Role Play exercise One of you is teacher, other is studentUsing the steps we just discussed….Teach student to do one of the following:Point to blinking fanOpen palm request for yummy treatGive to request more bubblesVocalize to continue a social routineReverse roles
97 Specific strategies to increase vocal production Vocal playImitation
98 Specific strategies to increase vocal production, continued use sounds within child’s repertoire
99 Specific strategies to increase vocal production, continued Verbally prompt for vocalizationsSpecifically acknowledge vocalizations
100 = Combining components Vocalization + eye gaze + gesture a clear, recognizable communication act!
101 Strategies for combining gesture, eye gaze and vocalizations Time DelayIf the child produces one or two components of a communication act, wait expectantly (i.e., use time delay) to prompt the second (or third) component.Ask, “what do you want?” or another general prompt and wait again
102 Strategies for combining gesture, eye gaze and vocalizations Immediately after the child produces the targeted component (eye gaze, vocalization or gesture), provide the appropriate consequence and verbal feedback
103 Considerations in working with specific populations Children with Down syndromeChildren with autismChildren with fragile X syndromeChildren with multiple disabilitiesChildren learning AAC
104 Children with Down Syndrome Characteristics to consider when planning assessments and interventionsIntelligibilityLearning style (may not respond well to “Do/say ___.”)PersistenceExciting new treatments in development!
109 Fragile X syndromeFragile X syndrome (FXS) is the leading inherited cause of mental retardationDelayed language typical in boysProfiles: relatively weak inShort term memoryProcessing sequential informationDirecting and sustaining attentionCo-occurrence of ASD in about 10-40% boys
110 Children with Fragile X Syndrome Characteristics to consider when planning assessments and interventionsWide range of variability of communicationMany autistic-like characteristicsMothers may be shy or reticent in their interactionsOral needsExciting new developmentsDrug trialsNewborn screeningChildren with Fragile X syndrome have many of the symptoms and characteristics of children with autism. They seem to feel most comfortable in a structured, predictable environment with few distractions and some chance to rest and escape from demands.
111 Adaptations for Children with sensory limitations Input includes sign and touch cuesDirectionality of communication act, indicated through whole body orientation (not just eye gaze)Routines emphasize tactile and vestibular stimuliPrompts are physical rather than verbal
112 When is it appropriate to target symbolic forms of communication? Research isn’t available yet to guide this decisionWe start working on words when children are communicating prelinguistically at a rate of more than one communication per minuteStart sooner with children who have severe physical impairments
113 Combining AAC and Prelinguistic Interventions How can AAC complement prelinguistic interventions?How can prelinguistic interventions complement AAC?How many of you work with children that you think will need to use, at least for some period of time, augmentative communication? If the children are prelinguistic, we feel many of the principles used in PMT of can be used in early AAC intervention.We have been thinking about this a lot. So I wanted to discuss blending AAC with prelinguistic modes and teaching strategies, particularly for two scenarios, first for kids who, for whatever reason pick up at least a few signs or graphic selections more readily than natural gestures and vocalizations. And second, for kids who demonstrate all the prelinguistic skills we target, but are having a very hard time acquiring speech.
114 ConsiderationsAAC does not slow down acquisition of speech communicationBlishak (2000); DiCarlo et al. (2001); Kouri (1988); Shepis et al. (1982); Yoder & Layton (1988)Acquisition of prelinguistic behaviors may follow a different course for some children with severe disabilitiesParents are eager for children to communicate symbolicallyWe know that learning to communicate with AAC does not retard speech acquisition and it may even promote speech acquisition.Secondly, although I’ve spent a lot of my career describing stages of prelinguistic communication development, such as starting with contact gestures, progressing to distal gestures and then more symbolic gestures and speech, I’ve met many children who don’t seem to follow this pattern. They skip around, and we don’t know that mastery of gestures and prespeech vocalizations are necessary to acquire before symbolic communication in all cases.Every parent is waiting for that first word, whether it’s spoken, signed or selected on a communication device. Parents may be more excited participants in their children’s interventions when a sign is targeted than when a natural gesture is targeted.
115 Scenario 1:child who is slow to acquire natural gestures and vocalizationsSome kids, for some reason, acquire a few signs or other AAC responses more readily than natural gestures. We’re going to look at some clips from a little girl who participated in 6 months of intensive PMT intervention with an excellent interventionist –Shelly Bredin-Ojay, a doctoral student working on our project.in addition to her early intervention services received through infant/toddler services. In terms of her PMT goals, we’re still trying to get her to combine eye gaze with gestures and vocalizations to produce clear communicative signals. However, she’s learned one sign along the way, I bet you can guess what it is... “More.” In this clip we’ve got a cup banging routine set up and I’m waiting for her to request the blocks so she can bang them some more. Watch clipShe uses this sign as a general request, quite appropriately. At the time of this videotaping, she’s 4 years old, and everyone, including myself is thrilled that she has learned a clear communicative signal that is recognizable by her immediate caregivers. Her parents are probably more thrilled that it happens to be a sign than a natural gesture.
116 Scenario 2:Child who meets/exceeds goals of PMT but is slow to develop speech.Use typical naturalistic teaching strategies such as incidental teaching, mand model and delayed prompts to teach AAC and spoken verbal utterancesNow, let’s shift slightly to thinking about children who communicate at a high rate with their gestures and vocalizations, including canonical vocalizations and they are getting older, but they aren’t acquiring spoken words yet. I have met many kids like this lately. They have labels like severe expressive language impairment or developmental apraxia of speech. These kids are getting lots of modeling etc. of speech and usually some speech therapy outside of our setting too but are making minimal progress learning to speak.For these kids we can use typical naturalist teaching strategies such as incidental teaching, mand model and delayed prompts to teach production via AAC and concurrently modeling verbal utterances. And continue to honor and encourage children’s use of gestures and prespeech vocalizations to communicate. Some nice examples of including AAC strategies such as remnant books, vocas, and signs are presented in three case studies in the Cumley and Swanson 1999 article in AAC.
117 Conclusion Incorporate AAC within prelinguistic interventions In beginning AAC instruction, focus on communicative foundations such as directing behaviors toward partners and use of gesturesResearch is needed to identify optimum strategies for combining prelinguistic intervention and AACPECS and spontaneity exampleBottom line/take home message is that those of us who are focused on teaching prelingustic behaviors such as communicative gestures and canonical vocalizations, we need to be open to incorporating AAC into this instruction , and for those of us who are more inclined to think about teaching children to produce alternative modes such as sign language and graphic selection/exchange modes, need to be mindful of teaching the communicative foundation including eye gaze, directionality, gestures, vocalizations with the use of AAC and at other times as well.And we need research to help zero in on how best to combine AAC and PMT and when it makes the most sense to do so, that is, identifying what type of learner profiles would benefit most from this combined approach.
118 What is the evidence base? Evidence that children increase their use of communicative gesturesYoder, Warren and colleagues studies:Effective for children in low-responsive environmentFey, Waren, Brady, Finestack, Bredin-Oja and Fairchild (2006)Significant increases after 6 months of interventionWarren, Fey, Finestack, Brady, Bredin-Oja (2008)Effects did not maintain over timePossible differences in effects for children with Down SyndromeSo far, we know that this type of intervention does increase children’s communication. They learn to gesture and vocalize more after participating in this type of intervention than participating in a control group.
119 Brady and Bashinski (2009) research with deafblind children Results from 9 children who had relatively good motor skills2 children with severe motor limitations
120 Data obtained from videotapes collected aproximately ¼ intervention sessions, later coded from the videotapes. We take lots of data on the forms and functions etc. but we’ve graphed just the initiations and responses (combined) and the prompted responses here. Note the increases in the initiations and the decreases in the prompted responses. The triangles are structured probes that are mini tests like the CSBS.
123 Brady & Bashinski Summary: All 9 kids with adequate motor skills increased their initiated communicationMostly requestsEffects did not generalize to different contextsLess effective for children with severely limited motor skillsWhat else should we take data on? Communication functions, use in other contexts, with other people…..
125 Increasing communication by working with partners Working with partners to increase responsiveness and decrease directivenessGoal is to promote a context where children have a need and desire to communicate
126 Peer based interventions Increase communicationPlaySocial interactions
127 Do we need to teach peer interactions? Video demonstrating need
128 Why focus on responsivity? Warren, S., Brady, N., Sterling, A., Fleming, K., & Marquis, J. (2010). Maternal resposivity predicts language development in young children with fragile X syndrome. American Journal on Intellectual and Developmental Disabilities, 115(1),Brady, N., Herynk, J., & Fleming, K. (2010). Communication Input Matters: Lessons From Prelinguistic Children Learning to Use AAC in Preschool Environments. Early childhood Services, 4,
129 Changing Adult Behavior It is very hard to change a person’s behavior.It is usually easier to learn a new behavior than to change an old one.People must be highly motivated in order to change behavior and maintain that change.It is very hard to change a person’s behavior, our own of someone else’s. It is probably harder to change an adult’s behavior that has been in use a long time than a child’s behavior.It is harder to change a behavior than to learn a new behavior. A newly learned behavior however may be substituted for an older behavior, especially if the new behavior is seen to be better or more effective in achieving the function of the behavior it replaces.When we want to teach a child with a disability a new behavior to replace an old less acceptable behavior, we need to learn what motivates that child and be ready to provide that reward when the child performs the behavior. We also need to be sure that the new behavior is at least as effective in accomplishing the function of the old behavior as the old behavior was.Our function here today was to provide information, not so much to try to change behavior. You students know that you can be highly motivated to learn, demonstrate and perhaps change a behavior or skill when you begin your practicum experiences and are observed by your instructor or supervisor.
130 Enhance partner responsivity Work with partner to increase:following the child’s leadwaiting for the child to respondlistening to the childPlay with the child face to face, placing few demands or constraints on the child’s actions.Imitate the child’s actions and sounds. commenting about child’s actions, etc.
131 Parent Education Strategies: Discussion of topics covered in reading; direct instructionGeneral sensitivity to parent issues of all kindsParent observation of intervention sessions
132 Example 1: Families with FXS Working with families that have a child with FXSPilot study: 4 familiesTen sessions were held approximately 1 week apart.Each session followed the Hanen curriculum but lessons were individualized. Key components of the intervention includedteaching parents to wait for their children to initiate interactionsrecognizing communication attemptsfollowing the child’s leadproviding simplified input
133 Results:Three mothers showed increases in facilitative interaction style behaviorsThree mothers decreased their number of utterances per turnTwo children increased the number of different words produced
138 Activity: identify some strentgths and goals Top 3 suggestions….
139 Observation and discussion of video-taped parent-child interactions Coaching regarding use of techniquesBrainstorming about the use of responsivity techniques in typical situations
140 Mothers helped select the goals for themselves and their child for the intervention. Mothers changed their behavior when the interventionist was present and coached them, but did not seem to maintain their skills.This is important for what some colleagues have called “buy in” We got more buy in when mothers identified what they felt they needed to work on most.
141 Excerpt from Checklist of Skills Mothers’ Checklist of SkillsWhen a skill is introduced, write the date in the Targeted space. When the skill is used at least part of the time, write the date in the Emerging space. When the skill is used during 80% of the opportunities provided, note the date under Mastered.Mother’s Name_____________________ Child’s Name ______________________Should be Skill is Skill isTargeted Emerging MasteredHow would you rate your skills in responding to your child’s communication in the areas ofResponding to GesturesResponding to VocalInitiationsResponding to VerbalInitiations (Words, Signs)Following Your Child’sFocus Within ActivityA sample of the first page and the first several skills on the checklist. There are 30 skills in all. We worked with the mothers until they felt they had mastered or were close to mastering all the skills. The intervention was more intensive at first, 2 or 3 30-minute sessions per week, and gradually decreased to once per week, then once every other week, and then once per month for the last two months that constituted the maintenance period. We were always available by phone to the mothers if they had a question between sessions. However, they typically called only if there was a need to cancel or change a session time or date.
142 Summary Need to work with partners and children Should parents learn intervention strategies, or to be facilitative?Need to measure changes in partners and children
143 ReferencesBlishak, D. (2000). Increases in natural speech production following experience with synthetic speech. Journal of Special Education Technology, 14, 47-57Brady, N., Marquis, J., Fleming, K., & McLean, L. (2004). Prelinguistic predictors of language growth in children with developmental disabilities. Journal of Speech, Language and Hearing Research, 47(3),Brady, N., Steeples, T., & Fleming, K. (2005). Effects of prelinguistic communication levels on initiation and repair of communication in children with disabilities. Journal of Speech, Language and Hearing Research, 48(5),Capone, N., & McGregor, K. (2004). Gesture development: A review for clinical and research practices. Journal of Speech, Language and Hearing Research, 47(1),
144 References continuedCrais, E., Day Douglas, D., & Cox Campbell, c. (2004). The intersection of the development of gestures and intentionality. Journal of Speech, Language and Hearing Research, 47,Cumley, G. & Swanson, S. (1999). Augmentative and alternative communication options for children with developmental apraxia of speech: Three case studies. AAC, 15,Fey, M., Warren, S., Brady, N., Finestack, L., Bredin-Oja, S., & Fairchild, M. (2006). Early effects of prelinguistic milieu teaching and responsivity education for children with developmental delays and their parents. Journal of Speech, Language and Hearing Research, 49(3),Hunt-Berg, M. (2001). Gestures in development: Implications for early intervention in AAC. ASHA Division 12 Newsletter, June 2001.
145 Warren, S. , Bredin-Oja, S. , Fairchild Escalante, M. , Finestack, L Warren, S., Bredin-Oja, S., Fairchild Escalante, M., Finestack, L., Fey, M., & Brady, N. (2006). Responsivity education/ Prelinguistic milieu teaching. In R. McCauley & M. Fey (Eds.), Treatment of language disorders in children (pp ). Baltimore, MD: Brookes Publishing Co.Warren, S., Fey, M., Finestack, L., Brady, N., Bredin-Oja, S., & Fleming, K. (in press). Longitudinal effects of low intensity responsivity education/prelinguistic milieu teaching for young children with developmental delays. Journal of Speech, Language and Hearing Research.Warren, S. F. (1992). Facilitating basic vocabulary acquisition with milieu teaching procedures. Journal of Early Intervention, 16(3),Yoder, P., & Warren, S. (1999). Facilitating self-initiated proto-declaratives and proto-imperatives in prelinguistic children with developmental disabilities. Journal of Early Intervention, 22(4),
146 ResourcesThe national Fragile x foundation:Down syndrome research: