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
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.
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).
Identify new skill to obtain "same" outcome (same function) as a challenging behavior.
Prompt use of new skill during "problem time" (new form).
Reinforce new form with desired outcome.
what are the potential functions?
adult reprimands, peer response, proximity
toys, food,, games, computer time, recess
Feels good, Tactile, visual, auditory sensation
adults or peers go away, no spinach, no puzzles, no circle time, transitions
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)
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.
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
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)
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
Not all of these children are caught within the hospital
Feeding & Oral Motor Development
Behavior Development & Disposition
Feeding & Oral Motor Development
One of the primary criteria for discharging newborns from NICU
Adjusted gestational age
Excess amniotic fluid (= lack of inuterine sucking & swallowing)
Type & duration of intubation
Type & degree of family involvement
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
Periodic referral for testing
Behavior & development
Behavioral organization and general condition predicts readiness for interaction
Oral feeding from nipple
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
3 states of organization:
Turning in (aka physiological state)
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
Make decisions about whether feeding therapy is needed
What aspects of the feeding and oral behavior ought to be addressed?
Oral feeding not an option Tube feeding
No role in this decision - supportive role
Help the parents in understanding the tube feeding decision and its consequences,
Helping them to make the eventual transition from tube to oral feeding.
Nonoral feeding options : Nasogastric, or N-G, Orogastric, Nasojejunal, Gastronomy
Nonoral feeding for extended periods -encourage opportunities for non-nutritive sucking (e.g., pacifier) during the tube feeding.
Oral stimulation - stroking the cheek, lips, and gums make the child ready for oral feeding
SLP help to create smooth transition to oral feeding
Working with nurses to help mothers start on breastfeeding
A crucial role helping the mother to understand the importance of interaction and communication in the baby's development
Specific techniques and instruction for facilitating feeding
Using specialized feeding equipment
Oral stimulation during feeding
Feeding & Oral Motor Development
Behavior Development & Disposition
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:
Videofluroscopic swallow study
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
- Visualization of relations between movements patters in oral and pharyngeal
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
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
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
Motherese, child-directed speech
Joint attention and scaffolding
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
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
- pediatricians and psychologists normally give these
Recognition of common objects and function
relational play (telephone to ear, combing doll's hair)
Simple pretend play (eating food from bowl)
Gaining attention of parent
Initiating social interaction (greeting, calling, "showing off")
Behavioral observations & standardized assessments
Language testing via behavioral measures
Feeding & Oral Motor Development
Intentionality and communication from the child
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
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
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
Full term, weighing 6.9 lbs
Maternal drug use, poor prenatal care= born NAS
NICU for 2 mos, 1 wk for methadone addiction
Global developmental delay (followed by EI)
Crawling 10 mos, standing 13 mos, walking 14 mos
Passed hearing screening three times since birth
"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
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
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"
Infrequent CV syllables ("ma" & "ba"); most often produced isolated vowels
No vocal response
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
Children at about 18 months of age produced an average of two communicative acts per minute in interactive samples
Request objects or actions, to establish joint attention, or to engage in social interaction (Hulit & Howard, 2002; Wetherby et al., 2004)
Intentions are expressed with gestures (Capone & McGregor, 2004) and vocalizations (Oller, 2000).
24 months children produce an average of five to seven communicative acts per minute (Chapman, 2000)
These communicative acts consist of words or word combinations, some nonverbal acts.
18 to 24 months -- combine words into simple two-word sentences (Luinge et al., 2006; Nelson, 1973)
78% of 25-month-olds - use multiword utterances (Roulstone, Loader, Northstone, & Beveridge, 2002)
24- to 36-months old (Luinge, 2006)
98% produced two word sentences
90% produced three-word sentences.
84% produced four-word sentences.
24-month-olds produced at least 10 different consonants
70% correct in their consonant productions (Stoel-Gammon, 1987, 2002)
75% of 24- to 36-month-olds are more than 50% intelligible (Luinge et al. 2006)