Assessment and Intervention for Emerging Language

Paul R. (2001). Language Disorders from Infancy through adolescence. Chapter 8

What is emerging language stage (EL)?

For normally developing children, corresponds to toddler age range Approx - 18 - 36 months

Who might be at the EL stage?

Children between 18-36 mos with no known risks but parents or others are concerned Children between 18-36 mos with known risks Older children with severe disabilities

To see them or not to see themthat is the question.

Children under 3 with intact cognitive, preverbal communicative, and sensory capacities with no risk factors - low priority Children with cognitive deficits, hearing impairment or chronic OM, preverbal communication problems, risks pre or perinatally - should be seen

But remember...
Therapy may facilitate development in normal slow talkers Children with later language disabilities often have histories of delayed language development

Normal Development
Expression
Wetherby et al. (1988); Paul & Schiffer, (1991) 18 mos 2 communicative acts/min 24 mos - 5 CAs/min Nelson (1973) 18 mos combining 2 words Miller (1981) 24 mos MLU 1.5-2.4

Vocabulary

Comp.

Fensen et al. (1990) Chapman (1978) 18 mos 110 words 18-24 mos understand 2-3 24 mos 312 words words/sentence 30 mos 546 words they hear

Assessment of Communication in EL
Multidisciplinary and Transdisciplinary assessment Play assessment Communication assessment

Play Assessment
Want to ensure child is at a developmental level consistent with communication development Relationships exist between play and language development Provides a more holistic picture of the child

Assessing Play
Communication and Symbolic Behavior Scales (Wetherby & Prizant, 1990) Play Scale (Carpenter, 1987)
parent plays with the child see Table 8-1, 8-2 p 251

McCune (1985)
child is given a set of toys and behaviours are analysed (see Table 8-2)

Symbolic Play Test (Lowe & Costello, 76)

Communication Assessment
Rating Scales
see Table 8-3, p. 253-254 Communication and Symbolic Behavior Scales (Wetherby & Prizant, 1990)
observe parent and child in various interactions rates performance in five areas

Informal examination of communication functioning

Informal Examination of Communication Function

Assessing Communicative Intention Assessing comprehension Assessing Production

Assessing Communicative Intention

Range of communicative functions
Proto-imperatives
Requests for objects Requests for actions Rejections or protests

Proto-declaratives Discourse functions

Requests for Information Acknowledgements Answers

Assessing Communicative Intention (contd)

Frequency of expression of intentions Forms of communication (e.g. gestural, vocal)

Assessing Communicative Intent: Worksheet

Table 8-4, page 256 Communicative Act:
Must be directed at adult. Child must look at or address the adult directly in some way. Must have an effect on influencing the adults behaviour/focus of attn or knowledge. Child must be persistent in the attempt to convey the message if the adult does not respond

Assessing Comprehension
Standardized language tests/scales
PPVT-III, Sequenced Inventory of Communicative Development (SICD), Receptive Expressive Emergent Lang Scale (REEL).

Comprehension Activities:
Understanding Single Words A collection of six to eight items Give me or Wheres Can assess body parts Assess verbs Comprehension of single words is normal for 12-18 mos.
What if they dont?

Comprehension activities: Two word combs (18-24m)

Action-object (use words understood at single-word stage) choose unusual combinations such as kiss the apple hug the shoe

Comprehension Activities: Beyond 2-words (24-36 m)

Agent-action-object instructions Rely on probability Start with vocabulary from earlier stages and then move on see Table 8-6

Comprehension beyond 36 months

Can be tested using formal comprehension measures such as PPVTIII, TACL-R, Miller-Yoder Test of Grammatical Comprehension, CELF-P

Comprehension Findings: What do they mean?

If comprehension is superior to production
better outcomes

If comprehension is poor:
need to include comprehension component in therapy as well as expressive component

Assessing Espressive Language

Speech motor development Speech sample/phonetic repertoire Phonological skills Lexical production/Vocabulary Semantic-syntactic production

(Lexical Production)
Expect a child to have at least 50 words and some two-word combinations in the 24-36 month stage Rating scales
MacArthur Communicative Development Inventories (Fenson et al., 1993) Language Development Survey (Rescorla,

Vocabulary

1989)

Semantic syntactic production

Children dont begin to combine words until

vocabulary size is approx 50 words

To assess semantic-syntactic production:

Determine the relative frequency of word combinations Evaluate semantic relations expressed
Table 8-7 (Browns Semantic Relations) Variety of relations Advanced relations

Normal toddlers express 8-11 different semantic

relations

Decision making based on assessment information

See Pauls decision tree on p. 253 (Fig. 8.2)

Intervention: Goals, Procedures & Context

Four main areas that may be targeted:
Functional and symbolic play skills Using intentional communication Language comprehension Production of sounds, words, and word combinations

Functional and Symbolic Play Skills

Step1: Establish reciprocal behaviour and anticipatory sets (e.g. peek-a-boo) Step 2: Model early forms of symbolic play and encourage imitation Step 3: Model play routines like pretending to give the doll a bath, meal time, store games

Developing Intentional Communicative Behaviours

Want children to initiate communication #1: Communication temptations
can model first with the parents (e.g. hand Mum a container and she hands it back to therapist and indicates take the lid off or says help. Then hand container to the child)

#2: Milieu model

place things out of reach and get the child to ask for it or draw the childs attention to it and wait for a response

Developing Intentional Communication (contd)

#3 : Use routines or script therapy and then violate the routines #4 : Respond as though the child is showing intent #5: If range of intent is limited, increase use of proto-imperatives and declaratives
model the behaviour pretend not to notice something that the child is interested in and wait for them to get your attention

Developing Intentional Communication (contd)

If child has adequate intentions but is only using gesture -->increase vocalising
Model the target response Withold response or pretend not to notice until some vocal behaviour produced

Developing Intentional Communication (contd)

If the child is using maladaptive behaviour:
immediately provide an alternative form of communication (e.g. I see you want it. Point to it and Ill give it to you.) might need to actually take the childs hands and demonstrate the action

Developing Receptive Language

Indirect Language Stimulation (parent training)
self-talk/parallel talk imitations expansions extentions build-ups and breakdowns recast sentences labelling see box 8-3

Developing sounds, words, and word combinations

Increasing phonological skills
expand the repertoire of sounds use developmental information

Developing a first lexicon

choose words based on normative data some words should be nouns for labeling other words should be chosen for expressing other functions see Table 8-10

Developing sounds, words, and word combos (contd)

Developing a first lexicon (contd)
MacDonald suggested choosing words that are within the childs interests Consider the childs phonetic repertoire
choose words with sounds in the childs repertoire early words may be limited to CV and CVC shapes

How should we teach first words?

Child centered approach
clinician provides many models use play contexts and dont require response

Hybrid approach
milieu teaching
place objects out of childs reach

script therapy
engage in a verbal routine, once it is overlearned, either violate it or use a cloze technique

How should we teach first words?

Hybrid approaches
focussed stimulation
set up the situation so that you are modeling the specific vocabulary you want to teach provide lots of opportunities for the child to produce it use recasts, expansions, extensions, etc.

Clinician-directed
may be suitable for older children

Developing word combinations

Word combinations express semantic relationships Client-centered
play situation-when the child produces a one-word utterance, the clinician expands it to a two-word phrase

Developing word combinations

Hybrid approaches
Schwartz et al.(85) - vertical structuring Whitehurst et al.(91) - see box 8-5 milieu approaches
put something out of childs reach - get X

focussed stimulation script therapy

perhaps use a book or song-play that has two words

Developing word combinations (contd)

Clinician-directed approaches
Leonard (75)
use a puppet and the puppet describes whats happening in the picture get the child to tell the puppet whats happening and to talk like the puppet

MacDonald et al. (74) - Environmental Language Intervention (ELI)

parent works on goal for 5 min in 3 conditions sessions are three times/week see Box 8-6