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developmental test 4

Terms in this set (78)

Practitioners use cognitive theory based principles to
Evaluate cognitive skills needed for language development
Observe children's play behavior with a cognitive theory perspective.
Schema: A schema is a concept, mental category, or cognitive structure;
Children form many different schemata as they interact with their environments.
Assimilation: A child evidences assimilation when he takes in new information and incorporates it into his existing schemata.
A child sees an unfamiliar animal - camel, and says "horse," he is evidencing assimilation.
Accommodation: A child evidences accommodation when he adjusts his schemata on the basis of new information.
e.g.: The child eventually accommodates new information and uses the word "camel."
Equilibrium: children attempt to find a balance between assimilating new information into old schemata and developing new schemata through accommodation. This balance is called equilibrium.
Disequilibrium: As a child recognizes that two schemata are contradictory, disequilibrium occurs.
Reorganization to higher levels of thinking is motivated by this disequilibrium.
E.g.: when the child recognizes that the word "horse" fails to capture the camel's unique characteristics.
Symbolic play: a child uses one object to represent another.
E.g.: Uses towel a cape and says that he is Superman.
Object permanence: child realizes that an object exists even when he cannot see it.
Very young children cannot understand that objects continue to exist even when they can't be seen or felt.
For example, prior to achieving object permanence, a child will quickly lose interest in (and not search for) a hidden toy.
Object constancy: A child learns that he is viewing the same object, regardless of distance, light, or different viewing angle.
Means-end: This behavior is evidenced when a child demonstrates intentionality;
It occurs when the child identifies a problem and makes a plan to solve the problem.
E.g.: A child pushing a button or pulling a string to make a toy move.
A child calling out "Mama!" and waiting for his mother to appear
Infant-directed talk:
Also called -- Motherese
Describes the characteristics of child-directed communication that enhance an infant's ability to learn language.
Characteristics of infant-directed talk include
The use of content words (i.e., nouns, verbs) in isolation
Placement of content words at the end of sentences ("A doggie, see the doggie?")
Increased pitch on content words
Talking about objects and events in the "here and now."
It has been theorized that these facilitating characteristics help infants extract the important information and make linkages between speech and objects or events.

Coordinating attention:
Adults follow an infant's focus of attention and match their communication to the child's eye gaze.
Try to direct infants' attention to specific objects by pointing or showing

Scaffolding: refers to adult support that allows a child to engage in a challenging activity.
Scaffolding techniques _ simplifying a task, providing directions and clarifying a task, reducing a child's frustration, modeling a correct response, and motivating and soliciting a child's task engagement.
When used effectively, scaffolding is faded from levels of high support to minimal levels of guidance.

Mediation: provide the learner with insights in order to teach the learner "how to learn."
E.g.: "Tell me the steps you are going to follow to finish this project."
The practitioner's goal is to increase the student's awareness of the steps required for task completion.

Parent-child communication routines: Adults structure infant play routines in systematic patterns sometimes called scripts.
Scripts involve predictable patterns of action that facilitate infant participation.
The interaction familiarity allows the child to anticipate his or her role in the interaction, building pragmatic communication skills (Baldwin & Meyer, 2007; Bruner, 1981).
Characteristics:
Atypical babbling
Delayed onset of meaningful speech
Decreased vocabulary
Decreased joint attention
More behavior problems
Hyperactivity
Trends in early word production:
Less complex syllable shapes
Fewer different consonants
These are SOME characteristics of SOME late talkers. It is actually a heterogeneous group.

More specific speech and language production characteristics:
Atypical babbling:
Delayed onset of canonical babbling (documented as late as 24 months)
decreased size of phonetic inventory
Increased percent of vowel babble.
Decreased babbling complexity (# different syllables per babble; complexity of canonical shapes)

Delayed onset of meaningful speech. Meaningful speech stage= 10 different words produced in a 2 hr language sample.

3. Babbling trends continue in early word production:
Less complex syllable shapes. For example, more open/less closed syllables
Continued decreased phonetic inventory: fewer different consonants used
In one study, Paul and Jennings (1992) found that children with normal language produced 18 different consonants between 24-34 months, while children with slow expressive language development produced only 10 different Cs at this age.
Note the close relationship between phonological and lexical development at this age.

There is a rate of recovery of about 50% per year from age 2 to age 5.

Children still-language delayed at age 5 are likely to continue to manifest significant language problems for many years, with few moving into the average range.

Rescorla et al (2000) propose that young children what are significantly delayed in expressive language after 24 months have weak language abilities. The most mildly impaired outgrow their delay by age 4, those with an intermediate level of SLI recover by age 5, and those most severely impaired continue to have language problems for many years. However, even those children who "recover" continue to perform significantly lower than on language and reading measures than their peers with normal language histories.

There is some debate: Is SELD it's own category, or is it just a risk factor for later developing disorders
12% of infants= high risk

Potential high risk for language disabilities for prelinguistic children:
Failed hearing screening
Lack of babbling
Poor prenatal care (drugs and alcohol)
Prematurity
Low birth weight
Genetic factors contributing to congenital defects
Poor oral motor development
Difficulty with feeding
High risk= "any condition that places a child's general development in jeopardy also constitutes a risk for language development" P&N p 185
March of dimes estimates that 12% of infants could be considered high risk

Most high-risk infants present with feeding problems, hearing loss, and neurological/behavioral difficulties
These issues result in deficit communicative development and language delay/impairment

Collaboration with other professionals is critical to helping children



1. Such as drug and alcohol use
2. Below 36 weeks gestation
3. Under 5 pounds

Risk factors = Familial or behavioral characteristics that suggest that a child is likely to have a true language impairment, as opposed to being a late bloomer.

Predictors of change = behavioral characteristics that suggest that a child who is delayed in language learning will catch up to his or her peers.

Prenatal factors
Drug and/or alcohol use/abuse
Exposure to environmental toxins: lead, mercury, heavy metals
In-utero infections: rubella, cytomegalovirus (CMV), toxoplasmosis

Prematurity & low birth weight
Prematurity= birth prior to 37 weeks gestation
Low birth weight= < 5.5 lbs
Developmental delays for approx. 50% infants born prematurely

Neonatal intensive care unit (NICU)
12% of children

Genetic & Congenital Disorders

Hearing Loss
Newborn hearing screenings are important
Very low birth weight = 3.3 lbs

Increased risk of developmental delay

Premature infants are more susceptible to illnesses and conditions:
Respiratory distress syndrome
May lead to intubation and require ventilators
Could result in bronchopulmonry dysplasia (thickening of lung wall, difficult oxygen exchange)= long term trach needed
Apnea (interrupted breathing)
Bradycardia (low heart rate)
Necrotizing enterocolitis (intestinal disorder)
Intracranial hemorrhage

NICU= noisy (= noise-induced HL)
- 85 db
Interferes with sleep
Difficult communicative environment
Learn at young age the painful environment= aversion, defensiveness
Less interaction with parent overall
Trauma/tissue damage to larynx

Despite all of this, good news is that infant mortality has decreased over the past few decades

Congential: Underlying abnormality directly impacts language and cognitive functioning

Not all children are identified at birth
HL
Not all of these children are caught within the hospital
Feeding & Oral Motor Development
Hearing Conservation
Behavior Development & Disposition
Parent-Child Interaction
Feeding & Oral Motor Development
One of the primary criteria for discharging newborns from NICU
2 components:
Chart review
Adjusted gestational age
Excess amniotic fluid (= lack of inuterine sucking & swallowing)
Type & duration of intubation
Respiratory disorders
Type & degree of family involvement
Feeding evaluation
Feeding behavior
Vocalizations & noises in the airway during feeding
Reflex patterns (suckling, sucking, rooting, phasic bite reflex)
Suckling= primitive form of sucking; extension and retraction of the tongue, up and down jaw movements, loose closure of the lips

Sucking= more mature, increased intraoral negative pressure, tongue tip is elevated rather than extended, and retracted, lip approximation is firmer, and more rhythmic jaw movement

Rooting= infant turns head toward the source of tactile stimulation of the lips or lower cheek (gentle rubbing)

Phasic bite= stimulation of teeth and gums causes the infant to use a rhythmic bite and release pattern= small jaw opening and closing

These are seen in TD full term infants
If premies don't exhibit them, don't be surprised
Needed for developing feeding plan

Criteria for oral feeding: Observation and Standardized Testing
Note: Gastroesophageal reflux
Causes deficient nutritional intake
Hearing conservation
Periodic referral for testing
Behavior & development
Behavioral organization and general condition predicts readiness for interaction

Oral feeding from nipple

Behavioral considerations:
Irregular respiration
Color changes
Body instability (jitteriness, flaccidity)
Disorganized patterns of alertness (all found in premature infants)

Many different instruments desgined to look at this in infants 28 to 40 wks gestational age
Help you get a feel for what conditions the infant operates in best so that you can facilitate interactions between the child and parents

Parent-child communication
3 states of organization:
Turning in (aka physiological state)
Coming out
Reciprocity
Failure to achieve reciprocity is a red flag for potential developmental delays
Assessed via standardized assessments
Also use parent interview to determine their "priorities and concerns"

Turning in= baby is sick and cannot participate/reciprocate interaction; all energy is geared toward survival
Coming out= no longer ill—breaths adequately and is gaining weight; first becomes responsive to environment; will benefit from interactions with parents—SLP should encourage interactions
Reciprocity= final stage; usually occurs before release from hospital; responds to parent interaction in predictable ways

- Counseling may be needed during intervention
Feeding & Oral Motor Development
Vocal Assessment
Hearing Conservation
Behavior Development & Disposition
Parent-Child Interaction
Feeding and Oral Motor development
6 months: new feeding pattern
Facilitate consumption of solid foods
Front to back movement of the tongue (used in sucking) with rhythmic up and down jaw movements to produce munching pattern
Other patterns in 6-2

Infants with trachs or neurological conditions, se specialized assessment:
Cervical auscultation
Videofluroscopic swallow study
Ultrasound study
Endoscopy

Typically, this is after the infant leaves the hospital
IF IFSP allows for follow-up from the SLP------
Infants in this stage per preintentional (or perlocutionry)
Stage of development where infants do not intend for a particular outcome for their behavior
However—adults act like they do
We attribute intentionality whenever there is none


Cervical auscultation - detects changes in upper areadigestive tract sounds; most noninvasive
Videofluroscopic swallow study
- Examines oral and pharyngeal movement during feeding; asses risk of aspiration
Ultrasound study
- Visualization of relations between movements patters in oral and pharyngeal
Endoscopy
Passing a fiberoptic tube through mouth, down esophagus, and into stomach while child is sedated
If you think a child is in danger of having reflux or aspiration---refer to medical professional

Vocal assessment
Listening for vowels and consonants
Pitch contours, pausing, and inhalations
Direct observations via standardized and nonstandardized testing & Parent reports
Canonical babbling: CV syllables
Failure to produce these types of syllables by 10 mos predicts delays in word learning and combining words at 2 years
Ratio of consosnants to vowels should increase over the 1st year
By 16 mos, samples should include more Cs than Vs
By 1 year, variegated babbling and changes in pitch contour expected
Parent-child communication
Pleasure and positive affect
Responsiveness to child cues
Readiness to interact
Baby's temperament and style
Reciprocity and mutuality (in sync)
Choice of objects during interaction
Language stimulation
Motherese, child-directed speech
Joint attention and scaffolding
Hearing Conservation
High risk infants should have hearing tested every 3 to 6 months during infancy
Counseling to discuss signs of Otitis Media
Pulling on ear or jaw
Fever
Unexplained fussiness
Maintenance of hearing aids & Referral to audiologist concerning cochlear implant candidacy
Child Behavior & Development
Many scales gauge: cognition, communication, language, motor, social-emotional, and adaptive/self-help behaviors
When children are approved for Cis and implanted before 2 yrs of age, efficient acquisition of expressive language and receptive language and speech intelligibility
Approximates normal rates

Bayley Scales of Dev
Vineland
Denver
- pediatricians and psychologists normally give these
Play behaviors
Communication behaviors
Intentionality
Feeding
Hearing Conservation
Play behaviors
Recognition of common objects and function
relational play (telephone to ear, combing doll's hair)
Simple pretend play (eating food from bowl)

Communicative behaviors
Vocalizations
Gestures
Intentionality
Requesting/rejecting
Gaining attention of parent
Initiating social interaction (greeting, calling, "showing off")
Behavioral observations & standardized assessments
Language testing via behavioral measures
Parent report

Feeding & Oral Motor Development

Hearing evaluation

Parent-child communication
Intentionality and communication from the child

Behaviors


Children are becoming intentional communicators and active participants in conversation
Begin to initiate communication
Illocutionary stage of language
Know how to express intention through signals, but not nec words yet
Growing understanding of functions and meanings
Chronological age vs developmental age

See play and language handout***

Be concerned if you do not observe intentional behaviors

Feeding & Oral Motor
Children with feeding issues at this age most likely have neurological involvement
SLP should refer to medical doctor to asses any associated medical conditions
What you should do:
Review medical, developmental, and feeding hx
Prefeeding assessment of posture and position, oral motor structure and function, social aspects of feeding
Observations of chewing, biting, swallowing, and interactions during feeding
Determine need for swallow study
Eating is a social experience
Incorporate behavioral strategies into remediation
Generalization and reinforcement
Hearing Conservation
Counseling to recognize signs and symptoms of otitis media
In hearing impaired children, amplification of the acoustic signal is crucial to later outcomes for young children

Behaviors
All behavior is communication
Maladaptive behaviors are saying something—it's our job to figure out what
One goal of intervention could be to reduce attention given to poor behavior and provide a more acceptable means for expression

agression and tantrums
Foster care
Birth hx:
Full term, weighing 6.9 lbs
Maternal drug use, poor prenatal care= born NAS
NICU for 2 mos, 1 wk for methadone addiction
Developmental hx:
Global developmental delay (followed by EI)
Crawling 10 mos, standing 13 mos, walking 14 mos
Passed hearing screening three times since birth
Language:
"duck" & "dog" meaningfully at 12 mos
Regression in language skills, no names for individuals in the home
Some sign language to communicate "more", "thank you", and "no"
Screams to communicate wants and needs
Other:
Socially, remains in the home; contact with 5 other children 9 mos to 8 yrs

RISK FACTORS: maternal drug use
regression in lang skills

tested with PLS-5 for expressive and receptive language and REEL-3 as well

behavioral observations:
Engaged in play with self only
Reluctant to share toys
Content only while care-giver was present
Refusal to separate (consistent with parent report)
To communicate wants and needs:
Pointing, crying, gestures, movements
Frequently sought attention from care-giver
Exploration of room with frequent transitions
Reciprocated social smile
Used age-appropriate eye contact during games
Did not follow simple 1 step directions
Engaged in shared reading activity with care-giver

Consistent response to name
No joint attention reported or observed
No imitation of facial or body movements
No engagement in social games with examiner
Reported that she does play these at home
Limited use of social gestures ("up")
Reported "hi" & "bye bye"
Vocalizations: Limited
Infrequent CV syllables ("ma" & "ba"); most often produced isolated vowels
No CVCV
No babbling
No vocal response
Limited turn-taking
Recognized names of body parts & clothing

Based on this evaluation, AR presents with a severe mixed receptive-expressive language disorder.
Already receiving support from other specialists; no other referrals at this time
Recommended speech tx 2x per week for 30 mins each session