Developmental Disabilities: Overview and Definitions

• Developmental disabilities include a wide range of conditions that affect development across multiple domains.
  • Examples mentioned: intellectual disabilities, autism, cerebral palsy, Down syndrome, fetal alcohol syndrome, sensory impairments (hearing loss, visual impairment), and various genetic conditions.
  • Kids with developmental disabilities may not share a single cause or pattern; there is variability in how and when areas are affected.
• Common misconceptions clarified in discussion:
  • Boys are at greater likelihood/prevalence for some disabilities, but boys are not an inherently at-risk population; risk factors exist beyond gender.
  • Being from a low-income background or other contextual factors increases risk but does not cause a disorder.
• At-risk vs at-risk population:
  • At-risk factors discussed include low SES, low parental education, family history, international adoption, abuse/neglect, and low birth weight (even if term).
  • These factors increase likelihood of communication and developmental challenges but are not determinative on their own.
• Importance for SLPs:
  • Early detection and ongoing support for children with developmental disabilities, particularly when impairments are in receptive/expressive language, feeding/swallowing, social communication, or cognitive communication.
• Distinctions introduced:
  • Social communication vs. cognitive communication (defined and differentiated below).
• Core question for early language development:
  • What is the function of a child’s language? How do early children express different functions (e.g., requesting, commenting, labeling, clarifying, expressing emotions)?
• Early functions (pragmatic goals) discussed include:
  • Requesting/needs-based communication (e.g., crying when hungry or needing something to eat or cook).
  • Clarification: seeking more information or ensuring understanding.
  • Expressing emotion or feelings.
  • Commenting about the environment or ongoing events.
  • Labeling: naming objects or events.
• Note on development of communicative intent:
  • Early intervention focuses on understanding these communicative functions to target development in natural contexts.

Social vs. Cognitive Communication: Concepts and Significance

• Social communication: why and how children communicate to engage with others (pragmatic functions, interactional skills).
• Cognitive communication: how cognition underpins communication (attention, executive function, processing, perspective-taking).
• Foundational link:
  • Attention and joint attention (the ability to coordinate attention with another person toward an object) are foundational for both communication and cognition.

Early Intervention (IDEA) Overview

• IDEA (Individuals with Disabilities Education Act) supports infants and toddlers with delays or disabilities and their families.
• Key timeframes:
  • Birth to three: IDEA Part C (early intervention).
  • Three to five: IDEA Part B (preschool services).
• Service environment and philosophy:
  • Least Restrictive Environment (LRE) principle applies; for birth-3, the natural environment is emphasized (home, day care, community settings).
  • Family-centered services: interventions are built around the family’s needs and routines.
• Core components and processes:
  • Screening, identification, assessment, and intervention are part of the service delivery model.
  • Screening and identification involve identifying red flags and at-risk children in the community (e.g., workshops, education, parent materials).
  • Culturally and linguistically appropriate detection strategies are essential for diverse populations.
  • Evaluation and assessment are used to determine eligibility and establish baseline functioning.
• Eligibility vs. diagnosis:
  • Eligibility for Part C is based on developmental delays or diagnosed conditions and varies by state.
  • Diagnosis is a separate determination from eligibility (eligibility is for access to services; diagnosis may specify a disorder).
• Comprehensive evaluation domains (Part C): evaluate five developmental domains:
  • Communication skills (expressive, receptive language, preverbal skills).
  • Cognition.
  • Physical abilities (gross motor and fine motor, bimotor).
  • Sensory skills.
  • Adaptive and self-help skills.
  • Social-emotional skills.
• Strengths and needs:
  • Assess and document both strengths and needs across domains to build a comprehensive profile for the child.
  • Collaboration with other professionals to form a complete picture (multidisciplinary approach).
• Intervention and service delivery:
  • Develop developmentally appropriate interventions to support the child and family.
  • IFSP (Individualized Family Service Plan) development and services, including direct intervention and caregiver coaching.
  • Services occur in the natural environment and embed strategies into play and daily activities.
  • Promote responsive interaction styles within the family’s routines.
• Collaboration and transition:
  • Team meetings to monitor progress and adjust goals.
  • Plan for transition to preschool (ages 3-5) and subsequent service pathways.
• Additional responsibilities and policy work:
  • Advocating for appropriate services and policies for young children.
  • Educating families about communication development and neurodiversity.
  • Coordinating with broader supports (e.g., WIC, housing, employment supports) to address the family’s overall needs, recognizing the home as the natural environment for early intervention.

Early Communication Intervention: Focus Areas and Methods

• Primary focus areas:
  • Prelinguistic (preverbal) communication, especially birth to 3 years, where delays are common.
• Caregiver coaching and family-centered approach:
  • Intervention is often delivered through caregiver coaching in the family’s home or typical environments to maximize carryover.
  • Direct services may be provided, but the emphasis is on coaching families to support their child’s development.
• Core targets in early communication:
  • Joint attention (both initiating and responding to joint attention) as a foundation for later language.
  • Gestures and early vocalizations (nonverbal and verbal prelinguistic communication).
  • Imitation as an important stepping-stone to symbolic communication and later language.
• Role of joint attention:
  • Joint attention predicts later expressive language skills.
  • Lack of joint attention is a core challenge for children with ASD.
  • Joint attention is foundational for symbolic communication, social-emotional development, and theory of mind.
• Theory of mind concept:
  • Ability to understand that others have thoughts and perspectives that may differ from one’s own.
• Natural environment observations and tools for joint attention assessment:
  • CSBS (Communication and Symbolic Behavior Scales)
  • Early Social Communication Scales (ESCS)
  • MCDI (MacArthur-Bates Communicative Development Inventories) as a parent-report tool
  • Structured probes (e.g., adults pointing to objects and observing the child’s response)
• Intervention strategies for joint attention:
  • Routine-based interventions that support predictable interactions.
  • Commenting and expansions: narrating ongoing activities, answering unasked questions, or expanding on a child’s communications.
  • Initiating AAC (augmentative and alternative communication) or other visual supports when needed to facilitate coordinated attention.
• Early communication milestones and gestures:
  • Gestures and language milestones support later language development; by 16 months, typically developing children should have at least 16 gestures.
  • Expectation: about 2 new gestures per month between 9 and 16 months.
  • Early gestures include head-shake/no, giving an object, showing objects to share interest, waving, and open-hand pointing.
  • By around 12 months: open-hand pointing and tapping to draw attention.
  • Sign language vs. gestures:
  • Sign language is symbolic communication and can be used alongside gestures; signs may be more abstractly symbolic than conventional gestures.
• Pairing gestures with verbal communication:
  • Model and encourage simultaneous use of gestures with speech (e.g., saying the word while performing the gesture).
• Motor and vocal development considerations:
  • Vocal play, imitation of child signs, animal sounds as a means to build symbolic understanding and language concepts.
• What to observe and assess in practice:
  • Face-to-face interactions and mutual gaze expectations from birth to 6 months.
  • Joint attention indicators (responding and initiating) and how child shares attention with others.
  • Eye gaze and sustained engagement with caregivers during activities.
  • Early communication samples and repertoire of sounds, babbling, and first words.

Assessment Tools and Multidisciplinary Approach

• Tools commonly used to assess joint attention and early communication:
  • CSBS (Communication and Symbolic Behavior Scales)
  • ESCS (Early Social Communication Scales)
  • MCDI (MacArthur-Bates CDI) for parent-reported vocabulary and communication skills
  • Structured observational probes for joint attention (e.g., adult cues and child responses)
• Assessment methods:
  • Comprehensive evaluation across five developmental domains (as listed in Part C) by a multidisciplinary team.
  • Distinction between screening/identification and formal diagnosis/eligibility.
• Language sampling and speech assessment:
  • Direct observation, speech sound assessment, language sampling to determine expressive and receptive abilities, phonology, morphology, syntax, and pragmatic use.
• Role of the SLP in evaluation:
  • Identify strengths and needs, collaborate with other professionals, and establish baseline functioning to inform IFSP goals.

Intervention Delivery: Practical Strategies and Concepts

• Intervention focuses on naturalistic, developmentally appropriate activities:
  • Embedding strategies into play and daily routines at home or in community settings.
  • Coaching families to respond to and scaffold a child’s communication attempts.
• Functional outcomes and goals:
  • Develop functional communication outcomes tied to real-life activities and family routines.
• Collaboration in intervention:
  • Regular IFSP team meetings to review progress and adjust supports.
  • Collaborative planning with families, therapists, teachers, and other professionals.
• Additional supports and services:
  • Coordination to connect families with services (nutrition programs like WIC, housing, employment resources) and medical care as needed, reflecting the home-centered approach.
• Transition planning:
  • Planning for preschool transition and ensuring continuity of services through the IEP pathway after age 3.
• Ethical and practical implications:
  • Emphasis on culturally and linguistically sensitive practices to ensure equitable access and appropriate identification.
  • Advocacy for services and policies that support families, not just the child.

Key Takeaways for Practice and Exam Preparation

• Early identification and intervention are built around four pillars:
  • Understanding developmental disabilities and risk factors, including how contextual factors influence access to services.
  • Differentiating social vs. cognitive aspects of communication and recognizing the central role of joint attention.
  • Implementing IDEA Part C services in the natural environment with a family-centered focus and a comprehensive evaluation across multiple domains.
  • Using evidence-based, family-centered strategies (routine-based intervention, caregiver coaching, AAC/visual supports) to promote early communication targets.
• Important distinctions:
  • Eligibility for early intervention vs. formal diagnosis are separate processes; both inform the provision of services.
  • Receptive and expressive language development, preverbal skills, cognitive development, motor and sensory domains, adaptive behavior, and social-emotional skills are all evaluated in a comprehensive assessment.
• Practical application notes:
  • Early joint attention and gestural development are strong predictors of later language outcomes; monitor progress in both RJA and IJA.
  • Use structured tools (CSBS, ESCS, MCDI) to assess early communication, and combine with naturalistic observation and parent reports.
  • Emphasize caregiver coaching and embedding strategies into daily routines to maximize generalization and long-term outcomes.

Required Actions and Coursework (Unit 2)

• Read Chapter 4 in the textbook.
• Review ASHA practice portal document referenced in slides.
• Complete the unit 2 quiz.
• Work on the unit 2 project; some portions may require homework.
• Prepare to discuss and apply these concepts in class, including potential case examples and activities involving IFSP/IEP planning, joint attention strategies, and early communication interventions.