The Goals Of This Plenary What I Hope To Do

Start screen recorder before playing this video Profectum s 3 rd Annual New York Conference Overcoming Barriers to Progress: Vital Pathways to Advance Development Comprehension across the spectrum: A longitudinal story of a child s triumphs and struggles with language development Sima Gerber, Ph.D., CCC Queens College, CUNY The Goals Of This Plenary What I Hope To Do 1. To present a child s story Albert Einstein!! not everything that can be counted counts. and not everything that counts can be counted The Goals Of This Plenary What I Hope To Do 2. To clarify what the comprehension of language is and what capacities impact its development 3. To illustrate what comprehension challenges may look like and what a child may do to compensate for these challenges The Goals Of This Plenary What I Hope To Do 4. To describe and illustrate our intervention approach to language comprehension challenges a developmental social-pragmatic approach informed by DIR Developmental Individual difference Relationship Based approach

What I will not be doing in this plenary (unfortunately) Matthew s family the R (relationship) in DIR Who is Matthew? The Prologue Matthew s school Define all terms Discuss all slides 1. Matthew Age 4 Chapter 1 Matthew s Profile 4 to 6 years old Getting ready to understand language Matthew s social-emotional levels FEDLs I. Shared Attention and Regulation* II. Engagement and Relating* III. Two way Communication* IV. Complex Problem solving* *Observed intermittently with support Chapter 1 Matthew s Profile 4 to 6 years old V. Creative Representations and Elaborations* - Connects 3-4 step sequences to represents realistic ideas and elaborates emotional themes VI. Representational Differentiation and Emotional Thinking* - Builds bridges between ideas - Elaborates abstract themes - Has reflective capacities Matthew s language and communication COMPREHENSION PRODUCTION Communicative intentions --------------------------------------------------------------------------------------------------- 1. Non-linguistic communication constricted constricted Gesture/ Facial expression/ Body language 2. Linguistic communication constricted frequent Novel word combinations Scripted utterances --------------------------------------------------------------------------------------------------- * Not reached

Matthew s language and communication Matthew presented with the atypical pattern of language development where Production > Comprehension The use of scripts as an entrée into language What are the signs of a comprehension problem? The child may imitate what is said to him or may use scripts The child may not respond to questions The child may not respond to comments or requests The child may not look at or get items named or pointed out in the environment The child may demonstrate anxiety, confusion, or dysregulation The child may not engage, relate, or communicate as we might expect. Our Challenge!! Can we shift from thinking about the child s difficulty producing language, i.e., talking à to his problem understanding language? This has a tremendous impact on your interactions with the child:! what you teach or facilitate how you coach the parent what you expect the child to do! The Interrelationship Of Developmental Domains Matthew had many strengths in development but the following areas were roadblocks to or the result of challenges in comprehension: *regulation challenges *challenges in interpersonal engagement *production > comprehension frequent use of scripts * Red flags for comprehension difficulties Regulation Joint attention Intentionality The Roots Of Comprehension REGULATION The Roots Of Comprehension the regulation of joint activity depends on shared interactive rules, a shared lexicon of communicative acts, and shared time. skilled performances with objects and language borrow their competencies from the capacity for the joint regulation of behavior regulation is accomplished by the operation of a communication system in which the infant communicates its regulatory status to the caregiver, who responds to the meaning of the communication Tronick, 2006

The Roots Of Comprehension The Roots Of Comprehension JOINT ATTENTION Joint attention makes relevant aspects of the context salient, helping children comprehend what is taking place. Joint attention enables the child to associate meaning with a particular utterance. SHARED INTENTIONALITY Social developments are the beginnings of the child s development of intentionality, an essential basis for language Shared intentionality is a collaborative activity in which participants share psychological states with one another. what s on your minds Following the mother s gaze and following the mother s point Tomasello, 1996 The Relationship Between Intentionality And Word Learning The child encounters an adult making funny noises at her. What is she to make of this odd behavior? If she understands the other person as an intentional being, she will attempt to determine the purpose for which that person is making these funny noises. Given that the child has previous experience in interpreting the adult's nonlinguistically expressed communicative intentions - as the adult points to things for her, shows her things, etc.- one possibility is that the adult is making these funny noises in an attempt to communicate with her. That having been decided, to determine precisely what the adult is attempting to communicate to her with some novel sound/word in particular (almost always embedded in a longer utterance), the child must now determine, first, the adult's overall communicative intention and, then, the particular way or ways that the new word in particular is contributing to that communicative intention. Tomasello, 2000 EFFORT Cognitive Development LANGUAGE The Intentionality Model Bloom and Tinker, 2001 FORM CONTENT USE ENGAGEMENT Social & Emotional Development Early Stages Of Language Comprehension < 12 Months The child understands a few words in context (plays peek-a-boo in response to words and gestures) The child responds to interactions with others The child responds to others communicative intentions to regulate his behavior to draw attention to themselves to draw attention to objects Miller and Paul, 1995; DMIC, 2005 Early Stages Of Language Comprehension < 24 Months The child understands two word combinations similar to those they can produce (eat cookie, Mommy jump, Mommy s shoes, kiss baby) The child understands words for objects that are not in view The child understands routine forms of who, what, and where questions. The child doesn t fully understand agent-action-object (Mommy kiss baby) Miller and Paul, 1995; DMIC, 2005

Matthew 4 years to 6 years Language intervention - Goals To facilitate regulation To facilitate joint attention To increase Matt s capacity to attune to and understand others intentions To coach Mom in floortime strategies that could be used throughout the day Language Intervention - Strategies To facilitate regulation, joint attention, intentionality: Mom and the clinician will interpret and respond to all of Matt s actions, behaviors, and verbal productions as intentional and meaningful even if they are unconventional Mom and the clinician will follow the contents of Matt s mind, joining HIS play theme or script contingently. Language Intervention - Strategies Mom and the clinician will maintain the rhythm and shared meaning of communication by taking a role in preferred play themes, including scripted ideas such as Finding Nemo Mom and the clinician will model language which codes Matt s actions The clinician will support Mom s use of strategies which she is comfortable using in her interactions with her son Early phases of facilitating comprehension for some children involves increasing their capacities for Regulation Joint attention Expressing and understanding communicative intent and not addressing language per se! But Should I Talk To The Child?? What developmental stage of language is your child at? This is unrelated to his chronological age. We re going to the playground now so let s get your bike versus Your bike!... Let s find it... Here s your bike!! Time for the playground! Matthew Language Sample 6 Years open the bubble gum you hafta help I need another toothpaste put this one over here we need to cover this one you do it can you help me cover up the we don t want it tooth? do it later you can cover this one I ll take the picture more you do it let s hit the hammer you brush it in there let s rinse the teeth I hold the toothbrush we hafta pull it out you hafta stay open open your mouth this teeth and this teeth take a deep breath take a picture of the teeth don t be scared no we hafta do it wait we hafta try another one it s run out it s my pull the tooth

Chapter 2 Matthew s Profile 7 to 9 years old Understanding a symbolic-linguistic rule-governed system Matthew s social-emotional levels FEDLs I. Shared Attention and Regulation* II. Engagement and Relating* Chapter 2 Matthew s Profile 7 to 9 years old V. Creative Representations * VI. Representational Differentiation and Emotional Thinking* III. Two way Communication* IV. Complex Problem solving* * Observed more consistently with structure and scaffolding given high affect, gestural, language, sensorimotor support *Not at age- expected level/ Observed intermittently without support -> Age-appropriate level in certain contexts Matthew s Profile Language and Communication 7 9 yrs Communicative intentions COMPREHENSION PRODUCTION ------------------------------------------------------------------------------------------------------------ 1. Non-linguistic communication emerging frequent Gesture/ Facial expression/ Body language 2. Linguistic communication frequent frequent Sentences Scripted utterances 3. Conversation constricted constricted ----------------------------------------------------------------------------------------------------------- The Interrelationship Of Developmental Domains Matthew had many strengths in development but the following areas continued to be roadblocks to or the result of challenges in comprehension: *regulation challenges *challenges in sustained engagement *production > comprehension frequent use of scripts * Red flags for comprehension difficulties Why Can We Comprehend Language? Why Can We Comprehend Language? `Twas brillig, and the slithy toves Did gyre and gimble in the wabe: All mimsy were the borogoves, And the mome raths outgrabe. Because you know the rules of your language, you can answer these questions But you also can experience what it might be like not to understand what is being said!! From The Jabberwocky, Lewis Carroll

Understanding A Symbolic-linguistic Rule-governed System Syntactic-semantic rules Contextualized vs. decontextualized Mid- Stages Of Pre-school Comprehension < 42months The child understands agent-action-object (subject-verb-object) Daddy ate the cookie The girl rode the bike The child understands a greater range of wh- questions what, where, who and whose earlier What is that? now What is he doing? The child understands and responds to simple causal why questions. Why is daddy fixing the bike? (in the context of Daddy fixing it) and later, When, How, and more complex Why questions. Miller and Paul, 1995; DMIC, 2005 Matthew 7 To 9 Years Language Intervention - Goals All of the earlier goals continued to be addressed To narrow the world of language to include early vocabulary and simple sentences To facilitate the development of the first question types to be acquired Who, Where, What in familiar contexts Language Intervention - Strategies Reduce the complexity of your language inputmaintain the grammar of the language, the melody, and the interactive flow of communication. Embed comprehension work in contexts that are familiar to the child and affectively strong Pair language with the child s actions; timing and contextual support (where these phrases naturally occur) are critical at early stages Present targeted language in many familiar contexts to promote learning 2. Reading with mom 3. Hansel and Gretel

Chapter 3 Matthew s Profile 10 to 12 years old The art of conversation Comprehension impacts the ability to engage in conversation, i.e. the ability to take turns in conversation requires comprehension! Comprehension can lead to greater contingency, i.e., the ability to stay on topic requires comprehension! Contingency can be addressed in play, language, and narrative Starting at the age of 10 years.. Matthew started to experience a developmental spurt!! Affective range Symbolic play Comprehension of language!! Language production Conversation Friendship Theory of mind And perhaps most importantly.. 4. Matt and Eli The integration of developmental capacities!! 5. Matt and the picnic And How Did This Happen?? The child s drive for development Finely attuned parents Collaboration between parent & therapist.. Developmentally based therapy And.magic!!

7. Matthew at the magic show! The Epilogue Selected References Bloom, L., & Tinker, E. (2001). The intentionality model and language acquisition. Monographs of the Society for Research in Child Development. 66 (4) Serial no. 267. Cawn, S., Gerber, S., Greenspan, S., Harrison, C., Lewis, D., Madell, J., & Wetherby, A. (2005). Language disorders. In Interdisciplinary Council on Developmental and Learning Disorders - Diagnostic Manual for Infancy and Early Childhood (pp.129-166). MD: ICDL Press. Gerber, S. (2012). A contemporary model of assessmentand intervention: The integration of developmental language models and the Developmental Individual Difference Relationship based approach, P. Prelock and R.Mac McCauley, Treatment of Autism Spectrum Disorders: Evidence-Based Intervention Strategiesfor Communication and Social Interaction. Baltimore:Brookes Publishing. Gerber, S. (2003). A developmental perspective on language assessment and intervention for children on the autistic spectrum. Topics in Language Disorders, 23, 74-95. Greenspan, S.I., & Wieder, S. (1998). The child with special needs: Encouraging intellectual and emotional growth. Reading, MA: Perseus Books. Tomasello, M. (2000). The social pragmatic theory of word learning. Pragmatics 10:4.401-413. Tomasello, M. (1996). The cultural roots of language. In B. Velichkovsky & D. Rumbaugh (Eds.), Communicating Meaning: The Evolution and Development of Language.Lawrence Erlbaum. Tronick, E. (2007). The neurobehavioral and social-emotional development of infants and children. NY: W.W.Norton & Company, Inc. Follow us on Twitter @MyProfectum Join us on Google+ Profectum Foundation Help us get the word out!