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FIRST WORDS Project NECTAS Child Find Teleconference

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Presentation on theme: "FIRST WORDS Project NECTAS Child Find Teleconference"— Presentation transcript:

1 FIRST WORDS Project NECTAS Child Find Teleconference
Model Demonstration Project Amy M. Wetherby, Ph.D. Project Director NECTAS Child Find Teleconference

2 Need to Improve Early Identification of Developmental Disabilities
Percentage of Population Receiving Special Education or Early Intervention Services in 1997/98: School-Age Children 6 to 18 years 10.95% Preschool Children 3 to 5 years 4.79% Infants and Toddlers Birth to 2 years 1.70% (US DOE, 1998)

3 Communication and language problems are the most common symptom in young children
Disability Category % Served Specific Learning Disabilities 51.1 Speech or Language 20.8 Mental Retardation 11.6 Serious Emotional Disturbance Multiple Disabilities Hearing Impairments Orthopedic Impairments Other Health Impairments Visual Impairments Autism Deaf-blindness Traumatic Brain Injury (US DOE, 1998)

4 Improving Early Identification
A child’s rate of language acquisition may be solidified by 2 to 3 years based on the rapid maturation of the brain. Instead of waiting to see if a child is late in talking, it is important to evaluate skills that are early indicators of language development.

5 Prelinguistic Predictors of Persisting Language Problems
SOCIAL COMMUNICATION Emotion and Use of Eye Gaze Use of Communication Use of Gestures EXPRESSIVE SPEECH AND LANGUAGE Use of Sounds Use of Words SYMBOLIC CAPACITY Understanding of Words Use of Objects

6 Profile Distinguishing Autism Spectrum and Delayed Language in Young Children (Wetherby, Prizant & Hutchinson, 1998) EMOTION AND USE OF EYE GAZE Weakness in gaze shifts/shared positive affect; excess negative affect USE OF COMMUNICATION Weakness in joint attention; comparable in behavior regulation  USE OF GESTURES Weakness in conventional & distal gestures; poor coordination of gestures and sounds USE OF SOUNDS Comparable limited consonant inventory & syllable structure    SYMBOLIC CAPACITY Weakness in language comprehension and pretend play; comparable constructive play

7 Evaluation versus Assessment
Evaluation for Identification Screening Diagnostic testing Determining initial and continuing eligibility Assessment for Educational Planning Profiling strengths and needs Monitoring changes with treatment

8 Recommended Practices for Evaluation and Assessment of Young Children
Utilize multiple sources of information (parent report, observation & sampling) Gather information from multiple observations Provide information about child’s growth rate and capacity for development Allow families and professionals to gather and share information to build consensus about strengths and needs

9 FIRST WORDS Project Evaluation Model
 Step One: Brief Parent Report Infant/Toddler Checklist for Communication and Language Development  Step Two: More Detailed Parent Report CSBS-DP Caregiver Questionnaire Ages and Stages Questionnaires  Step Three: Child & Family Evaluation CSBS-DP Behavior Sample of child interacting with caregiver and clinician

10 CSBS Developmental Profile: Behavior Sample
Warm-up Communicative Temptations (Wind-up toy, Balloon, Bubbles, Jar, and Toys in Bag) Sharing Books Symbolic Play (feeding set) Language Comprehension (object names, person names, and body parts) Constructive Play (stacking blocks) Caregiver Perception Form (caregiver rates how typical child’s behavior is during sample) (Wetherby & Prizant, 1998)

11 CSBS Developmental Profile
Measurement Parameters for Checklist, CQ & BS Emotion and Use of Eye Gaze Use of Communication Use of Gestures Use of Sounds Use of Words Understanding of Words Use of Objects

12 CSBS Developmental Profile
Correlations for Three Measures Checklist and CQ r=.92 p< n=129 CQ and BS r=.78 p< n=127 Checklist and BS r=.72 p< n=114 (Wetherby & Goldstein, 1999)

13 CSBS Developmental Profile
Correlations for Test-Retest of the Three Measures Checklist 3 month retest interval r=.88 p< n=108 CQ 4 month retest interval r=.87 p< n=112 BS 4 month retest interval r=.80 p< n=26 (Wetherby & Goldstein, 1999)

14 Correlations for CSBS-DP and MacArthur CDI Vocabulary Production at 24 months
Mean Initial Age months months Checklist Use of Words r= .65 r= .60 TOTAL r= .44 r= .50 CQ Use of Words r= .80 r= .73 TOTAL r= .65 r= .64 BS Use of Words r= .58 r= .67 TOTAL r= .65 r= .64 (Wetherby & Goldstein, 1999)

15 Possible Outcomes of Children Late in Talking
 Late Bloomer  Impairment in one or more of the following: Hearing Speech Language Communication

16 Accuracy of Diagnosis at Age 2
Diagnosis of Specific Language Impairment About half of children identified as late talkers at age 2 receive a diagnosis of specific language impairment at age 3 Children who are delayed in expressive language only are very likely to catch up on their own Children who are also delayed in receptive language, use of gestures, and play are more likely to have persisting language problems (Paul, 1991; Rescorla, 1991; Thal, Tobias, & Morrison, 1991)

17 Accuracy of Diagnosis at Age 2
Diagnosis of Autistic Disorder 72% of children diagnosed at age 2 retained that diagnosis at age 3 94% retained diagnosis of ASD at age 3 Diagnosis of Atypical Autism (PDD-NOS) 42% of children diagnosed at age 2 retained that diagnosis at age 3 74% retained diagnosis of ASD at age 3 (Lord, 1995; Lord & Risi, 2000)

18 Clinical Features of Autism Spectrum in Young Children
Social Impairments were prominent at 24 months Communication Impairments were prominent at 24 months Restricted Repertoire of Activities and Interests were not prominent until 36 months (Lord, 1995; Stone, Lee, Ashford, Brissie, Hepburn, Coonrod, & Weiss, in press)

19 Markers Based on CHAT at 18 months
Proto-declarative pointing Gaze-monitoring Pretend play 12 of 16,000 failed these 3 key items and 10 received diagnosis of autism (.06%). 22 of 16,000 failed 2 of the 3 items and 15 were developmentally delayed without autism (.08%). (Baron-Cohen, et al., 1992; 1996)

20 Features Distinguishing Autism Based on Home Videotapes at 12 months
Pointing Showing Looking at Others Orienting to Name Only the latter two distinguished children with autism from children with developmental delays. (Osterling & Dawson, 1994; 1999)

21 Practice Parameters for Screening and Diagnosis of Autism Spectrum
Absolute Indications for Immediate Further Evaluation: No babbling by 12 months No gesturing (pointing, waving bye-bye) by 12 months No single words by 16 months No 2-word spontaneous (not just echolalic) phrases by 24 months ANY loss of ANY language or social skills at ANY age ********** Child Neurology Society and American Academy of Neurology (Filipek, Accardo, Baranek, et al., 1999)

22 Linking to Intervention
We are now serving a small proportion of young children needing services Improving early identification efforts will increase the need for early intervention, … be ready to expand services

23 FIRST WORDS Project Menu of Service Options
Preventative Family Education/Support Services Intensive, Individualized Early Intervention

24 Preventative Family Education/Support Services
parent education group meetings in the community infant/toddler peer play groups caregiver education modules for families and service providers parent support and networking groups resource and referral database 

25 Intensive, Individualized Early Intervention
individualized intervention through a family-guided assessment of the child’s communication and the communicative environment parents are essential partners in the identification of specific concerns, intervention planning, and evaluation of outcomes Back to Public Awareness Child Find

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