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 262-285

developing receptive language

indirect language stimulation(ILS)

learn to follow the child's lead by imitating actions,sounds,and words the child produces and providing words to match the child's actions and activities.

let the child choose the topic,activity,or material and of being sure to comment on someth-ing the child is already doing.

if the child is looking at a doll,the parent can say,"doll.pretty doll!it's a pretty doll."

guidelines for parent training

1.be sure parents understand specific goals before beginning training

2.involve as many family members and caregivers as are willing to participate in the intervention

3.delineate parent and clinician reponsibilities clearly

4.explain the purpose of all procedures

5.collect baseline data

6.model procedures for the parent;observe parent using procedures

7.provide feeedback to parent,using videotape or group-training procedures

8.monitor the parent's use of the procedures,using direct observation or audio recorded by the parent during intervention sessions in the home

9.encourage parents to make incidental use of the procedures in natural day-to-day activities

10.maintain regular contact with families

11.monitor the effectiveness of the intervention

developing sounds,words,and word combinations

increasing phonological skills

18-36 months

phonological work should focus primarily on expanding the repertoire of sounds and syllable shapes,rather than on correcting errors relative to adult target words.any conventional word approximations that children with developmental delays are producing ought to be rewarded,not corrected.at the emerging language stage of development,the goal is to get the child talking and to increase the range of phonological structures available to support this talk.

developing a first lexicon

半數的人first words are nouns，these nouns include the child's own name and names of pets and family members,names for objects the child acts on directly(shoe,spoon),names for body part(nose,belly button)and preferred foods(cookie,juice),labels for objects that move and change(ball,light),and for social games and routines.

teaching first words not just as labels for objects bu also for other kinds of communication.

pronouns(i,you),function words(that ,the),verbs(help,is ),and relational words(more,alldone)

words for a first lexicon

rejection,nonexistence,or disappearance(no,allgone,away)

cessation or prohibition(no,stop,alldone)

recurrence(more,again)吃了一塊🍪，還想吃，我還要吃🍪

existence(this,that,there,what)

action on objects(get,do,make,throw,eat,find,draw,fix,wash,kiss,bump,help)

locative action(put,take,up,down,out,fit,sit,fall,go,dump,turn,in,on,here,out,off)

attribution(big,hot,pretty,dirtys,some)

naming(i ,it,you)objects child acts on(shoe,cup);objects that move(dog,car);familiar people (mom,dad,sibling name)

possession,commenting social interaction(my,mine,want)hi,bye-bye,night-night,yes

teach children words that they can make use of often to accomplish their social goals.

不要老用what is this,since this kind of format is unlikely to teach the child how to use the word in the real communicative world.

if，for example,a child demonstrates driving cars during the play assessment,drive would be an accessible word,although simplified pronounciation(/dai/)should be expected.教柔柔說踩車（ai 車），🍰（an 糕），打印機（a 摁 機）

provide a range of labels for objects,events,and relations in clear,here-and-now contexts,if they see that the child is looking at a truck,for example,we should encourage them to label it for him not only as truck,but with more sepcific terms,as well,such as flatbed,cherry-picker,or pick-up,in this way,receptive vocabulary can continue to move ahead even when production is limited.

developing word combinantions

most early two-word sentences convey a small range of semantic relations that are common across children and related to their current knowledge and interest,regardless of the language they are learning.

if the child were playing with a spoon to feed a doll and said,"eat",the clinician might reply," yes,the doll eats!"if the child were playing with a car and bumped it into another one,said" bump!"the clinician could remark,"yes,the cars bump!"or "you bump the cars!"

where is the doggy?

if the child then responds to the question with another fragmentary remark("bed"),the clinician takes the two pieces produced by the child and expands them into a more complete utterance("yes,the doggy is in the bed.")

suggestions for a parent administered program of early language intervention:word combinations

1.introduce word combinations:begin to require child to produce two-word versions of request used in earlier activities.reward with verbal praise("good talking!")

2.shift reward from verbal to social:have the child label objects and activities in which the reward is attention and praise,rather than receipt of the object or activity.

3.storybook reading:parent asks the child to label pictures during book reading,parent responds to child's label with a wh- question("what does the cow say?")

4.open-ended quesitons:parent uses open-ended prompts during storybook reading("tell me about this page.").parent is taught to expand on child's remarks.

three phases of the environmental learning intervention stratege

phase one:imitation

a linguistic and nonlinguistic stimulus are paired.the child is told to imitate the adult;e.g.,the adult pets a stuffed animal and says."pet the bunny.you say it :"pet the bunny."if the child responds correctly,the adult repeats the child's utterance,gives praise and a token reinfor-cement(e.g.,"pet the bunny.good talking!"and present a plastic chip).if the child fails to respond or responds incorrectly,the adult looks away for 3s,then repeats the stimuli.

phase two:conversation

the nonlinguistic stimuli are the same as in the imitation phase,the linguistic stimulus is a question,rather than a request for imitation(e.g.,what am i doing?).response to correct productions is the same as in the imitation phase.if the child fails to respond or responds incorrectly,an imitative prompt is given,followed by a repetition of the linguistic stimulus(e.g.,say pet the bunny,what am i doing?)this may be repeat.

phase three:play

while the child is playing with the material used as nonlinguistic sitmuli in the imitation and conversation phases,the adult asks for the conversational response in an appropriate context(e.g.,if the child pets the toy bunny,the adult can ask,what are you doing,or the adult can pick up one of the toys and ask,what shall i do?).if the child gives a correct response contanining a two-word expression of the target sematic relation,a cofirming response is given(e.g., yeah,you pet the bunny!).if the child does not respond or responds incorrectly,the adult does not confirm the response or comply with the request,instead,a 3s pause is followed by a request for an imitation of the target utterance.

preliteracy development

ways to use storybooks in working with toddler and their families in order to build early language and literacy skills

1.working collaboratively to select books that are developmentally appropriate and attractive to toddlers and being sure families have access to these books.

2.teaching parents routines interactive reading strategies,such as pointing out connections between pictures and text,stopping to let children"fill in "elements after they have heard the story a few times,etc.

3.encouraging parents to use exaggerated intonation and stress during reading to highlight important elements in the text 

4.encouraging parents to develop play activities around the themes from storybooks read; e.g.,after reading one fish,two fish,children can be encouraged to find red and blue things in their house

5.exposing children to decontextualized talk relating the stories they have heard to their own day-to-day activities;e.g.,talking about times the child has seen fish

toddlers with ASD

impairment in communication is one of the core symptoms of ASD

assessment considerations for toddlers with ASD

screening

evaluating communication

communication deficits in toddlers with ASD

delayed acquisition of spoken language

depressed rate of preverbal communicative acts

delayed development of pointing gestures,both in terms of use and responsiveness

use of nonconvertional means of communicating,such as pulling a person by the hand, instead of pointing or looking.

reduced responsiveness to speech and to hearing their names called,resulting in lower scores on comprehension than production

restricted range of communicative behaviors,limited primarily to regulatory functions (gettng people to do or not do things),with very limited use of communication for social interaction or to comment or establish joint attention

atypical preverbal vocalizations

deficits in pretend and imaginative play

limited ability to imitate

diagnostic assessment

recommendations for multidisciplinary diagnotic assessment of ASD in toddlers

medical examination

rule out hearing and vision loss

assess dysmorphology and family history;conduct genetic testing if indicated

conduct neurological examination

parent report

obtain thorough developmental history

administer structured interview to gather information on social,communicative,play and adaptive skills,as well as restricted and repetitive behaviors.

child observation

provide play context in which to observe social,communicative,play ,and repetitive behaviors

confirm with parents that observation was consistent with child's typical behavior

language and developmental testing

assess expressive vocabulary,word combination(if present)

assess response to name

assess receptive vocabulary,understand of simple word combinations

assess fine and gross motor skill

evaluate adaptive behaivor

receptive language

providing highly engaging joint attentional opportunities,by sharing interesting objects and activities with the client;actively attracting their attention and gaze to the object and to the communication partner;providing simple,repetitive language to accompany the activity

when taught names of pictures ,children with ASD did not recognize the real objects the pictures represented as having the same label as the picture,suggests that children with ASD have difficulty understanding that pictures are representations of objects,it is important to teach receptive language in relation to real,functional objects rather than pictures with this population.圖片和實物脫節，看圖片能說出物品名稱，看到實物後不一定能說出物品名稱（圖片儘量使用相片，不要使用卡通、素描之類的）

vocabulary and utterace length

working with echolalia

some communicative functions of echolalia:

turn taking,verbal completion,declaration,"yes" answer,request,protest,directive,calling, provide information

several approaches to help reduce echolalia include:(p.268)

using a third person(or puppet)to model what should be said

mitigated echolalia

adapting scripts

considerations for older clients in the emerging language stage

children with severe intellectual disability,those with autism,and children who suffer severe effects of acquired neurological damage are examples of clients who may present this picture.

to maximize the effectiveness of the emerging communicative forms they express,to provide opportunities for them to expand the sophistication of their communication to as great an extent as possible,and to work on expanding the opportunities for and responsiveness to their communication by people in their environment.

modifying assessments for older clients with emerging languae

play and gesture

intentional communication

communicative signals(such as gestures,sounds ,limb actions,facial expressions,body postures,and orientation)

we need to know what and how the client is attempting to communicate in order to proviede more mature means for expressing these intentions that are already present.

問題行為出現，意圖是什麼（為了得到某樣東西？逃避任務？還是其他）

comprehension

before using pictures to test language comprehension,we need to pretest the child's ability to associate pictures with their referent.

如果認不了簡筆畫換成彩色圖片，不行就換成相片，還不行就換成實物

如果讓孩子在一堆圖片中選出目標圖片（比如4張圖片選一張）有困難，換成在兩張圖片中選出目標圖片

phonological and lexical production

motor skills assessment

for client with severe speech and physical impariments ,the choice of an AAC system is strongly dependent on the physical abilities of the client to manipulate the aspects of the system,

discover motor capabilities that can be used to access a system

this assessment involves examination of the following five major componets:(p.271)

movement(try to find the client's best movement pattern)finger,hand,arm,and head movements are used most often,chin,mouth and shoulder movements are used if these others are not available.

control site(the point of contact with the communication device)

input method（打字，觸屏抑或其他方式）

positioning

targeting

intervention targets and procedures for older clients with emerging language

play and gesture

using practical jokes as play activities with older clients with emerging language.using vocational and daily living props for unconventional ,silly uses is another way to encourage play.

intentional communication

turn a radio or MP3 player on to favorite music for a moment,then turn it off and wait for a request to turn it on again.(柔柔喜歡看我用打印機，打印機不動她會拉我的手，意思是要繼續打，慢慢開始讓他用言語表達，先說機，再說en 機，再到a 摁 機，最後到打印機

put a favorite item in a clear glass jar,close the lid tightly,and hand the jar to the client, waiting for a request for help to open the jar.

列出一些活動清單，有喜歡的有不喜歡的，讓孩子選擇，剛開始會隨意選擇，選到什麼就讓孩子做什麼，慢慢會有意識地選擇自己喜歡的活動圖片

functional communication training involves identifying the purpose fo maladaptive behavior, finding out what triggers it,and providing the student with new,more adaptive ways to solve the problems with which they are confronted.

steps to teaching communicative rejection

1.identify behaviors used to avoid or escape events

2.if behavior is unacceptable,inefficient or hard to interpret,replace old form with newer,more efficient and acceptable form.

3.define new replacement behavior in objective,measurable terms;e,g., "when presented with an unwanted object,student will select the 'don't want'symbol on communication board within 15s"

4.ensure new form is efficient by making sure the new form is easy to perform and leads to consistent reinforcement,be sure everyone who interacts with the student knows it

5.provide insturction in new form when student is highly motivated to reject,use incidental teaching techniques to provide extra practice

6.creat extra opportunities for practice by offering objects or activities,and giving the nonpreferred choice,even when student requests the other

7.at first use prompts to elicit the new behavior;provide immediate and consistent reinforcement for new behavior,no reinforcement for maladaptive behavior,gradually fade prompts

8.be sure the new behavior is always rewarded with stopping the unwanted object or activity consistently by all who interact with student

production

in developing an effecitve AAC system,we will need to go beyond teaching it to the client,we will also need to work directly with parents,teacher,and peers to encourage and support them in making the system work for the client,using more normative platforms,such as smart phones and notepad computers,can help in this endeavor.

emergent literacy

if even minimal reading and writing skills can be developed,they greatly enhance a client's opportunities for communication and independent living.

book reading and storytelling

emergent literacy intervention strategies for children with emerging language who use AAC

model literacy activities:encourage parents and teachers to demonstrate their use of books to get information and entertainment,writing lists,labeling objects in the environment with signs,and so on

make literacy artifacts attractive and accessible:print menus for school lunches and song sheets for favorite songs,label photos of favorite people and activities,make sure children have opportunities to write and draw with interesting material

provide opportunities to request specific books and reading activities:include pictures of favorite books and serval reading related options("pick a book""read to me""read it again'" turn the page")on communication boards

provide adapted writing opportunities:for example,put a marker through a hole cut in a tennis ball or a pencil on a headstick

use multimedia:interactive storybooks on CD-ROM or downloadable "apps" can be used to increase interactions with texts

increase story particaipation:put a series of pictures copied from a favorite book on a communication board overlay and have the client "retell" the story by pointing to the pictures,or program a VOCA to emit story elements so the student can "retell"it

build from these routine productions to develop concepts(if an overlay for "over the river and through the woods"has been made,use the "over"symbol in other contexts,such as simon says,in which the client instructs peers to go over,under and through)and multiword expressions(encourage client to pair"over"symbol with another to describe events ,such as over the river,over the bridge,over the barn)

encourage the development of phonological awareness:pair known pictures on the communication board with their written form in which first or last letters are underlined, make a page of all /b/ words and talk with child about how all the words on the page start with the same sound;encourage the child to point to other objects in the environment that begin with the same sound;provide a "sounds like"symbol on the communication board,and help children identify words that"sound like "boat (e.g.,coat,float,goat)using pictures or yes/no responses.