Assessment and Treatment for Language Disorders

Consideration For Evaluation

• Language : screening to determine if full speech and language assessment is needed

• Baseline Testing: seeing where the child is at starting new therapy after having already received therapy

• Complete Speech and Language Assessment evaluation of speech abilities

Full Speeh and Language Evaluation

The Parent Interview
• Parental Concern
• Birth and Medical Hx
• Family Hx
• Educational Hx
• Hearing
• Developmental Milestones (Speech/ Language/ Motor Milestones/ Feeding)
• Languages/Dialects (Primary and Secondary Languages)
• Language exposures
• Daily Routines

Assessment Tools

• Norm Referenced Tests

• Criteria Referenced Tests

Norm Referenced Tests ( Assessment Tools)

Compares an individual’s abilities to those of his peers

Pros

• Efficent to administer

• clear directions

• computing scores

• determines eligibility

Cons

• adminstered in unfamiliar contexts

• overidentifies students

• Only a few items may
  assess each language
  target

Criteria Referenced Tests (Assessment Tools)

Compares an individual’s performance with a prespecified standard or a specific skill

Pros

• Can choose one that will
  identify the student’s
  weaknesses

• Scoring simplicity

• Intervention goal planning

  Cons

• Assessment protocol is
  not well defined

• Lack of strict testing
  protocol may cause
  variability between
  testers
  

Validity

the test (or subtest) measures exactly what it says it is measuring

Reliability

the degree to which a test produces stable and consistent results.

Language Sampling

• To identify or document a language disorder,

• to provide the detailed description needed to initiate a focused intervention program, and

• to provide a method for monitoring progress
  in language intervention.

Purpose of Sampling

Provides an assessment in real-life context
• MLU is a highly reliable and valid index of language acquisition
• Language can be sampled in a variety of communication contexts
• It is culturally sensitive
• Allows the assessor to gather information and make adjustments to assist student learning
• Avoids “learning of the test”
• Can be used as a measure of progress
• Can use the information for formulating treatment goal

How is a Language Sample Done?

• Collection – transcription- analysis- and interpretation.
  • Compute the MLU and check your developmental charts.
  • Note: language sampling becomes an unreliable measure once a child reaches an MLU of
  3.5 or above.
  • Consider gaps in form/content/use
  • During sampling consider receptive strengths and weaknesses

Commonly Used Assessments

P• Preschool Language Scale -5: Pearson
• Rosetti Infant Toddler Scale: Pro-ed
• Receptive Expressive Emergent Language Test -3: Pro-ed
• Language and Speech Sampling
• Calculate MLU
• Bloom & Lahey language developmental model
• The Westby Play Scale
• Brown’s Stages
• Utilize your parent interview information

Risk Factor

Current or historical findings that suggest that a child is at risk for having or developing a
communication disorder ( premature birth, anoxia, alcohol abuse from mom, hearing loss)

Clinical Clue

Specific behaviors or physical findings that are a cause for concern that a child may
currently have a communication disorder. ( cleft palate/ lip, not meeting speech and language milestones)

Goal Planning

Goals of intervention focus on:
• 1. Facilitating communication development
• 2. Changing or eliminating the communication problem
• 3. Changing specific aspects of the individual’s communication function by teaching specific skills and
• 4. teaching compensatory techniques to improve the individual’s communication functioning.( sign language as a bridge to learn language, baby signing)

Types of Goals

• Long term (umbrella goal, very broad, breeds short term goal, first goal)

• Short Term ( from the long term goal)

• Session Goals( from the short term goal)

SMART Goals

Specific ( what will the child do)

Mesaurable ( how often they will do it)

Acheveiable

Relevant (what context will they perform)

Time based (when they will master the skill)

Relationship Based Therapies (Therapy Methodology)

• The Play project

• DIR Floortime

• Hanen Program

Behavior Based Therapy (Therapy Methodology)

• Applied Behavior Analysis

• TEACCH Method

Behavioral Therapy( Theoretical Approaches)

Pespective of development that asserts speech and lang are behaviors that come about through operant conditioning

Nativist Theory ( Theoretical Approaches)

Perspective of lang emphasizing acquisition of language as an innate, and genetically transmitted verbal phenomenon ( Language Acquisition Device )

Semantic Cognitive Theory ( Theoretical Approaches )

perspective of Language development emphasizing interrelationship between lang learning and cognition. Learning is intertwined with language. How children learn the lexicon through interaction with the world.

Social pragmatic Theory ( Theoretical Approaches )

Considers communication is the basic function of language. We want to be communicative, works well with the behaviorally theory

Emergentist Theory ( Theoretical Approaches)

There are certain forms that emerge before other forms. There is a developmental progression and certain things are going to emerge before others

Reich Therapy Intervention Model

• Early intervention is family driven, what the family feels is important for the child to do in the written paperwork

• Nonverbal vs. MLU 3.5

• Form ( Lang)

• Cognition ( Content, areas in paperwork and goals )

• Communication ( Functional language, hearing a back and forth)

Hanen Programs for Parents

• Theory is based in Social Interaction Theory with elements of Behaviorist Theory.

Parents are taught to use:
1. Child centered strategies ( following childs lead)
2. Interaction promoting strategies ( things that engage the child)
3. Language modeling strategies
• Reciprocal vocal play
• Focused stimulation model( focusing on something and saying it over and over)

Dynamic assessment ( Sampling)

trying to do something to see whether or not it will help the child in therapy

Prelinguistic Milieu teaching / Responsivity Education (RE) (Part of Hanen program)

Play based intervention
• Use shorter utterances
• Slow your rate, but keep prosody
• Use fewer utterances
• OBSERVE and WAIT during interactions
• Follow the child’s lead
• Establish joint attention through reciprocal eye gaze
• Increase use of gestures
• Combine components of communicative acts
• Imitate actions and sounds, engage in reciprocal vocal play
• Use responsive language input
• Use natural consequences to engage and comment
• Limit questions and commands
• Model language by mapping and recasting

Mapping

figuring out what is being said

Recasting

Saying what was said back

OWLS (PMT)

Observe, Wait, and Listen

Enhamced Milieu Therapy

EMT is a naturalistic, conversation-based intervention strategy for teaching
language and communication skills to children in the early stages of language
development.

“Continuum of Naturalness” (EMT)

working within the child’s daily routines encourages
generalization of the skill.

Environmental Arrangement (EMT)

– arrange the environment to ensure more opportunities for communication and by following the child’s lead

Communication Temptations (EMT)

– do the unexpected, engage in routines and WAIT for request to continue, the “absent minded parent”, create situational obstacles to encourage request

Components of EMT

1. Environmental Arrangement

2. Responsive Interaction

3. Target Lead Language

4. Expansions and Extensions

5. Time Delay

6. Milieu Teaching

1. Environmental Arrangement

- select toys and activities that encourage the child to talk

2. Responsive Interaction

- every form of communication is followed buy an adult response

3. Target-level Language

– just a bit above the child’s MLU

4. Expansions and Extensions

–repeat with additional semantic or syntactic information

5. Time Delay

– pause using an expectant look to indicate that a child’s
response is required

6. Milieu Teaching

– naturalistic and use of mand-model (verbal prompting)

The Four I’s Of the Hanen Program

• Helpful for children with autism and parents

• (1) Include: the childs interests , make sure child with ASD has communicative intent

• (2) Imitate: in order for communication, use reciprocal vocal play

• (3) Interpret: Mapping the chids’s thoughts on language, interpreting what they mean

• (4) Intrude: Force yourself in ( ASD specifically) when a child wants to be on their own, making the child accept your play

• all of thse occur simultaneously