Transcript Assessment and Intervention in the Prelinguistic Period

Assessment and Intervention in
the Prelinguistic Period
Paul, R. (1995). Language
disorders from infancy through
adolescence. Chapter 7
What is the prelinguistic stage?
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Newborn Period
Preintentional period (1-8 months)
Prelinguistic communication (9-18
months)
Risk factors for infants
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Prenatal Factors
– maternal drug or alcohol abuse
– exposure to toxins or in utero infections
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Prematurity
– low birth weight associated with
developmental delay
– susceptibility to illness
– respiratory difficulties
– less interaction early on
Risk factors (continued)
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Genetic and congenital disorders
– number of syndromes that can occur
– autosomal chromosomal abnormalities
(Down syndrome)
– sex chromosome disorders (Kleinfelter’s
syndrome)
– craniofacial disorders
– metabolic disorders
Risks after the newborn period
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Hearing Impairment
Autism
Developmental delay
Abuse/neglect
Assessment and Intervention for
Newborns at Risk
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Feeding and oral motor development
Hearing conservation and aural rehab
Infant behaviour and development
Parent-child communication
Feeding and oral motor
development
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Observe feeding and oral behaviour
Interview parents and staff regarding
feeding and oral behaviour
Assessing Feeding/Oral
Behaviour
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Reflexes
– suckling
– sucking
– rooting
– phasic-bite reflex
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Formal assessments
Informal interview (see Box 7-1, p. 197)
Management of Feeding
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Tube feeding
– nasogastric
– orogastric
– gastrostomy
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Stimulate oral motor development
Educate parents about feeding
Management of Feeding (contd)
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Specific Techniques for Facilitating
Feeding
– Positioning
– Jaw stabilisation
– Oral stimulation in feeding
– Nonfeeding oral stimulation
Hearing Conservation and Aural
Rehab
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Advocate for early audiological
screening
Advocate for hearing testing in child’s
early years
Child Behavior and Development
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Assessment should be to determine the
current strengths and needs
– Identify what risks the infant faces
– Evaluate level of infant’s physiological
organization i.e. How much stimulation and
handling can the child tolerate? What is
the most comfortable position for
stimulation?
Management of Behaviour &
Development
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Suggest ways to counteract low levels
of language and interactive stimulation
in ICU
Advocate oral development and
stimulation
Assessment of Parent-Child
Communication
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Assessing infant readiness for
communication
– Educate parents about stages - Turning in,
coming out, reciprocity
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Assessing parent communication and
family functioning
– Discuss the parents concerns
Management of Parent-Child
Communication
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Inform parent about different states the
infant may be exhibiting (see Table 7-3)
Encourage parental interaction when
the infant is ready
– look at, handle, talk to the baby
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Help parent identify end of interaction
– wait for signals of interaction like eye gaze
– watch for signals of distress
Preintentional Infants - 1-8 mos
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Preintentional - infants have not yet
developed cognitive skills to represent ideas
in their mind and pursue goals
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Perlocutionary (Bates, 1976)
– infants do not intend any particular
outcome by their behaviour
– adults act as if they do (normal and impt
for communication development)
Assessment and Intervention for
Preintentional Infants
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Feeding and oral motor development
Hearing conservation and aural rehab
Infant behaviour and development
Parent-child communication
Assessment of feeding and oral
motor development
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Feeding assessment - observe new
feeding patterns
– integrating sucking with jaw movements
– chewing
– rotary jaw movements
– tongue lateralization
– sustained bite
Assessment of feeding and oral
motor development
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Vocal assessment (see Table 7-4, p
205)
– observe child and ask parent about vocal
behaviours
– use corrected gestational age - age -weeks
premature = CGA
– observe sound play, consonants,
intonational changes, babbling
Management of feeding and oral
motor behaviour (1-8 mos)
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Feeding
– continue oral stimulation
– introduce solid foods
– see Box 7-2, p 207
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Vocal Development
– talk and babble to baby
– imitate any non-cry vocalization
– use “baby-talk”
– use toys
Hearing in preintentional period
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Encourage assessment by audiologist
Counsel regarding otitis media and
signs of otitis media such as pulling on
ear, fussing
Child Beh’r & Dev’t (1-8 mos)
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Assessment
– Involves general assessment of
development
– Instruments available include:
• Bayley Scales of Infant Development
• Vineland Adaptive Behavior Scales
• Receptive-Expressive Emergent Language
Scale
• Sequenced Inventory of Communication
Development (SICD)
• Rossetti Infant-Toddler Language Scale
Child Beh’r & Dev’t Management
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General motor and cognitive stimulation
Home-Based Programs
– activities should be performed in
communicative manner
– parent advocate
Parent-Child Communication
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Assessment
– Formal instruments
– Informal observation
• responsiveness to child’s cues of readiness
and unreadiness to interact
• choice of objects and activities
• language stimulation and responsiveness
(cooing, babbling, responding
• encouragement of joint attention
Communication - Management
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Act as a support and encourage parent
Paul suggests three main aspects:
– Increase awareness of infant
communication patterns
– Provide Instruction and modeling of adultinfant communication
– Help parents self-monitor
Awareness of comm. patterns
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Explain that it may be difficult to interact
with an unresponsive infant
Make communication enriching and
responsive
– provide visual, auditory, tactile cues to
engage baby
– allow infant to explore novel stimuli
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Explain interactive pattern of infants
– educational videos
Modeling Interactive Beh’s
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Turn-taking and imitation
– ensure baby is ready to interact
– use smiles and vocalisations to elicit infant
behaviour
– wait for the infant to initiate
– imitate it and then wait for infant to do
something else
– vocalization and imitation of vocalization
should be especially encouraged
Interactive Behaviours
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Joint Attention Routines
– identify the infant’s focus and share
attention to that
– make a comment or gesture about what
the baby is looking at or doing
– peekaboo
– choral vocalization
Interactive Behaviours
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Establishing anticipatory sets
Playing baby games
– provide the baby with predictable series of
sounds and actions
– basis for script development
– use baby games that the family have used
before and/or are culturally appropriate
Interactive Behaviours
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Self-monitoring skills
– video-taping sessions
– ensure a non threatening environment for
the parents
Assess’t and Treatment at
Prelinguistic Comm. Stage (9-18)
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Infants become intentional
communicators
Illocutionary stage (Bates, 1976) - child
expresses intention through signals
Assessment
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Play assessment (eg. Symbolic Play
test)
Observe play
– recognition of common objects (brush,
phone)
– engages in simple play schemes
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Is any functional communication present
– attempts to request objects or actions
– eliciting attention
Management
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If child is expressing some
communicative intent– scaffold (e.g. break routines)
– vocalise the child’s demands
– shared book-reading
• joint attention to pages
• stop and wait for child to respond
– Communication temptations (see box 7-3)
Management (cont’d)
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Facilitate comprehension
– baby games (e.g. show me your nose,
ears, etc)
Management (cont’d)
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If the child is not showing intentionality– provide intensified input (book reading, lots
of parallel talk, joint attention activities)
– improve comprehension skills
– encourage vocalization
– respond to the child’s actions and
initiations
Considerations for older
prelinguistic children
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Feeding and oral motor development
Hearing conservation and aural
rehabilitation
Intentionality and communication
– symbolic systems of communication