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(164)assessment and intervention in the prelinguistic period

已有 1369 次阅读 2019-3-17 15:40 |系统分类:科研笔记

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 199-214

parent-child communication

assessment

when observing parents interacting with their at-risk babies,we can look for the following:

1.pleasure and positive affect

2.responsiveness to the child's cues of readiness and unreadiness to interact

3.acceptance of baby's overall style and temperament

4.reciprocity and mutuality-the degree to which the parent and infant seem to be in tune with each other

5.appropriateness of choice of objects and activities for interaction;the parent's awareness of safety issues and choice of activities and objects that interest and engage the baby

6.language stimulation and responsiveness;the degree to which the mothers talks the baby appropriately,engage in back-and-forth and "choral" babbling activities

7.encouragement of joint attention and scaffolding the baby's participation,the extent to which the mother is effective in directing the baby's attention to objects of mutual inter-est,and the ways she evokes progressively more elaborated reponses from the baby

when assessing parent-child interaction patterns,we must show respect and appreciation of the parent's attempts to get through to the child.if we behave as if we know better than the parents how to interact with this baby,we will be undermining rather than supporting them.不要以专家自居,要尊重和赏识他人付出的努力

to the parents of a handicapped or at-risk infant is that of maximizing the parents' effectiveness,rather than correcting their mistakes.

management

awareness of infant communication patterns

parents are more likely to cooperate if they feel that we understand the difficulties of communicating with an at-risk baby,who may not be normally reponsive and interactive.

first,although the infant participates in structuring the interaction,the infant-because of his or her immaturity-has very little choice about how to interact.

parents need to know that they are the ones who need to adapt for the interaction to succeed,even when it is the infant who is causing the problem by being difficult or unresponsive.

second,the parents need to know that the most important thing they can do for their babies is to enjoy them.

the thrid thing we want parents to know is that communication that enhances development has two major characteristic:it is enriching and responsive


parents should think about providing visual,auditory,and tactile experiences that engage the baby's attention and allow the child to explore novel stimuli that have been carefully chosen for safety and interest,they also should attempt to make their interactions responsive to and contigent on what the infant is doing.


modeling interactive behaivors

4 type of interactive behavior should be encouraged

turn-taking

imitation

establishing joint attention

developing anticipatory sets

the parent should be sensitive to the infant's readiness to interact(a state of alertness,gaze at the parent,and the expression of comfort vocalizations)


tips for working with parents of preintentional infants to optimize parent-child communication

take turn:coach parents to engage in back-and-forth interactions with babies through songs,games such as peek-a-boo,and play with toys.encourage parents to do something the baby enjoys,then wait for the child to do something(anything!)before the adult takes another turn.

imitate:coach families to play"monkey see,monkey do"or "copy cat" by mirroring any infant actions or sounds.

point things out:coach families to engage the baby in joint attention routines by bringing things the child likes within view,and monitoring that the child is looking at them before making them move,sound, or operate,later,when the child is 6 to 10 months old,use gestural pointing to establish joint attention to objects at a distance in addition to bringing objects near the child.

set the stage:coach parents to establish anticipatory sets by repeating simple gemes and songs the child like,when the child has become very familiar with these,encourage parents to stop momentarily in the middle to allow the child to anticipate and request the next part of the action.


developing self-monitoring skills

use of videorecording to monitor communicative interactions and allow the parent to self-monitor

allowing parents to view videos and analyze their own performance,rather than having it analyzed by the clinician.


assessment and intervention for infants at prelinguistic stages of communication:9-12 months

in the last quarter of the first year of life,infants express intentions through signals to others but do not yet use conventional language.

assessment

observation of the child's play

use a parent-report instrument to elicit information about early communicative behaivor(provides a checklist)

whether any functional communication is present

typical funtions expressed at this level include requesting objects or actions;attempting to get the adult's attention on what the child is interested in ;and initiating social interactions through greeting, calling,or showing off.


management

for the at-risk child at a 9-18 months developmental level who is expressing some communicative intent, we need to encourage parents to learn how to scaffold or support the child's move toward more conventional communication.

媽媽用手把臉摀住,直到嬰兒伸手過來再把手拿開

媽媽用手把臉摀住,嬰兒伸手過來要媽媽把手拿開,媽媽不肯,知道嬰兒發出聲音再把手拿開

by requiring increasingly more mature and sophisticated behaivors on the baby's part to complete the routine,the mother is shapping his behavioral repertoire to include more conventional  way of expressing his intents.


arranging the environment by putting things the child will want in view but out of reach or by violating the order of events the child has come to expect.


follow the child's attentional lead and focus on the child's item of focus.

如果孩子看著某樣東西,我們也跟隨孩子的目光看著某樣東西,耐心等待孩子坐點什麼(anything!)

it is important to adapt our expectations to the child's initiation rate,which may be lower than we would like.it is more important to wait for the child to do something,then make our actions contingent on the child's ,than it is to get the child to do something as a response to our own action.


time-delay(prompts involve interrupting an ongoing turn-taking activity or routine and withholding the continuation until the child initiates some form of request to resume.)

verbal(prompts can be open-ended questions "what" or directions"look at me")

gaze intersection(involves the adult's moving into the child's gaze when the child does not make eye contact.)

modeling(models are used to increased the child's use of vocal and gestural communication)

natural consequences(the child's communication is rewarded with its intended goal)如果嬰兒用手指著裝滿🍪的罐子,媽媽把🍪給寶寶(哪怕很快就到飯點了),媽媽還可以說,喔,你想要🍪。

reading books to babies(engaging babies in looking at simple picture books as soon as the child can sit up)

waiting for the child to initiate interest in something in the book by looking or pointing

being face-to-face during book sharing

asking questions

verbally inviting children to interact

labeling and talking about pictures in the book 

communication temptations(involve creating situation in which the child is strongly motivated to try to get a message across to the adult and then responding swiftly and positively when the child does attempt to communicate.)

suggestions for communication temptations

.eat a desirable food item in front of the child without offering any to him or her

.activate a wind-up toy,let it run down,the hand it to the child

.give the child several blocks,one at a time,to drop in a can,then give the child a smll toy figure to drop in

.initiate a familiar game,play it until the child expresses pleasure,then wait.look expectantly at the child,and give a prompt("what do you want?")

.open a jar of bubbles,blow some bubbles,the close the jar tightly,and hand it to the child

.blow up a balloon,and let the air out,then hand the deflated balloon to the child

.hold a food item the child does not like near his or her mouth

.place a desired toy or food item in a clear container with a tight lid that the child cannot open,give the child the container and wait.

.put the child's hand in a cold,wet,or sticky substance such as pudding or paste

.roll a ball to the child,after several rolls back and forth,substitute a car or other wheeled toy

.put a toy that makes noise in an opaque bag,shake the bag and hold it up to the child

.bring the child a new toy,or initiate a silly or unusual event(wear a clown nose).wait for the child to do something,when he or she does,map the child's action onto a linguistic form("you think my nose silly!")

.pay less attention than usual to the child;back away or turn your back during an ongoing game.wait for the child to try to elicit your attention

.give the child the run of the room for a few minutes.wait for the child to direct you attention to an object he or she finds of interest

develop comprehension of language

respond consistently to any initiation on the child's part,of course ,even if it is in the form of gestures or nonconventional vocalizations.

imitating the child's vocal behaviors and providing simple,conventional single words in reponse to the baby's vocalizations.

keep the focus on responding to the baby's needs and interests,making the communication contigent on the infant's actions


considerations for older prelinguistic clients and those with autism spetrum disorders

a child can be nonspeaking yet still be a linguistic communicator.(children with cerebral palsy)


feeding and oral-motor development in older prelinguistic clients

.comprehensive guideline for conducting the major portions of the evaluation of children with feeding and swallowing disorder which include the following:

.review of medical,developmental ,and feeding history

.physical examination,including growth and nutrition,neurodevelopmental,oral-facial,cranial nerve, res-piratory, and gastrointestinal elements

.prefeeding assessments,such as posture and position,oral-motor structure and function,and social and affective aspects of feeding

.direct observations of chewing,biting,swallowing,and interactions during feeding 

assessment of food preferences

.deciding whether to employ instrumental assessment,such as the videofluoroscopic swallow study


eating is a social experience,a pleasant,interactive atmosphere is essential to developing a good feeling about food and eating.


developing oral-motor skills through feeding is important because eating is important ,but it will not guarantee that these skills will generalize to speech,to develop speech skills,speech must be addressed directly in an intervention program.


suggestions for facilitating consonant production in early speech

1.to increase length and rhythm of productions,engage the child in simple repetitive motor activities,such as bouncing on a large ball while modeling repetitive syllables in time with his movement(/ba, /ba/, /ba/).stop periodically to attempt to get him to make the sound in order to continue the activity,when he can produce one syllable fairly consistently,switch to a different single syllable(/mi, /mi/, /mi/),then string repeating syllables together(/baba/, /baba/, /baba/),then nonrepeating syllables(/bama/, /bama/, /bama/).,eventually and words(“go, go, go,” “jump, jump, jump”).

2.to connect sounds to with meaning,teach songs such as "the wheels on the bus," with verses that include simple sounds(the wipers on the bus go whoosh,whoosh whoosh;the babies on the bus to wah, wah, wah)

3.encourage expression of emotion with conventional vocalizations,set up games and routines in which exclamations such as"yeah!""wow!""uh-oh!""haha!"and"whee!"are used in playful interactions.

4.use stressed syllables to facilitate consonant production(baby to facilitate /b/)

5.use velar consonants to facilitate closed syllables

6.introduce a alveolar consonants before a front vowel(tea to facilitate/t/)

7.to facilitate production of a consonant at a new place of articulation,use a word that contains another consonant at the same place of articulation(toss to facilitate/s/)

8.use words with fricatives between vowels(taffy to facilitate/f/ )to elicit first fricatives


hearing conservation and aural habilitation

for children who are found to have impaired hearing,early identification and amplification are two of the most important factors in determining good outcomes.


child behavior and development

older prelinguistic clients may become frustrated over the difficulty of getting their messages across to others.for this reason they sometimes display aberrant or maladaptive behaviors such as aggression or self-abuse.有时我想向他人传达我的意图,说来说出别人都不明白,我会气死,同样地,那些不能用言语让别人明白自己需要什么的小孩也会抓狂,说不出来,就用行动去表达自己的不满或者表达自己的需求,这也是一种沟通

these behaivors can be understood as a form of communication for clients who do not have more conventional,comprehensible means at their disposal。

这些问题行为有时会在不经意间被家长或老师强化

我们需要provide clients with more acceptable means of expressing their intentions

differential reinforcement of other behavior


intentionality and communication

milieu communication training include:

1.training is undertaken in everyday environments(e.g.,home or classroom)rather than a "therapy room."

2.activities take place throughout the day,rather than only at "therapy time."

3.preferred toys and activities are included in the environment so that participation in activities is self-reinforcing.

4.adults encourage spontaneous communication by refraining from prompting and using "expectant waiting"(use of gaze,posture,and facial expression to indicate the adult expects the child to do something).学会等待,学会发现

5.the child initiates teaching situation by gesturing or indicating interest in a desired object or activity.

6.teachers provide prompts and cues for expansion of the child's initiation.

7.expanded child reponses are rewarded with access to a desired object of activities.


guidelines for teaching repair of prelinguistic communication breakdowns(p.209)


providing transitional support to enhance communication

social support(helping each communication partner to understand and expand on their assigned roles)

adjusting the complexity of input,using simpler language;modeling use of communicative device in input to clients as well as by client

emotional support(helping partners to respond to the emotional state of one another)

providing and responding to client requests to "stop,""start over,"etc.;adjusting task difficulty if client becomes frustrated;choosing motivation,chronologically age-appropriate materials

functional support(helping partners to achieve their communication goals and to understand and support their partner's goals

creating clear opportunities for client to fill in a turn in a back-and-forth activity;providing a predictable sequence of activities;arraging the environment to minimize distraction and enhance attention;providing a clear beginning and end to each interchange

physical support(providing access to communication and physical support for enhancing communication)

using visual supports to provide a predictable,organized sequence,enhance attention,and encourage involvement in group activities;using AAC devices and methods;using prompts and cues to encourage participation;providing activities that includ movement as as sitting

event support(scaffolding events to provide contextual support for communication,to establish participation patterns,and to let participants know what to expect)

providing visual schedules to enhance preditability and ease transitions;offering repeated opportunities to practice new skills with different partners;coaching within natural interactions to remind client of skills taught

discourse support(providing scaffolds,discourse markers,and discourse support to expand on and encourage communication of others)

providing opportunities and scaffolds to initiate interactions;using coaching and modeling to extend interactions


autism spectrum disorders

ABA

functional analysis

task analysis

selection and systematic implementation of effective reinforcers












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