Transcript No Slide Title

Infants and Children with Developmental Disabilities
Emergent Literacy
and
Reach Out and Read
Monica H. Ultmann, M.D.
Director,
Center for Children with Special Needs
and
Division of Developmental Behavioral Pediatrics
Floating Hospital for Children
at Tufts Medical Center
Clinical Professor of Pediatrics
Tufts University School of Medicine
Boston, Massachusetts
Objectives

Discuss the concept of emergent literacy and the
implications for infants and children with
developmental disabilities.

Present literacy challenges in infants and children
with specific developmental disabilities.

Discuss delivering anticipatory guidance
surrounding literacy issues with families of infants
and children with developmental disabilities.
Emergent Literacy: Definition
• In addition to being a cognitive process, literacy
acquisition involves a complicated balance of social,
psychological, and linguistic factors.
• Process of learning about the environment leading to
the development of meaning and concepts, including
reading and writing.
• Early language and literacy experiences form the
foundation for later reading, writing, and language
competencies.
• Children’s literacy skills develop before training in
reading and writing.
• Reading and writing develop concurrently.
• “Characterized by the early development of
understanding that abstract symbols have meaning and
that people use these symbols for the communication of
ideas” (Koenig, 1992)
Emergent Literacy: The Concept
• Complex process that is a continuum beginning
at birth continuing throughout an individual’s
lifetime.
• Emergent literacy as an example of
“scaffolding” child development.
• Focuses primarily on the child as an active
learner and the adult as a facilitator and
extending child-initiated learning.
Emergent Literacy: The Concept
(con’t)
Involves all domains of child development:
• Early verbal and nonverbal interactions
Environmental interactions
Motor exploration
• Broadens as child acquires intentional language and
concepts
Wider explorations
• Child gains understanding of language and symbols
Has experience with books
Gains fine motor skills for scribbling and drawing
• Child gains concepts of reading and writing
Emergent Literacy: The Concept
(con’t)
• Constructive: Through communication and exploration
the child builds internal concepts about all aspects of
his/her environment.
• Functional: Over time child develops necessary skills to
function in his daily environment (reading a calendar
and directions).
• Interactive: Involves feedback from adults and other
children in regard to language and play.
Emergent Literacy: Components
• Reading Aloud: The most important factor in laying the groundwork
for a child’s later love of reading.
• Concept of a Symbol: Acquiring the understanding that a symbol
represents something that has functional meaning.
• Emergent Writing: Reading and writing concepts develop
concurrently and children learn from demonstration and
experience.
• Literacy Environments: Opportunities in a child’s environment play
a crucial role in encouraging literacy development:
Adult interactions and role modeling in literacy activities.
Availability of books and writing material for hands-on
experiences.
Adults who value literacy interactions and the child’s reading
efforts.
Emergent Literacy:
Implications for Infants and Children with
Developmental Disabilities
• Quantitative and qualitative divergence in experiences which often
limit the progress of emergent literacy acquisition:
Limited interactive, sensory, or cognitive skills
Altered communicative intent
Physical barriers to exploration
• Environmental implications:
Significant time devoted to physical care and therapies
Attachment issues and parent/child interactions
Caregiver insights, attitudes, and involvement
Misunderstanding or underestimating child’s abilities, thus limiting
their access and experience with books, toys, games, and writing
material
Literacy Challenges
in Infants and Children
with Developmental Disabilities:
General Considerations
•Maintaining individual and joint attention during story book
reading.
•Pointing to pictures or to words.
•Holding a book or turning pages.
•Understanding words because of limited experiences
(visual, hearing, tactile).
•Understanding story content due to delayed language
development.
•Participating in story retelling, predicting, commenting.
•Participating in the chanting of songs, rhymes and stories.
•Holding and controlling pencils, crayons, markers, paint brushes.
•Manipulating magnetic letters, puzzle pieces, card games.
Adapted from Augmentative Communication Community Partnerships Canada
(ACCPC, 2004)
Literacy Challenges
in Infants and Children
with Developmental Disabilities:
General Considerations
Challenges complicated by the frequent co-existence
of multiple developmental disabilities:
Sensory impairments (vision, hearing, tactile)
Attentional challenges
Motor planning difficulties and mobility issues
Developmental language issues
Learning disabilities
Mental Retardation
Sensory Deficits:
Hearing Impairment
How a child’s hearing loss impacts the attainment of new
developmental milestones depends on several important factors:
• The age at which the child’s hearing loss occurs is important.
Infants born with hearing loss face different challenges than
toddlers, preschool, and school-age children who may have had
some hearing for crucial periods in their development.
• The severity and type of the hearing loss have an important impact
on their overall development.
• How correctable the child’s hearing is with amplification, such as
hearing aids, plays a significant role in their development.
• Presence of additional disabilities, such as a cleft lip or palate, that
also affect motor, language, self-care, personal-social, and
cognitive skills.
Hearing Impairment (con’t)
During a primary care visit:
• Assess visual and auditory attention and focus.
• Assess fine motor skills, pointing, and imitation.
• Assess language development: imitation and degree of speech
production.
• Assess posture/position of child in relation to adult reading with
child.
Sensory Deficits:
Visual Impairment: Low Vision, Blind
How a child’s vision loss impacts the attainment of new developmental
milestones depends on several important factors:
• The age at which a child’s visual loss occurs is important. Infants
born with vision loss face different challenges than toddlers,
preschool, and school-age children who may have had some sight
for crucial periods in their development.
• The severity and type of the vision loss experienced by a child has
an important impact on their overall development.
• How correctable the child’s vision is with optical aides, such as
glasses, plays a significant role in their development.
• A child may have additional disabilities that also affect their motor,
language, self-care, personal-social, and cognitive skills
Visual Impairment: Low Vision, Blind (con’t)
Expect children with visual impairment to:
• Show curiosity and ask questions.
• Listen.
• Get close to objects.
• Need opportunities to explore his or her
environment.
• Need to be shown how to do things.
• Be unaware of dangers and need to be taught.
Visual Impairment: Low Vision, Blind (con’t)
• Assess attentiveness/orientation to the reader.
• Assess independent mobility and exploration, crucial tools
for environmental awareness, interaction, and concept
development.
• Assess tactile awareness and fine motor skills crucial for
turning pages, orienting books, exploring objects, and learning
Braille.
• Assess language development, including repetition and memory.
Visual Impairment: Low Vision, Blind (con’t)
Maeghann
4 years, 10 months
Hallerman-Streiff Syndrome
Short stature
Hydrocephalus with shunt placement
Small eyes, cataracts, congenital glaucoma, strabismus, nystagmus
Some functional vision in the right eye, wears glasses: reaching for objects,
and recognizes some large objects, and colors.
Visual acuity approximately 20/1000 in the right eye
Mild developmental delays before shunt placement.
Received EI services with a low vision specialist and mobility expert
Now in a half day early childhood special education setting for her therapies
(OT, S/L, and vision/mobility) and a half day regular pre-K setting.
Speech and Language Impairment
• The most common developmental problems of
childhood affecting almost 1 in 10 children.
• Covers a spectrum of problems from sound
substitutions to global communication disorders and
oral motor concerns, impacting speech and feeding.
• Speech disorders encompass difficulties producing
speech sounds or abnormalities in voice quality
• Language disorders reflect deficits in verbal and
nonverbal expressive and receptive language skills,
comprehension, language processing, and pragmatic
skills, the social context of language.
• Early intervention demonstrated to be most beneficial
for later school functioning.
Encouraging Literacy
Repeat your child's strings of sounds (e.g., "dadadada, bababa") and add to them.
Talk to your child during daily routine activities such as bath or mealtime and respond to
his or her questions.
Talk to your child and name objects, people, and events in the everyday environment.
Draw your child's attention to print in everyday settings such as traffic signs, store
logos, and food containers.
Introduce new vocabulary words during holidays and special activities such as outings
to the zoo, the park, and so on.
Read picture and story books that focus on sounds, rhymes, and alliteration (words that
start with the same sound, as found in Dr. Seuss books).
Reread your child's favorite book(s).
Focus your child's attention on books by pointing to words and pictures as you read.
Provide a variety of materials to encourage drawing and scribbling (e.g., crayons, paper,
markers, finger paints).
Encourage your child to describe or tell a story about his/her drawing and write down
the words.
From asha.org
Autism Spectrum Disorders
A neurodevelopmental disorder most often evident by three years of
age involving delays in the following areas:
•
•
•
•
•
Verbal and nonverbal communication
Development of age appropriate social and play skills
Repetitive activities and movements
Difficulties with changes in routine and transitions
Altered response to sensory input and experiences
Prevalence- Most recent CDC estimates (2009)- 1/100-150, 8 year olds
Autism Spectrum Disorders
Coltin
23 months old
Language regression and “withdrew into his own little world”
at 18-20 months.
Now babbles strings of consonant sounds; 4 words.
Improved eye contact with family; fleeting with strangers
Significant delays in imitation skills, no pointing
Improving attention for activities of interest, otherwise short,
in constant motion
Lines up and looks at toys at angles, spins.
CAT/CLAMS: Visual Motor DQ 90
Language DQ 58
Childhood Autism Rating Scale: 41 (severe)
Head circumference >97th percentile
Autism Spectrum Disorders
• Assess eye contact: normal, brief, sustained .
• Assess attention for task as well as joint attention and focus.
• Assess language development:
Expressive: verbal (words, phrases, rhyming,
spontaneous conversation)
nonverbal (gestures, pointing)
Receptive: Understanding directions, the storyline in books.
Pragmatics: the social context of language
Atypical Language: echolalia (immediate and delayed)
contextual conversation
• Observe fine motor skills: holding book, turning pages, pointing
tactile abilities and preferences
mouthing, tearing pages
• Observe the presence of turn-taking in the adult-child reading dyad
Autism Spectrum Disorders:
Encouraging Literacy
• The potential for developing literacy capabilities in children with autism
spectrum disorder historically has been significantly underestimated.
• Shared reading time, literacy-rich environments, modeling literacy
activities, and access to print materials are critical for the development of
emergent literacy skills in young children with autism.
• Literacy development in young children with autism is enhanced by
factors similar to those identified in young, typically functioning children.
Of special note:
Incorporating shared reading time as an anticipated part
of the daily routine (“sensory diet”, bedtime)
Rhyming, alliteration, and singing
Books with a tactile component
Sharing emotions
Capturing the child’s attention
Social stories
Anticipatory Guidance:
Encouraging Literacy Activities for Children with
Developmental Disabilities
• Balance the demands of educational goals, therapies, and medical
needs of the child with time for activities of mutual pleasure- shared
reading, story-telling, playing interactive games- at the
developmental level of the child promoting emergent language
and literacy and joint and individual attention.
• Encourage communication and literacy modeling and rich home
learning environments.
• Acknowledge what parents and caretakers are already doing
with the child to encourage emergent literacy- reading in
standers, rhymes with stretching activities, positioning with
reading to encourage joint attention.
• Direct parents to early intervention programs and disability-specific
resources where they can learn how to engage their child in language,
literacy, and play activities at home.
• Encourage adaptive approaches and tools to meet a child’s specific
needs (story boxes or tactile experience books for children with visual
impairments).
References
Council on Children with Disabilities, Section on Developmental Behavioral Pediatrics,
Bright Futures Steering Committee, Medical Home Initiatives for Children with Special
Needs Project Advisory Committee: “Identifying Infants and Young Children with
Developmental Disorders in the Medical Home: An Algorithm for Developmental
Surveillance and Screening.” Pediatrics: 118: 405-420, 2006.
DA Koppenhaver, PP Coleman, SL Kalman, DE Yoder: “The Implications of Emergent
Literacy Research for Children with Developmental Disabilities.” American Journal of
Speech-Language Pathology: 1: 38-44, 1991.
SE Gurry and AS Larkin: “Literacy Learning Abilities of Children with Developmental
Disabilities: What Do We Know?” Currents in Literacy: Volume 2 Number 1
(http://www.lesley.edu/academic_centers/hood/currents/v2n1/gurry_larkin.html)
JM Stratton: “Emergent Literacy: A New Perspective”
(http://www.braille.org/papers/jvib0696/vb960305.html)
A Kurtz: “Literacy and Developmental Disabilities”
(http://www.ccids.umaine.edu/resources/fcmaine/litdd.html)
FP Roth, DR Paul, A-M Pierotti: “Emergent Literacy: Early Reading and Writing
Development: (http://www.asha.org/public/speech/emergent-literacy.htm)