assessment and intervention for emerging language paul r. (2001). language disorders from infancy...
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Assessment and Intervention for Emerging Language
Paul R. (2001). Language Disorders from Infancy
through adolescence. Chapter 8
What is emerging language stage (EL)?
For normally developing children, corresponds to toddler age range
Approx - 18 - 36 months
Who might be at the EL stage?
Children between 18-36 mos with no known risks but parents or others are concerned
Children between 18-36 mos with known risks
Older children with severe disabilities
To see them or not to see them…that is the question.
Children under 3 with intact cognitive, preverbal communicative, and sensory capacities with no risk factors - low priority
Children with cognitive deficits, hearing impairment or chronic OM, preverbal communication problems, risks pre or perinatally - should be seen
But remember...
Therapy may facilitate development in “normal” slow talkers
Children with later language disabilities often have histories of delayed language development
Normal Development
Expression Vocabulary Comp.Wetherby et al.(1988); Paul &Schiffer, (1991) 18 mos – 2
communicativeacts/min
24 mos - 5 CAs/min
Fensen et al. (1990) 18 mos – 110 words 24 mos – 312 words 30 mos – 546 words
Chapman (1978) 18-24 mos –
understand 2-3words/sentencethey hear
Nelson (1973) 18 mos – combining
2 wordsMiller (1981) 24 mos – MLU –
1.5-2.4
Assessment of Communication in EL
Multidisciplinary and Transdisciplinary assessment
Play assessmentCommunication
assessment
Play Assessment
Want to ensure child is at a developmental level consistent with communication development
Relationships exist between play and language development
Provides a more holistic picture of the child
Assessing Play
Communication and Symbolic Behavior Scales (Wetherby & Prizant, 1990)
Play Scale (Carpenter, 1987) parent plays with the child see Table 8-1, 8-2 p 251
McCune (1985) child is given a set of toys and behaviours are
analysed (see Table 8-2)Symbolic Play Test (Lowe & Costello, ‘76)
Communication Assessment
Rating Scales see Table 8-3, p. 253-254 Communication and Symbolic Behavior
Scales (Wetherby & Prizant, 1990)observe parent and child in various
interactionsrates performance in five areas
Informal examination of communication functioning
Informal Examination of Communication Function
Assessing Communicative IntentionAssessing comprehensionAssessing Production
Assessing Communicative Intention
Range of communicative functions Proto-imperatives
Requests for objectsRequests for actionsRejections or protests
Proto-declaratives Discourse functions
Requests for InformationAcknowledgementsAnswers
Assessing Communicative Intention (cont’d)
Frequency of expression of intentions
Forms of communication (e.g. gestural, vocal)
Assessing Communicative Intent: Worksheet
Table 8-4, page 256Communicative Act:
Must be directed at adult. Child must look at or address the adult directly in some way.
Must have an effect on influencing the adults’ behaviour/focus of attn or knowledge.
Child must be persistent in the attempt to convey the message if the adult does not respond
Assessing Comprehension
Standardized language tests/scales PPVT-III, Sequenced Inventory of
Communicative Development (SICD), Receptive Expressive Emergent Lang Scale (REEL).
Comprehension Activities:Understanding Single Words
A collection of six to eight itemsGive me… or Where’s…Can assess body partsAssess verbsComprehension of single words is
normal for 12-18 mos. What if they don’t?
Comprehension activities: Two word comb’s (18-24m)
Action-object (use words understood at single-word stage)
choose unusual combinations such as “kiss the apple” “hug the shoe”
Comprehension Activities:Beyond 2-words (24-36 m)
Agent-action-object instructionsRely on probabilityStart with vocabulary from earlier
stages and then move onsee Table 8-6
Comprehension beyond 36 months
Can 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?
If comprehension is superior to production better outcomes
If comprehension is poor: need to include comprehension
component in therapy as well as expressive component
Assessing Espressive Language
Speech motor developmentSpeech sample/phonetic repertoirePhonological skills Lexical production/VocabularySemantic-syntactic production
Vocabulary (Lexical Production)
Expect a child to have at least 50 words and some two-word combinations in the 24-36 month stage
Rating scales MacArthur Communicative Development
Inventories (Fenson et al., 1993) Language Development Survey (Rescorla,
1989)
Semantic syntacticproduction
Children don’t begin to combine words until vocabulary size is approx 50 words
To assess semantic-syntactic production: Determine the relative frequency of word
combinations Evaluate semantic relations expressed
Table 8-7 (Browns Semantic Relations)Variety of relationsAdvanced relations
Normal toddlers express 8-11 different semantic relations
Decision making based on assessment information
See Paul’s decision tree on p. 253 (Fig. 8.2)
Intervention: Goals, Procedures & Context
Four main areas that may be targeted: Functional and symbolic play skills Using intentional communication Language comprehension Production of sounds, words, and word
combinations
Functional and Symbolic Play Skills
Step1: Establish reciprocal behaviour and anticipatory sets (e.g. peek-a-boo)
Step 2: Model early forms of symbolic play and encourage imitation
Step 3: Model play routines like pretending to give the doll a bath, meal time, store games
Developing Intentional Communicative Behaviours
Want children to initiate communication#1: Communication temptations
can 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)
#2: Milieu model place 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)
#3 : Use routines or script therapy and then violate the routines
#4 : Respond as though the child is showing intent
#5: If range of intent is limited, increase use of proto-imperatives and declaratives model the behaviour pretend not to notice something that the child is
interested in and wait for them to get your attention
Developing Intentional Communication (cont’d)
If child has adequate intentions but is only using gesture -->increase vocalising Model the target response Withold response or pretend not to
notice until some vocal behaviour produced
Developing Intentional Communication (cont’d)
If the child is using maladaptive behaviour: immediately provide an alternative form
of communication (e.g. I see you want it. Point to it and I’ll give it to you.)
might need to actually take the child’s hands and demonstrate the action
Developing Receptive Language
Indirect Language Stimulation (parent training) self-talk/parallel talk imitations expansions extentions build-ups and breakdowns recast sentences labelling see box 8-3
Developing sounds, words, and word combinations
Increasing phonological skills expand the repertoire of sounds use developmental information
Developing a first lexicon choose words based on normative data some words should be nouns for labeling other words should be chosen for expressing
other functions see Table 8-10
Developing sounds, words, and word combos (cont’d)
Developing a first lexicon (cont’d) MacDonald suggested choosing words
that are within the child’s interests Consider the child’s phonetic repertoire
choose words with sounds in the child’s repertoire
early words may be limited to CV and CVC shapes
How should we teach first words?
Child centered approach clinician provides many models use play contexts and don’t require response
Hybrid approach milieu teaching
place objects out of child’s reach
script therapyengage in a verbal routine, once it is overlearned,
either violate it or use a cloze technique
How should we teach first words?
Hybrid approaches focussed stimulation
set up the situation so that you are modeling the specific vocabulary you want to teach
provide lots of opportunities for the child to produce it
use recasts, expansions, extensions, etc.
Clinician-directed may be suitable for older children
Developing word combinations
Word combinations express semantic relationships
Client-centered play situation-when the child produces a
one-word utterance, the clinician expands it to a two-word phrase
Developing word combinations
Hybrid approaches Schwartz et al.(‘85) - vertical structuring Whitehurst et al.(‘91) - see box 8-5 milieu approaches
put something out of child’s reach - “get X”
focussed stimulation script therapy
perhaps use a book or song-play that has two words
Developing word combinations (cont’d)
Clinician-directed approaches Leonard (‘75)
use a puppet and the puppet describes what’s happening in the picture
get the child to tell the puppet what’s happening and to “talk like” the puppet
MacDonald et al. (‘74) - Environmental Language Intervention (ELI)parent works on goal for 5 min in 3 conditionssessions are three times/weeksee Box 8-6