Early Language Disorders Final Study Guide

Directive Approach

A strategy consists of adult-led interactions that attempt to elicit specific communication behaviors from a child while supporting the child to gain a desired response.

Responsive Approach

A strategy that attempts to encourage a child's engagement and to provide opportunities for child-initiated and child-directed behavior and for reciprocal and balanced turn-taking between communication partners.

Directive Approach May Consist

- Implement the procedures systematically through adults

- Provide only as much prompting as is necessary to elicit behavior

- Fade prompting as the child becomes more independent

- Plan for increased initiations

- Design generalization opportunities in collaboration with the family.

Responsive Approach May Consist

- Self-talk and parallel talk

- Following a child’s lead

- Contingent imitation

- Responding to a child’s nonverbal initiations

- Providing meaningful feedback

- Expanding (Correcting the response by finishing the error word with no added new information) and extending (Adding new information while fixing the errored word)

Hybrid (Blended) Approach

A mix of directive and responsive approaches that heavily emphasize arranging the environment to promote communication in natural environments.

Hybrid Approach May Consist

- Environmental sabotage

- Setting up communication opportunities

- Providing choices

- Waiting and listening

- Changing a routine

Self-Talk

An adult describes his or her own actions while engaging in play with a child (e.g., "Push car. Mommy push car.")

Parallel Talk

Provides self-talk for the child as the adult talks about the child's action.

Following a Child's Lead

Allowing the child to establish an interest or attempt to communicate and then responding in an appropriate way

• e.g., naming an object or action that is the focus of attention

Contingent Imitation

Imitating the child may teach the child to imitate due to increasing motor neuron firing.

Natural Consequences

Experiences that follow naturally as a result of a behavior (e.g., gestural request for a cookie might be followed by handing one to the child when possible or replying, "Yes, you want cookie. Eat banana, then cookie.")

Providing a Meaningful Feedback

Provides a label, described the child's behavior, acquiesced to a request, or replied in another way.

Expansions

Elaborating on children's speech, increasing its complexity (e.g., gestural request in the form of a reach followed by a verbal response like "Want juice.")

Extension

Replies that build on an action or utterance by providing additional information (e.g., if the child reaches, the adult might respond "Want cookie. Sierra likes cookies and milk.")

Environmental Sabotage

Manipulation of the environment in such a way so that a child's access to a desired object or activity is prohibited, thus creating an opportunity for communication.

Setting Up Communication Opportunities

The goal is to encourage expression, play, engagement, and independence

• It can range from creating situations to encourage food requests, objects or protesting.

Choice-Making

One of the earliest and most critical aspects of communications.

• It can range from snacks to objects or activities.

Waiting and Listening

This method works well in situations in which a child needs assistance that is withheld while the adults waits.

Changing a Routine

Once a child has learned a routine or a predictable turn-taking activity, he or she anticipates what will come next, so changes elicit responses from a child.

Mand-Model

The adult waits until the child shows interest and then requests that the child communicate in some way, as in "What do you want?"

Incidental Teaching

Everyday events are used as the vehicles for intervention. (e.g., bath time, snack, play, dressing)

Example of Mand-Model

Adult: "Say, 'I want the truck."

Child: "Truck!"

Adult: "Great job asking for the truck! Here it is."

Example of Incidental Teaching

(Scenario) Child plays with a set of blocks.

Teacher: "Those blocks look like you're building something really cool!"

Child: "Yeah, Tower!"

Teacher: "That's awesome! How many blocks is in your tower?"

Child: "Um, four."

Teacher: "Nice counting!"

Fading

Eliminating a teaching prompt, enabling the child to perform the behavior independently.

Enhancing Natural Gestures (ENGs)

Intentional behaviors present in a child's motor repertoire or can be easily taught based on a child's motor skills and are easily recognizable and interpretable.

What are the Four Treatment Approaches?

- Directive

- Hybrid

- Responsive

- Focused

Vocal Imitation

The ability of a child to reproduce sounds, words, or phrases by mimicking the speech of others, serving as a foundational skill in early language development.

Presymbolic

Communication refers to early forms of nonverbal communication and behaviors that occur before using conventional symbols, such as words or signs

• It includes actions like gestures, facial expressions, and joint attention.

Symbolic

Communication involves using conventional symbols, such as words, signs, or symbols, to represent and convey meaning, transitioning to more advanced and abstract forms of communication beyond nonverbal actions.

Examples of Presymbolic

Joint attention, imitation, and means end

Examples of Symbolic

First Words and pretend play

Means-End

Refers to a cognitive concept in which an individual, typically a child, demonstrates the understanding of using specific actions or behaviors to achieve a desired outcome or goal.

Imitation of Motor Behavior

The ability of an individual, often a child, to replicate or mimic physical movements and actions observed in others.

Joint Attention

The ability to coordinate attention between people and objects for social purposes.

Teaching Joint Attention (Initial Steps)

- Engaging activities

- Modeling

- Pointing/using gestures

- Following their lead

- Reinforcement

- Gradual progression/consistency

Facilitated Communication (FC)

It was a method that used a keyboard and hand-guiding to enable some clients to communicate via computers by typing their messages.

Common Indicators for Speech Development

- Risk for difficulties with vocal development

- Feeding difficulties

- Delayed onset of vocalization

- Neuromotor difficulties for speech and language

Best Predictors of Speech and Language

- Five or more conventional words in a 5-minute interaction with a parent

- The rate of protodeclarative use

- The ratio of number of words used to number of words understood

Semantic Category

Refer to a group of words or concepts that share a similar meaning or are related in terms of their meaning.

Phoneme Inventory

Refers to the set of distinct speech sounds, or phonemes, that are used in a particular language.

Early Symbolic Intervention

Refers to using symbols, such as words, gestures, or images, to support communication and cognitive development in young children.

Understanding Symbolic Representation

Symbolic representation involves using one thing to represent another.

• For example, using a picture to represent an object or a word to represent an action.

Language Development

Early symbolic intervention is closely tied to language development. It helps children understand and use symbols to express their thoughts and needs.

Play-Based Learning

Incorporate symbols into play activities. This can include using dolls to represent family members, drawing pictures to tell stories, or using toy animals to act out scenarios.

Visual Supports

Visual aids, such as visual schedules, pictures, or symbols, can help children understand routines and expectations. This is particularly beneficial for children with communication challenges.

Individualization

Recognize that each child is unique, and their understanding and use of symbols may vary. Tailor interventions to the child's interests, preferences, and developmental level.

Parent/Caregiver Involvement

Involve parents and caregivers in the intervention process. Provide them with tools and strategies to incorporate symbolic communication into daily activities at home.

Multimodal Approaches

Cultural Sensitivity

Consider cultural factors when selecting symbols. Ensure that the symbols used are meaningful and relevant to the child's cultural background.

Progress Monitoring

Regularly assess the child's progress in understanding and using symbolic communication. Adjust interventions based on the child's evolving needs and abilities.

Collaboration with Professionals

Work collaboratively with speech therapists, educators, and other professionals to create a holistic intervention plan that addresses both communication and overall development.

Expansion

Taking the words that the child says and repeat them, while adding in missing words.

Modeling

Guides the client through the exploration of their own metaphors, organization, interactions, and patterns.

Responses and feedback

Even incorrect or inaccurate child verbalizations can provide an opportunity for language learning. Responses to incorrect verbalizations can involve giving corrective feedback and also reinforce the child with adult attention.

Tracheostomy

At-risk children for this procedure can create a failure to thrive.

Soft-Solid Foods

- Introduction of texture.

- Transition to soft solids.

- Encouraging chewing movements.

Solid Foods

- Gradual introduction.

- Finger foods

- Diverse food choice.

When are babies ready to eat textured food?

6-8 months of age.

Positioning

Often involves a child sitting upright and taking a bottle independently.

When is crunchy solids introduced?

9-12 months of age.

Dysphagia

A swallowing and feeding disorder.

Feeding disorder

A difficulty in preparation of food for the swallow. Often co-occur with dysphagia.

Failure to maintain weight

Infants born premature may have additional complications in neurological development, cardiovascular conditions, respiratory conditions that complicate feeding and swallowing.

Failure to thrive (FTT)

Negative impact of inadequate nutrition on growth and development.

Silent aspiration (symptoms)

- Choking, coughing, gagging while eating

- Weak sucking

- Fast or stopped breathing while feeding

- Hoarse voice or crying

- Noisy breathing or wheezing

Position changes

Include swaddling, facing infant toward feeder, side-lying option, support for older children to maintain 90 degree angle during feeding, depending on the needs of the child.

Pacing

Occur through breaks and through controlling flow of fluid.

Texture Changes

Include thickening liquids to provide more sensory input and a more well-formed bolus.

Oral stimulation

Move toward a more functional sensory response to feeding and to improve motor control and coordination.

Behavior treatment

Includes both positive and negative reinforcement.

Positive Reinforcement Example

A child takes a bite of a non-preferred food and gains positive reinforcement in the form of a preferred food.

Negative Reinforcement Example

A child takes a bite of a non-preferred food and gets the plate of a non-preferred food removed for a period of time.

The Hanen Model (It Takes Two to Talk)

Goal is to increase a child's social communicative skills by enhancing the quality of adult-child interactions.

• Parents are also taught specific interactional behaviors for the more direct communication goals of the child.

Parental child-centered strategy

Strategies designed to promote interaction by facilitating and balancing turns and keeping the conversation going, such as asking questions and cueing the child to take a turn.

Responsive education

Emphasizes creating a responsive and supportive learning environment for children, especially those with developmental delays or language difficulties.

Prelinguistic Milieu Teaching (PMT)

Is a specific language intervention approach designed for young children who are not yet using words or have limited verbal communication skills.

The principal components of RE/PMT

- Arranging the environment to increase communication opportunities and naturally support the need to communicate.

- Following the child's attentional lead.

- Building social routines in which the child and caregiver play predictable roles.

Myth 5: Children Must Be a Certain Age

Intervention practices tend to underutilize ACC in early intervention.

Myth 6: Developmental Hierarchy of Symbols

Although a hierarchy of symbols from concrete to abstract does exist, it does not reflect a developmental order.

Myth: Bilingualism Causes Confusion in Children.

Reality: Research indicates that bilingual children can successfully learn and distinguish between two languages. Code-switching, or using elements of both languages, is a normal part of bilingual development and does not signify confusion.

Myth: Children with (CI) should be limited to only one language.

Reality: Research and clinical experience suggest that being exposed to and learning multiple languages can be beneficial for children with communication impairments.

Risk of myths to bilingual language development.

- Caregiver's may have difficulty communicating with the child if they only speak english.

- Asking caregivers to not teach their child their native language is like asking them to forget about their culture.

Role of SLP to dispel misinformation.

Ensure the family that it is beneficial to raise their child as bilingual and that all studies show no correlation between bilingualism and communication impairments.

Telegraphic speech

Two word sentences (e.g., I hungry, mommy eat).

Language modeling

Simplified language with a child.

Function of gestures

- Expressive communication

- Facilitating verbal communication

- Requesting or pointing

- Joint attention

- Turn-taking

- Emphasizing speech

Teaching gestures

- Modeling

- Repetition and reinforcement

- Joint attention activities

- Interactive play

- Expanding

- Imitation

- Consistency

Examples of aided AAC

- Communication boards

- Picture exchange communication systems (PECS)

- Speech-generating devices (SGDs)

Communication boards

Physical boards or books containing symbols or pictures that individuals can point to or touch to communicate.

Picture Exchange Communication System (PECS)

A system using pictures or symbols that individuals exchange to communicate their needs or desires.

Speech-Generating Devices (SGDs)

Electronic devices that produce spoken or written output. Examples include devices like tablets with communication apps or dedicated AAC devices.

Unaided AAC Systems

relies on the individual's own body to communicate without external tools

• It includes gestures, facial expressions, and sign language.

Examples of unaided AAC systems

- Gestures

- Facial expressions

- Manual sign language

Pediatrics (swallowing differences)

Children differ from adults in their anatomy and physiology, causes of feeding and swallowing difficulty, communication skills, types of swallowing impairment, and the fact that they are still developing.

Adults (swallowing differences)

Common causes of a swallowing difficulty in the adult population include stroke, traumatic brain injury, and degenerative diseases.

Common reasons for AAC abandonment

- Failure of a device to enhance independent functioning.

- Limited access to a device, such as one kept at school.

- Difficulty in programming or maintaining a device.

- Questionable reliability of the device.

- High levels of assistance required by the child to use the device.

Parental concerns with AAC

- Program issues

- Device issues

- Generalization

Environmental sabotage

Manipulation of the environment in such a way so that a child's access to a desired object or activity is prohibited, thus creating an opportunity for communication.

Focused Approach

A child speech therapy approach to repeat a word or phrase multiple times in a conversation to facilitate comprehension and possible language production.