child lang lecture 7

Late Language Emergence (LLE)

Children around two or three years old who fail to meet expressive language milestones and have no other diagnosed disability in cognitive or motor domains.

Late Language Emergence (LLE) — vocabulary feature

Fewer than 50 words and no two-word combinations by 24 months of age.

Prevalence of Late Language Emergence

Approximately 10%–20% of two-year-olds.

Key Features of LLE

Language development below age expectations with no other diagnosis.

Primary language difficulty in LLE

Primarily expressive language, such as fewer than 50 words at 24 months.

Secondary features of LLE

May include difficulty following directions, limited use of gestures or sounds to communicate, limited symbolic play, and few or no word combinations.

Protective Factors for LLE (4)

Reading and sharing books with infants;

informal play opportunities;

quality prenatal, perinatal, and postnatal care;

access to speech therapy.

Variables Increasing Likelihood of LLE (5)

Family history;

male gender (three times more likely in males than females); twin birth, especially identical twins;

birth status,

including less than 85% optimal birth weight or birth before 37 weeks;

lower family socioeconomic status (SES).

Prognosis of LLE

Approximately 50%–80% of children catch up through spontaneous recovery.

Spontaneous Recovery

When a child's language development catches up without the delay persisting.

Effect of Speech-Language Therapy on Prognosis

Speech-language therapy improves long-term outcomes and accelerates progress.

Factors Affecting Spontaneous Recovery (6)

Family history;

socioeconomic status (SES);

symbolic gestures and play skills;

babbling and phonology;

severity of delay;

comprehension skills.

Premature Birth

Birth before 37 weeks of gestation.

Low Birth Weight

Less than 5.5 pounds.

Very Low Birth Weight (VLBW)

Less than 3.3 pounds.

Extremely Low Birth Weight (ELBW)

Less than 1.1 pounds.

Prematurity and Developmental Delay percentage

50% of premature babies experience a delay.

Other Known Risks for Developmental Delay (3)

Genetic disorder;

hearing impairment;

environmental factors such as poverty, trauma, and stress.

concerns at age 2 (3)

failure to begin using words,

absence of a vocabulary spurt,

failure to begin combining words during the second year of life.

Pre-verbal Assessment

Focuses on prelinguistic skills, including joint attention, play, and gesture.

Verbal Assessment (4)

Focuses on gesture, vocalization, words, and functional communication.

Pre-verbal Assessment — Parent-Report Instrument

Use a parent-report instrument to gather information about the child's communication.

Pre-verbal Assessment — Functional Communication

If functional communication is present, examine which communication behaviors occur, how often they occur, and their purpose.

Pre-verbal Assessment — Communication Behaviors

Identify the behaviors used to communicate, including gestures, vocalizations, and verbal communication.

Pre-verbal Assessment — Frequency

Determine how often the child's communication behaviors occur.

Pre-verbal Assessment — Purpose

Determine the purpose of communication, such as social interaction versus requesting.

Receptive-Expressive Emergent Language Scale, Third Edition (REEL-3)

Designed to identify major receptive and expressive language problems in infants and toddlers.

Rossetti Infant-Toddler Language Scale

Developed for children from birth to three years old; includes a parent questionnaire and test protocol to gather observed, elicited, and parent-report information.

Rossetti Infant-Toddler Language Scale — Areas Assessed (6)

Play, interaction-attachment, gesture, pragmatics, language comprehension, and language expression.

MacArthur-Bates Communication Development Inventories (MCDI)

Parent-report instruments used to determine children's comprehension and production vocabularies.

MCDI — Words and Gestures

Used to assess comprehension and production vocabularies in children communicating with words and gestures.

MCDI — Word Combinations

Includes assessment of production vocabulary in children using word combinations.

Verbal Assessment — Parent Report

May use a parent-report instrument for communication.

Verbal Assessment — Norm-Referenced Assessment

May use a norm-referenced communication assessment, such as the Preschool Language Scales.

Individualized Family Service Plan (IFSP)

IDEA (2004) requires an IFSP for children from birth to three years old.

IFSP — Required Element 1

Information about the child's present level of development.

IFSP — Required Element 2

A statement of the family's resources, priorities, and concerns.

IFSP — Required Element 3

A statement of the major outcomes expected to be achieved for the child and family.

IFSP — Required Element 4

Statements of the frequency, intensity, and method of delivering services, and the environments in which early intervention services will be provided.

IFSP — Required Element 5

A list of other services, including medical and other services the child needs, and the funding sources that will pay for those services.

IFSP — Required Element 6

Projected dates for initiation of services and anticipated duration of those services.

IFSP — Required Element 7

The name and discipline of the service coordinator.

IFSP — Required Element 8

A plan for transition to preschool services.

Traditional/Medical Model of Early Intervention

Emphasizes individual areas of deficit; the therapist selects goals; the family receives home activities; the child moves from one therapist to another.

Family Systems Model of Early Intervention

Places the family at the center of intervention; outcomes for children are better when families are involved; families are decision makers; family style and culture are respected; relationships across disciplines, the family, and community are collaborative.

Multidisciplinary Team

Each specialist works independently; findings are pooled but may not be well coordinated; represents the most traditional team approach.

Interdisciplinary Team

Specialists coordinate more closely; the family is fully integrated as team members; the child is assessed separately, but the team presents a cohesive report and coordinates intervention services.

Transdisciplinary Team

Responsibility is shared among the family and other team members; each contributes unique expertise through an arena approach; service planning is fully integrated.

Purpose of Intervention (3)

Change the disorder, teach compensatory strategies, or modify the communicative context.

Facilitation

An intervention outcome in which the rate of learning is accelerated and milestones are achieved earlier.

Maintenance

An intervention outcome in which a behavior that might disappear is maintained or preserved.

Induction

An intervention outcome in which the endpoint would not be reached without intervention; the slides note that this is rarely something that can be proven.

Early Intervention Goals — Child Without Intentional Communication

If the child does not yet show intentional communication, even with models, focus intervention on turn-taking, imitation, play, and joint attention.

Early Intervention Goals — Child With Intentional Communication

If the child already communicates intentionally, focus intervention on increasing communication functions and vocabulary.

Fey's Continuum of Naturalness

Organizes intervention approaches from most natural and child-centered to least natural and clinician-directed.

Child-Centered Intervention

Daily activities and facilitated play; the child leads within natural contexts.

Hybrid Intervention

Milieu therapy, focused stimulation, and script therapy; combines naturalistic interaction with more structured intervention.

Clinician-Directed Intervention

Drill, drill play, and CD modeling; the clinician has greater control over activities.

Naturalistic Modifications of Clinician-Directed Activities

Modifications of clinician-directed activities that make them more naturalistic, such as cohesive scripts.

Language Facilitation / Facilitated Play

Provides opportunities for the child to give target responses within the context of play. The clinician selects materials or toys, but the child otherwise leads.

Self-Talk

Describe one's own actions while engaging in play. Example from the slides: “Wow, I have red playdoh. I wonder if there is green.”

Parallel Talk

Talk about the child's actions during joint attention. Example from the slides: “Hey, you have a red ball; I wonder if it bounces.”

Imitation

Repeat or imitate the child's communication or actions.

Expansion

Add grammatical markers to the child's utterance to make it grammatically accurate. Example: child says “him want one too”; adult says “oh, HE wants one too?”

Extension

Add semantic information to the child's utterance. Example: child says “I got that one”; adult says “You got the big elephant!”

Recast

Alter the child's sentence by adding language or grammar.

Milieu Communication Teaching (MCT)

A group of approaches that includes Prelinguistic Milieu Teaching (PMT), Milieu Teaching (MT), and Responsivity Education (RE).

Prelinguistic Milieu Teaching (PMT)

Delivered by a speech-language pathologist (SLP), not the parent. Targets children with limited intentional communication and no more than a handful of signed or spoken words.

Milieu Teaching (MT)

Delivered by an SLP. Targets children who make relatively frequent intentional requests or comments and have at least five productive spoken or signed words.

Responsivity Education (RE)

Provided by an SLP to train parents.

RE/PMT

Responsivity Education/Prelinguistic Milieu Teaching; involves parents and an SLP working with the child to facilitate early language. Usually followed by Milieu Teaching or focused stimulation.

RE/PMT — Target Population

Children between 12 and 54 months who use fewer than one communicative act per minute.

RE/PMT — Theoretical Basis

Social-interactionist theory and behaviorism.

Linguistic Mapping

Recognize the child's behavior as intentional and repeat or expand the message.

RE/PMT — Basic Component 1

Arrange the environment to increase opportunities for communication.

RE/PMT — Basic Component 2

Follow the child's lead.

RE/PMT — Primary Goal

Increase the frequency, clarity, and complexity of the child's nonlinguistic communicative acts.

Three Procedures to Meet RE/PMT Goals

Prompts, models, and natural consequences.

Time Delay

A prompt procedure in which the adult pauses to encourage a response.

Linguistic Prompts

Prompts that encourage a response using language.

Nonlinguistic Prompts

Prompts that show the expected response without using language.

Models

Demonstrations of a response without requiring the child to imitate it.

Natural Consequences

Respond naturally to the child's communicative act.

RE/PMT Goal 1

Establish routines that serve as a communicative context.

RE/PMT Goal 1, establish routines — Steps

Imitate the child's motor acts

Imitate the child's vocal acts.

Interrupt patterns of action with an adult turn, wait for the child to take a turn, and repeat.

Perform an action the child finds funny or interesting, pause, and then repeat.

When the child produces one part of a routine, perform the action to complete the routine.

RE/PMT Goal 2 — Increase Nonlinguistic Vocalizations

Increase the child's use of nonlinguistic vocalizations.

RE/PMT Goal 2, Increase Nonlinguistic Vocalizations — Steps

1. Linguistically map the child's nonlinguistic vocalization with a word.

2. During vocal play activities, model vocalizations with sounds and word shapes known to be outside the child's repertoire.

3. Imitate the child's spontaneous vocalizations as precisely as possible when they are not part of a communicative act.

RE/PMT goals (5)

1. establish routines for communicative context

2. Increase Nonlinguistic Vocalizations

3. increase eye gaze

4. increase gestures

5. Combine Components of Intentional Communication

RE/PMT Goal 3

Increase the frequency and spontaneity of eye gaze.

RE/PMT Goal 3,Increase Eye Gaze — Steps

1. Create a need for communication within a routine in which the child looks at an object.

2. Provide the desired object or action contingent on the child looking at the adult.

3. Verbally prompt for eye gaze.

4. Move the desired object to the adult's face to encourage a more explicit look.

5. Move the adult's face into the child's line of regard to intersect the child's gaze.

6. Once the child complies, label and provide the desired object or action.

7. If the child fails to produce the targeted act after the preceding methods, provide the desired object or action anyway.

RE/PMT Goal 3, Increase Eye Gaze — If the Child Does Not Produce the Targeted Act

If the child fails to produce the targeted act after the preceding methods, provide the desired object or action anyway.

RE/PMT Goal 4

Increase the frequency, spontaneity, and range of conventional and non-conventional gestures.

RE/PMT Goal 4, Increase Gestures — Steps

1. Create a need for communication within a routine, such as placing a desired object out of reach.

2. Pretend not to understand by looking and gesturing quizzically and saying, “What?” or “What do you want?”

3. Tell the child explicitly to produce a particular gesture, such as “Show me!” or “Give it to me!”

4. Physically help the child produce the targeted gesture.

5. Once the child complies, label and provide the desired object or action.

6. Provide the desired object or action contingent on the use of a gesture; ask the child to be more specific; model an appropriate gesture.

RE/PMT Goal 4 , Increase Gestures— Additional Gesture Support

Provide the desired object or action contingent on the use of a gesture; ask the child to be more specific; model an appropriate gesture.

RE/PMT Goal 4 , Increase Gestures— If the Child Does Not Produce the Targeted Gesture

If the child fails to produce the targeted act after the preceding methods, provide the desired object or action anyway.

Intentional Communication — Three Components

Eye contact, vocalization, and gesture.

RE/PMT Goal 5

Help the child combine components of intentional communication.

RE/PMT Goal 5, Combine Components of Intentional Communication — Steps

1. If the child produces one or two components of a communicative act, wait expectantly using time delay to prompt the second or third component.

2. If the child does not add another component after the time delay, intersect the child's gaze or use the child's name to prompt eye gaze.

3. If the communicative act is clearly focused on an object, attribute, or event, recast the act by producing a word; do not produce a nonlinguistic vocalization.

4. If needed, ask “What do you want?” or give another general prompt, then wait again.

5. Model or help the child produce a gesture.

6. Immediately after the child produces the targeted component, label the object or action and provide the appropriate consequence, as described under Goals 1–4.

7. If the child fails to produce the targeted act after the preceding methods, provide the desired object or action anyway.

RE/PMT Goal 5, Combine Components of Intentional Communication — If the Child Does Not Produce the Targeted Act

If the child fails to produce the targeted act after the preceding methods, provide the desired object or action anyway.

RE/PMT Advantages

Parents learn skills for everyday communication; intervention occurs in a natural setting.