Language Disorders in Children Exam 3 Review

Zone of Proximal Development

- the distance between current level of functioning and potential level of performance

- What the child is ready to learn with help

- Knowledge of normal development is necessary

Continuum of Naturalness

the extent to which the settings and activities in intervention resemble "real life" or the world outside the clinic room

Continuum of Naturalness: Most Natural

- Child-centered

> Daily activities

> Facilitated play

Continuum of Naturalness: Medium Natural

-Hybrid

> Mileu therapy

> Focused stimulation

> Script therapy

Continuum of Naturalness: Least Natural

- Clinician-directed

> Drill

> Drill Play

> CD modeling

Ways to Modify the Linguistic Signal

- Slow Rate

- Repetition

- Increasing Perceptual Saliency Through Prosody and Word Order

- Controlling Complexity

- Pragmatically Appropriate Responses

Slow Rate

gives more time to process, comprehend, execute

Repetition

increase/maximize opportunities

Increasing Perceptual Saliency through Prosody and Word Order

- "Therapeutic register"

- Emphasize/stress word

- Draw Attention to targets

Controlling Complexity

semantically simple, but not simplified syntactically

Pragmatically Appropriate Responses

Carefully select linguistic stimuli

Reinforcement

increases the frequency/maintenance of the behavior and increases attention to task

> Intrinsic: natural social reward

> Extrinsic: outside the interactive frame, do not contribute to interaction itself

Feedback

gives information about the communicative value or linguistic accuracy of the utterance

> Provides scaffold

> Not intended to increase frequency of behavior

What are two essential ingredients in effective intervention?

Feedback and reinforcement

EBP

conscientious, explicit, and unbiased use of current best research results in making decisions about the care of individual clients... by integrating clinical expertise with the best available external clinical evidence from systematic research

Approach for EPI

- P: Individualize question to particular patient or problem

- I: choose an intervention that has internal evidence and face validity for this patient

- C: identify a comparison treatment, such as your usual approach to compare and contrast with "I"

- O: specify a desired outcome

Prelinguistic Milieu Teaching (PMT)

for children 9-18 months, not yet speaking; develop intentional communication skills by increasing frequency, complexity, and maturity of communication

PMT what is it

- Combination of gaze, gestures, vocalizations within Interactive routines through imitation of child, turn-taking, and repetition

> Arranging environment to show desired items, but not allow access

> Follow child's lead --> wait for anu communication attempt for requesting item

> Reward immediately --> allow access to ite

Enhanced Milieu Teaching (EMT)

for children who have some verbal imitation skills; at least 10 productive words; MLU = 1-3.5

EMT Activities

- Choose materials of interest to child; arrange environment to support engagement and requesting

- Use environmental arrangment to elicit initiations

- Mirror child actions to take a nonverbal turn; pause and wit expectantly following an adult remark to give child a chance to take a turn

- Recognize and respond to what child communicates verbally or nonverbally

- Expand child utterances to those at child's current zone of proximal development

TIPS

(Intervention for pre-intentional)

- Turn Taking: back-forth interactions: songs, toys (peek-a-boo)

- Imitate: mirror actions/vocals: monkey-see-monkey do, copycat

- Establishing joint attention ("Point things out"): bring into view, then move them to monitor eye gaze/response

- Developing anticipatory sets ("Set the stage"): repeat simple games/songs...pause often...wait for child to respond

Interactive Book Reading (CART)

- Promotes language and literacy skills

- The younger the better

-CART:

> Commenting: comment on something child is interested in

> Ask questions: ask question about something of interest

> Respond by adding a little more: expand, extend, recasts

> Time to respond: use expectant wait-time for child to respond

- Activities to develop comprehension should be included - pair words with gestures and referents, label

- Use therapeutic register

-Use contingent responses

Categories of play

- Symbolic

- Functional

- Exploratory

- Relational

Goals for 5 areas of language

target both receptively and expressively in each area

Phonology goals

- Children with productive phonological problems during the DL period may have trouble acquiring phonological awareness, placing them at risk for reading problems

- Children with both phonology and morphosyntactic errors – evidence change in both areas when addressing morphosyntax

Semantics goals

- Children with DLD have difficulty with receptive vocabulary and are slow to develop first words

- Difficulty with words to talk about cognitive states, verb vocabulary, and prepositions

Syntax and Morphology goals

- Grammatical difficulties

> Many children with grammatical deficits also have speech intelligibility issues, small vocabularies, word-finding problems, limited preliteracy skills, or difficulties with play, thinking, and conceptual development

Pragmatics goals

- Play

- Social interactions (executive function skills)

> Make sure targeted language forms are learned and practiced in pragmatic contexts

Parallel Talk

Narration of the actions of another person, typically that of the child. The adult follows the child's lead and describes in short phrases of 3-6 words what the child sees, hears, or touches

Self-Talk

an adult talks to the child about what the adult sees, does, or hears at any particular moment in time

Gestalt Language

- ASD individuals

- Situational gestalts: "gestalt cognitive processing"

> Whole experience thinking

> Connected to the emotional experience

- Often referred to as echolalia, see as a self-stimulating/self- regulating behavior