Language Disorders:from Infancy through Adolescence:

Listening, Speaking, Reading, Writing, and Communicating

Rhea Paul, PhD, CCC-SLPProfessor, Yale Child Study Center

New Haven, Connecticut

Courtenay F. Norbury, PhD

Senior Research Fellow Department of Psychology Royal Holloway University of London London,England

pages 183-189

family-centered practice

the burden of caring for and fostering the development of infants at risk for communication disorders falls on their families,who may already be experiencing a great deal of stress.even caring for a healthy newborn is hard work.imagine how much harder that work becomes when it is done in the context of consistant anxiety about the infant's well-being and futrue.

when thinking about the needs of the high-risk infant,we need to think about the needs of the family,too,to provide that infant with the best environment for growth and develop-ment.

not only to maximize the development of the child but also to optimize the family's capacity to address the child's special needs.

service plans for prelinguistic clients

individual family service plan focues on the child within the context of the family,the IFSP should include information about the family's resource,priorities ,and concerns for the child's developmet,the plan ,also may include some services for the family,such as skilled child care to provide respite for them,or other social services that the family feels are necessary to help them to cope with the stress of raising a handicapped child.

information about the child's present level of physical,cognitive,social ,emotional,communicative,and adaptive development,based on objective criteria.

a statement of the family's resources,priotities,and concerns related to enhacing the development of the child,with the concurrence of the family.

a statement of the major outcomes expected to be achieved for the child and the family,and the criteria,procedures,and timelines used to determine progress and whether modifications or revisions of the outcomes or services are necessary.

a statement of the specific early intervention services necessary to meet the needs of the child and the family to achieve the specified outcomes including (1)the frequency,intensity,and method of delivering the services and (2)the environments in which early intervention services will be provide and a justification of the extent,if any,to which the services will not be provided in a natural environment, the location of the services,and the payment arragements,if any.

a list of the other services such as (1)medical and other services that the child nees and (2)the funding sources to be used in paying for those services or the steps that will be taken to secure those services through public or private source.

projected dates for initiation of the services as soon as possible after the IFSP meeting and anticipat-ed duration of those services

the name and discipline of the service coordinator who will be responsible for the implementation of the IFSP  and coordination with other agencies and persons

a plan for transition to preschool services

these children may have conditions that are not identified at birth,nospecific forms of intellectual disability that have no obvious physical signs,or autism that does not become apparent until later when communication skills emerge in normal development.

language disorders are the most common developmental problem that presents in the preschool period, so any infant at risk for a developmental disorder in general is at risk for language deficits in particular.

when working with high-risk infants,primary and secondary prevention are the predominant goals. we hope that by working with these families to enhance the baby's communicative environment,we can ward off some of the deficits for which they may be at risk or minimize the extent of these deficits.

many high-risk infants presnet with feeding problems,hearing losses,and neurological and behavioral difficulties that can influence communication development.

risk factors for communication disorders in infants

prenatal factors產前

these factors include maternal consumption of excessive alcohol as well as abuse of other drugs.

exposure to environment toxins such as lead,mercury,and other heavy metals,and in utero infections such as rubella ,cytomegalovirus,and toxoplasmosis also place a child at risk.

prematurity and low birth weight早產和低體重

低出生體：低於2500g/5.5磅

極低出生體重：低於1500g/3.3磅

有報告指出treatment of the premature child may have negative consequences,even though it is necessary to save the child's life.newborn intensive care nurseries can be noisy and overstimulating;in the past,some infants even suffered noise-induced hearing losses.

the first hurdle that the premature infant faces is to survive the premature birth.

醫學發展，出生低體重或極低體重存活率提高

early intervention had its greatest effect on infants whose mothers had less than a high school educat-ion.a relatively small investment in intervention can have important effects for children who have risks associated with prematurity and low birth weight.

genetic and congenital disorders遺傳和先天性疾病

inborn errors of metabolism先天性代謝缺陷

craniofacial顱面 disorder

a variety of chromosome abnormalities 染色體異常，比如唐氏綜合症、貓叫綜合症、X和Y染色體異常

產前查出問題還要把孩子生下來是極其不負責任的行為，害了自己也害了孩子

other risks identified after the newborn period

not all children with special needs are identified at birth.such as autism，nonspecific intellectual disability ,and specific language disorder.

hearing impairment is one condition that may not be identified at birth.新生兒聽力篩查

受虐或者被忽視的兒童

assessment and intervention for high-risk infants and their families in the newborn intensive care nursery

feeding and oral motor development

assessment

excess amniotic fluid at delivery that could signal a lack of intrauterine sucking and swallowing,type and duration of intubation,respiratory disorders,and degree of family involvement

羊水过多很有可能是有胎儿的畸形，尤其是羊水特别增多的情况，很可能会合并消化系统、或中枢神经系统的畸形。（摘自网络）

在餵養期嬰兒反應（p.187）

suckling

sucking

rooting

phasic bite reflex

the presence or absence of these reflexes ,though,will both determine the need for future assessment and cntribute to the development of the feeding plan for the infant.

considerations for readiness for oral feeding

gestational age

severity of medical condition

respiratory/cardiovascular stability

motoric stability

coordination of sucking,swallowing,and breathing

behavioral state organization

demonstration of hunger

questions for informal assessment of feeding and oral skills(p.187)

management

because of the neurological immaturity of the infant or because of other medical conditions contribu-ting to intolerance of enteral feeding (by way of the intestines),which can result in excessive vomiting and lead to esophagitis and oral defensiveness,oral feeding may not be an option.in these cases,tube feeding may be initiatied.

three options currently are in used for nonoral feeding

三種方式各有其利弊

nasogastric tube

nasojejunal tube

gastronomy tube 胃管？

嬰兒需要借助氣管導管幫助呼吸，會削弱他們吸吮和口腔運動能力發展

在tube feeding 期間使用安撫奶嘴 help strengthen the sucking reflex and also help the baby learn to associate sucking with feeling contented from feeding.

stroking the cheek,lips,and gums,may also help make the child ready for oral feeding

有研究表明

non-nutritive sucking alone and combined with oral stimulation showed strong positive results for reducing transition time to oral feeding .

specific techniques and instruction for facilitating feeding by either breast or bottle can be provided, such as the following:

1.positioning

keeping the child's face near the feeder's to encourage eye contact and social interaction.

trial and error may be necessary to find the best position.

2.jaw stabilization

3.negative resistance

who bite rather than suck or have an inefficient sucking pattern,as the infant pulls on the nipple during sucking ,the feeder tugs gently back

4.using specialized feeding equipment

if breastfeeding is not possible ,nipples with various characteristics of flow rate,suction,and compressi-on should be tried ,as well as angled bottles.

5.modifying temperture and consistency

有研究指出chilling liquids has been tried to increase swallowing rate and decrease pooling of liquid in the pharynx.

6.oral stimulation in feeding(p.189)

7.nonfeeding oral stimulation

provide gentle stimulation to the baby's face,rubbing it gently with fingers or soft toys and providing non-nutritive sucking of a pacifier or finger whenever possible

putting a finger(nail down)in the baby's mouth and rubbing the palate with an upward motion(midsection to front)to stimulate non-nutritive sucking

rhythmically stroking the midsection of the tongue,front to back

rubbing the infant's cheeks,one at a  time,with a circular motion

tapping around the baby's lips in a complete circle

placing a finger or toothbrush in the mouth and massaging the upper and lower gums