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Describe outcomes of premature birth

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Describe outcomes of premature birth

Premature birth and low birth weight can contribute to communication impairments and they predict LLE, a hallmark characteristic of children with language impairment and is often the first symptom of a language problem

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Understand the provisions made through the Individuals with Disabilities Education Act for the birth through three population.

In 1986 it was created as a legal requirement to provide services for children with DD and their families

1990 part C created to focus on services for birth-3 years of age with development of IFSP to determine service delivery

1997 part C was strengthened emphasizing role of the family

2004 reauthorized to enable a possible extension of Part C through age 6

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Identify tenets (principles/beliefs) of cultural competency.

Culture impacts SLPs in Early Intervention but being culturally competent is being self-aware of what we know about early development based on the development within the dominant culture, but it is our responsibility to attain knowledge, skills, attitudes and behaviors that indicate values and understandings of different cultures- process of being humble enough to learn and grow

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Explain characteristics consistent with a diagnosis of developmental disability.

Developmental disabilities are severe, chronic disabilities that are:

-Attributable to mental or physical impairment or combination of impairments

-Manifested before age of 22 years

-Likely to continue indefinitely

-Results in substantial functional limitations in 3+ areas of life such as self-care, receptive and expressive language, learning, mobility, self-direction, capacity for independent learning, and economic self-sufficiency

-reflects the individual's need for combination and sequence special, interdisciplinary or generic services, individualized supports, or other forms of assistance that are of lifelong extended duration and are individually planned and coordinated

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Vygotsky's zone of proximal development

Zone of proximal development recognizes that we learn best things that differ only slightly from what we already know so dynamic assessments utilize to determine child's current level of communication and assess their ability to learn behaviors slightly past what they already know

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Skinner's behaviorism

Reinforcement strategies are a good way to increase behaviors so if a child receives positive reinforcement it increases the likelihood of it happening again because the positive reinforcement motivates the child

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Explain the transdisciplinary team model for Early Intervention.

The transdisciplinary team maximizes collaboration by team members so the role of the family members is maximized, there are more blended roles for other team members, ongoing collaboration and education throughout service delivery, role of Primary Service Provider (PSP) is to deliver direct, cross-disciplinary services with the family

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Describe play-based interaction assessment as part of an early intervention assessment.

In structured play, the partner attempts through manipulation of the context to elicit specific behaviors from the child while using a play mode. The professional or parent can roll a ball under or behind another object to see if the child will search for it or see if the child will follow suit and the process of the interaction takes precedence over the product or result.

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Understand and explain IFSP.

Individualized Family Service Plan is an individualized program that is offered in a natural environment or LRE for infants and toddlers. It addresses the needs of the child and the family unit and includes current status, recommended services and expected outcomes, and projection of duration of service delivery. Outcome statements reflect outcomes that the family wants for the child/family to enable ownership of plan and the PSP is the coordinator for identification and implementation of services

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Discuss IFSP and the natural environment.

The child's development needs to be monitored through accurate record keeping and recognize that children with established risk are more likely to require more intervention for improvement than those without established risk and the natural environment is the setting that is considered typical for the infant and toddlers where the child spends the most time

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Proximal gestures

touching an object with the hand, giving an object to an adult, reaching for an object, moving on object toward an adult

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Distal gestures

head shaking, waving, pointing to a distant object or action, requesting by reaching for a distant object, turning the palm up to single give me

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Enhanced natural gestures

intentional behaviors that are 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.

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Requesting gestures

can be signaled by a hand gesture accompanied by a vocalization and eye contact with a communication partner

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Rejecting gestures

might include shaking the head side to side, turning away, or using a defensive hand gesture, such as the hands extended as if pushing something away

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Explain mediated learning.

Asking questions rather than providing answers to a learner. Mediated assistance is guidance in which the amount and type of assistance are individualized to suit the learner and task and are slightly different from what the child can do at present

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Discuss language assessment in early intervention. o measures for bilingual children.

Receptive assessment focuses on comprehension of routines, watching others and linguistic comprehension. Expressive measures early language, early word combinations through semantic or constructivist approach (slide 92 on ipad) and benchmark of words and combinations by certain ages

Best measure of vocabulary for bilingual children is total vocabulary which is measures across all languages rather than a comparison of either language to a benchmark

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Discuss dynamic assessment in early intervention.

Utilized to determine not only what a child knows but how a child requires novel content including what supportive strategies are helpful (rooted in concept of Zone of Proximal Development) and utilizes test-teach-retest model for instruction and has mediated assistance utilized, individualized guidance to determine amount and type optimal for each child (repeating cues, modeling, helping child complete task)

Uses scaffold support on what is already known with minimum amount of support for child to be successful

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Discuss Autism Spectrum Disorder in early intervention.

ASD is an established risk

It is present during early developmental period but behaviors may not be fully manifested until later when social demands exceed the child's abilities

It has presence of social communication deficits and presence of ritualistic and repetitive behaviors that limit function

Communication is the primary area of concerns and early signs may be:

-decreased oral motor gestures

-excessive mouthing of objects at one year of age

-aversion to touch

-extreme irritability

-lack of facial expressions

-cries that have less variation and more dysphonia

-diminished eye contact and less orientation when name is called

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Legal basis for EI:

WHO focused on health care for vulnerable groups such as mothers and children and received government-mandated services for very young children

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Developmental disability:

Mental/physical impairment manifested before age 22 that is indefinite with functional limitations in 3+ areas of life and needs support/services/assistance

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Laws and amendments (Education of the handicapped act amendments, IDEA, IDEIA and Part C:

Education of Handicapped Act Amendments (1986)

Public law (PL) 99-457 is an amendment that was passed in 1986 that created a legal requirement to provide EI services to children with developmental disabilities and their families

Individuals with Disabilities Act (IDEA) (1990)

IDEA requires free appropriate public education (FAPE) for children with disabilities

In 1990, IDEA Part C focused on services for children between birth and 3 years old with the development of an IFSP to determine service delivery

In 1997, IDEA strengthened the role of the family in Part C

Individuals with Disabilities Education Improvement Act (IDEIA) (2004)

In 2004, a reauthorization enabled a possible extension through age 6

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inability to perform

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abnormality in function/structure

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social consequences of disability

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Transdisciplinary team:

maximizes collaboration by team members and creates more blended roles for other team members, ongoing collaboration and education throughout service delivery, and role of PSP to deliver direct, cross-disciplinary services with the family

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Family-Centered Service Delivery:

equal partnership with families that will assist you in overcoming barriers to family involvement in service delivery, dynamic relationship and recognition that strengthens and needs will change over time, recognizes the impact of stress with families, freely exchange information with families and provides choice to families in terms of level of participation

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Overcoming barriers:

frequent barriers to working with families are clinician factors such as caseload size and lack of time, family factors such as lack of interest, education and cultural differences and sometimes lack of experience

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Cultural considerations:

much of what we know about caregiver-infant interactions comes from American majority culture

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Cultural competence:

dynamic ongoing process of attaining knowledge, skills, and practices that enable you to work effectively in cross-cultural settings

SLP's honor and respect beliefs, behaviors and parenting styles of clients

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Bilingual development:

children with CI can develop bilingually and need parental input of language in the home and english will occur through media and school

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Very important within early communication intervention to see behaviors and conversational participation between child and parents

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Tailored to individual child with flexibility as child continues to develop

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Natural environment

Settings that are typical for infants and toddlers and individualized programs should be offered in the child's natural environment or in the least restrictive environment

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Daily routines

opportunities for child to learn and develop within events occurring naturally in the home environment

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has a positive impact on developmental, academic, adaptive, and social progress of young children with disabilities

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Individualized Family Service Plan

Child and family's current status, recommended services and expected outcomes, and a projection of the duration of service delivery

Family needs to feel ownership of the plan through participation and plan should be reviewed and updated as needed to accommodate the child's and family's changing needs

Family is part of the transdisciplinary team

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EBP and evaluating research

Decision-making is informed by a combination of scientific evidence, clinical experience, and client needs

EBP can be inconclusive (outcomes not plausible with design flaws), suggestive (flaws exist but outcomes are plausible), and preponderant (minor flaws and certain outcomes are more likely possible), and conclusive (certain outcomes are undoubtedly the result)

Develop a well-built question, select evidence sources, execute a search strategy, examine and synthesize the evidence, apply the evidence, and evaluate the application of the EBP evidence

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Communication impairment

Children who have late language emergence that don't mature out of their difficulties

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Late language emergence

Hallmark characteristic of children with language impairment and often the first diagnostic symptom of a larger language problem

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Early identifying signs of health and developmental problems

Deficits occur gradually over time as child's delays become evident

Infant or toddler fail to meet milestones of typical development and often the family reports initial concerns

Infants with established risk can typically be detected at birth but other impairments may take longer to be identified

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score given to newborn by physician or nurse at one and five minutes after delivery to assess newborn's general status and adaptability to life

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Functional communication

Use of symbols or actions to express basic wants and needs and to obtain desired outcomes; ability to communicate effectively through use of any means

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Transactional model

Typical communication and language development in which the parent and child are both contributing partners, is widely accepted and suggests a functional model for intervention

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Carryover behaviors across contexts and can be enhanced through sufficient exemplars, common stimuli, and general case programming

General case programming uses strategies such as cuing and responding and the selection and sequencing of teaching to build generalized responding across contexts

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Family-centered intervention

Home-based intervention programs are success with children with varying disorders because the family's daily routines and activities are unique, creating specific interactions that shape a child's development

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Contextual fit between caregiver's current strategy, a child's communication goal, and identified routine so the SLP and caregiver select specific teaching strategies to meet specific needs of child

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Responsive Interaction strategies:

include models of target communication behavior without obligation for the child to respond (following child's lead, expanding on child's topic, engaging in self-talk and parallel talk)

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Directive Interaction strategies:

manipulate antecedents and consequences that surround desired behavior; adults alter cues and prompts to elicit behavior and manipulate what follows the behavior to give corrective feedback and strengthen desired response while weakening others (hold cookie in front of child and ask "what do you want" and if the child says "cookie" then adult gives child cookie and verbally responds in positive way)

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Blended strategies:

or hybrid intervention, structural behavioral strategies frequently fail to generalize to more functional and interactive environments (include teaching in natural environments using strategies for modeling language and responding to children's communication from typical mother-child interactions)

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Family centered services and rationale

Set of beliefs, values, principles, and practices that support and strengthen a family's ability to enhance a child's development and learning

Families provide lifelong context for child's development and services align with family's unique characteristics

Intervention based on real everyday experiences, caregiver-child interaction, family concerns and child's age, development, cognitive level, learning style, strengths and interests

Rationale: interested in entire family and not just the child because SLP's serve families and children and understanding how cultural and familial differences shape child is key doctor in developing collaborative interventions

Family systems theory: child needs to be considered an individual in an emotional unit known as the family

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Ecological theory

four systems that contain cultural (macro), community (exo), organizational (meso), and interpersonal (micro) influence child's development

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Parent interaction style variables

Parents communicate toward their children with disabilities more directive and less conversational than parents of TD children

More parent-child interactions within daily activities can exert significant positive influence on a young child's communication development

Amount of parent-child interaction, responsiveness to child communication, amount of quality of linguistic input, and use of language-learning support strategies help child's language development

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Collaboration with parents

Team members and primary agents that support their child's development and act in the role of decision-making as well as generalizing intervention through daily routine and helping SLP's know their child's history, behaviors, interests to help increase child's motivation in intervention

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How to talk to young children

Animation, communicate at eye level, listen take turns and know when to stop, provide rich input, best times to communicate and have child's attention, always respond, speak in short phrases, speak slowly and repeat words, follow child's lead, use gestures to aid comprehension

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Using daily routines

SLP helps parents identify ordinary daily routines (bath and bedtime) and play to create opportunities for communication

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Incidental teaching:

naturalistic, child-directed intervention strategy used during unstructured activities (child standing to one side but watching another child play and teacher prompts child to initiate interaction by asking to join the play)

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Friendship activities:

naturalistic interventions for improving young children's peer interactions (common class activities by encouraging children to make friendly statements, smile, be nice, share)

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Social integration:

systemic teacher and peer support for young children with social interaction difficulties (SLP uses prompts and scaffolds to encourage children to interact such as suggesting how to play or assigning roles for play and directly prompt play)

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Explicit teaching:

relatively intensive training of specific social strategies, explicit social skills training including stay-play-talk (stay with your friend, play with your friend, talk with your friend)

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Role of SLP as part of EI team

SLPs are uniquely qualified to help families enhance their child's communication development and has following primary functions: prevention, screening eval and assessment, planning implementing and monitoring interventions, consultation with other team members, service coordination, transition planning, advocacy to raise awareness about importance of EI, awareness and advancement of knowledge base in EI through experimental and clinical research

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one time evaluation to collect data, structured and formal and rely on use of standardized instruments to determine eligibility for services by identifying child's level of developmental functioning

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continuous and less formal and rely on multiple tools and methods for ongoing process of identifying a child's unique needs, family's priorities and concerns, and nature and extent of EI services needed by both

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Transdisciplinary model of assessment

Young children typically need assessed by more than one professional and may have disorders in several developmental areas so an arena assessment is best to assess child all together and integrate all testing and observation

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Communication data is frequently collected through free and structured play with child

In structured play, partner attempts to manipulate context to elicit specific behaviors from child while using a play mode

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Role of parents and caregivers in assessment

Parents help child attain current level of communication but role is participation in early intervention to create empowerment and ownership to make decisions, may fill out reports/questionnaires to add additional information and participate in assessments or observe

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Family concerns:

vary with each family and are influenced by characteristics of family culture and dynamic because family knows child best and sometimes have specific concerns

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what family feels to be most important based on their beliefs, values, and culture

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not all families take same roles within service delivery and decision making so resources help parents identify and use their roles in EI

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Informal assessment

Recognize behaviors and identify most significant early communication developments that affect early language and recognize which behaviors have the greatest impact on later CI

Can be done through observation and can be completed informally

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child's attempts to communicate, possibly through screaming to signal a desire or making consistent sound that are unique to child and caregiver; incomprehensible to others outside of immediate context

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focusing on symbols and the ways in which the child understands and expresses

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focusing on words and following rules to communicate and understand each other

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Forms and means:

communication forms can be intentional or unintentional and means can be physical, vocal, or both

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Functional equivalence:

two behaviors have the same effect on the environment (screaming or tapping listener both gets attention then its functionally equivalent)

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Response efficiency:

relationship between effort and outcome

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Communication success:

communication goal is attained

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Evaluating caregiver-child interactions

Contingency or relatedness of response to behavior of child, consistency of adult response, timeliness or quickness with which adult responds can add to quality of this

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draw partner's focus towards something

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Joint attention:

ability to coordinate attention between partner and object for social purpose

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Motor imitation:

used by presymbolic TD children to coordinate attention between social partners and objects within interaction

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Functional use:

children talk about things they know so when they use an object for intended purpose that means they form a concept or begin to know that object by its use and you can build on that knowledge in intervention (whats an apple? Something you eat)

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Intentional communication:

any child gesture and or vocalization that is either conventional or symbolic in form and produced in combination with a behavior that demonstrates coordinated attention to both an object or event and person at same time

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Presymbolic gestures:

deictic gestures can be interpreted by context or by calling attention to or indicating an object or event (taking adults hand or pointing and reaching)

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Representational gestures:

object-related gestures that signify some feature of the referent (cupping hand to mouth to represent drinking or waving bye)

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of gesture is use of coordinated attention to adult and object combined with gestures or vocalizations or conventional gestures or symbols directed toward an adult

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Gesture development:

6-7 months- protesting/showing off

7-13 months- requesting objects, actions, assistance

8-10 months- showing objects

9-10 months- pointing to actions, objects

10-13 months- giving

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Oral motor abilities:

structure and function is important to see if motor planning is affecting expressive language

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productions of early sounds and words with diversity of sounds and syllable types is important for later expressive language

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Level of play:


infant examines environment through combination of sensory modes

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Level of play:


child is influenced by social or cultural properties of objects

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Level of play:


infant uses objects in combination but without regard for attributes or functions of the objects

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Level of play:


child uses object attributes that are not present or substitutes objects

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Level of play:


adopts role

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may impact child's speech and language development

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Motor and cognitive skills:

related to communication abilities and may create likelihood of speech and language deficits

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Feeding and swallowing:

necessary for nutrition, health and development and precursors to the development of early oral communication

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recognitory gestures are play schemes in which object is used for intended function and representational/symbolic gestures do not manipulate referent but instead symbolize referent (run with arms extended to symbolize airplane)

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words will gradually replace gestures

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Reinforcing combinations:

convey matching info such as pointing to juice and to glass to indicate wanting juice poured in as child says juice class

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