Questions Regarding Evaluation of Speech and Language Disorders in - PowerPoint PPT Presentation

Frequently Asked Questions Regarding Evaluation of Speech and Language Disorders in Children Under 18 months Presenter: Nicole Kret, MA, CCC-SLP

My favorite way infants communicate

How do you evaluate a child’s speech and language skills when he/she is not talking?

Standardized Assessments Used • The Rossetti Infant-Toddler Language Scale by Louis Rossetti, Ph.D. Preschool Language Scales, Fifth Edition (PLS-5) by Violette G. • Steiner, BS, Roberta Evatt Pond, MA

Interaction Attachment • SLP will assess the cues and responses that reflect a reciprocal relationship between the caregiver and the child Example checklist from the Rossetti for a child 3-6 months old • • Smiles spontaneously to human contact Smiles when playing alone • • Smiles at faces of several family members Stops crying when spoken to • Shows different responses to different family members • Example checklist from the Rossetti for a child 9-12 months old • • Shows sensitivity to others’ moods Displays fear of strangers • Allows release of contact in new situations • • Performs for social attention

Gestures • Definition: To express an idea or meaning through the movement of a part of the body There are no expected gestures for a child 3-6 months old • Example checklist from the Rossetti for a child 9-12 months old • Covers and uncovers face during “Peek -a- boo” • • Reaches upward as a request to be picked up Waves “hi” and “bye” • Extends arm to show an object • • Points to objects to indicate awareness

Pragmatics • Assess the way the child uses language to communicate with and affect others in a social manner Example checklist from the Rossetti for a child 3-6 months old • • Produces different cries for different reasons Maintains eye contact • • Vocalizes in response to vocalization Imitates facial expressions • • Example checklist from the Rossetti for a child 9-12 months old Vocalizes to call others • Indicates a desire for a change in activities • • Vocalizes when another person calls

Play • Assess the changes in a child’s play that reflect the development of representational thought • Example checklist from the Rossetti for a child 3-6 months old Enjoys frolic play • Smiles at self in a mirror • • Reaches for objects Bangs objects in play • • Example checklist from the Rossetti for a child 9-12 months Participates in speech-routine games • Covers face with a towel during “Peek -a- boo” • • Resists removal for a toy Tries to secure an object out of reach • • Imitates stirring with a spoon Pushes a toy car •

Language Comprehension Assess the child’s understanding of verbal language with and • without linguistic cues Example checklist from the Rossetti for a child 3-6 months • • Turns head toward a voice Searches for the speaker • Responds to sounds other than voices • • Recognizes own name Stops crying when spoken to • • Responds to “no” half of the time Discriminates between threatening and friendly voices • Anticipates feeding • • Cries at an angry tone of voice

Language Comprehension Example checklist from the Rossetti for a child 9-12 months • • Attends to new words Gives objects upon verbal request • • Looks at a person saying child’s name Performs a routine activity upon verbal request • Looks at familiar objects and people when named • • Attends to objects mentioned during conversation Follows simple commands occasionally • • Understands simple questions Gestures in response to verbal requests • Verbalizes or vocalizes in response to verbal requests • • Participates in speech-routine games Identifies two body parts on self •

Language Expression • Assess the child’s use of preverbal and verbal behaviors to communicate with others • Example checklist from the Rossetti from a child 3-6 months Vocalizes in response to singing • Vocalizes feelings through intonation • • Takes turns vocalizing Laughs • • Babbles Vocalizes to express displeasure • Stops babbling when another person vocalizes • • Initiates “talking” Demonstrates sound play when alone or with others • • Whines with a manipulative purpose Attempts to interact with an adult • Interrupts another person’s vocalizations •

Language Expression Example checklist from the Rossetti of a child 9-12 months • Says “mama” or “dada” meaningfully • Imitates consonant and vowel combinations • • Imitates non-speech sounds Vocalizes with intent frequently • Uses a word to call a person • • Says one or two words spontaneously Vocalizes a desire for a change in activities • • Imitates the names of familiar objects

PLS-5 • Contains 2 subtests which evaluate the child’s receptive language and expressive language skills. There is also an articulation screener. • Uses manipulatives in addition to a picture book to assess the child’s language skills. • Completing this test results in a standardized score for receptive, expressive, and total language skills.

Oral Motor Skills • Assessing the speech motor system consists of examining facial symmetry; dentition; the structure and function of the lips, tongue, jaw, and velopharynx, and respiratory, phonatory, and resonance functions as they are used for speech. (Paul, 2007)

Beckman Oral Motor Assessment Is a clinical tool in addition to standardized tests • Criterion referenced • Uses assisted movement • • Looking at muscle response to displacement, either reflexive or active Assess these components of movement: • • Response to pressure and movement Range • • Strength Variety • Control of movement • • For the following structures: Lips, cheeks, jaw, tongue, soft palate, hard palate • (Beckman, 1986 Rev. 2007)

Using the Beckman Oral Motor assessment on an infant to assess labial musculature Upper lip: • First observe the movement during facial expression, talking, • eating. Measure assisted movement: measure protrusion and • elongation “Place finger and thumb together at top of philtrum. • Compress the tissue and move downward to end of upper • gum. Move fingers away until finger pads line up with edge of • nose. Bring fingers together, supporting lip muscle between • fingers. • Move fingers downward to the end of the upper surface. Release slowly.” • (Beckman, 1986 Rev. 2007) “Caution This information is to be used only under the direction of a therapist trained in the application of this information.” (Beckman, 1986 Rev. 2007)

Beckman Oral Motor Assessment Cont. Assess labial strength • • “Place middle finger and thumb of the dominate hand on the lower edge of the jaw. With pad of index finger, provide light touch to displace • vermilion of the lip at 6 points, 3 on upper, 3 on lower. Displace the lip, moving away from the center of the mouth, • maintaining contact with the finger pad for 1 second at each point. Minimal competence is a change in muscle state from flaccid to • firm within 1 second following displacement.” (Beckman, 1986 Rev. 2007) “Caution This information is to be used only under the direction of a therapist trained in the application of this information.” (Beckman, 1986 Rev. 2007)

The infant’s hearing was WNL when tested at birth, should it be evaluated again if the child is demonstrating speech/language difficulties?

Hearing Evaluation Yes, I normally recommend a child receive a formal hearing • evaluation if there are concerns with speech development. Newborns receive a hearing screening when they are born consisting • of 1 of these 2 tests: • Otoacoustic Emissions: in which a miniature earphone and microphone are placed in the ear, sounds are played and a response is measured. If a baby hears normally, an echo is reflected back into the ear canal measured by the microphone. Auditory Brainstem Response (ABR): in this test sounds are • placed in the baby’s ears. Electrodes are placed on the baby’s head to detect responses. This test measures how the hearing nerve responds to sounds. These 2 tests are good at screening initially but it is possible for • hearing loss to go undetected in the initial screen or for the child to develop hearing loss after this initial screen, often seen with children with severe OME. (My Baby’s Hearing, 2016)

Early Signs of a Hearing Impairment If a child is NOT doing these things at: • • 4 months Child awaken/stirs to loud sounds • • Child startles to loud noises Calms to the sound of familiar voices • Responds to parents voice (smile, coo) • • 4-9 months Turns eyes toward source of sound • • Smiles when spoken to Notices sound making toys • Makes babbling sounds • • 9 to 15 months Babbles with many different sounds • • Responds to name Responds to changes in tone of voice • Says “ma - ma” or “da - da” • • Repeats some sounds you make Uses his/her voice to attract attention • (Hearing Loss in Children, 2015)

The child interacts differently at home, how will you get an accurate evaluation of the child’s speech and language skills?