Language Intervention: Test 1

Late Language Emergence (LLE)

*Ages 2-4 years*

a delay in the language onset with no other diagnosed disabilities or developmental delays in other cognitive or motor domains

Incidence of LLE:

refers to the number of new cases identified in a specified time period

Prevalence of LLE:

refers to the estimated population of children who are exhibiting LLE at any given time

LLE may evolve into other disabilities, such as:

-social communication disorder

-autism spectrum disorder

-intellectual disability

-learning disability

-attention-deficit/hyperactivity disorder

Children w/ LLE vs Late Bloomers

-Some researchers distinguish a subset of children with LLE as late bloomers. Late bloomers are children with LLE who catch up to their peers. At the onset, it is difficult to distinguish children with LLE from late bloomers because this distinction can be made only after the fact.

-Some research suggests that there may be some early differences. For example, late bloomers used more communicative gestures than age-matched children with LLE who remained delayed, thereby compensating for limited oral expressive vocabularies. Late bloomers also were less likely to demonstrate concomitant language comprehension delays when compared with children who remain delayed.

Characteristics of LLE (Symptoms):

-parent report instruments (parent observation/questionnaire)

-widely used: fewer than 50 expressive words and no 2-word combos by 24 months (putting words together)

-review criteria regularly to look at language growth and if language skills are outside developmental tracks and if the child exhibits LLE

-look at other language development factors: vocabulary growth rate, speech sound development, emerging grammar, language comprehension, social language skills, gestural use, and symbolic play

Late Talkers*:

-phonological differences (differences in sounds) when they produce their first words

-delayed comprehension

-poor gestural use (late, or not enough) --> eye gaze, head nod

-shorter utterances

-comprehend fewer words

Characteristics of LLE: Perdictions and Outcomes

-50 to 70% will "catch up"

-7yrs: 20% of the history of LLE exhibit language impairments

-By kindergarten, many show normal receptive and exceptive skills, BUT there were scores were lower than kids who had no history of LLE

-LLE can be an early sign of language impairment (a disorder in one or more of the basic learning processes involved in understanding or in using spoken or written language; phonology, morphology, syntax, semantics,pragmatics)

-Best predictors: receptive language skills, size of their expressive vocabulary, and SES

Causes of LLE:

Risks:

-Child: gender, motor development, birth status, early language development, and abilities at 12 months

-Family: history, only child vs. siblings (more likely to have LLE due to mother's attention split), mothers' education level, and SES --> higher risk for LLE

-Screen time: for children younger than 18 months other than video chatting is discouraged; exposure to certain types of media is associated with lower language scores

-Early identification and treatment

Protective Factors (buffers) of LLE:

-reading/sharing books daily

-informal play (tossing a ball)

-daycare (high quality)

-access to pre-, peri-, and post-natal care

-learning opportunities (conversation, rich syntax, good vocabulary, access to books)

The SLP (LLE): General Roles

-work with child and family

-clinical and educational services

-prevention

-advocacy

-education

-administration

-research

The SLP's Roles: LLE

-recognizing the risks posed by LLE

-information, education, and counseling with families

-working and collaborating with other professionals

-accounting for bilingualism (english as a second language), dialect, and ESL culture

-staying current with research findings

-advocacy

The SLP's Roles (LLE): In-Depth Assessment

-comprehensive assessment of speech and language, mindful of CLD (culturally and linguistically diverse)

-diagnose presence of a language disorder

-treatment planning and documenting progress

-consultation, collaboration, and teaming

-transition planning

Assessment (LLE): General Guidelines

-determine if at risk for later language and literacy problems

-broad check of speech and language development, periodic monitoring *(complete assessment if delays persist or if additional developmental problems arise)*

-ideally in-home or care setting

-norm~referenced tests, developmental observations, interviews, and language sampling

*most common concerns*:

-not using words

-no "spurt in vocabulary" --> 18 months

-not combining words in year 2

Assessment (LLE): Nonverbal and Communicators

nonverbal: preverbal behaviors (play, gestures, and other nonverbal communication and interaction)

communicators: (using gestures, words, and vocalizations) --> how well these forms are used functionally

Assessment (LLE): Case History

gather information from family and other caregivers

-what are other concerns about the child's speech and language?

Does an assessment include a hearing screening?

yes!

Assessment (LLE): Spoken Language

receptive and expressive

-means of communication (e.g., vocalizations, words, gestures, eye gaze)

-functions of communication (e.g., requesting and protesting, greeting, commenting)

-vocabulary

-word combinations

-early grammar

-comprehension of simple commands

Assessment (LLE): Play Behaviors

symbolic, pretend, and social routines

Assessment: Speech Sound & Emergent Literacy (LLE) --> during early speech and language development, children learn skills that are important to the development of literacy (reading and writing)

1. Oral Mechanism: This refers to the physical structures and functions of the mouth involved in speech production, including the lips, tongue, teeth, jaw, and palate; the tongue's position can change the sound produced

2. Sound and Syllable Shape Inventories: These are lists of all the different sounds (phonemes) and syllable structures that a child can produce

3. Multisyllabic Utterances: These are words or phrases that contain more than one syllable

4. Phonemic Awareness: This is the understanding that words are made up of individual sounds, and the ability to manipulate these sounds.

5. Interest in Handling Books, Crayon/Pencil Use, Retelling Stories, and Print Concept Knowledge: These are all indicators of early literacy skills.

Differential Diagnosis: LLE

determine whether or not it is LLE or something else

-variability in vocabulary growth and early word combinations (remember that how quickly young kids learn new words and start combining words can vary greatly from child to child)

-sole indicators, individual differences before the age of 4 are NOT highly predictive of later language outcomes (be aware that the differences in how quickly or slowly a child under 4 years old learns these skills don't necessarily predict how well they'll use language when they're older)

-receptive delay may have poorer prognoses than those with mainly expressive delay -->kids who struggle with understanding language (receptive language delay) generally have a harder time in the long run than kids who mainly struggle with using language (expressive delay)

Treatment: LLE

varies:

direct (more SLP) ---> works directly with the child and their family and indirect

(less SLP) ---> monitor, check-in

-no other delays (nothing more than LLE): monitoring

-persistent language delays/other disabilities: direct speech and language services are necessary

goal: stimulate overall language development and teach language skills in an integrated style and context

-promotes effective everyday communication and improves the family's ability to support the child

Treatment: Working with Families (LLE)

-identify the family's concerns and what they hope treatment will accomplish

-what do they perceive are the child's needs and strength

-identify their priorities

-resources relative to priorities

-preferred roles in decision-making process (collaborative)

-establish supportive, informed, and collaborative relationship

-family~centered approach

Indirect Intervention: LLE

-activities to stimulate language development

-provide ideas and sample activities

-enrichment activities and multimodal communication (using all forms of communication)

-interactive styles that stimulate language competence in young children (modeling spoken language, nonverbal communication, imitations, extensions, expansions, and reinforcing communication attempts)

Direct Intervention: LLE

-activities designed and implemented by you

-effective intervention promotes a child's participation in natural environments:

• comprehensive, coordinated, and team-based

• developmentally supportive

• family-centered

• culturally and linguistically responsive

Treatment Approaches: LLE

naturalness continuum (therapeutic activities that vary in their degree of resemblance to real-life communication situations):

-clinician directed --> more professional

-child centered --> play-based, everyday activities at home or daycare

-hybrid --> dialogic reading (sitting together and reading a book)

*don't forget siblings*

when to consider AAC:

-a temporary means of communication for children with late language emergence

-research shows that the use of augmentative and alternative communication may in fact aid in the development of natural speech and language

-basic signs --> express basic needs

avoid recommending monolingualism; bilingualism not shown to inhibit language development or treatment outcomes in the presence of language disorders

Services: LLE

-IFSP: Individual Family Service Plan (six months) /birth to 3 years

-IEP: Individual Education Plan (yearly)/ 3 years and beyond: preschool-based to school-based

-format: structure of treatment session (individual or group)

-provider: person who gives treatment (direct and indirect)

-dosage: frequency, intensity, and duration of service

-setting: treatment location

Social Communication Disorder (SCD)

aka Social ( ______?) Communication Disorder

Persistent difficulties with what kind of language, for what purpose?

Difficulties with ______. ________, ______. and _______

What is an example of a cultural norm that should be minded ?

-DSM-5

-aka social (pragmatic) communication disorder

-persistent difficulties with verbal and nonverbal language for social purposes

-difficulties with social interaction, social understanding, pragmatics, and language processing (connecting meaning to what we hear)

-be mindful for cultural norms (EX: EYE CONTACT)

Challenges: SCD

misinterpreting ..?

communcation for ?

g and s

comprehending ?

-communication for social purposes (wedding)

-altering communication for context of listener needs (child, elder, interview)

-conversational rules and storytelling

-comprehending conversation

-understanding nonliteral, inferential language (inference skills), and indirect statements

-grammar and semantics

-misinterpreting context

-affects academic, occupational success, friendships, romantic relationships, and participating in social settings

SCD: NOT the same as ASD

ASD = Autism Spectrum disorder

-SCD: you don't have autism

-ASD: have SCD + exhibit the restricted, repetitive behavioral patterns

Social Communication allows us to:

what is pragmatics ?

3 things social cognition allows us to do.

-share experiences, thoughts, and emotions, adjust speaking style, perspective taking, and rules of verbal/non verbal communication, syntax, and semantics

-pragmatics: social use of language

-language processing: expressive and receptive

-social interaction: communication between 2+ individuals

-social cognition: appropriate and inappropriate behaviors, beliefs and values, create social events (AKA social knowledge), mental and emotional states of others and self, and social schemes

Incidence and Prevalence: SCD

stats are what?

stats for 8th grader?

associated disorders?

if there is history of DLD, what percent had a sig. risk? Without DLD history what percent is 3x to have SCD?

What is the DD (Developmental disability) w SCD male:female ratio?

-stats difficult to determine

-8th graders: 7-11%

-more males

-associated disorders: schizophrenia, preterm births

-history of DLD = significant risk (30%) for SCD or 3x greater without DLD history (9%)

-DD with SCD = male: female --> 2.5:1

Affects Ability to Use/Understand: SCD

4 examples

-appropriate greetings

-stories

-conversations

-language and communication style based on context

-repairs of communication breakdowns (let me rephrase that or say it again)

-appropriate verbal and nonverbal signals for indicators

-ambiguous or figurative language

-inferences

-close relationships

Causes: SCD

Is it known when its the primary diagonsis?

examples of associated conditions?

unknown (when SCD is the primary diagnosis)

defined in terms of associated conditions:

-ID (intellectual disability)

-Spoken and written language disorders

-Pediatric or adult TBI

-Aphasia

-Dementia

SLPs Scope of Practice: SCD

always screening for what?

4 things

(always screening for “everything”)

-educating and counseling others

-screening social skills

-diagnosis

-referrals and related services

-consulting and collaborating with affected families

-staying current with research

-advocacy

Assessment: SCD

What is screened for social skills?

Which children are screened?

What type of tools are used?

In a complete assessment what are you looking for?

-screen for social skills: comprehensive evaluation of speech and language

-which children to screen (ADHD, TBI, disruptive behavior disorder, abuse/neglect)

-adults: (dementia/neurogenerative, aphasia, ADHD, TBI, RHD)

-rule of hearing loss

-comprehensive assessment: look for overlapping symptoms of SCD

-be mindful of cultural norms and mores and context

-use a combo of tools (formal and informal) and multiple data sources

Assessment (Specific Areas): SCD

4 examples ?

-literacy

-verbal and nonverbal communication

-spontaneous communication (saying "hi")

-conversational skills

-turn taking

-discourse (skills in different settings), adult (vocational)

-figurative/ambiguous language

-interpreting emotions

-reciprocal social functions (smiling/waving at someone)

Assessment Challenges: SCD

Ppl with SCD have issues w what?

What strength do ppl with SCD have?

What are the reasons for the lack of valid standardized assessments?

differential diagnosis: person with SCD have marked problems identifying a social or emotional state associated with pragmatic errors; strengths are morphosyntax (compared to -DLD)

lack of valid standardized assessments:

-difficult to conceptualize SCD

-crosses over into other diagnoses

-lack of understanding of developmental social communication skills

Treatment: SCD

What is the focus of treatment for SCD?

what are some examples for treatment?

focus: increasing active engagement and independence in natural communication environments

-one-on-one, group interventions, school-based environmental situations with peers/teachers, mediated interventions (behavioral interventions --> modifying existing behaviors or teach new ones, peer/teacher mediated interventions --> *typically developing --> interact with non-typically developing*

Treatment (2): SCD

What type of therapy will be used?

What does SCORE stand for?

Intervention for….?

What 3 types of therapy can be used for treatmet?

Social communication therapy:

-comic strip conversations (illustrate what people are doing, saying, and thinking --> help to understand information)

-*******SCORE skills strategy (Share. Compliment, Offer help, Recommend changes nicely, Exercise self-control) *small group********

-social communication intervention (focuses on functional social communication goals --> plan, do, and review)

-social communication intervention project (pragmatic --> use and social communication needs)

-social stories/scripts (uses stories to explain social situations to children and learn socially appropriate behaviors)

-social skills group (uses instruction, role-play, and feedback to teach appropriate interactions with peers)

Transitioning Youth and Adults: SCD

What is important for teens?

What does teen treatment look like?

What is ToM training?

What is important for adults?

Important for HoH people?

What changes as we get older?

-teens: peer relationships, friendships, loyalty, and individual differences

-adults: college, work, social settings

-expectations change as we get older

-people who are deaf/HoH (exposure to and hearing social events)

-teen treatment: social skills training, curriculum-based interventions, and ToM (theory of mind) training --> knowing that other people have their own thoughts and feelings

What is the M-CHAT?

Modified checklist for autism in toddlers

Screen for autism

has yes/no questions

What does SCERTS stand for?

• “SC” - Social Communication

• “ER” - Emotional Regulation

• “TS” – Transactional Support

What is the TASI

Toddler Autism Symptom Inventory

used to identify symptoms of autism in toddlers through caregiver reports.