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CSHA Monterey State Convention April 15-18, 2010

Choosing Initial Vocabulary Targets for Children Who Are Late Talkers:

A Child and Family-centered Approach

Saturday, April 17, 2010

2:00-5:00pm

Cindy Earle, M.A., SLP CCC

Program Manager for Target Word ® — The Hanen Program ® for Parents of Children who are Late Talkers

The Hanen Centre

Choosing Initial Vocabulary Targets for Children Who Are Late Talkers Cindy Earle, M.A., SLP CCC The Hanen Centre CSHA Monterey State Convention • April 15-18, 2010

CSHA Monterey State Convention April 15-18, 2010

Choosing Initial Vocabulary Targets for Children Who Are Late Talkers:

A Child and Famil y- -centered A

roach

pp

Saturday, April 17, 2010

2:00-5:00pm

Cindy Earle, M.A., SLP CCC

Program Manager for Target Word ® — The Hanen Program ® for Parents of Children who are Late Talkers The Hanen Centre

Manager for Target Word ® — The Hanen Program ® for Parents of Children who are

Objectives for today

• To define Children who are Late Talkers

• To identify steps for setting vocabulary goals

• To become familiar with criteria for choosing target vocabulary

• To explore a framework for setting communication goals and choosing lexical targets collaboratively with parents

• To apply the information on choosing initial vocabulary targets through case examples

collaboratively with parents • To apply the information on choosing initial vocabulary targets through case examples

Agenda

• The learning objectives

• Definitions of Children who are Late Talkers

• Initial goal setting: a collaborative task

• Criteria for choosing target vocabulary Break

• Words that are motivating for the child to say

• Including verbs in target vocabulary

• Applying the information

• Questions and Wrap up

for the child to say • Including verbs in target vocabulary • Applying the information •

All Hanen Programs

• A family-centered orientation

• A naturalistic approach to intervention

• The parent/caregiver as the primary change agent

• Evidence-based

group sessions for parents/caregivers led by a Hanen SLP

individual video feedback sessions – help parents apply strategies successfully so child can achieve communication goals

video feedback sessions – help parents apply strategies successfully so child can achieve communication goals

The Hanen Centre

The Hanen Centre

Paul and Sheffer, 1991, found no difference between children with SLI-E and typically developing children in the proportion of times the child provided some type of social, communicative cue to their mother during interactions. The SLI-E group of children relied more on unclear vocalizations, noises, gestures and actions.

(Rescorla & Ratner, 1996)

To facilitate early word acquisition, their language- learning environment must be modified further.

(Lederer, 2002)

To facilitate early word acquisition, their language- learning environment must be modified further. (Lederer, 2002)
environment must be modified further. (Lederer, 2002) © Hanen Early Language Program, 2010. All rights reserved

© Hanen Early Language Program, 2010. All rights reserved.

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Choosing Initial Vocabulary Targets for Children Who Are Late Talkers Cindy Earle, M.A., SLP CCC The Hanen Centre CSHA Monterey State Convention • April 15-18, 2010

Children who are late talkers

• Age range

• # words

• Other areas of development

Children who are late talkers • Age range • # words • Other areas of development

Definitions

“A child who is 24 months of age and is using less than 50 words and is not combining words and presents as positive for the presence of risk factors

(Wetherby, 2000)

“Typical criteria for late talkers include a failure to use 50 different words or 2-word utterances by 24 months of age, in the absence of other observable cognitive, sensory, or neurological disorders”

(Wing, 2007)

by 24 months of age, in the absence of other observable cognitive, sensory, or neurological disorders”

Definitions of late talkers

“toddlers whose development is slow, but who evidence no major deviations from patterns of normal acquisition; this is the group of late talkers”

(Stoel-Gammon, 1991)

“children who are using fewer than 50 words and/or producing limited word combinations by 24 months”

(Kelly, 1998)

limited word combinations by 24 months” (Kelly, 1998) Children who are late talkers • Age range
limited word combinations by 24 months” (Kelly, 1998) Children who are late talkers • Age range

Children who are late talkers

Age range and # words 18-20 months < 10 words 21-24 months < 25 words 24-30 months < 50 words &/or no 2-word combinations

Other areas of development no major areas of concern

24-30 months < 50 words &/or no 2-word combinations • Other areas of development no major

The research

“…very little is known about the prognosis for the 2 year-old with delayed onset of language”

(Paul, 1991)

“data regarding the efficacy of early intervention for late-talking toddlers is scant”

(Robertson &Weismer, 1999)

“whether children with late language emergence (LLE), also know as “late talking,” recover from the late start- up or whether a late start is prognostic of a longer lasting risk for language acquisition” (is the question)

(Rice, Taylor & Zubrick, 2008)

is prognostic of a longer lasting risk for language acquisition” (is the question) (Rice, Taylor &

The research

“the group mean for the late language emergent (LLE) children was within the typical range for an omnibus measure of general language ability and measures of specific dimensions of language. However a greater proportion of LLE children, relative to the normal language emergent children, performed below normative expectations on a measure of general language ability”

(Rice, 2008)

emergent children, performed below normative expectations on a measure of general language ability” (Rice, 2008)
on a measure of general language ability” (Rice, 2008) © Hanen Early Language Program, 2010. All

© Hanen Early Language Program, 2010. All rights reserved.

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Choosing Initial Vocabulary Targets for Children Who Are Late Talkers Cindy Earle, M.A., SLP CCC The Hanen Centre CSHA Monterey State Convention • April 15-18, 2010

The research

“Late onset of language foretells a protracted growth difference for some LLE children relative to NLE children, particularly for syntax and morphosyntax”

(Rice, 2008)

particularly for syntax and morphosyntax” (Rice, 2008) “continuing weaknesses in vocabulary, grammar and verbal

“continuing weaknesses in vocabulary, grammar and verbal memory may be evident into adolescence, relative to peers with typical language histories from the same backgrounds.”

(Rescorla, 2009)

evident into adolescence, relative to peers with typical language histories from the same backgrounds.” (Rescorla, 2009)

Children who are late talkers

Age range and # words 18-20 months < 10 words 21-24 months < 25 words 24-30 months < 50 words &/or no 2 word combinations

Other areas of development no major areas of concern

Positive for the presence of risk factors

word combinations • Other areas of development no major areas of concern  Positive for the

The real question

The real question “Will children who are late talkers talk?” “How will they use language as

“Will children who are late talkers talk?”

The real question “Will children who are late talkers talk?” “How will they use language as

“How will they use language as they get older?”

The real question “Will children who are late talkers talk?” “How will they use language as

Children who are late talkers

Clinical description • Quiet as a baby • Family history • Parent interaction style •
Clinical description
• Quiet as a baby
• Family history
• Parent interaction style
• Ear infections
• Consonant repertoire
• Pretend play
• Comprehension
• Communicative gestures
• Imitation
• Word types
• Social skills
• Change/time

Predictor of change

or

Risk factor

Olswang, Rodriguez & Timler, 1998; Wetherby, 2000

Social skills • Change/time Predictor of change or Risk factor Olswang, Rodriguez & Timler, 1998; Wetherby,
Children who are late talkers Add to our clinical description • Quiet as a baby/now
Children who are late talkers
Add to our clinical description
• Quiet as a baby/now
• Family history
• Parent interaction style
• Ear infections
• Consonant repertoire
• Pretend play
• Comprehension
Predictor of change
 Communicative gestures
 Imitation
 Word types
• Social skills
 Change/time
Olswang, Rodriguez & Timler, 1998; Wetherby, 2000

Gestures support early vocabulary

• Gestures

• Complementary

• Supplementary

Gestures support early vocabulary • Gestures • Complementary • Supplementary
• Gestures • Complementary • Supplementary © Hanen Early Language Program, 2010. All rights reserved .

© Hanen Early Language Program, 2010. All rights reserved.

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Choosing Initial Vocabulary Targets for Children Who Are Late Talkers Cindy Earle, M.A., SLP CCC The Hanen Centre CSHA Monterey State Convention • April 15-18, 2010

Gestures support early vocabulary

Gestures

• Complementary

• Supplementary

Gestures support early vocabulary Gestures • Complementary • Supplementary

Gestures support early vocabulary

• Gestures

Complementary

• Supplementary

Gestures support early vocabulary • Gestures Complementary • Supplementary

Gestures support early vocabulary

• Gestures

• Complementary

Supplementary

“gesture-speech combinations encoding 2 semantic elements… preceded or co-occurred with the 1 st productions of multiword utterances”

(McEachern & Haynes, 2004)

of multiword utterances” (McEachern & Haynes, 2004) The research Action words/verbs • Difficult for children
of multiword utterances” (McEachern & Haynes, 2004) The research Action words/verbs • Difficult for children

The research

Action words/verbs

• Difficult for children who are late takers to learn

• Foundation for early sentences

Early vocabulary – nouns represent approximately 65% of word count

to learn • Foundation for earl y sentences Early vocabulary – nouns represent approximately 65% of

The research

Gesture-Speech Combinations as a Transition to Multiword Utterances

(McEachern & Haynes, 2004)

Using the Hands to Study How Children Learn Language

(Goldin-Meadow, 2009)

Utterances (McEachern & Haynes, 2004) Usin g the Hands to Study How Children Learn Language (Goldin-Meadow,

First words and sentences

verb-focused intervention is intended to facilitate the transition to early sentences Tense marking emergence 24
verb-focused
intervention is
intended
to facilitate the
transition to
early
sentences
Tense marking
emergence
24 to 33 mos
Sentences
consistent use
24 to 26 mos
Combos
grow rapidly
18 to 24 mos
Vocabulary
12 to 15 mos

Clinical Decision-Making With Late-Talking Children Pamela A. Hadley, Ph.D., CCC-SLP, Janet Olson, M.A., CCC-A/SLP, Cindy Earle, M.A., CCC-SLP ASHA Presentation 2005

Pamela A. Hadley, Ph.D., CCC-SLP, Janet Olson, M.A., CCC-A/SLP, Cindy Earle, M.A., CCC-SLP ASHA Presentation 2005
Cindy Earle, M.A., CCC-SLP ASHA Presentation 2005 © Hanen Early Language Program, 2010. All rights reserved

© Hanen Early Language Program, 2010. All rights reserved.

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Choosing Initial Vocabulary Targets for Children Who Are Late Talkers Cindy Earle, M.A., SLP CCC The Hanen Centre CSHA Monterey State Convention • April 15-18, 2010

The research

First Word Stage

13-18 months - child using single words

At single word stage for > 6 months - child is at risk

change over time

Stage 13-18 months - child using single words At single word stage for > 6 months

Communication Goals

What do parents say?

1. More words

2. Increase vocabulary

3. Talk more

4. Other?

Communication Goals What do parents say? 1. More words 2. Increase vocabulary 3. Talk more 4.

Late talking children are good communicators

Late talking children send messages



For a variety of reasons

In a variety of ways  With words
In a variety of ways
With words

Recognizing children’s messages

Face to face

• Waiting

• Observing

• Listening

all

• Create opportunities for children to send messages

messages Face to face • Waiting • Observing • Listening all • Create opportunities for children

Children who are late talkers

Add to our clinical description

*Quiet as a baby/now

• Family history

• Parent Interaction style

• Ear Infections

• Consonant repertoire

• Pretend Play

• Comprehension

*Communicative gestures

*Imitation

*Word types

• Social skills

• Change/time

*Consider when goal setting

Olswang, Rodriguez,& Timler, 1998; Wetherby, 2000

types • Social skills • Change/time *Consider when goal setting Olswang, Rodriguez,& Timler, 1998; Wetherby, 2000

Target Word ® – The Hanen Program ® for Parents of Children who are Late Talkers: Appendix D

Target Word ® – The Hanen Program ® for Parents of Children who are Late Talkers:
for Parents of Children who are Late Talkers: Appendix D © Hanen Early Language Program, 2010.

© Hanen Early Language Program, 2010. All rights reserved.

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Choosing Initial Vocabulary Targets for Children Who Are Late Talkers Cindy Earle, M.A., SLP CCC The Hanen Centre CSHA Monterey State Convention • April 15-18, 2010

Target Word ® Parent-Child Interaction Form

Target Word ® Parent-Child Interaction Form
Target Word ® Parent-Child Interaction Form

Choosing specific vocabulary

• Understood by the child

• Motivating for the child to say

• Starts with a sound in the child’s repertoire (“in phonology”)

• Gestures

• Action words/verbs

• Occurs throughout the day

Focused stimulation

repertoire (“in phonology”) • Gestures • Action words/verbs • Occurs throughout the day Focused stimulation

Caregivers need to discuss and understand the communication goal

Noisy - vocalization with each communicative turn

Imitation - spontaneously copies single words

Single words - uses single words spontaneously

Combinations - using word combinations

words spontaneously Combinations - using word combinations Choosing specific vocabulary Understood by the child •
words spontaneously Combinations - using word combinations Choosing specific vocabulary Understood by the child •

Choosing specific vocabulary

Understood by the child

• MacArthur-Bates CDI

• Parent Report

• Observation

Choosing specific vocabulary Understood by the child • MacArthur-Bates CDI • Parent Report • Observation

Choosing specific vocabulary

Starts with a sound in the child’s repertoire (“in phonology”)

• Observation (clinician, caregiver)

• Speech Sound checklist

• Avoid initial clusters

(“in phonology”) • Observation (clinician , caregiver) • Speech Sound checklist • Avoid initial clusters

Target Word ® Speech Sound Checklist

Target Word ® Speech Sound Checklist
initial clusters Target Word ® Speech Sound Checklist © Hanen Early Language Program, 2010. All rights

© Hanen Early Language Program, 2010. All rights reserved.

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Choosing Initial Vocabulary Targets for Children Who Are Late Talkers Cindy Earle, M.A., SLP CCC The Hanen Centre CSHA Monterey State Convention • April 15-18, 2010

Choosing specific vocabulary

Motivating for the child to say

From the child’s perspective

Occurs throughout the day (pretend play)

vocabulary Motivating for the child to say From the child’s perspective Occurs throughout the day (pretend

Choosing specific vocabulary

Motivating for the child to say

From the child’s perspective

Occurs throughout the day (pretend play)

vocabulary Motivating for the child to say From the child’s perspective Occurs throughout the day (pretend

When choosing target vocabulary consider:

• Comprehension

• In phonology sounds

• Interests

• Motivating to say

• Verbs

and then

• Add a gesture

• Focused Stimulation

• In phonology sounds • Interests • Motivating to sa y • Verbs and then •

Case study

Communication goal

Noisy

Imitation

Single words

Combinations

Case study Communication goal  Noisy  Imitation  Single words  Combinations

Focused stimulation

• Word at least five times during an interaction

• Grammatically correct

• No pressure for the child to say the word

• Opportunities for imitation

the child to say the word • Opportunities for imitation Case study Communication goal • Age
the child to say the word • Opportunities for imitation Case study Communication goal • Age

Case study

Communication goal

• Age

• MacArthur-Bates

• Speech sounds

• Child’s interests

• Gesture

• Situations

Remember – at least 4 verbs

Age • MacArthur-Bates • Speech sounds • Child’s interests • Gesture • Situations Remember – at
Gesture • Situations Remember – at least 4 verbs © Hanen Early Language Program, 2010. All

© Hanen Early Language Program, 2010. All rights reserved.

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Choosing Initial Vocabulary Targets for Children Who Are Late Talkers Cindy Earle, M.A., SLP CCC The Hanen Centre CSHA Monterey State Convention • April 15-18, 2010

Choosing target vocabulary

(word)

(gesture)

Situations:

Choosing target vocabulary (word) (gesture) Situations:

Final questions/comments

Final questions/comments Cindy Earle, M.A. SLP CCC REG CASLPO Program Manager, Target Word ® - The

Cindy Earle, M.A.

SLP CCC

REG CASLPO

Program Manager, Target Word ® - The Hanen Program ® for Parents of Children who are Late Talkers

(905) 574-6876 x 236

cindy.earle@hanen.org

® - The Hanen Program ® for Parents of Children who are Late Talkers (905) 574-6876

Summary

Assessment

(observation, MacArthur-Bates/ Language Development

Inventory, Speech Sound Inventory, Receptive Language, Predictors of Change) including collecting

Additional Information

(child’s interests, communication goal)

Strategies for Responsive Interactions

Choose Target Vocabulary

Caregiver Plan and Tracking

(activity plans, diary, vocabulary lists [specific & general])

Choose Target Vocabulary Caregiver Plan and Tracking (activity plans, diary, vocabulary lists [specific & general])
plans, diary, vocabulary lists [specific & general]) © Hanen Early Language Program, 2010. All rights reserved

© Hanen Early Language Program, 2010. All rights reserved.

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