1. Assessment and Intervention in the Prelinguistic Period Paul, R. (1995). Language disorders from infancy through adolescence. Chapter 7

2. What is the prelinguistic stage? n Newborn Period n Preintentional period (1-8 months) n Prelinguistic communication (9-18 months)

3. Risk factors for infants n Prenatal Factors –maternal drug or alcohol abuse –exposure to toxins or in utero infections n Prematurity –low birth weight associated with developmental delay –susceptibility to illness –respiratory difficulties –less interaction early on

4. Risk factors (continued) n Genetic and congenital disorders –number of syndromes that can occur –autosomal chromosomal abnormalities (Down syndrome) –sex chromosome disorders (Kleinfelter’s syndrome) –craniofacial disorders –metabolic disorders

5. Risks after the newborn period n Hearing Impairment n Autism n Developmental delay n Abuse/neglect

6. Assessment and Intervention for Newborns at Risk n Feeding and oral motor development n Hearing conservation and aural rehab n Infant behaviour and development n Parent-child communication

7. Feeding and oral motor development n Observe feeding and oral behaviour n Interview parents and staff regarding feeding and oral behaviour

8. Assessing Feeding/Oral Behaviour n Reflexes –suckling –sucking –rooting –phasic-bite reflex n Formal assessments n Informal interview (see Box 7-1, p. 197)

9. Management of Feeding n Tube feeding –nasogastric –orogastric –gastrostomy n Stimulate oral motor development n Educate parents about feeding

10. Management of Feeding (contd) n Specific Techniques for Facilitating Feeding –Positioning –Jaw stabilisation –Oral stimulation in feeding –Nonfeeding oral stimulation

11. Hearing Conservation and Aural Rehab n Advocate for early audiological screening n Advocate for hearing testing in child’s early years

12. Child Behavior and Development n Assessment should be to determine the current strengths and needs –Identify what risks the infant faces –Evaluate level of infant’s physiological organization i.e. How much stimulation and handling can the child tolerate? What is the most comfortable position for stimulation?

13. Management of Behaviour & Development n Suggest ways to counteract low levels of language and interactive stimulation in ICU n Advocate oral development and stimulation

14. Assessment of Parent-Child Communication n Assessing infant readiness for communication –Educate parents about stages - Turning in, coming out, reciprocity n Assessing parent communication and family functioning –Discuss the parents concerns

15. Management of Parent-Child Communication n Inform parent about different states the infant may be exhibiting (see Table 7-3) n Encourage parental interaction when the infant is ready –look at, handle, talk to the baby n Help parent identify end of interaction –wait for signals of interaction like eye gaze –watch for signals of distress

16. Preintentional Infants - 1-8 mos n Preintentional - infants have not yet developed cognitive skills to represent ideas in their mind and pursue goals n Perlocutionary (Bates, 1976) –infants do not intend any particular outcome by their behaviour –adults act as if they do (normal and impt for communication development)

17. Assessment and Intervention for Preintentional Infants n Feeding and oral motor development n Hearing conservation and aural rehab n Infant behaviour and development n Parent-child communication

18. Assessment of feeding and oral motor development n Feeding assessment - observe new feeding patterns –integrating sucking with jaw movements –chewing –rotary jaw movements –tongue lateralization –sustained bite

19. Assessment of feeding and oral motor development n Vocal assessment (see Table 7-4, p 205) –observe child and ask parent about vocal behaviours –use corrected gestational age - age -weeks premature = CGA –observe sound play, consonants, intonational changes, babbling

20. Management of feeding and oral motor behaviour (1-8 mos) n Feeding –continue oral stimulation –introduce solid foods –see Box 7-2, p 207 n Vocal Development –talk and babble to baby –imitate any non-cry vocalization –use “baby-talk” –use toys

21. Hearing in preintentional period n Encourage assessment by audiologist n Counsel regarding otitis media and signs of otitis media such as pulling on ear, fussing

22. Child Beh’r & Dev’t (1-8 mos) n Assessment –Involves general assessment of development –Instruments available include: Bayley Scales of Infant Development Vineland Adaptive Behavior Scales Receptive-Expressive Emergent Language Scale Sequenced Inventory of Communication Development (SICD) Rossetti Infant-Toddler Language Scale

23. Child Beh’r & Dev’t - Management n General motor and cognitive stimulation n Home-Based Programs –activities should be performed in communicative manner –parent advocate

24. Parent-Child Communication n Assessment –Formal instruments –Informal observation responsiveness to child’s cues of readiness and unreadiness to interact choice of objects and activities language stimulation and responsiveness (cooing, babbling, responding encouragement of joint attention

25. Communication - Management n Act as a support and encourage parent n Paul suggests three main aspects: –Increase awareness of infant communication patterns –Provide Instruction and modeling of adult- infant communication –Help parents self-monitor

26. Awareness of comm. patterns n Explain that it may be difficult to interact with an unresponsive infant n Make communication enriching and responsive –provide visual, auditory, tactile cues to engage baby –allow infant to explore novel stimuli n Explain interactive pattern of infants –educational videos

27. Modeling Interactive Beh’s n Turn-taking and imitation –ensure baby is ready to interact –use smiles and vocalisations to elicit infant behaviour –wait for the infant to initiate –imitate it and then wait for infant to do something else –vocalization and imitation of vocalization should be especially encouraged

28. Interactive Behaviours n Joint Attention Routines –identify the infant’s focus and share attention to that –make a comment or gesture about what the baby is looking at or doing –peekaboo –choral vocalization

29. Interactive Behaviours n Establishing anticipatory sets n Playing baby games –provide the baby with predictable series of sounds and actions –basis for script development –use baby games that the family have used before and/or are culturally appropriate

30. Interactive Behaviours n Self-monitoring skills –video-taping sessions –ensure a non threatening environment for the parents

31. Assess’t and Treatment at Prelinguistic Comm. Stage (9-18) n Infants become intentional communicators n Illocutionary stage (Bates, 1976) - child expresses intention through signals

32. Assessment n Play assessment (eg. Symbolic Play test) n Observe play –recognition of common objects (brush, phone) –engages in simple play schemes n Is any functional communication present –attempts to request objects or actions –eliciting attention

33. Management n If child is expressing some communicative intent- –scaffold (e.g. break routines) –vocalise the child’s demands –shared book-reading joint attention to pages stop and wait for child to respond –Communication temptations (see box 7-3)

34. Management (cont’d) n Facilitate comprehension –baby games (e.g. show me your nose, ears, etc)

35. Management (cont’d) n If the child is not showing intentionality- –provide intensified input (book reading, lots of parallel talk, joint attention activities) –improve comprehension skills –encourage vocalization –respond to the child’s actions and initiations

36. Considerations for older prelinguistic children n Feeding and oral motor development n Hearing conservation and aural rehabilitation n Intentionality and communication –symbolic systems of communication