Chapter 8 - Communication Disorders

Assessment and
Intervention for Emerging
Paul R. (2001). Language
Disorders from Infancy
through adolescence.
Chapter 8
What is emerging language
stage (EL)?
For normally developing children,
corresponds to toddler age range
Approx - 18 - 36 months
Who might be at the EL
Children between 18-36 mos with no
known risks but parents or others are
Children between 18-36 mos with known
Older children with severe disabilities
To see them or not to see
them…that is the question.
Children under 3 with intact cognitive,
preverbal communicative, and sensory
capacities with no risk factors - low
Children with cognitive deficits, hearing
impairment or chronic OM, preverbal
communication problems, risks pre or
perinatally - should be seen
But remember...
Therapy may facilitate development in
“normal” slow talkers
Children with later language disabilities
often have histories of delayed language
Normal Development
E xp re ssio n
V o ca b u la ry
Com p.
W e th e rb y e t a l.
(1 9 8 8 ); P a u l &
S ch iffe r, (1 9 9 1 )
 18 m os – 2
co m m u n ica tive
a cts/m in
 2 4 m o s - 5 C A s/m in
N e lso n (1 9 7 3 )
 1 8 m o s – co m b in in g
2 w o rd s
M ille r (1 9 8 1 )
 2 4 m o s – M LU –
1 .5 -2.4
F e n se n e t a l. (1 9 9 0 )
 1 8 m o s – 1 1 0 w o rd s
 2 4 m o s – 3 1 2 w o rd s
 3 0 m o s – 5 4 6 w o rd s
C h a p m a n (1 9 7 8 )
 1 8 -2 4 m o s –
u n d e rsta n d 2 -3
w o rd s/se n te n ce
th e y h e a r
Assessment of
Communication in EL
Multidisciplinary and
Play assessment
Play Assessment
Want to ensure child is at a
developmental level consistent with
communication development
Relationships exist between play and
language development
Provides a more holistic picture of the
Assessing Play
Communication and Symbolic Behavior
Scales (Wetherby & Prizant, 1990)
Play Scale (Carpenter, 1987)
parent plays with the child
see Table 8-1, 8-2 p 251
McCune (1985)
child is given a set of toys and behaviours
are analysed (see Table 8-2)
Symbolic Play Test (Lowe & Costello, ‘76)
Rating Scales
see Table 8-3, p. 253-254
Communication and Symbolic Behavior
Scales (Wetherby & Prizant, 1990)
observe parent and child in various interactions
rates performance in five areas
Informal examination of communication
Informal Examination of
Communication Function
Assessing Communicative Intention
Assessing comprehension
Assessing Production
Assessing Communicative
Range of communicative functions
Requests for objects
Requests for actions
Rejections or protests
 Proto-declaratives
Discourse functions
Requests for Information
Assessing Communicative
Intention (cont’d)
Frequency of expression of intentions
Forms of communication (e.g. gestural,
Assessing Communicative
Intent: Worksheet
Table 8-4, page 256
Communicative Act:
Must be directed at adult. Child must look at
or address the adult directly in some way.
Must have an effect on influencing the adults’
behaviour/focus of attn or knowledge.
Child must be persistent in the attempt to
convey the message if the adult does not
Assessing Comprehension
Standardized language tests/scales
PPVT-III, Sequenced Inventory of
Communicative Development (SICD),
Receptive Expressive Emergent Lang Scale
Comprehension Activities:
Understanding Single Words
A collection of six to eight items
Give me… or Where’s…
Can assess body parts
Assess verbs
Comprehension of single words is normal
for 12-18 mos.
What if they don’t?
Comprehension activities:
Two word comb’s (18-24m)
Action-object (use words understood at
single-word stage)
choose unusual combinations such as
“kiss the apple” “hug the shoe”
Comprehension Activities:
Beyond 2-words (24-36 m)
Agent-action-object instructions
Rely on probability
Start with vocabulary from earlier stages
and then move on
see Table 8-6
Comprehension beyond 36
Can be tested using formal
comprehension measures such as PPVTIII, TACL-R, Miller-Yoder Test of
Grammatical Comprehension, CELF-P
Comprehension Findings:
What do they mean?
If comprehension is superior to
better outcomes
If comprehension is poor:
need to include comprehension component in
therapy as well as expressive component
Assessing Espressive
Speech motor development
Speech sample/phonetic repertoire
Phonological skills
Lexical production/Vocabulary
Semantic-syntactic production
(Lexical Production)
Expect a child to have at least 50 words
and some two-word combinations in the
24-36 month stage
Rating scales
MacArthur Communicative Development
Inventories (Fenson et al., 1993)
Language Development Survey (Rescorla,
Semantic syntactic
 Children don’t begin to combine words until
vocabulary size is approx 50 words
To assess semantic-syntactic production:
 Determine the relative frequency of word
Evaluate semantic relations expressed
Table 8-7 (Browns Semantic Relations)
Variety of relations
Advanced relations
 Normal toddlers express 8-11 different semantic
Decision making based on
assessment information
See Paul’s decision
tree on p. 253 (Fig.
Intervention: Goals,
Procedures & Context
Four main areas that may be targeted:
Functional and symbolic play skills
Using intentional communication
Language comprehension
Production of sounds, words, and word
Functional and Symbolic
Play Skills
Step1: Establish reciprocal behaviour and
anticipatory sets (e.g. peek-a-boo)
Step 2: Model early forms of symbolic
play and encourage imitation
Step 3: Model play routines like
pretending to give the doll a bath, meal
time, store games
Developing Intentional
Communicative Behaviours
Want children to initiate communication
#1: Communication temptations
can model first with the parents (e.g. hand
Mum a container and she hands it back to
therapist and indicates ““take the lid off” or
says “help”. Then hand container to the child)
#2: Milieu model
place things out of reach and get the child to
ask for it or draw the child’s attention to it
and wait for a response
Developing Intentional
Communication (cont’d)
#3 : Use routines or script therapy and
then violate the routines
#4 : Respond as though the child is
showing intent
#5: If range of intent is limited, increase
use of proto-imperatives and declaratives
model the behaviour
pretend not to notice something that the
child is interested in and wait for them to get
your attention
Developing Intentional
Communication (cont’d)
If child has adequate intentions but is
only using gesture -->increase vocalising
Model the target response
Withold response or pretend not to notice
until some vocal behaviour produced
Developing Intentional
Communication (cont’d)
If the child is using maladaptive
immediately provide an alternative form of
communication (e.g. I see you want it. Point
to it and I’ll give it to you.)
might need to actually take the child’s hands
and demonstrate the action
Developing Receptive
Indirect Language Stimulation (parent
self-talk/parallel talk
build-ups and breakdowns
recast sentences
see box 8-3
Developing sounds, words,
and word combinations
Increasing phonological skills
expand the repertoire of sounds
use developmental information
Developing a first lexicon
choose words based on normative data
some words should be nouns for labeling
other words should be chosen for expressing
other functions
see Table 8-10
Developing sounds, words,
and word combos (cont’d)
Developing a first lexicon (cont’d)
MacDonald suggested choosing words that
are within the child’s interests
Consider the child’s phonetic repertoire
choose words with sounds in the child’s repertoire
early words may be limited to CV and CVC shapes
How should we teach first
Child centered approach
clinician provides many models
use play contexts and don’t require response
Hybrid approach
milieu teaching
place objects out of child’s reach
script therapy
engage in a verbal routine, once it is overlearned,
either violate it or use a cloze technique
How should we teach first
Hybrid approaches
focussed stimulation
set up the situation so that you are modeling the
specific vocabulary you want to teach
provide lots of opportunities for the child to
produce it
use recasts, expansions, extensions, etc.
may be suitable for older children
Developing word
Word combinations express semantic
play situation-when the child produces a
one-word utterance, the clinician expands it
to a two-word phrase
Developing word
Hybrid approaches
Schwartz et al.(‘85) - vertical structuring
Whitehurst et al.(‘91) - see box 8-5
milieu approaches
put something out of child’s reach - “get X”
focussed stimulation
script therapy
perhaps use a book or song-play that has two
Developing word
combinations (cont’d)
Clinician-directed approaches
Leonard (‘75)
use a puppet and the puppet describes what’s
happening in the picture
 get the child to tell the puppet what’s happening
and to “talk like” the puppet
 MacDonald et al. (‘74) - Environmental
Language Intervention (ELI)
parent works on goal for 5 min in 3 conditions
sessions are three times/week
see Box 8-6