child language midterm

1. part 1 = functioning and disability made of body function and structure, activity limitations, and participation restriction

2. part 2 = contextual factors made of environmental and personal factors

2 parts of the ICF

International Classification of Functioning, Disability, and Health

ICF

body functions

the physiological functions of body structures (including psychological functions)

body structures

the anatomical parts of the body that facilitate functions

activity

the execution of a tasks or action by a individual

• limitations are difficulties in executing these

participation

the involvement in a life situation

• can be restricted which impacts experience of involvement

environemnetal factors of the ICF

the phsycial, social, and attitudinal environement in which people live and conduct their lives

personal factors of the ICF

the particular background of an individual that are not part of a health condition or health states

• may be gender, age, or other health conditions

performance is what an individual does in their current environment

capacity is what an individual is capable of doing in a standardized environment (ex. school)

performance vs capacity

1. collection of statistical data

2. clinical research

3. clinical use

4. social policy use

5. educational tool

5 uses of the ICF

1. case history and parent report

2. functional communication

3. speech and language in ambient language

4. speech and language in home lanaguge(s)

4 key assessment criteria for all langauge a child speaks

converging evidence approach

SLP technique that looks at information from the parent and the SLP or teacher, which allows for concern in multiple languages and multiple source analysis

• takes intelligibility and accuracy scores along with outside guardian cocnern

1. DEAP - diagnostic evaluation of articulation and phonology

2. GFTA-3 - Goldman Fristoe of Articulation 3

3. Hodson Assessment of Phonological Patterns

4. Hearing Screening

5. Verbal Motor production assessment for children

6. dynamic assessment

6 clinical tools to assess speech

1. assesses physiology functions of a body system including psychological/mental functions

2. articulation

3. expression of language - verbal and non-verbal

4. reception of written language

key elements of assessing body functions

1. CELF-P3

2. Expressive One Word Picture Vocab Test

3. PPVT-5

4. Structured Photographic Expressive Langauge Test

5. MLU

6. Test of Primary Language Development

clinical tools to assess language

1. CELF Literacy Checklust

2. Phonologcial Awareness Screening

3. Preschool Word and Print Awareness

4. Test of Phonoligical Awareness (TOPA)

4 clinical tools to assess literacy

1. Kaufman Brief Intelligence Test (KBIT)

2. Primary Test of Nonverbal Intelligence (PTONI)

2 clinical tools to test nonverbal IQ

1. learning and applying knowledge with general tasks

2. communication

3. movement

4. self care

5. domestic and community life areas

6. interpersonal interactions and relationships

exmaples of activities and participation

1. talking with caregiver and child about impedances

2. FOCUS

3. CELF-P3

4. Intelligibiliy context scale (translated to Patois)

5. Speech particpation and activity Assessment

clinical tools to assess blockades to activities and participation

1. observations

2. interviews

3. dynamic assessment

4. conceptual evaluation to rescore performance

clinical tools to assess contextual factors

1. products and technology

2. natural environment and man made changes

3. support and relationships

4. attitudes

5. services, systems, and practices

examples of environmental contextual factors

1. gender

2. race

3. age

4. health conditions and lifestyle

5. upbringing

6. education

examples of personal contextual factors

1. improves the quality and consistency of clinical documentation which reduces denials

2. reduces variability in documentation through consistent terms

3. focuses on meaningful functional change with goals and outcomes

why we use the ICF framework

1. the target is age appropriate

2. intervention is built around the child’s environment and what works best with family

3. all senses and sensory considerations are taken into account

4. end goal is communication - not necessarily speech

5. the process is active and dynamic

5 key elements of intervention

1. highest priority is forms and functions the client uses in 10-50% of contexts (in ZPD)

2. high priority is forms and functions the clients uses in 1-10% of required contexts - must be understood in receptive task formats

3. lowest priority is forms and functions used in 50-90% of required contexts (already used a lot)

intervnetion goal priority ranking

1. meet the childs needs that result from disability

2. meet each of teh child’s other educational needs resulting from disability

3. support ongoing development by connecting goals to learning/acedemic standards

4. support ongoing development by engaging in goal adpaation

4 elements of designing goals

acedemic standards are statements about what the students should how to do and how they can show adequate performance

classroom cirriculum is devised by districts to prepaere students to meet standards with materials

• links what is taught (acedemic standards) to how it can be measured

difference between acedemic standards and classroom cirriculum

1. assess the child

2. determine need

3. discuss acedemic standards

4. determine present level of achievement and functional performance related to acedemic standards

5. develop goals

5 steps to connecting goals to acedmeic standards ADDDD

1. environment - room, seating choices, position

2. input - way materials are presented

3. difficulty

4. level of support

5. participation expectations

6. size - amount of info in activity

7. time - amount allowed for tasks

8. alternative teaching oppourtunities - at meal times or car rides

9. output - how the child responds

10. alternative goals - multiple goals with same oppourtunity

10 types of goal adaptations

1. goal

2. teaching moment

3. context

4. procedural issues

the guiding taxonomy for intervention of developing language

1. what is the focus?

2. what are the charcteristics of the goal/target?

3. whats the language context?

4. what is the progression strategy?

4 key questions of how to shape the intervention goal

1. what is the antecedent event? - allow child choices for the activity

2. what is the response level? - what type of output do you want

3. what is the consequent event? - what is the reward or response to the child’s output

3 key questions of the teaching moment

1. who is the intervnetion agent? (parent, SLP, teacher, other children)

2. where is the venue (school, home, clinic)

3. what is the session format? (group or individual)

4. what resources are used? (toys, paper, workbook)

5. what kind of activities (structured, fun, natural)

5 key questions for the context of intervention

1. intensity - duration or frequency

2. training - how required is this approach

3. evaluation - different ways to evaluate the kid

3 main procedural issues with intervention goals

capacity goal

a goal for discrete language abilities in a standardized environment

• ex. improving plurals

functional goals

a goal for improving everyday skills with acquired language tasks

-ex. improving communication with peers to make more friends

S - speciifc - detailed description

M - measurable - how progress will be made/how goal is achieved

A - attainable - ability to accomplish goal

R - relaistic - capable of skills needed for goal

T - timely - include deadline

SMART goals

1. who is involved

2. what are the desired outcomes

3. how progress is measured

4. proficiency level

4 measureable objectives for intervention goals

1. conditions are clear how student will achieve goal

2. behavioural verbs to describe behaviour

3. clear crietria of how well the student performs the goal

3 elements for writing good goals

1. to know

2. to understand

3. to fully appreciate

4. to internalize

5. to grasp the significance of

6. to have an awareness of

terms to avoid when writing goals

zone of proximal development

the gap between what a learner can do independently and what they can achieve with guidance from the SLP

• where learning happens best, allowing individuals to develop new skills through support and scaffolding. 

1. change or eliminate the underlying problem or deficit

2. chnage the disorder by teaching specific language behaviours

3. teach compensatory strategies

4. change the child’s environment

4 purposes of intervention

results in better functional communication outcomes (new vocab, grammar, morphemes, expansions)

• best when working with DLD children

how does teaching specific language behaviours impact intervention

• teaches metacognitive strategies

• gives tools to improve functioning and outcomes

  • ex. story maps, sequence boards, AAC devices can be applied throughout the day

how does teaching compensatory strats impact intervention

• not focused on child directly

• influences the context of learning which bleeds to different communication contexts

• can be used in conjunction with other techniques

how does changing environment impact intervention

1. clinician directed (least natural)

2. hybrid

3. child directed (most natural)

3 intervention approaches

1. drill

2. drill play

2 clinician directed techniques

1. daily activities

2. facilitated play

2 child directed techniques

1. milieu therapy

2. focused stimulation

2 hybrid intervention techniques

adult = chooses goals and activities, uses behavioural techniques to teach the prompts and reinforcement

child = responds to adult

role of adult vs child in clinician directed therapy

clinician directed therapy intervention

therapy intervention guided by the therapist that is structured, drill-like, and product oriented

• therapist usually goes from receptive → imitation → production → conversational speech goals

prompt = the stimuli prodicded to give direction to elicit a certain response

reinforcement = the contingency that provides feedback on response

prompt vs. reinforcement in clinician directed intervnetion

fading = planned, purposeful withdrawal of reinforcement

shaping = developing more complex responses from those already in the child’s repertoire

fading vs. shaping in clinician directed intervnetion

1. clinician provides instructions - “say x for me”

2. stimulus - clinician presnets stimulus - “big ball!”

3. clinician waits for child to respond, no response → prompt

4. reinforcement

5. feedback - info on performance

5 step protocol of clinician directed therapy

primary = a turn in a game, token or sticker (tangible rewards)

secondary = social praise like “good talking” (reinforces functional use of language)

primary vs. secondary reinforcement

1. prompts to imitate - “say big ball”

2. cloze procedures - “Big ___”

3. prompts to imitate with a cloze procedure “say big ___”

4. expansion prompts - “tell me more, say the whole thing”

5. repitition request prompts - “tell me again”

6. self correction/monitoring prompts - did you say that correct, was that cap or tap”

6 types of prompts

adult - follow child’s lead, respond naturally to facilitate langauge, dont be the one to choose a goal (be aware of a target)

child - active listener that choose topics and activities, no imitation on command

role of adult and child in child-directed therapy

child-directed therapy

therapy approach that is lead by the child, unstructured, naturalistic, and context oriented

• mimics natural learning with simplified but specific input

1. clinician waits for child to initiate joint attention or play idea

2. clinician follows childs lead with presenting language models matching the child’s interest

3. clinician strives for 5 utterances/leads towards the goal in exchange

4. clincian expands on utterances with mature or additional grammar

5. reinforcement is not used but it can be used if intrinsic or social

5 step protocol for child-directed therapy

1. center the child - follow their lead and get on their level

2. promote interaction - wait for response and make comments

3. model language - label, expand, extend

3 strategies for child-directed therapy

expansion

technique used in child-directed therapy where the SLP takes what the child said and adds the grammatical markers and semantic details that would make it an acceptable adult utterance.

• ex. child says car go, SLP says the car goes fast!

extension

technique used in child directed therapy where the SLP adds comments for more semantic information to a remark made by the child.

• ex. daddys home, SLP would says Yes, he was gone at work

recasting

teachnique used in child directed therapy where the SLP expands the child’s remark into a different type or more elaborated sentence.

• ex. doggy in house, SLP would say Is the doggy in the house or the backyard? (or change it negative)

build ups and break downs

technique used in child directed therapy where the SLP will expand the child’s utterance to a fully grammatical form, then segment it into several phrases of sequential utterances that overlap in content.

self talk

technique used in child-directed therapy where the SLP describes our own actions as we engage in parallel play which provides a clear and simple match between actions and words.

parallel play

technique used in child-directed therapy where the SLP provides self-talk or commentary for what the child is doing in play

adult = select specific goals (could be materials) but follow the child’s lead to model language and elicit targets

child = required to respond to some models and gets motivated to produce targets

roles of adult and child in hybrid therapy

hybrid therapy approach

therapeutic approach that is semi-structured, quasi-natrualistic and focus on the product AND meaningful context

• integrates both clincian and child goals in session

focused stimulation

hybrid therapy technique where specific goals are repeated 3+ times in an interaction to target specifc word goals

• imitation is not used but child may be enticed to initiate the target

1. high density of targets via labels, expansions, extensions, parallel talk

2. child is encouraged to initiate with evocative techniques

3. focus is natural convo following child’s lead

4. measure outcomes by density of teaching moments and amount of child uptake

5. avoid prompts, requests for production and verbal reinforcement

5 elements of focused stimulation

1. pause and wait

2. environmental manipulations

3. requests for clarification and redirection

4. forced choice question

5. topic contigent questions

5 main techniques used in focused stimulation

1. clinician sleects goals

2. clicnian waits for child to initiate joint attention and play idea OR clcincian intiates play

3. play activity provides high density of oppourtunities to elicit goals

4. clinician follows lead of child

5. clincian exapnds and extends verbal utterances or continues to provide evocative techniques

6. reinforcement, prompt, and request for production

6 step protocol for focused stimulation

1. environement arrangement

2. responsive interaction

3. conversation based context

3 features of miliieu training of hybrid intervention approach

Milieu Training

a hybrid intervention technique that arranges the envrionment catered to interests to eleicit communciation from a child, involves waiting and giving many communciation oppourtunities

1. clcincian selects goals and waits for child to initiate focus and play idea OR clcicnican iniatates

2. play activity is engineered to provide many oppourtunities for child to iniate communication

3. clinican follows childs lead and waits for communication

4. clinician confirms communciation BUT can use 2 prompts if there is no verbal response

5. reinforcment should only be used if it is social or intrinsic

5 step protocol for milieu training

advantages = useful for teaching vocab in context, word combos, the learning is generalizable

disadvantages = more challenges to teach early morphology and less appropriate for older children

advantages and disadvantages to hybrid approach

late talkers

children with fewer than 50 words and no word combs by 24-30 months

• concerns with children from 18 months+ not saying words. limited vocab and sentences

• most have moderate receptive langauge difficulties and potential motor issues

1. profile 1: limited words and verbal imitation, possible CAS or motor issue

2. profile 2: mostly uses single words, limited verbs and modifiers, no combining

3. profile 3: mostly uses short sentences, difficulties with articles, plural, and pronouns, nonspecific vocab

3 profiles of late talkers

support and see approach

approach for late talkers that implements strageies to guide parents while not providing therapy immediately in case they do recover

profile 1: vocab growth

profile 2: word combos and function words

profile 3: use of content words and sentence complexity

what should you monitor with the 3 late talker profiles

1. sit face to face to follow childs lead

2. use songs and pasue to model

3. pair gestures

4. imitate the childs gestures and actions

5. interpeet communicative turns

5 ways of caregiver coaching if child is not using single words

gestures that look like what they mean

• help highlight semantic info to help with word learning

• can include some signs

how do iconic gestures help late talkers

1. imitate gestures and single words

2. use single words

3. follow 2 step instructions

goals for profile 1 late talkers

1. imitate and use 2 word combos

2. using 10 new verbs

3. understanding and using my/your

goals for profile 2 late talkers

1. play face to face to follow childs lead

2. expand childs message

3. model short grammatical 2-3 word phrases

4. interpret unclear productions

5. model verbs

5 ways to coach caregivers if child is not combining words

1. expand sentence complexity

2. use specific subjects in sentences

3. using plurals and articles

goals for profile 3 late talker

1. play face to face to follow childs lead

2. expand childs message

3. model specific grammar and vocab

3 ways to coach caregivers if child is missing grammar compelxity

language modelling strategies do not require that the child produces the target (it does help for morphosyntactic difficulties)

important distinction between modelling and eliciting

teach-model-coach-review model

caregiver coaching model that requires clincians to teach and model the strategy provided for the child then give feedback on caregiver attempts and check in

1. personal check-in with caregiver

2. caregiver participates in most session activities and practices

3. teach-model-coach

4. feedback in real time

5. specific homework assignment via discussion with caregiver

caregiver coaching checklist

behavioural assessment have limited predictive accuracy for long term language outcomes but it can be used for all children and gives a personal experience

neuroimaging is sensitive to movement and must be non-invasive for children to particpate but it reveals neuroplasticity and intervention effect

how do behavioural assessments vs. neuroimaging studies differ in challenges on DLD children

1. basal ganglia and motor cortex play a key role and the left IFG emerges

2. preschoolers show that the putamen is a crucial reason

3. smaller vocab can be compensated with gestures and a negative correlation to the right motor cortex

4. procedural system is associated with early expressive langauge performance

what were the key neuroimaging findings from the MRI study

neurodivergency

the differing in mental or neurological function from what is considered typical or perceived as the neuro-majority

social: individuals limitations are not due to disability but rather societal barriers and failure to support

medical: set of deficits in the areas of social communciation and interaction with repetitive behaviours

social vs. medical model of autism

socio-ecoglogical model

model of austism that views it as an interaction between the person and environmental layers of family, culture, policies

core deficit theory of autism

outdated theory of autism, stating that there is one deficit in theory of mind or executive function is what causes and explains all people with autism

• his was a way to implement social skills programs and make them fit in

that we should be treating it as a fluid disorder of support needs that can waver

• it is a 2 party system between the client and provider who may not understand each others ways (double empathy problem)

• care should be based on functional goals catered to the client (can be self advocacy, autonomy, inclusion)

what does current research state about autism

1. not fixing core deficits but rather supporting communication and participation in real life

2. should be collaborative and focused on the clients wants

3. include caregievrs, edcuators, and the client for intervnetion in multiple settings

how should autism intervnetion be framed in SLP

The Individualized CLient Profile

a profile for the needs and capcities for the client

• can be based around communciation strnegths, interests, sensory nedds, cultural humility, priorities and stressors, previous SLP experiences