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 them…that 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 Vocabulary Comp.Wetherby et al.(1988); Paul &Schiffer, (1991) 18 mos – 2

communicativeacts/min

24 mos - 5 CAs/min

Fensen et al. (1990) 18 mos – 110 words 24 mos – 312 words 30 mos – 546 words

Chapman (1978) 18-24 mos –

understand 2-3words/sentencethey hear

Nelson (1973) 18 mos – combining

2 wordsMiller (1981) 24 mos – MLU –

1.5-2.4

Assessment of Communication in EL

Multidisciplinary and Transdisciplinary assessment

Play assessmentCommunication

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

interactionsrates performance in five areas

Informal examination of communication functioning

Informal Examination of Communication Function

Assessing Communicative IntentionAssessing comprehensionAssessing Production

Assessing Communicative Intention

Range of communicative functions Proto-imperatives

Requests for objectsRequests for actionsRejections or protests

Proto-declaratives Discourse functions

Requests for InformationAcknowledgementsAnswers

Assessing Communicative Intention (cont’d)

Frequency of expression of intentions

Forms of communication (e.g. gestural, vocal)

Assessing Communicative Intent: Worksheet

Table 8-4, page 256Communicative 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 itemsGive me… or Where’s…Can assess body partsAssess verbsComprehension of single words is

normal for 12-18 mos. What if they don’t?

Comprehension activities: Two word comb’s (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 instructionsRely on probabilityStart with vocabulary from earlier

stages and then move onsee Table 8-6

Comprehension beyond 36 months

Can be tested using formal comprehension measures such as PPVT-III, 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 developmentSpeech sample/phonetic repertoirePhonological skills Lexical production/VocabularySemantic-syntactic production

Vocabulary (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,

1989)

Semantic syntacticproduction

Children don’t 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 relationsAdvanced relations

Normal toddlers express 8-11 different semantic relations

Decision making based on assessment information

See Paul’s 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 child’s attention to it and wait for a response

Developing Intentional Communication (cont’d)

#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 (cont’d)

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 (cont’d)

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 I’ll give it to you.)

might need to actually take the child’s 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 (cont’d)

Developing a first lexicon (cont’d) MacDonald suggested choosing words

that are within the child’s interests Consider the child’s phonetic repertoire

choose words with sounds in the child’s 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 don’t require response

Hybrid approach milieu teaching

place objects out of child’s reach

script therapyengage 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 child’s reach - “get X”

focussed stimulation script therapy

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

Developing word combinations (cont’d)

Clinician-directed approaches Leonard (‘75)

use a puppet and the puppet describes what’s happening in the picture

get the child to tell the puppet what’s happening and to “talk like” the puppet

MacDonald et al. (‘74) - Environmental Language Intervention (ELI)parent works on goal for 5 min in 3 conditionssessions are three times/weeksee Box 8-6