FIRST WORDS Project

Model Demonstration Project

http://firstwords.fsu.edu

Amy M. Wetherby, Ph.D.Project Director

NECTAS Child Find

Teleconference

Need to Improve Early Identification of Developmental DisabilitiesPercentage of Population Receiving Special Education or Early

Intervention Services in 1997/98:

School-Age Children

6 to 18 years 10.95%

Preschool Children

3 to 5 years 4.79%

Infants and Toddlers

Birth to 2 years 1.70%

(US DOE, 1998)

Communication and language problems are the most common symptom in young childrenDisability Category % ServedSpecific Learning Disabilities 51.1Speech or Language 20.8Mental Retardation 11.6Serious Emotional Disturbance 8.7Multiple Disabilities 1.8Hearing Impairments 1.3Orthopedic Impairments 1.2Other Health Impairments 2.2Visual Impairments 0.5Autism 0.5Deaf-blindness 0.1Traumatic Brain Injury 0.1

(US DOE, 1998)

Improving Early Identification

A child’s rate of language acquisition may be solidified by 2 to 3 years based on the rapid maturation of the brain.

Instead of waiting to see if a child is late in talking, it is important to evaluate skills that are early indicators of language development.

Prelinguistic Predictors of Persisting Language ProblemsSOCIAL COMMUNICATION

Emotion and Use of Eye GazeUse of CommunicationUse of Gestures

EXPRESSIVE SPEECH AND LANGUAGEUse of SoundsUse of Words

SYMBOLIC CAPACITYUnderstanding of WordsUse of Objects

Profile Distinguishing Autism Spectrum and Delayed Language in Young Children (Wetherby, Prizant & Hutchinson, 1998)EMOTION AND USE OF EYE GAZE

Weakness in gaze shifts/shared positive affect; excess negative affect

USE OF COMMUNICATION Weakness in joint attention; comparable in behavior regulation

 USE OF GESTURES Weakness in conventional & distal gestures; poor coordination of

gestures and sounds

USE OF SOUNDS Comparable limited consonant inventory & syllable structure  

 SYMBOLIC CAPACITY Weakness in language comprehension and pretend play;

comparable constructive play 

Evaluation versus Assessment

Evaluation for Identification Screening Diagnostic testing Determining initial and continuing eligibility

Assessment for Educational Planning Profiling strengths and needs Monitoring changes with treatment

Recommended Practices for Evaluation and Assessment of Young Children

Utilize multiple sources of information (parent report, observation & sampling)

Gather information from multiple observations

Provide information about child’s growth rate and capacity for development

Allow families and professionals to gather and share information to build consensus about strengths and needs

FIRST WORDS ProjectEvaluation Model

Step One: Brief Parent Report Infant/Toddler Checklist for Communication and

Language Development

Step Two: More Detailed Parent Report CSBS-DP Caregiver Questionnaire Ages and Stages Questionnaires

Step Three: Child & Family Evaluation CSBS-DP Behavior Sample of child interacting with

caregiver and clinician

CSBS Developmental Profile:

BehaviorSample

Warm-upCommunicative Temptations (Wind-up toy,

Balloon, Bubbles, Jar, and Toys in Bag)Sharing BooksSymbolic Play (feeding set) Language Comprehension (object names,

person names, and body parts)Constructive Play (stacking blocks)Caregiver Perception Form (caregiver rates how

typical child’s behavior is during sample)

(Wetherby & Prizant, 1998)

CSBS Developmental Profile

Measurement Parameters for Checklist, CQ & BS

Emotion and Use of Eye GazeUse of CommunicationUse of GesturesUse of SoundsUse of WordsUnderstanding of WordsUse of Objects

CSBS Developmental Profile

Correlations for Three Measures

Checklist and CQr=.92 p< .0001 n=129

CQ and BSr=.78 p< .0001 n=127

Checklist and BSr=.72 p< .0001 n=114

(Wetherby & Goldstein, 1999)

CSBS Developmental Profile

Correlations for Test-Retest of the Three Measures

Checklist 3 month retest intervalr=.88 p< .0001 n=108

CQ 4 month retest intervalr=.87 p< .0001 n=112

BS 4 month retest intervalr=.80 p< .0001 n=26

(Wetherby & Goldstein, 1999)

Correlations for CSBS-DP and MacArthur CDI Vocabulary Production at 24 months

Mean Initial Age 21 months 15 months

ChecklistUse of Words r= .65 r= .60TOTAL r= .44 r= .50CQUse of Words r= .80 r= .73TOTAL r= .65 r= .64BSUse of Words r= .58 r= .67TOTAL r= .65 r= .64

(Wetherby & Goldstein, 1999)

Possible Outcomes of Children Late in Talking

Late Bloomer

Impairment in one or more of the following: Hearing

Speech

Language

Communication

Accuracy of Diagnosis at Age 2

Diagnosis of Specific Language Impairment

About half of children identified as late talkers at age 2 receive a diagnosis of specific language impairment at age 3

Children who are delayed in expressive language only are very likely to catch up on their own

Children who are also delayed in receptive language, use of gestures, and play are more likely to have persisting language problems

(Paul, 1991; Rescorla, 1991; Thal, Tobias, & Morrison, 1991)

Accuracy of Diagnosis at Age 2

Diagnosis of Autistic Disorder

72% of children diagnosed at age 2 retained that diagnosis at age 3

94% retained diagnosis of ASD at age 3

Diagnosis of Atypical Autism (PDD-NOS)

42% of children diagnosed at age 2 retained that diagnosis at age 3

74% retained diagnosis of ASD at age 3

(Lord, 1995; Lord & Risi, 2000)

Clinical Features of Autism Spectrum in Young Children

Social Impairments were prominent at 24 months

Communication Impairments were prominent at 24 months

Restricted Repertoire of Activities and Interests were not prominent until 36 months

(Lord, 1995; Stone, Lee, Ashford, Brissie, Hepburn, Coonrod, & Weiss, in press)

Markers Based on CHAT at 18 months

Proto-declarative pointing

Gaze-monitoring

Pretend play

12 of 16,000 failed these 3 key items and 10 received diagnosis of autism (.06%).

22 of 16,000 failed 2 of the 3 items and 15 were developmentally delayed without autism (.08%).

(Baron-Cohen, et al., 1992; 1996)

Features Distinguishing Autism Based on Home Videotapes at 12 months

Pointing

Showing

Looking at Others

Orienting to Name

Only the latter two distinguished children with autism from children with developmental delays.

(Osterling & Dawson, 1994; 1999)

Practice Parameters for Screening and Diagnosis of Autism Spectrum

Absolute Indications for Immediate Further Evaluation:

No babbling by 12 monthsNo gesturing (pointing, waving bye-bye) by 12

monthsNo single words by 16 monthsNo 2-word spontaneous (not just echolalic) phrases

by 24 monthsANY loss of ANY language or social skills at ANY age

**********

Child Neurology Society and American Academy of Neurology(Filipek, Accardo, Baranek, et al., 1999)

Linking to Intervention

We are now serving a small proportion of young children needing services

Improving early identification efforts will increase the need for early intervention, …..so be ready to expand services

FIRST WORDS Project Menu of Service Options

Preventative Family Education/Support Services

Intensive, Individualized Early Intervention

Preventative Family Education/Support Servicesparent education group meetings in

the communityinfant/toddler peer play groupscaregiver education modules for

families and service providersparent support and networking

groupsresource and referral database 

Intensive, Individualized Early Intervention

individualized intervention through a family-guided assessment of the child’s communication and the communicative environment

parents are essential partners in the identification of specific concerns, intervention planning, and evaluation of outcomes

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