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 189-199

hearing conservation and aural habilitation聽力保護

the incubators ,cardiorespiratory monitors,and ventilators present in the NICU can generate noise levels of more than 85dB,which not only interferes with sleep but may result in hearing loss by means of cochlear damage.

child behaivor and development

assessment

the purpose of assessment for infants should not be to predict future behavior,but to determine the infant's current strengths and needs.

first ,it is important to know as much as we can about what risks the infant faces.

second,we need to evaluate the infant's level of physiological organization.an important part of the assessment of the at-risk newborn involves evaluating the extent to which the baby can maintain physiological and attentional states.

identify the conditions under which the baby functions best,what places stress on the baby,how much handling and stimulation the baby can tolerate,how easily the baby's homeostasis is disrupted,what supports are useful to the baby in maintaining self-control,and how much endurance the baby has for interactive functioning.

management

the goal of intervention for the baby n the NICU is to achieve stabilization and homeostasis of physiological and behaivoral state and to prevent or minimize any sencondary disorders that might be associated with the child's condition,rather than to attain milestones appropriate for full-term babies.

encourage careful monitoring both of noise levels and infant hearing within the NICU

develop staff awareness of the dangers of ototoxic effect of medications

educate staff about the efficacy of early intervention

encourage parents to talk to ,touch,and hold the baby,help with positioning

help parents recognize,understand,and interpret the infants' signals,help time caregiving and interaction to promote the infants state regulation and allow for natural sleep-wake cycles.

parent-child communication

assessment 

assessing infant readiness for communication

three stages of behavioral organization in high-risk newborn,the child's state of organization deter-mines when he or she is ready to participate in interactions.(p.190)

turning in (or physiological state)和死神作鬥爭

coming out呼吸順暢，體重增加

reciprocity回家了，可以和父母進行互動了

assessing parent communication and family funcitoning

one of the best way to find out about family members' priorities and concerns is to talk with them.in discussing how a family can best cope with a handicapped or at-risk child,it is a good idea to remember that the family is probably experiencing a good deal of shock,grief,guilt,confusion,fear,and a feeling of loss of the perfect baby they dreamed of having.

a family-centered approach involves not a complicated psychology,but rather a simple,human attempt to treat others as we would wish to be treated if we were experiencing the difficult transition that the NICH infant's family must face.

換位思考，面對同樣困難時，我們希望別人如何對待我們

management 

skin-to-skin每日30min

infant states

deep sleep(implications for interaction:little possible,adults will do better to wait to feed or interact until child arouses naturally)

light sleep(implications for interaction:makes up largest part of newborn sleep pattern;brief fuss sounds may cause adults to try to feed,rouse,or interact with babies before they are ready)

drowsy(implications for interaction:infants left alone in this state may return to sleep,but if parents provide something for the baby to look at,listen to ,or suck on,baby may be aroused to a more responsvie state.

quiet alert(implications for interaction:providing something for baby to look at ,listen to ,or suck may maintain this state,which is ideal for interaction)

active alert(implications for interaction:parents can cuddle and console to bring baby to a less aroused state)

crying (implications for interaction:tells parents the child has reached his or her limits ,needs to be fed or consoled)

infant's signs  of stress,such as averting the gaze,turning the head away,spreading the fingers,arching the back,and grunting.

a natural part of the baby's transition from one state to another

give the baby "time out" to reorganize.not to try to re-establish mutual gaze if the baby has broken it,instead,wait for signals,such as bodily quieting and a reinteraction.

charting the child's behaivor，learn to be better observers of the child's behavior

紀錄孩子的行為表現，我柔柔的進步我都忘了紀錄了，星期五的時候上完廁所會自己沖廁所、提褲子，能蒽壓水龍頭洗手

assessment and interaction for preintentional infants and their families:1-8 months

infants do not intend any particular outcome by their behaivor,that adults act as if they do.adults' willingness to attribute intentionality to the young infant's behavior is one way babies are "taught" how to have these intentions,which will eventually lay the basis for communication later in the first year of life.

賦予行為意圖

feeding and oral-motor development

feeding assessment

development of feeding and oral-motor skills 

0-4months 

food type:liquid 

oral-motor skills:suck on nipple

development skill:head control acquired

4-6months

food type:purees

oral-motor skill:suckle off spoon,progress to sucking

development skill:sitting,hands to midline

6-9months

food type:soft chewables

oral-motor skill:vertical munching,"sippy"cup drinking,limited lateral tongue movements

development skill:hand-to-mouth reach,grasp;finger feeding,assist with spoon

9-12months

food type:lumpy textures

oral-motor skill:independent "sippy"cup drinking

development skill:pincer grasp;grasps spoon

12-18months

food type:all textures 

oral-motor skill:lateral tongue action;straw drinking 

development skill:scoops food to mouth;increased independence in feeding

18-24months

food type:more chewable food 

oral-motor skill:rotray chewing

development skill:independent walking;can obtain food/nonfood object on own

24months

food type:tougher solids

oral-motor skill:mature chewing

development skill :total self-feeding;use of fork,open cup

vocal assessment

某個年齡階段能否發出某些音節

developmental vocal assessment form(p.195)

出生到2個月

crying with sudden pitch shifts,extremely high pitch

fussing or discomfort

vegetative sounds(burps,sounds accompanying feeding)

neutral sounds(grunts,sighs)

vowel-like sounds(i, I, e, ^, u, U, o, a]

2-4個月

vowel sounds predominate,but a few consonants emerge(primarily velars and glottals)

marked decrease in crying(after 12週）

begins consonant plus vowel;mostly "coo"and "goo"

begins to produce pleasure sounds ,such as "mmmmm"

4-6個月

consistent production of consonant-vowel(syllabilc)combinations

imitation of sounds in back-and-forth babbling games with others

more variations in vowel production

number of consonant segments increases to include front stops and nasals

laughter emerges(around 16週）

front sounds begin to predominate,including blowing"raspberries," bilabial trills,lip smacks

begins variation of intonational(pitch)contours,often when playing alone with toys

extreme pitch glides,such as yells ,squeals,and low-pitched growls

6-10個月

canonica,repetitive,or reduplicated babbling begins to appera媽媽、噠噠、吶吶

consistent variation of intonational contours

early nonreduplicated consonant-vowel sequences appear

parent may report hearing first word around 10個月

utterances produced with full-stop consonant(p, b, t, d, are most common)

short exclamations such as "ooh" begin to appear

10-12個月

variegated babbling(successive syllables not identical)appears

variety of consonant-vowel and CVC combinations with sentence-like intonation

syllables other than consonant-vowels produced

use of jargon,protowords,or phonetically consistent forms emerges

increased development of prosodic contours to match intonation patterns of ambient language

approximations of meaningful single words;phonological processes may operate on word approximations

managing feeding

for the nursing or bottle-feeding infant

oral stimulation,in the form gentle touching,encouragement of non-nutritive sucking,and presentation fo safe items for the baby to mouth,such as soft rubber toys,a toothbrush,or teething ring,also can be encouraged.

what item should and should not be mouthed

managing vocal development

using rattles,tickling games,and mirrors to elicit infant vocalization in these back-and-forth games,for many baby with deficits in vocal development ,all family members can be encouraged to talk "baby talk" to the baby as often as possible.if family members are uncomfortable with or not proficient in baby talk,the clinician can teach baby-talk register-including high-pitched speech;exaggerated intonation; simple words;and short,repetitive sentences-directly through modeling.

hearing conservation and aural habilitation

對於high-risk infant，出生第一年建議每3-6個月做一次聽力評估

signs of otitis media,such as pulling on the ear or jaw,fever,or unexplained fussiness accompanying a cold.

good candidates for cochlear implants are children who meet the following criteria(植入人工耳蝸）

are at least 8-12 months of age

have profound hearing loss in both ears

can receive little or no useful benefit from hearing aids

have no other medical conditions that would make the surgery risky

have families who are involved all aspects of the informed consent process,understand their roles in successful use of cochlear implants,have realistic expectations for cochlear implants use and are willing to be involved in intensive rehabilitation services

have support from their educational program to emphasize the development of auditory skills

cochlear implantation before 2 years of age promotes the efficient acquisition fo expressive language, as well as receptive language and speech lintelligibility.

child behavior and development

assessment

cognitive ,language,motor,social-emotional ,and adaptive behavior

a sample of language assessment tools for infants in the prelinguistic period(p.198)

management

the at-risk infant's mothor 

should

和不同的人打交道，不同的人會提供不同的建議

聽從不同人的不同建議，會感覺自己忙不過來

the multitude of professionals inundating her with advice and assignments can be overwhelming, especially in situation already fraught with worry.

SLPs can help the parents sort through the advice;devide on an overall schedule for delivering therapy and medication to the baby;and help the mother seek support from her network of resource,including family,neighbors,and firends,to get her through the difficult first few months.

love and play with the baby

the baby needs a family that is healthy and rested.