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

What is emerging language stage (EL)? zFor normally developing children, corresponds to toddler age range zApprox months

Who might be at the EL stage? zChildren between mos with no known risks but parents or others are concerned zChildren between mos with known risks zOlder children with severe disabilities

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

But remember... zTherapy may facilitate development in “normal” slow talkers zChildren with later language disabilities often have histories of delayed language development

Normal Development

Assessment of Communication in EL z Multidisciplinary and Transdisciplinary assessment z Play assessment z Communication assessment

Play Assessment zWant to ensure child is at a developmental level consistent with communication development zRelationships exist between play and language development zProvides a more holistic picture of the child

Assessing Play zCommunication and Symbolic Behavior Scales (Wetherby & Prizant, 1990) zPlay Scale (Carpenter, 1987) yparent plays with the child ysee Table 8-1, 8-2 p 251 zMcCune (1985) ychild is given a set of toys and behaviours are analysed (see Table 8-2) zSymbolic Play Test (Lowe & Costello, ‘76)

Communication Assessment zRating Scales ysee Table 8-3, p yCommunication and Symbolic Behavior Scales (Wetherby & Prizant, 1990) xobserve parent and child in various interactions xrates performance in five areas zInformal examination of communication functioning

Informal Examination of Communication Function zAssessing Communicative Intention zAssessing comprehension zAssessing Production

Assessing Communicative Intention zRange of communicative functions yProto-imperatives xRequests for objects xRequests for actions xRejections or protests y Proto-declaratives yDiscourse functions xRequests for Information xAcknowledgements xAnswers

Assessing Communicative Intention (cont’d) zFrequency of expression of intentions zForms of communication (e.g. gestural, vocal)

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

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

Comprehension Activities: Understanding Single Words zA collection of six to eight items zGive me… or Where’s… zCan assess body parts zAssess verbs zComprehension of single words is normal for mos. yWhat if they don’t?

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

Comprehension Activities: Beyond 2-words (24-36 m) zAgent-action-object instructions zRely on probability zStart with vocabulary from earlier stages and then move on zsee Table 8-6

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

Comprehension Findings: What do they mean? zIf comprehension is superior to production ybetter outcomes zIf comprehension is poor: yneed to include comprehension component in therapy as well as expressive component

Assessing Espressive Language zSpeech motor development zSpeech sample/phonetic repertoire zPhonological skills zLexical production/Vocabulary zSemantic-syntactic production

Vocabulary (Lexical Production) zExpect a child to have at least 50 words and some two-word combinations in the month stage zRating scales yMacArthur Communicative Development Inventories (Fenson et al., 1993) yLanguage Development Survey (Rescorla, 1989)

Semantic syntactic production zChildren don’t begin to combine words until vocabulary size is approx 50 words zTo assess semantic-syntactic production: y Determine the relative frequency of word combinations yEvaluate semantic relations expressed xTable 8-7 (Browns Semantic Relations) xVariety of relations xAdvanced relations zNormal toddlers express 8-11 different semantic relations

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

Intervention: Goals, Procedures & Context zFour main areas that may be targeted: yFunctional and symbolic play skills yUsing intentional communication yLanguage comprehension yProduction of sounds, words, and word combinations

Functional and Symbolic Play Skills zStep1: Establish reciprocal behaviour and anticipatory sets (e.g. peek-a-boo) zStep 2: Model early forms of symbolic play and encourage imitation zStep 3: Model play routines like pretending to give the doll a bath, meal time, store games

Developing Intentional Communicative Behaviours zWant children to initiate communication z#1: Communication temptations ycan 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) z#2: Milieu model yplace 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

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

Developing Intentional Communication (cont’d) zIf child has adequate intentions but is only using gesture -->increase vocalising yModel the target response yWithold response or pretend not to notice until some vocal behaviour produced

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

Developing Receptive Language zIndirect Language Stimulation (parent training) yself-talk/parallel talk yimitations yexpansions yextentions ybuild-ups and breakdowns yrecast sentences ylabelling ysee box 8-3

Developing sounds, words, and word combinations zIncreasing phonological skills yexpand the repertoire of sounds yuse developmental information zDeveloping a first lexicon ychoose words based on normative data ysome words should be nouns for labeling yother words should be chosen for expressing other functions ysee Table 8-10

Developing sounds, words, and word combos (cont’d) zDeveloping a first lexicon (cont’d) yMacDonald suggested choosing words that are within the child’s interests yConsider the child’s phonetic repertoire xchoose words with sounds in the child’s repertoire xearly words may be limited to CV and CVC shapes

How should we teach first words? zChild centered approach yclinician provides many models yuse play contexts and don’t require response zHybrid approach ymilieu teaching xplace objects out of child’s reach yscript therapy xengage in a verbal routine, once it is overlearned, either violate it or use a cloze technique

How should we teach first words? zHybrid approaches yfocussed stimulation xset up the situation so that you are modeling the specific vocabulary you want to teach xprovide lots of opportunities for the child to produce it xuse recasts, expansions, extensions, etc. zClinician-directed ymay be suitable for older children

Developing word combinations zWord combinations express semantic relationships zClient-centered yplay situation-when the child produces a one-word utterance, the clinician expands it to a two-word phrase

Developing word combinations zHybrid approaches ySchwartz et al.(‘85) - vertical structuring yWhitehurst et al.(‘91) - see box 8-5 ymilieu approaches xput something out of child’s reach - “get X” yfocussed stimulation yscript therapy xperhaps use a book or song-play that has two words

Developing word combinations (cont’d) zClinician-directed approaches yLeonard (‘75) xuse a puppet and the puppet describes what’s happening in the picture x get the child to tell the puppet what’s happening and to “talk like” the puppet y MacDonald et al. (‘74) - Environmental Language Intervention (ELI) xparent works on goal for 5 min in 3 conditions xsessions are three times/week xsee Box 8-6