chapter8 el

8/12/2019 Chapter8 EL

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Assessment and

Intervention for Emerging

Language

Paul R. (2001). Language

Disorders from Infancythrough 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 noknown risks but parents or others are

concernedChildren 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 - lowpriority

Children with cognitive deficits, hearing

impairment or chronic OM, preverbalcommunication problems, risks pre orperinatally - should be seen


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But remember...

Therapy may facilitate development innormal slow talkers

Children with later language disabilitiesoften have histories of delayed languagedevelopment


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Normal Development

Expression Vocabulary Comp.Wetherby et al.(1988); Paul &Schiffer, (1991)

18 mos 2communicativeacts/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 2-3

words/sentencethey hear

Nelson (1973)

18 mos combining2 wordsMiller (1981)

24 mos MLU 1.5-2.4


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Assessment of

Communication in EL

Multidisciplinary andTransdisciplinaryassessment

Play assessment

Communicationassessment


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Play Assessment

Want to ensure child is at adevelopmental level consistent with

communication developmentRelationships exist between play and

language development

Provides a more holistic picture of thechild


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Assessing Play

Communication and Symbolic BehaviorScales (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 BehaviorScales (Wetherby & Prizant, 1990)

observe parent and child in various interactions

rates performance in five areas

Informal examination of communicationfunctioning


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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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Intention (contd)

Frequency of expression of intentions

Forms of communication (e.g. gestural,

vocal)


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Intent: Worksheet

Table 8-4, page 256

Communicative Act:

Must be directed at adult. Child must look ator address the adult directly in some way.

Must have an effect on influencing the adultsbehaviour/focus of attn or knowledge.

Child must be persistent in the attempt toconvey the message if the adult does notrespond


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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 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 normalfor 12-18 mos.

What if they dont?


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Comprehension activities:

Two word combs (18-24m)

Action-object (use words understood atsingle-word stage)

choose unusual combinations such askiss the apple hug the shoe


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Comprehension Activities:

Beyond 2-words (24-36 m)

Agent-action-object instructions

Rely on probability

Start with vocabulary from earlier stagesand then move on

see Table 8-6


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Comprehension beyond 36

months

Can be tested using formalcomprehension measures such as PPVT-

III, TACL-R, Miller-Yoder Test ofGrammatical Comprehension, CELF-P


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Comprehension Findings:

What do they mean?

If comprehension is superior toproduction

better outcomesIf 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 wordsand some two-word combinations in the

24-36 month stageRating scales

MacArthur Communicative Development

Inventories(Fenson et al., 1993)Language Development Survey (Rescorla,

1989)


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Semantic syntactic

production

Children dont begin to combine words untilvocabulary size is approx 50 words

To assess semantic-syntactic production:

Determine the relative frequency of wordcombinations

Evaluate semantic relations expressed

Table 8-7 (Browns Semantic Relations)Variety of relations

Advanced relations

Normal toddlers express 8-11 different semanticrelations


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Decision making based on

assessment information

See Pauls decisiontree 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 communicationLanguage comprehension

Production of sounds, words, and word

combinations


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Functional and Symbolic

Play Skills

Step1: Establish reciprocal behaviour andanticipatory sets (e.g. peek-a-boo)

Step 2: Model early forms of symbolicplay and encourage imitation

Step 3: Model play routines like

pretending to give the doll a bath, mealtime, 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. handMum a container and she hands it back totherapist and indicates take the lid off orsays help. Then hand container to the child)

#2: Milieu modelplace things out of reach and get the child to

ask for it or draw the childs attention to it

and wait for a response

D l i I t ti l


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Communication (contd)

#3 : Use routines or script therapy andthen violate the routines

#4 : Respond as though the child isshowing intent

#5: If range of intent is limited, increaseuse of proto-imperatives and declaratives

model the behaviour

pretend not to notice something that thechild is interested in and wait for them to get

your attention

D l i I t ti l


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If child has adequate intentions but isonly using gesture -->increase vocalising

Model the target responseWithold response or pretend not to notice

until some vocal behaviour produced

D l i I t ti l


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If the child is using maladaptivebehaviour:

immediately provide an alternative form ofcommunication (e.g. I see you want it. Pointto it and Ill give it to you.)

might need to actually take the childs handsand demonstrate the action

D l i R ti


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Developing Receptive

Language

Indirect Language Stimulation (parenttraining)

self-talk/parallel talk

imitations

expansions

extentions

build-ups and breakdowns

recast sentences

labelling

see box 8-3

D l i d d


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Developing sounds, words,

and word combinations

Increasing phonological skills

expand the repertoire of sounds

use developmental informationDeveloping a first lexicon

choose words based on normative data

some words should be nouns for labelingother words should be chosen for expressing

other functions

see Table 8-10

D l i d d


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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 interestsConsider the childs phonetic repertoire

choose words with sounds in the childs repertoire

early words may be limited to CV and CVC shapes

H h ld t h fi t


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How should we teach first

words?

Child centered approach

clinician provides many models

use play contexts and dont require responseHybrid approach

milieu teaching

place objects out of childs reachscript therapy

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

H h ld t h fi t


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How should we teach first

words?

Hybrid approaches

focussed stimulation

set up the situation so that you are modeling thespecific vocabulary you want to teach

provide lots of opportunities for the child toproduce it

use recasts, expansions, extensions, etc.Clinician-directed

may be suitable for older children

D l i d


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Developing word

combinations

Word combinations express semanticrelationships

Client-centeredplay situation-when the child produces a

one-word utterance, the clinician expands itto a two-word phrase

D l i d


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Developing word

combinations

Hybrid approaches

Schwartz et al.(85) - vertical structuring

Whitehurst et al.(91) - see box 8-5milieu approaches

put something out of childs reach -get X

focussed stimulationscript therapy

perhaps use a book or song-play that has twowords

D l i d


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Developing word

combinations (contd)

Clinician-directed approaches

Leonard (75)

use a puppet and the puppet describes whatshappening in the picture

get the child to tell the puppet whats happeningand to talk like the puppet

MacDonald et al. (74) - EnvironmentalLanguage 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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