Early Intervention Quiz 2

Late Talkers

a child that produces fewer words than expected for their age

later expressive lang can occur b/c of a number of factors (sensory, cognitive, and/or neurological problems) or have no known causal link

myths about late talkers

children will “grow out of it”

children are choosing what lang they understand or produce

there is always a clear reason for delayed language development

all late talkers will have developmental language disorders

all late-talkers will have issues with reading, spelling, and writing

learning 2 languages can cause language de;ay

using a pacifier can cause late talking

younger siblings may be more likely to be late talkers

Why do some toddlers struggle to communicate?

poor understanding of cognitive concepts like cause and effect and object permanence

lack of opportunities to practice

personality differences

limited wants and needs/preferences (may lead to limited variation in their communication intentions

toddlers with delayed language

children with delayed language typically have the same need and want to communicate effectively with their parents/caregivers and peers

may experience more frequent failed comm attempts

this could cause frustration and inc in negative behavior

behavior should be seen as attempts to communicate

communication intentions for children with delayed language

less variation in their communication intentions: range of intentions such as requests for objects, requests of actions, rejections/protests, request for info, acknowledgements, and answers to ?s

less frequency of comm intentions: 18 mo-expected to produce about 2 instances of intentional comm per min, 24 mo- expected to produce about 5 instances of intentional comm per min

Communication Breakdown

happens when the child’s need aren’t understood by them comm partner

naturally occurs for ALL children, can be viewed as ways of problem solving and gaining new skills in order to successfully handle the communication situation in the future

all children may need support to clarify, restate, and/or provide additional info in order to be understood by their comm partner

communication and children with delayed language 

children with delayed language may experience more frequent and more complex comm breakdowns

due to delays in: background knowledge and/or vocan

problem solving skills

familiarity with the comm partner

familiarity with the context

limited opportunities to practice

poor linguistic models

may not feel their words have meaning and/or power

when should a child be referred for EI eval

not responding to sound, lack of babbling, unable to follow 1-step directions by 18 mo

no words by 18 mo

poor eye contact (cultural differences)

lack of imitation

lack of gestural comm

no word combos by 2 yrs

regression in lang skills

not responding to name

est risk ID

difficulty being understood less than ½ the time by age 2.5

why do you think there may be a delay in referral and/or start of services

naive or unaware- don’t want to admit (shame, embarrassed, scared, or nervous)

they think child is perfect

lack of service providers/evaluators

lack of education about child dev/ EI

time

horror stories- neg perspectives onEI

lang barrier, cultural differences

parent cognitive and/or learning abilities

grief

other services take prioroty

rural areas or areas of high need- technology dead areas

Evaluation IDEA Definition

the procedures used by qualified personnel to determine a child’s initial and continuing eligibility

procedures include: developmental checklists, standardized tests, review of records, observation, parent/caregiver report, informed clinical decision

initial eval

the evaluation that determines initial eligbility

core eval

evaluations are typically conducted in the home by 2 professionals as a team

may or may not be needed if a child has a medical diagnosis

they address all 5 areas of development

team approach

provide info on the child’s strengths and areas of need

strengths can be used to support areas of need in the future (ex: imitating actions may help support verbal imitation later on

positively support the parents to ID needs

core eval goals

collect developmental data to understand how the child is functioning 

ID the priorities, concerns, and resources of the family including likes and dislikes

obtain info about how the child participates in family routines and everyday activities

determine eligibility for EI services

formulate a plan for intervention

enlist the caregivers’ collaboration in intervention 

monitor progress

Rossetti Infant-Child Language Scale

0-3 yrs, assessed in 3 mo intervals

methods: direct testing, observation, and parent/caregiver report

English and Spanish, “gold standard” of early language assessment protocols

areas assessed: interaction-attachment, pragmatics, gestures, play, lang comprehension, and lang expression

Receptive-Expressive Emergent Language Scale

0-3 yrs

parent/caregiver interview, quick to give

assesses receptive and expressive lang

Preschool Language Scale 5

2 wks-6:11

methods: standardized and norm-referenced assessment, direct testing and parent/caregiver interview

assesses expressive and receptive lang

Developmental Assessment of Young Children 

0-5:11

combines observations, direct assessment, and parent interview

assesses: 5 separate score forms for each area of development, language is broken into expressive and receptive

formal assessment

will give a score that will help to determine eligibility for services

may or may not give a complete picture of the child’s prelinguistic and/or linguistic skills

scores may drive eligibility but we ,ay need to engage in more informal assessment procedures in order to have enough information to make informed decisions about therapeutic planning

eligibility criteria in NYS

child must be under 3 yo

developmental delay: the child has development in at least one area of development, such as communication, social-emotional, adaptive, cognitive, or physical

diagnosis: the child has a diagnosed physical or mental condition that is likely to lead to developmental problems

Developmental Delay criteria in NYS

12 mo delay in one or more domains of development

or

a 33% delay in one domain of development

2 standard deviations below the mean in one area of development

or

a 25% delay in two domains of dev

1.5 standard deviations below the mean in 2 or more domains of dev

informal assessment

may not always take place within the eval

may help to describe communicative behaviors and/or skills of the child that may lead to communicative behaviors

procedes can include: observation of play and/or daily interactions, observation of imitation, gestures, joint attention, etc, parent/caregiver interview, word/sentence lists, language sampling (older children)go

goal of informal assessment

to identify the forms and means of communication

understand the form, content, and use of lang and/or prelinguistic behaviors

identify when and how communication breakdowns occur

gain an understanding of caregiver-child interactions

understand potential negative behaviors

identify situations when the child is successful in communication and situations where breakdowns occur

tips for evaluations

offer clear and concise info to parents/caregivers

explain procedures

maintain ongoing communication with the family and other team members throughout the entire eval process

show respect and compassion towards parents'/caregivers

be cognizant of the fear, frustration, grief, or stress that may be linked to their child’s speech and lang difficulties

potential difficulties with EI evaluations

inaccurate parent/caregiver report

differences in report for multiple caregivers and/or teachers

only seeing the child for a short period of time-are you truly able to get an adequate description of skills

child may feel uncomfortable and be noncompliant with tasks 

service delivery

EI should provide services that are individualized, align with the priorities of the family, match the child’s comm needs, are consistently monitored, family-centered

goals should be selected that focus on the child’s strengths and needs, family preferences, communication contexts, and communication partners, services provided in natural setting

building rapport with families

building a positive relationship with both the child and their caregivers is paramount

be respectful

communicate effectively and honestly

recognize the strengths of the child and the family

ask ?s to help understand the child and the family’s situation without judgement

take opportunities to observe the family’s interactions and routines

use strengths based phrases

tips for establishing and maintaining family centered practice

spend time with the family to learn about their wants, needs, values, etc.

find out what the families expectations are include family in assessment process both formal and informal

provide choices and options on how a family can participate

work with families to pick natural environments

identify normal routines and contexts that can be used to create learning opportunities

review progress with the family

work together to develop ways to use the child’s interests

provide families opportunities to work directly with the child and to improve their interactionsttr

transactional model of intervention

communication occurs within the context of social interaction

parent and child are both part of the interaction

parent and child factors are addressed in therapy

general therapy principles for young infants

all activities should be presented to the fmaily in the context of back and forth, warm, affectionate comm

teach about early comm attempts and how to respond to them

remind the family that what the baby needs is to be loved and played with

therapy can focus on acceptance of the baby’s comm style, appropriate choice of toys for play, modeling play and interaction, language stimulation, and scaffolding of activities to prompt joint attention

conduct therapy where the infant is most comfortable (on the floor, mat, person’s lap or arms)

involve the family as much as possible

pre-linguistic intervention

focus on jey skills that help build the foundation for verbal comm skills (before focusing on sounds and words)

includes: joint attention

imitation

parent-child interaction and communication

turn-taking and/or reciprocity

managing behavior

potential feeding difficulties if present

intervention: 1-8 mo 

rapport with family is paramount!

SLP may be the only support person going into the home

continue to support feeding including progression to solids as the infant ages closer to 6-9 mo

all activities can be presented in the context of back and forth warm affectionate comm

encourage vocalization

foster parent-child communication

intervention: 9-18 mo

children move from being participants in their interactions to being intentional communicators

they can express intentions to others but do not yet use conventional language

we want to foster the communication the child is using

natural consequences can provide opportunities for children to engage

foster relationships b/t words and objects

comm temptations

encourage book reading, including pointing to pictures, asking ?s, etc.

foster early play skills

older prelinguistic children

severely or profoundly impaired ind. with cognitive deficits that limit their ability to communicate

feeding issues can be addressed with behavioral approaches involving new skill acquisition, generalization, and reinforcement

emphasize the communicative aspects of feeding

behaviors can be understood as a form of communication

we need to ID and educate about intentionality and comm attempts

implement AAC

functional communciation

comm that is effective  at obtaining the desired outcomes

children need to learn to begin and respond to comm attempts in acceptable ways

they need to recognize and repair breakdowns

may begin with requesting objects or actions

how can we work with families to ensure that therapy targets are functional?

first words

common first words: mama, dada, hi, bye, sissy, bubba or brother, car, eat, drink, milk, juice, banana or nana, mine, no, yes, up, go, stop, night-night, ball, baby, dino, doggies (or pets names), cookie, fish (goldfish)

most of these are nouns, so consider words and work on words beyond nouns (action words, names for ppl, etc.)

creating word/vocab target lists

therapist, family, and others should work together to come up with an appropriate list of words that:

occur in daily routines, are high frequency, contain sounds or syllables that the child can produce, are words the child understands, high preference to the child

managing behavior

focuses on the interaction patterns that exist b/t the infant and their family

guide families to recognize comm attempts and ID breakdowns when they occur

provide education on the general developmental level of the child and expectations

help families to ID child strengths and needs, as well as re-evaluate these throughout the therapy process

promoting joint attention

can begin by modeling for the parent/caregiver how to ID the child’s focus and then share attention to it

follow the child’s lead

introduce an attractive toy and demonstrate how to engage the child

age appropriate toys

model activities that promote joint attention such as singing, early games, rhymes, etc.

tips for teaching joint attention skills

adult can exaggerate movements and/or lang model

giving objects to the child

using objects in silly ways

making silly noises

imitating the child’s vocalizations or actions

bringing an object close to an adults face

turn, look, point, and use exclamatory words

we know a child is improving joint attentional skills when they begin to:

respond with gesture and/or lang

shift gaze from object to person

show an object

give an object

teaching imitation

if the child is not yet imitating words we need to lookka t what the child is able to imitate

are they imitating: actions-gross motor and fine motor, facial expressions, vocalizations, babbling, animal noises and car noises, exclamatory phrases (uh oh, wow)

building imitation skills

imitation of actions with objects: banging to blocks together, crashing a car into a tower

imitation of gross motor actions: stomping feet, marching, dancing

imitation of communicative gestures: waving hi/bye, blowing kisses, high 5s

imitation of non verbal actions with face/mouth: puffing cheeks, pushing tongue out, raspberry sounds

imitation of vocal movements: fake coughing, panting like a dog, other vocalizations

imitation of exclamatory words/vocalizations in play: animal noises, wow, uh oh, ahchoo

imitation of words in context: use verbal routines so that words are predictable, ready set ___

imitation of single words: imitate functional words

imitation of short phrases

anticipatory sets

expectations that actions that have been repeated often will occur in a particulat sequence so that the child knows what is goign to happen

provide the baby with predictable series of sound and aciton

can increase the baby;

turn taking

model turn-taking during play for the parents and child

encourage use of age appropriate toys and/or activities

promote early gestures such as pointing or showing

scripts of familiar routines can also promote turn-taking

can be done in play with simple prompts and imitation

responsive interaction approaches

following the child’s lead

responding to a child’s initiations

extending a child’s topic in reply

self talk and parallel talk

provide meaningful and specific feedback

expanding the child’s model

following the child’s lead- young infants

observe the child’s interests, actions, and reactions

provide and model age appropriate toys

respond to their cues

mimic their sounds, mvmt, or acitons

make sure the response is related to the infants behavior and it’s not drawing their attention away from the desired activity

increases motivation and interest

SILLY acronym

S- silence all distractions

I- be in the moment with your child

L- let your child lead

L- listen and respond

Y- say yes (support child’s creativity and use positive statements)