Assessment in the Assessment in the Prelinguistic PeriodPrelinguistic Period

Who are our PrelinguisticWho are our Prelinguistic ClientsClients??

• 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 11/2 to 2 years, identified by their parents, pediatricians or teachers

• Children with autism• Children with significant developmental delays• Children with significant motor involvement

Form,Form, Content, Content, UseUse

Form:Form: Sounds & Sounds & GesturesGestures

Content:Content: familiar people familiar people objects objects activities activities soundssoundstone of voicetone of voice

Use:Use: Reflexive response, joint attention, Reflexive response, joint attention, social interaction, behavioral regulation.social interaction, behavioral regulation.

Children with AutismChildren with Autism

• Primarily a problem of USEUSE• Secondarily a problem of CONTENTCONTENT• Together these result in significant

functional difficulties• Often FORMFORM 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 Children with Significant Developmental DelaysDevelopmental 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 Children with Significant Motor InvolvementInvolvement

• 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?What do We Want to Know?

• History• Feeding skills• Overall level of development

– Cognition– Social– Play– Motor

• Communication skills– Who?– How?– Why?

HistoryHistory

• 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 g1000g = 2.2lb

AppearancePulse

GrimaceActivity

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: SkillsFeeding: Skills

Feeding: Methods of AssessmentFeeding: Methods of AssessmentBehavioral Observation• Modified barium swallow • Feeding sessionsDynamic 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 DevelopmentOverall 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 SkillsCommunication SkillsStandardized Tests• Communication & Symbolic Behavior Scales• McArthur-Bates Communication Development Inventory:

Words & GesturesDevelopmental Scales• Rossetti Infant-Toddler Language Scales• Sequenced Inventory of Communication DevelopmentBehavior Observation• SCERTS• Parent interview & observation• Play with a purposeDynamic Assessment

Parent Report & ObservationParent 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 PurposePlay 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:Form: SoundsSounds

Stages & Types: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: SoundsForm: SoundsA Pre-intentional Developmental Sequence:1. Spontaneous, reflexive, accidental2. Recognizes vocalizations in own repertoire;

stops activity, smiles3. Takes turns vocalizing4. Imitates sound in repertoire when she initiates,

but does not follow adult change5. Imitates sound in repertoire when adult initiates,

but does not follow adult change6. Imitates sounds in repertoire and follows adult

changes7. Tries to imitate novel sounds presented by

adults

Form: GesturesForm: GesturesDeictic 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: GesturesForm: 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 FamiliarContent: 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 FunctionsUse: Sound FunctionsStages & FunctionsStage 1 (1 mo) Reflexive Sound-making: parents

interpret these as hunger, pain, discomfortStage 2 (2 – 3 mo) Reactive Sound-making: turn-

taking, parents respond more selectivelyStage 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 ActsUse: 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 ActsUse: 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 IntentUse: Classifying Communicative IntentYoder & 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 RegulationBehavioral 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: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 routine2. Request comfort3. Call4. Greet5. Show off 6. Request permission

(Protoimperatives & protodeclaratives)

Joint AttentionJoint 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 action2. Request information

(Protodeclaratives)

Prelinguistic Communication Rates & Prelinguistic Communication Rates & Early Vocabulary AcquisitionEarly 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 TermsSome 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 = .20 Medium = .50 Large = .80

• Confidence Interval: Indicates the reliability of an estimate• Correlation (r): Statistical relationship between two or more

variables/sets of data Correlation Negative Positive

None −0.09 to 0.0 0.0 to 0.09

Small −0.3 to −0.1 0.1 to 0.3

Medium −0.5 to −0.3 0.3 to 0.5

Large −1.0 to −0.5 0.5 to 1.0

Communicative Functions

Mean (SD) t(25) p d 95th CI

Total Comm ActsPrelinguistic 1.12 (1.02) 3.19 .004 0.61 0.49-1.16

Linguistic 2.12 (1.84)Protoimperatives

Prelinguistic 0.27 (0.33) 0.62 .54 0.12 -0.43-0.66Linguistic 0.33 (0.27)

ProtodeclarativesPrelinguistic 0.88 (0.85) 2.68 .01 0.51 -.04-1.06

Linguistic 1.81 (1.85)Canonical Vocalizations

Prelinguistic0.22 (0.37) 2.33 .03 0.44 -0.11-0.99

Linguistic 0.61 (0.85)

* p < .05

Comprehension Production13 mos 20 mos 13 mos 20 mos

Total Comm Acts7mos r

d95th CI

.39*0.82

0.25-1.38

.370.77

0.21-1.34

.39*0.81

0.25-1.38

.46*0.99

0.42-1.5810 mos r

d95th CI

.19 .04 .47*1.04

0.46-1.62

.46*1.00

0.42-1.57Protodeclaratives7mos r

d95th CI

.41*0.87

0.31-1.44

.44*0.94

0.36-1.51

.28 .42*0.89

0.31-1.46

10 mos rd

95th CI

.22 -.01 .51*1.14

0.55-1.72

.46*0.99

0.42-1.57Canonical Vocalizations7 mos r

d95th CI

.48*1.05

0.47-1.63

.47*1.02

0.45-1.60

.300.61

0.06-1.16

.310.64

0.08-1.2010 mos r

d95th CI

.05 .06 .340.70

0.14-1.26

.42*0.89

0.31-1.46