Assessment and Intervention for Emerging Language

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Assessment and Intervention for Emerging Language

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

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What is emerging language stage (EL)?

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

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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

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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

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But remember...

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

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Normal Development
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Assessment of Communication in EL

• Multidisciplinary and Transdisciplinary
  assessment
• Play assessment
• Communication assessment

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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

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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)

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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

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Informal Examination of Communication Function

• Assessing Communicative Intention
• Assessing comprehension
• Assessing Production

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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

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Assessing Communicative Intention (contd)

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

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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

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Assessing Comprehension

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

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Comprehension ActivitiesUnderstanding 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?

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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

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Comprehension ActivitiesBeyond 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

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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

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Comprehension FindingsWhat 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

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Assessing Espressive Language

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

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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)

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Semantic syntacticproduction

• 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

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Decision making based on assessment information

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

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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

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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

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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

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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

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Developing Intentional Communication (contd)

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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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