Assessment in the Prelinguistic Period

Who are our Prelinguistic Clients ? Infants in the Neonatal Intensive Care Unit High-risk infants and babies discharged from the NICU, typically on Early Intervention System caseloads Children who are not talking by 1 1/2 to 2 years, identified by their parents, pediatricians or teachers Children with autism Children with significant developmental delays Children with significant motor involvement

Form, Content, Use Form: Sounds & Gestures Content: familiar people objects activities sounds tone of voice Use: Reflexive response, joint attention, social interaction, behavioral regulation.

Children with Autism USEPrimarily a problem of USE CONTENTSecondarily a problem of CONTENT Together these result in significant functional difficulties FORMOften FORM is a strength relative to other areas of communication performance –Difficulties with intelligibility are often related to suprasegmental and pragmatic difficulties, rather than phonology

Children with Significant Developmental Delays Overall developmental and cognitive performance are key Communication level is judged in relation to other developmental skills Is there a gap for growth or is the child performing at their current overall potential? What is interfering most with successful, functional communication?

Children with Significant Motor Involvement Are cognitive and receptive language skill levels significantly better than expressive language? Is the child nonverbal or prelinguistic? Is the absence of expressive language the result of lack of linguistic acquisition or lack of neuromotor control needed for talking? It may be necessary to establish a means of consistent motoric response before any of these questions can be determined Dynamic assessment while establishing a consistent motoric response will give you part of your answer.

What do We Want to Know? History Feeding skills Overall level of development –Cognition –Social –Play –Motor Communication skills –Who? –How? –Why?

History Gestation (relative to 40 weeks) APGAR Score (10 max: 5 scales 0-2) Weight – typical 3400g; high risk<1500g; very high risk<1000g Complications & diagnoses – respiratory, heart, sensory, CNS, GI, feeding, infection Equipment & follow-up Family structure & support Developmental milestones 1 lb. = 454 g 1000g = 2.2lb Appearance Pulse Grimace Activity Respiration

Is there evidence of aspiration? Is the baby gaining weight? Tube or oral feeding, or a combination? What is the baby being fed? Endurance Oral hyper- or hyposensitivity Coordination of breathing, sucking, & swallowing Transition to foods Limited repertoire Feeding: Skills

Feeding: Methods of Assessment Behavioral Observation Modified barium swallow Feeding sessions Dynamic Assessment Feeding trials using different levels of support or compensations Different nipples, bottles (cups, spoons for older children) Different formulas, thicknesses, textures, tempratures & tastes Different supports and positions Different environmental conditions

Overall Development Is there a gap between communication skills and overall development? Developmental Scales Ages & Stages Questionnaires Denver Developmental Screening Test-II Standardized Tests Bayley Scales of Infant Mental Development Battelle Developmental Inventory Developmental Assessment of Young Children Vineland Adaptive Behavior Scales

Communication Skills Standardized Tests Communication & Symbolic Behavior Scales McArthur-Bates Communication Development Inventory: Words & Gestures Developmental Scales Rossetti Infant-Toddler Language Scales Sequenced Inventory of Communication Development Behavior Observation SCERTS Parent interview & observation Play with a purpose Dynamic Assessment

Parent Report & Observation Trust parent’s observations/descriptions Observation does not equal interpretation Elicit description with examples Many assessment tools rely on parent report at this stage Observe parents in play with their children –Note directiveness and responsiveness –Note language (purpose & means) –Note vocalization (patterns & sounds) –Note play levels (who, activities, symbolic)

Play with a Purpose Imitate any sound or action the child makes (can be done at a distance) Set up communication temptations (bubbles, bloons) –Increase opportunities for purposeful communication Establish short routines –Initially accept any attempt the child makes –Once the routine is established, increase the requirement Include dynamic assessment –Observe responses following facilitative techniques (modelling, recasting, prompting)

Form: Sounds Stages & Types: Stage 1 (1 mo) Reflexive: crying, laughing, sneezing Stage 2 (2 – 3 mo) Cooing (vowel sounds), & Gooing (back sounds): + nasals in primitive CVs Stage 3 (4 – 6 mo) Vocal Exploration: squeals, growls, yells, raspberries, friction noises, primitive CVs Stage 4 (7 – 12 mo) Babbling: stops, nasals, glides, lax vowels; reduplicated (“mamamama”) & variegated (“gabaka”) babbling Stage 5 (12+ mo) Jargon Babble: add stress and intonation patterns; words increase

Form: Sounds A Pre-intentional Developmental Sequence: 1.Spontaneous, reflexive, accidental 2.Recognizes vocalizations in own repertoire; stops activity, smiles 3.Takes turns vocalizing 4.Imitates sound in repertoire when she initiates, but does not follow adult change 5.Imitates sound in repertoire when adult initiates, but does not follow adult change 6.Imitates sounds in repertoire and follows adult changes 7.Tries to imitate novel sounds presented by adults

Form: Gestures Deictic  Used to indicate or direct attention to an object or event  Showing, giving, reaching, pointing  Pointing may be contact or distal  Protoimperatives(do somting) & protodeclaratives,(im commenting on somting) Representative  Establish reference and carry semantic content  Head nod (yes), head shake (no), wave (bye- bye, allgone), pantomime Deictic and representative gestures can be conventional (pointing, waving) or unconventional (banging, blowing)

Form: Gestures A Pre-intentional Developmental Sequence: Shows interest; stops activity, smiles Performs an action, but does not imitate Attempts to imitate, but is inaccurate Imitates by gradual approximation Imitates gestures that he can see himself do Imitates gestures he cannot see himself do

Content: The Familiar Babies’ communicative reactions and attempts focus on familiar: people (and pets) objects activities of daily living play routines sounds tones of voice

Use: Sound Functions Stages & Functions Stage 1 (1 mo) Reflexive Sound-making: parents interpret these as hunger, pain, discomfort Stage 2 (2 – 3 mo) Reactive Sound-making: turn- taking, parents respond more selectively Stage 3 (4 – 8 mo) Activity Sound-making: babies make sound when involved in activity, with or without an adult Stage 4 ( 9+ mo) Communicative Sound-making: used in conjunction with communicative intent

Use: Communicative Acts Communicative Acts are an important precursor to talking - they are a real readiness cue and their absence is an indication of a language disorder. Three Mandatory Elements: 1. Communicative means (e.g.,a vocalization, a gesture, a verbalization) 2. Directed toward another person 3. Communicative function (e.g., request for object)

Use: Identifying Communicative Acts 1.Was there a gesture, vocalization or verbalization? –Gesture –Syllable structure and phonetic inventory –Words 2.Was it directed toward another person? –Gesture –Touch –Gaze 3.Did it serve a communicative function? –Behavioral Regulation –Social Interaction –Joint Attention

Use: Classifying Communicative Intent Yoder & Warren Protoimperatives – stands for something Protodeclaratives- comments and questions about something Wetherby & Prizant Behavioral Regulation (protoim) Social Interaction (protoim) Joint Attention (divided into both)

Behavioral Regulation Acts used to regulate the behavior of another person for a specific result Goal: to get the adult to do something or to stop doing something 1.Request object/action 2.Protest object/action (Protoimperatives)

Social Interaction: Acts used to attract or maintain another’s attention to oneself Goal: to get the adult to look at or notice him/her 1.Request a social routine 2.Request comfort 3.Call 4.Greet 5.Show off 6.Request permission (Protoimperatives & protodeclaratives)

Joint Attention Acts used to direct another’s attention to an object, event, or topic of a communicative act Goal: To get the adult to look at or notice something 1.Comment on object or action 2.Request information (Protodeclaratives)

Prelinguistic Communication Rates & Early Vocabulary Acquisition Proctor-Williams, Dixon, Brown, Ringley, Barber & Light- Newell (in prep) children with TL, rates of prelinguistic communicative behaviors increase with age (7 to 20 mos) & stage (prelinguistic to linguistic). children’s early rates (7 & 10 mos)of prelinguistic behaviors are predictive of later (13 & 20 mos) vocabulary size. 10 min unstructured, uninstructed parent-child samples provide useful clinical information –limitation in the number of protoimperative behaviors that they elicit.

Some Statistical Terms Mean (M): Average Standard Deviation (SD): Statistical average difference of scores from the mean (worrisome if bigger than the mean) Effect Size (d): a measure of strength of relationship between two variables. Doesn’t indicate if relationship is stat significant (p-value)/true. Complements inferential stats Small =.20Medium =.50Large =.80 Confidence Interval: Indicates the reliability of an estimate Correlation (r): Statistical relationship between two or more variables/sets of data CorrelationNegativePositive None−0.09 to to 0.09 Small−0.3 to − to 0.3 Medium−0.5 to − to 0.5 Large−1.0 to − to 1.0

Communicative Functions Mean (SD)t(25)pd95 th CI Total Comm Acts Prelinguistic1.12 (1.02) Linguistic2.12 (1.84) Protoimperatives Prelinguistic0.27 (0.33) Linguistic0.33 (0.27) Protodeclaratives Prelinguistic0.88 (0.85) Linguistic1.81 (1.85) Canonical Vocalizations Prelinguistic 0.22 (0.37) Linguistic0.61 (0.85)

* p <.05 ComprehensionProduction 13 mos20 mos13 mos20 mos Total Comm Acts 7mos r d 95 th CI.39* * * mos r d 95 th CI * * Protodeclaratives 7mos r d 95 th CI.41* * * mos r d 95 th CI * * Canonical Vocalizations 7 mos r d 95 th CI.48* * mos r d 95 th CI *