Assessment and Intervention in the Prelinguistic Period

Paul, R. (1995). Language disorders from infancy through adolescence. Chapter 7

What is the prelinguistic stage?

Newborn Period Preintentional period (1-8 months) Prelinguistic communication (9-18

months)

Risk factors for infants

Prenatal Factors– maternal drug or alcohol abuse– exposure to toxins or in utero infections

Prematurity– low birth weight associated with developmental

delay– susceptibility to illness– respiratory difficulties– less interaction early on

Risk factors (continued)

Genetic and congenital disorders– number of syndromes that can occur– autosomal chromosomal abnormalities

(Down syndrome)– sex chromosome disorders (Kleinfelter’s

syndrome)– craniofacial disorders– metabolic disorders

Risks after the newborn period

Hearing Impairment Autism Developmental delay Abuse/neglect

Assessment and Intervention for Newborns at Risk

Feeding and oral motor development Hearing conservation and aural rehab Infant behaviour and development Parent-child communication

Feeding and oral motor development

Observe feeding and oral behaviour Interview parents and staff regarding

feeding and oral behaviour

Assessing Feeding/Oral Behaviour

Reflexes– suckling– sucking– rooting– phasic-bite reflex

Formal assessments Informal interview (see Box 7-1, p. 197)

Management of Feeding

Tube feeding– nasogastric– orogastric– gastrostomy

Stimulate oral motor development Educate parents about feeding

Management of Feeding (contd)

Specific Techniques for Facilitating Feeding– Positioning– Jaw stabilisation– Oral stimulation in feeding– Nonfeeding oral stimulation

Hearing Conservation and Aural Rehab

Advocate for early audiological screening

Advocate for hearing testing in child’s early years

Child Behavior and Development

Assessment should be to determine the current strengths and needs– Identify what risks the infant faces– Evaluate level of infant’s physiological

organization i.e. How much stimulation and handling can the child tolerate? What is the most comfortable position for stimulation?

Management of Behaviour & Development

Suggest ways to counteract low levels of language and interactive stimulation in ICU

Advocate oral development and stimulation

Assessment of Parent-Child Communication

Assessing infant readiness for communication– Educate parents about stages - Turning in,

coming out, reciprocity Assessing parent communication and

family functioning– Discuss the parents concerns

Management of Parent-Child Communication

Inform parent about different states the infant may be exhibiting (see Table 7-3)

Encourage parental interaction when the infant is ready – look at, handle, talk to the baby

Help parent identify end of interaction– wait for signals of interaction like eye gaze– watch for signals of distress

Preintentional Infants - 1-8 mos

Preintentional - infants have not yet developed cognitive skills to represent ideas in their mind and pursue goals

Perlocutionary (Bates, 1976)– infants do not intend any particular

outcome by their behaviour– adults act as if they do (normal and impt

for communication development)

Assessment and Intervention for Preintentional Infants

Feeding and oral motor development Hearing conservation and aural rehab Infant behaviour and development Parent-child communication

Assessment of feeding and oral motor development

Feeding assessment - observe new feeding patterns– integrating sucking with jaw movements– chewing– rotary jaw movements– tongue lateralization– sustained bite

Assessment of feeding and oral motor development

Vocal assessment (see Table 7-4, p 205)– observe child and ask parent about vocal

behaviours– use corrected gestational age - age -weeks

premature = CGA– observe sound play, consonants,

intonational changes, babbling

Management of feeding and oral motor behaviour (1-8 mos) Feeding

– continue oral stimulation– introduce solid foods– see Box 7-2, p 207

Vocal Development– talk and babble to baby– imitate any non-cry vocalization– use “baby-talk”– use toys

Hearing in preintentional period

Encourage assessment by audiologist Counsel regarding otitis media and

signs of otitis media such as pulling on ear, fussing

Child Beh’r & Dev’t (1-8 mos)

Assessment– Involves general assessment of development– Instruments available include:

• Bayley Scales of Infant Development

• Vineland Adaptive Behavior Scales

• Receptive-Expressive Emergent Language Scale

• Sequenced Inventory of Communication Development (SICD)

• Rossetti Infant-Toddler Language Scale

Child Beh’r & Dev’t - Management General motor and cognitive stimulation Home-Based Programs

– activities should be performed in communicative manner

– parent advocate

Parent-Child Communication

Assessment– Formal instruments– Informal observation

• responsiveness to child’s cues of readiness and unreadiness to interact

• choice of objects and activities• language stimulation and responsiveness

(cooing, babbling, responding• encouragement of joint attention

Communication - Management

Act as a support and encourage parent Paul suggests three main aspects:

– Increase awareness of infant communication patterns

– Provide Instruction and modeling of adult-infant communication

– Help parents self-monitor

Awareness of comm. patterns

Explain that it may be difficult to interact with an unresponsive infant

Make communication enriching and responsive– provide visual, auditory, tactile cues to engage

baby– allow infant to explore novel stimuli

Explain interactive pattern of infants– educational videos

Modeling Interactive Beh’s

Turn-taking and imitation– ensure baby is ready to interact– use smiles and vocalisations to elicit infant

behaviour– wait for the infant to initiate– imitate it and then wait for infant to do

something else– vocalization and imitation of vocalization

should be especially encouraged

Interactive Behaviours

Joint Attention Routines– identify the infant’s focus and share

attention to that– make a comment or gesture about what

the baby is looking at or doing– peekaboo– choral vocalization

Interactive Behaviours

Establishing anticipatory sets Playing baby games

– provide the baby with predictable series of sounds and actions

– basis for script development– use baby games that the family have used

before and/or are culturally appropriate

Interactive Behaviours

Self-monitoring skills– video-taping sessions– ensure a non threatening environment for

the parents

Assess’t and Treatment at Prelinguistic Comm. Stage (9-18) Infants become intentional

communicators Illocutionary stage (Bates, 1976) - child

expresses intention through signals

Assessment

Play assessment (eg. Symbolic Play test) Observe play

– recognition of common objects (brush, phone)– engages in simple play schemes

Is any functional communication present– attempts to request objects or actions– eliciting attention

Management

If child is expressing some communicative intent-– scaffold (e.g. break routines)– vocalise the child’s demands– shared book-reading

• joint attention to pages• stop and wait for child to respond

– Communication temptations (see box 7-3)

Management (cont’d)

Facilitate comprehension– baby games (e.g. show me your nose,

ears, etc)

Management (cont’d)

If the child is not showing intentionality-– provide intensified input (book reading, lots

of parallel talk, joint attention activities)– improve comprehension skills– encourage vocalization– respond to the child’s actions and

initiations

Considerations for older prelinguistic children Feeding and oral motor development Hearing conservation and aural

rehabilitation Intentionality and communication

– symbolic systems of communication