2. When (and to whom) should I refer a child for screening or assessment for language delays?

Transcription

1 1. What is the range of typical language development? 2. When (and to whom) should I refer a child for screening or assessment for language delays? 3. How do I support parents in fostering their child s language development during my contact with them during a well child visit? 1

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3 Phonology speech sounds And how they are combined in words Semantics words and their meaning Syntax grammar How words and phrases are arranged Pragmatics social language use How and why, the appropriateness 3

4 Phonology 0-2 mos vegetative sounds 2-4 cooing, laughing 4-6 vocal play 6-10 babbling baba Semantics 8 mos: turns head when hear name Syntax (generally after 50 words) Pragmatics Smiles back Enjoys games like peeka-boo Phonology Babble with intonation patterns of native language Semantics Understand 3-50 words Produce first words Recognize their name Syntax (generally after 50 words) Pragmatics Smile Gesture and vocalize to: Request Refuse Comment Communication Games 4

5 Phonology 12 mos: Initial: /b, d, g, m, h/ Final: /m/ Frequent errors Syllables: ephant-elephant Deletions: up-cup Substitutions: do-go Syntax May or may not combine words Semantics Produce first 50 words At 18 mos: 20 words minimum, average Pragmatics More frequently vocalize and gesture to: Request Refuse Comment Communication Games Phonology Initial: 9-10 /b, d, m, n, h, w, p, k, g, t/ Final: 5-6 Speech is 50% intelligible Semantics Understand functional language 18 mos: average mos: average Syntax 2-word combinations Some grammatical markers: e.g., verb+ing, in, on Consistent word order Pragmatics 18 mos: simple pretend play More words than gestures More intents Request information Answer questions 5

6 All 2-year-old children 1/5 home language other than English 10-15% Late Talkers 50% Late Bloomers 50% Language Impaired Do they truly catch up in language? 7% of all children 6

7 At age 9 (Rescorla, 2002) Significantly lower language skills (but within the average range). Differences in reading ability. At age 17 (Rescorla, 2009) Comparable nonverbal IQ. Lower language, memory, and reading scores than typically developing children (but within average range). Of Late Talkers Majority of school-age children with language impairment exhibit language-learning disabilities such as reading disabilities. Of Late Bloomers Majority resolved by 5 years old(?) Low end of the normal range Lower academic achievement 7

8 Degree of delay in early expressive language Comprehension deficits Few gestures Little symbolic play Recurrent episodes of otitis media Low SES Family history of language and learning difficulties Delayed early gross motor skills ASHA; Olswang, Rodriguez, & Timler, 1998; Paul, 2000 Is there a clear delay? No Are there additional risk factors? No Yes Yes Respond and Refer Respond and Refer Respond and Monitor, Refer if no progress Wait & see with no response (suggestions) not the best option 8

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10 0-3 year olds: Wisconsin Birth-3 program Eligibility 1. Diagnosed condition When condition has a high (>50) probability of resulting in a developmental delay 2. Developmental delay 25% or 1.3 SD below the mean 3. Atypical development (evaluated) 3-5 year olds: Child Find Local school district Eligibility in WI Generally 1.75 SD below the mean through the school system Private clinics and university clinics vary 10

11 Phonology 36 mos: Speech is 75% intelligible Rhyme awareness and production emerge Semantics Understand and use what, who, where, then why questions 36 months, words Syntax 24 mos: 2-4 word utterances More grammatical markers: e.g., -ing, -ed May overuse past -ed No, not, will, can t won t, gonna, wanna, hafta Pragmatics Language during play increases Topic continuation 50% Narrative stories, first heaps of information, then some sequencing 11

12 Phonology 48 mos: Speech is 90% intelligible, some errors Increasing awareness of sounds in words (phonological awareness) Semantics Understand and use when and how questions 48 mos: 1500 words Syntax Fairly sophisticated: Complex sentences, prepositional phrases Because, when, that, behind the, in front of the Pragmatics More flexibility in requests Can you? Would you? Narratives, themes and some organization Past events, reason, predict, express empathy, imaginary roles in play Phonology Speech is 100% intelligible Some residual errors that do not significant impact intelligibility Segment words into syllables, identify first sounds in words Syntax Fairly adult-like grammar Complex sentences Semantics Over 2000 words Concepts: descriptive, spatial, temporal Pragmatics Topic maintenance Conversational repair Narratives, themes and organization Social role-playing Language to problem solve, explore 12

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14 Waiting Room An opportunity to model importance of health, language, and literacy Books and literacy materials 14

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17 Promote eye contact Arrange environment to increase communication opportunities Follow child s lead and wait Imitation of sounds and gestures Social routines to help children learn and remember Exposure to literacy 17

18 1. Allow the child to lead Observe, wait, listen 2. Adapt to share the moment Be face to face Imitate Interpret Take turns 3. Add language: one new thing 1. -e.g. Match +1 18

19 Evidence-based C Comment A Ask R Respond Materials available in English, Korean, Tagalog, Mandarin, Spanish, Vietnamese 38 19

20 Examples Birth to Two Years Read to your child. Select books that are sturdy and have large, colorful pictures. Two to Four Years Expand your child s vocabulary by naming body parts, animals, clothing items, transportation objects and foods. Four to Six Years Introduce new words and their definitions. Encourage your child to ask what words mean. 20

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22 Recommended Resources ml ent/ spx?webcode=olsdetails&title=speech,+langua ge,+and+hearing+milestones:+birth+to+age+fiv e+dvd ent/parent-stim-activities.htm 22

23 Birth to Two Years Model vowel-like and consonant-vowel sounds during play, such as ma, ba and da. Imitate your baby s laughter and facial expressions. Use gestures such as waving goodbye to help convey meaning. Introduce animal sounds to associate a sound with a specific object. Read to your child. Select books that are sturdy and have large, colorful pictures. Name pictured objects for your child. Two to Four Years Expand your child s vocabulary by naming body parts, animals, clothing items, transportation objects and foods. Ask questions that require a choice. Do you want a banana or a cracker? Sing simple songs and/or nursery rhymes that your child can imitate verbally or through gestures. Engage in simple pretend play activities that resemble the child s daily routine (e.g. feeding a baby doll, putting baby to bed, brushing baby s hair). Encourage creativity in your child s play. Involve the child s senses when exploring new toys by asking questions about what the child hears, sees, smells, feels or even tastes. 23

24 Four to Six Years When your child starts a conversation, give your full attention whenever possible. Continue to build vocabulary. Introduce new words and their definitions. Encourage your child to identify when he/she doesn t know a word and to ask what it means. Talk about spatial relationships (first, middle, and last; right and left) and opposites (up and down; on and off). Offer descriptions or clues, and have your child guess what you are describing: "We use it to sweep the floor" (a broom). Help your child follow 2-3 step directions: "Go to your room, and bring me your book. Encourage your child to give directions. Take advantage of daily activities. For example, while in the kitchen, encourage your child to name the utensils needed. While shopping for groceries, discuss what you will buy, how many you need, the size (large or small), shape (long, round, square), and weight (heavy or light) of the packages. 24