language disorder lecture 3 review

prelinguistic period

the stage before children consistently use spoken words to communicate. they may communicate through eye gaze, gestures, body movements, facial expressions, and vocalizations.

application:

• baby reaches toward a toy, looks at the caregiver, or makes sounds to get their attention

developmental levels in the prelinguistic period

1. newborn: focus on physiological stability

2. 1-8 months: pre-intentional communication

3. 9-18 months: intentional prelinguistic communication

4. older prelinguistic communicator: focus on functional communication, participation, and communication-partner support

physiological stability

infants ability to maintain a stables physical and behavioral state so they can participate in interactions

SLP should consider: feeding, hearing, alertness/regulation, and parent-infant interaction

application:

• if a newborn becomes stressed or cannot stay alert during an interaction, the priority is supporting stability - not expecting the infant to meet an age-level communication milestone

pre-intentional communication

infant produces behaviors that are not yet consistently directed toward another person to communicate a specific message. caregivers interpret the behaviors and respond

application:

• a baby cries or moves around. the caregiver interprets the behavior as possibly meaning the baby is hungry, uncomfortable, or needs a break

intentional prelinguistic communication

the child intentionally directs communication toward another person to achieve a goal, but may not use spoken words.

application:

• a toddler points to a snack, reaches for a toy while looking at a caregiver, or uses a gesture to ask for help

intentionality

when a child directs behavior toward a communication partner to achieve a communication goal

application:

• a toddler looks at a caregiver and reaches toward a closed container to request help opening it.

reciprocity

back-and-forth interaction between and child and another person

application:

• the caregiver makes a sound, the infant responds with a sound, and the caregiver responds again

joint attention

when a child and another person share attention toward the same object or event

application:

• a toddler points at a dog, looks at the caregiver, and shares interest in the dog

family-centered practice

an approach that treats the family as a key partner in intervention and considers the child’s everyday environment

An SLP should:

• learn the family’s priorities and concerns

• consider routines, culture, and available supports

• observe communication during everyday activities

• coach caregivers to notice and respond to communication cues

• build strategies into routines that already happen

application: instead of practicing communication only during therapy, the SLP helps a caregiver create communication opportunities during snack time or play.

IFSP

Individualized Family Service Plan, used for birth-to-three early intervention services. it addresses the child within the context of the family and everyday environments

It includes:

• the child’s current functioning and strength/needs

• family priorities

• functional outcomes

• services and settings

• coordination and transition planning

what should an SLP ask when assessing a prelinguistic child?

what can this child do now, under what conditions, and with what partner support?

Ex:

• what can the child already do?

• what helps the child communicate?

• does communication change with different people or routines?

what areas are assessed during the prelinguistic period?

• regulation and state: can the child stay alert, participate, and recover from stress

• social engagement: does the child orient toward people, share affect, imitate, and interact back and forth

• intentionality: does the child direct behavior toward a partner to communicate

• means: how does the child communicate

• functions: why does the child communicate

• comprehension and play: what does the child understand, and how does the child use or imitate objects

Communication means

how the child communicates

• eye gaze

• body movements

• gestures

• vocalizations

• signs

• AAC

• emerging spoken words

communicative functions

why the child communicates

• requesting

• protesting

• rejecting

• gaining attention

• commenting/ sharing

• greeting

• responding

application:

• a toddler points to a cup to request a drink

• means: pointing

• function: requesting

best practice for assessing prelinguistic communication?

combine:

• caregiver interviews

• developmental or standardized measures

• repeated observations in natural situations, across different people and routines

why? one test or one observation may not show everything the child can do in everyday life

What is a risk factor? Does it automatically mean a child has a language disorder?

increases the likelihood of communication difficulties, but is not automatically a diagnosis

• prenatal: exposure to alcohol or drugs, environmental toxins, or infection before birth

• perinatal: prematurity, low birth weight, or complications around birth

• congenital: genetic, metabolic, craniofacial, or hearing conditions present from birth

• identified later: hearing loss or developmental and environmental risks recognized later

main goal of intervention during prelinguistic period?

build the child’s next functional communication skill, rather than simply trying to reach the next age-level milestone

application:

• child communicates by reaching, an SLP might help the child develop more reliable ways to request an item

how should an SLP support a newborn in the NICU?

physiological stability comes first

an SLP might:

• assess feeding and oral skills

• consider hearing and hearing follow-up

• observe alertness, stress cues, and endurance

• help caregivers recognize when the infant is ready to intercat

• encourage caregivers to pause when the infant is stressed

application:

• if an infant shows stress during interaction, the caregiver pauses rather than continuing to stimulate the infant

how should an SLP supports infants aged 1-8 months?

focus on pre-intentional communication, regulation, and caregiver-infant interaction

strategies include:

• follow infant’s lead

• imitate and expand the infant’s sounds or movements

• pause to give the infant time to respond

• use predictable social routines

• help caregivers recognize signs of stress vs. engagement

application:

• baby coos, the caregiver imitates the sound, waits, and responds to the baby’s next vocalization

how should an SLP support intentional communicators aged 9-18 months?

create a natural opportunities for the child to communicate

steps:

1. follow child’s interests

2. create an opportunity to communicate

3. wait and observe

4. respond to child’s communication

5. repeat opportunities across routines and communication partners

application:

• during play, the caregiver holds a desired toy where the child can see it, waits, and responds when the child reaches, points, vocalizes, or uses AAC

what does it mean to create an opportunity to communicate?

arrange a natural situation that gives the child a reason to communicate

ex:

• offer two choices

• pauses during familiar game

• put a desired item in view but not immediately within reach

• wait expectantly during a routine

what is AAC and when should it be introduced?

Augmentative and alternative communication. it includes communication supports such as gestures, signs, picture-based systems, or communication devices. Don’t wait for speech to develop before providing a reliable way to communicate

what does “function first” mean for older prelinguistic communicators?

first help the child communicate important messages reliably. do not make spoken words the only acceptable ways to communicate.

prioritze ways to:

• request

• reject/protest

• gain attention

• make choices

• comment/ share

• repair communication breakdowns

application:

• if a child cannot reliably say “no”, support a clear way to reject something using a gesture, sign, picture, or AAC

how should intervention support communication in children with autism who are prelinguistic?

assess and support communication in ways that respect the chid’s individual communication style.

• joint attention

• gestures and imitation

• play and response to name

• nonverbal communication

• preferred activities, visuals, AAC, and predictable routines

• shared engagement without making eye contact the goal

clinical principle:

• interpret behavior as potentially communicative and build more effective ways for the child to communicate

ex: a 7mth old cries and moves around. the caregiver interprets the behavior as a sign that the baby needs a break. is this pre-intentional or intentional communication?

pre-intentional

• the caregiver interprets the infants behavior, but the behavior is not yet consistently directed toward another person to communicate a specific message

A 12 month old points to a toy and looks at their caregiver. What is the show?

intentional prelinguistic

• The child is using a gesture and directing communication towards another person to achieve a goal

A toddler reaches towards a snack. The SLP identifies reaching as a communication means and requesting as the function is this correct

Yes

• means= how the child communicates → reaching

• function= Why the child Communicate → requesting

NSLP assesses a toddler only during a structured test and does not speak with the family or observe the child at home what is missing?

A family centered naturalistic view of Communication

• why? The SLP should also consider caregiver input and observe the child across every day, routines and communication partners

A caregiver wants her child to say words, but the child currently communicates by pointing and reaching what should the SLP do?

build up on the child’s current communication and help them develop the next functional skill

• why? The child already has ways to communicate. intervention should Build from those strengths rather than focusing only unspoken words

A child has limited spoken language and the family is told to wait until the child talks before trying AAC is this consistent?

no, because providing functional communication in AAC when speeches, insufficient rather than postponing access while waiting for speech

an infant in the Nicu becomes stressed during interaction. Should the SLP encourage the caregiver to keep interacting to meet communication milestones?

No

• why? physiological stability and readiness comes first the caregiver should recognize dress cues and pause when needed

A toddler does not use eye contact consistently, but shares enjoyment with a caregiver during a preferred activity. Should I contact automatically become a therapy goal?

no

• why? supporting shared engagement without making eye contact itself the goal

A child has a known risk factor for language difficulties. Can the SLP conclude that the child has a language disorder based on that risk factor alone

no

• why? A risk factor increases the likelihood of difficulty. It does not automatically establish a diagnosis.

an SLP wants to help a toddler communicate more during play. What should the SLP do?

follow the child’s interest create opportunities to communicate. Wait for a response. Respond to the child’s communication and repeat the opportunities across routine

• why? this makes communication meaningful and gives the child natural reasons to interact