Language Intervention for Toddlers and Preschoolers with...

PATTI SOLOMON-R ICEGLOR IA SOTO

NOV EMBER 17, 2011ASHA 2011 ANNU AL CONV ENTION

SAN D IEGO, CA

Language Intervention for Toddlers and Preschoolers with Significant Speech Impairments

Outline

Solomon-Rice & Soto 2011

Problem statement

Vocabulary selection

Language intervention approaches

Care-giver training

Contexts for intervention

Theories of early word learning

Conclusions

Problem Statement


Toddlers and preschoolers who benefit from AAC often demonstrate expressive language delays in combination with severe speech impairments.

This population uses unaided and aided multi-modal methods to communicate.

This population often requires language intervention to facilitate vocabulary production.

What language intervention strategies should be implemented to facilitate vocabulary production with toddlers and preschoolers who are multi-modal communicators?

Purpose of Presentation


This presentation will describe explicit and validated intervention strategies which support

vocabulary productions in toddlers and preschoolers who use multi-modal AAC through:

Systematic vocabulary selection

Evidence-based language intervention approaches

Inclusion of care-giver training

Selection of appropriate contexts for intervention

Representational considerations

Systematic Vocabulary Selection


Consider coverage vocabulary within the child’s receptive language repertoire that is not produced (Vanderheiden & Kelso, 1987).

Include core vocabulary (Banajee, Decarlo, & Stricklin, 2003).

Include fringe vocabulary (Beukelman & Mirenda, 2005).

Systematic Vocabulary Selection continued…


Include words that are frequently produced by typically developing and late talking toddlers and preschoolers (Rescorla, Alley, & Christine, 2001).

Incorporate caregiver tools such as the MacArthur-Bates Communicative Development Inventories, Second Edition (Fenson, et al., 2007).

Evidence-Based Language Intervention Approaches


Focused Stimulation SLP provides multiple models of targeted vocabulary or

grammatical constructions within meaningful contexts a minimum of ten times.

Child has multiple opportunities to produce targeted vocabulary/grammatical constructs.

Naturalistic contexts promote production of targeted language (Cleave & Fey, 1997).

What Research Tells Us about Focused Stimulation


Cyclical goal attack strategies facilitated

learning specific grammatical forms; SLP

treatment more consistent than parental treatment

(Fey, et al. 1993; Fey, et al., 1997).

Structured routines and theme based activities

facilitated vocabulary and 2-3 word phrases in

toddlers (Robertson & Ellis Weismer, 1999).

Story-book reading activities facilitated

production of grammatical morphemes through

modeling and recasts with three school-aged children

who used aided AAC (Binger, Maguire-

Marshall, & Kent-Walsh, 2011).

Focused Stimulation with Toddlers Who Use Multi-Modal AAC


Vocabulary is targeted that toddlers comprehend but do not produce.

SLP models targeted vocabulary 10 times during child-centered, interactive play within a natural context.

Exploratory research suggested toddlers who use multi-modal AAC might benefit from focused stimulation; two of three toddlers demonstrated improved vocabulary production (Solomon-Rice & Soto, in process).

Focused Stimulation Video Clip


Aided AAC Modeling


SLP points to a graphic symbol on a child’s AAC device while simultaneously producing the corresponding spoken word during natural communication exchanges (Goosens’, 1989).

What Research Tells Us about Aided AAC Modeling


SLP pointed to and labeled 12 graphic symbols during scripted

routines with a preferred activity; three cognitively impaired preschoolers demonstrated

increased symbol comprehension and production (Harris & Reichle,

2004).

SLP pointed to and labeled two symbols, followed by production of

a grammatically complete sentence, during imaginative play scenarios; four of five preschoolers

consistently produced multi-symbol messages (Binger & Light,

2007).

AAC Modeling with Toddlers Who Use Multi-Modal AAC


Vocabulary is targeted that toddlers comprehend but do not produce.

SLP models targeted vocabulary 10 times while simultaneously modeling toddler’s unaided or aided AAC system (e.g. manual sign, graphic symbols) during child-centered, interactive play within a natural context.

Exploratory research suggested two of three toddlers who used multi-modal AAC demonstrated improved vocabulary production (Solomon-Rice & Soto, in process).

AAC Modeling Video Clip


Inclusion of Caregiver Training


Responsivity Education

Child oriented behavior - following the child’s lead

Interaction promoting strategies

Language modeling strategies (Manolson, 1992)

What Research Tells Us about Responsivity Education


Decreased directiveness and increased responsiveness with

mothers and their preschoolers with developmental and

language delays (Girolametto, 1988; Tannock, et al. 1992)

Improved mother-child interactions for initiation,

responding, and requesting with toddlers diagnosed with cerebral palsy (Pennington, et

al., 2009)

Responsivity Education and Aided AAC Modeling


Caregivers instructed in language facilitation techniques

Open-ended question asking with expectant delays

Modeling desired productions on child’s AAC device

Responding to child’s productions using AAC imitation, expansion, and recasts (Binger, Kent-Walsh, Berens, Del Campo, & Rivery, 2008; Rosa-Lugo & Kent-Walsh, 2008)

What Research Tells Us about Responsivity Educationand Aided AAC Modeling


Caregivers consistently used RE and AAC modeling

strategies during story book reading

activities across studies.

Three preschoolers increased multi-

symbol productions; more time was needed

to produce 2-word phrases using a

communication board versus a VOCA

(Binger, et al. 2008).

Two school-aged children increased

communicative turn-taking and expressed

novel semantic concepts (Rosa-Lugo

& Kent-Walsh, 2008).

Six preschool and school-aged children

increased communicative turn-

taking and use of different semantic

concepts (Kent-Walsh, Binger, & Hasham, 2010).

The System for Augmenting Language for Toddlers with AAC Needs


Vocabulary is targeted that toddlers neither comprehend nor produce.

Caregivers are coached in naturalistic intervention strategies and one of three treatment conditions:

augmented input

augmented output

spoken communication only with no use of AAC

Augmented input consists of VOCAs and gesturing but no signing.

Naturalistic intervention strategies are used to learn targeted vocabulary (Romski, et al., 2010).

What Research Tells Us about the System for Augmenting Language with Toddlers


Toddlers in the augmented input and output treatment groups produced significantly more augmented and spoken vocabulary.

Toddlers in the augmented output group were more likely to produce spoken words at session 18 and maintain the words at session 24 in comparison to the other two groups (Romski, et al., 2010).


“Word learning is the product of the active mind of a child. Children strive to learn the words that can express what they have in mind….A language will never be acquired without engagement in a world of persons, objects and events (Bloom 2000 p. 44).”

The Context for Early Word Learning


Engagement: Intentional Attention for the purpose of deriving and sharing MEANING

Meaning: what is perceived as relevant to the individual (based on prior knowledge, needs and interests)


Children acquire language through interaction with others as they engage in shared activities

Experience is the encounter of the child with aspects of the environment. It involves attention, perception, action and interaction

Experiences are filtered through language into verbalized events. A verbalized event is constructed online in the process of speaking (Slobin, 1996)

EARLY Word Learning in AAC:Putting it all together


It is not about lists. It is about EXPERIENCE and PARTICIPATION with true communicative responsibility;

The process of early word learning changes in the course of development: From expressing owns intentions to understanding

others’

From highly referential to conversational and “storied”

So, what does it take to learn a word?


constraints/principles theories social pragmatic view

associationisticaccounts

the emergentistcoalition theory

Constraints/Principles Theories


Emphasize the importance of cognitive biases or assumptions that children make in early word acquisition :

reference

extendibility

whole object bias

conventionality

categorical scope

novel name-nameless categories

Social/Pragmatic Theories


Children use social cues that point to referential intent (Tomasello).

Adults talk about objects, actions and events that children are focused on, thereby producing language that is relevant to the child’s interests (L. Bloom). relevance discrepancy elaboration

Associationistic Theories


Children map word to meaning through association of the most frequently word used to the most salient referent : perceptual saliency

association

frequency

Emergentist Coalition Model


• Children recruit a “coalition” of social, attentional, cognitive and linguistic cues to learn the meaning of new words.

• The cues for word learning “change their weights” over development.

Language Acquisition Theories – Common Ground


Children must have access to linguistic units and must be sensitive to the possible relations between those units to learn grammar.

Children are born with sensitivities to language-relevant data properties in the input (Hirsh-Pasek & Golinkoff, 1996).

Context

Language

Child


Grounding Aided Word Learning


Attentional Cues perceptual saliency temporal contiguity

Social Cues social eye gaze Social context

Linguistic Cues morpho-syntax

Cognitive Cues

Attentional Cues in Aided Word Learning


Perceptual Saliency

Temporal Contiguity highly referential and contextualized intervention

words cannot be taught in isolation

heavy emphasis on observable objects, properties and events

Word Learning in AAC: Social Cues


Pictures have symbolic potential when presented with pragmatic cues.

The adult’s communicative intent

seem to be the strongest cue in how a child

interprets the meaning of a picture under

different conditions.

Word Learning in AAC: Linguistic Cues


Language develops; AAC must be learned (Smith, 2006).

Children need a range of lexical types and grammatical markers in order to realize different types of clauses and phrases (Kaul, 2003).


When grammatical markers are provided, word order matches environmental language (Nakamura et al., 1998) even with nonreaders (Koul, 2003)

Word Learning in AAC: Cognitive Cues


Words direct children’s attention to aspects of reality that get encoded in their native language, eg., tight of fit, spatial preposition, path of motion.

In Conclusion


To Facilitate Vocabulary Production in Toddlers and Preschoolers:

Systematically select vocabulary within the child’s receptive repertoire; include both core and fringe vocabulary; include vocabulary typically produced by toddlers and preschoolers; and include caregiver input in vocabulary selection.

Evidence-based research supports the use of focused stimulation, aided AAC modeling, and caregiver training in responsivity education combined with AAC modeling as effective intervention approaches.

Children need participants in meaningful experiences and access to linguistic systems to learn the meaning of words.

Thank you!Any comments or questions, please contact:


Patti Solomon-Rice, Ph.D. CCC-SLP

[email protected]

Gloria Soto, Ph.D.

[email protected]

Department of Special Education and

Communicative Disorders

San Francisco State University

mailto:[email protected]�

mailto:[email protected]�

References


Banajee, M., Dicarlo, C., & Stricklin, S. (2003). Core vocabulary determination for toddlers. Augmentative and Alternative Communication, 19, 67-73.

Beukelman, D.R., & Mirenda, P. (2005). Augmentative and alternative communication: supporting children and adults with complex communication needs, 3rd Edition. Baltimore: Paul H. Brookes Publishing Co.

Binger, C., Kent-Walsh, J., Berens, J., Del Campo, S., & Rivery D. (2008). Teaching Latino parents to support the multi-symbol message productions of their children who require AAC. Augmentative and Alternative Communication, 24, 323-338.

Binger, C. & Light, J. (2007). The effect of aided AAC modeling on the expression of multi-symbol messages by preschoolers who use AAC. Augmentative and Alternative Communication, 23, 30-43.

Binger, C., Maguire-Marshall, M., & Kent-Walsh, J. (2011). Using aided AAC models, recasts, and contrastive targets to teach grammatical morphemes to children who use AAC. Journal of Speech, Language, and Hearing Research, 54, 160-176.

Cleave, P.L., & Fey, M.E. (1997). Two approaches to the facilitation of grammar in children with language impairments: Rationaleand description. American Journal of Speech-Language Pathology, 6, 22-32.

Fenson, L., Marchman, V.A., Thal, D. J., Dale, P.S., Reznick, J.S., & Bates, E. (2007). MacArthur-Bates Communicative Development Inventories, Second Edition. Baltimore, MD: Paul H. Brookes Publishing Co.

Fey, M.E., Cleave, P.L., & Long, S.H. (1997). Two models of grammar facilitation in children with language impairments: Phase 2.Journal of Speech, Language, and Hearing Research, 40, 5-19.

Fey, M.E., Cleave, P.L., Long, S.H., & Hughes, D.L. (1993). Two approaches to the facilitation of grammar in children with language impairment: An experimental evaluation. Journal of Speech and Hearing Research, 36, 141-157.

Girolametto, L. (1988). Improving the social-conversational skills of developmentally delayed children: An intervention study. Journal of Speech and Hearing Disorders, 53, 156-167.

Goossens’, C. (1989). Aided communication intervention before assessment: A case study of a child with cerebral palsy. Augmentative and Alternative Communication, 5, 14-26.

References continued


Harris, M.D., & Reichle, J. (2004). The impact of aided language stimulation on symbol comprehension and production in children with moderate cognitive disabilities. American Journal of Speech-Language Pathology, 13, 155-167.

Kent-Walsh, J., Binger, C., & Hasham, Z. (2010). Effects of parent instruction on the symbolic communication of children using AAC during storybook reading. American Journal of Speech-Language Pathology, 19, 97-107.

Manolson, A. (1992). It takes two to talk – A parent’s guide to helping children communicate. Toronto, Ontario, Canada: The Hanen Centre.

Pennington, L., Thomson, K., James, P., Martin, L., & McNally, R. (2009). Effect of it takes two to talk – the Hanen program for parents of preschool children with cerebral palsy: Findings from an exploratory study. Journal of Speech, Language, and Hearing Research, 52, 1121-1138.

Rescorla, L., & Alley, A. (2001). Validation of the Language Development Survey (LDS): A parent report tool for identifying language delay in toddlers. Journal of Speech, Language, and Hearing Research, 44, 434-445.

Robertson, S.B., & Ellis Weismer, S. (1999). Effects of treatment on linguistic and social skills in toddlers with delayed language development. Journal of Speech, Language and Hearing Research, 44, 1234-1248.

Romski, M.A., Sevcik, R.A., Adamson, L.B., Cheslock, M., Smith, A., Barker, R.M., & Bakeman, R. (2010). Randomized comparison of augmented and nonaugmented language interventions for toddlers with developmental delays and their parents. Journal of Speech, Language and Hearing Research, 53, 350-364.

Rosa-Lugo, L. J. & Kent-Walsh, J. (2008). Effects of parent instruction on communicative turns of Latino children using augmentative and alternative communication. Communication Disorders Quarterly, 30, 49-61.

Solomon-Rice, P. & Soto, G. (in process). Facilitating vocabulary production in toddlers with AAC needs: An exploratory comparison between focused stimulation and AAC modeling.

Tannock, R., Girolametto, L. & Siegal, L. (1992). Language intervention with children who have developmental delays: Effects of an interactive approach. American Journal of Mental Retardation, 97, 145-160.

Vanderheiden, G. & Kelso, D. (1987). Comparative analysis of fixed-vocabulary communication acceleration techniques. Augmentative and Alternative Communication, 3, 196-206.

Language Intervention for Toddlers and Preschoolers with...

Documents

Transcript of Language Intervention for Toddlers and Preschoolers with...