Developmental Language
Disorders SPH 801A
Assessment of pre-linguistic and
emerging language
Jenny Brown, Macquarie University,
August 2015
I the use of some of Dr Liora Ballins slides from
the 2013 Beijing SP Summer School lectures,
which assisted in the revision of this presentation.
Texts:
Paul, R & Norbury, C.F (2012). Language disorders:
From infancy through adolescence (4th ed). St. Louis,
MI: Mosby.
Owens, R. E. (2011). Language development: An
introduction (8th ed.). Boston, MA: Pearson Education.
Why do we need to assess?
To
To
To
To
To
establish a childs level of functioning
screen
diagnose
decide on intervention
set goals
Assessment (Haynes & Pindzola, p3)
Principles of assessment
Developmental research on the
sequence and processes of typical
language and communication
development should provide the
framework for assessing a childs
language and communicative
abilities
Principles of assessment
Assessment involves gathering
information about a childs
communicative behavior across
situational contexts over time;
Assessment is an ongoing process,
not a one-time episodic event
Principles of assessment
Assessing and responding to the
needs of the family will contribute to
the childs ultimate progress
Principles of assessment
Assessing the interactions between the
child and the childs communicative
partners to determine which behaviours
help or hinder the development of
language and communication skills
The purpose of assessing partner style is to
help partners develop an awareness of
strategies that facilitate successful and
positive interactions
Principles of assessment
To ascertain a childs communicative
strengths and needs, therapists
should use a variety of strategies,
including direct assessment,
naturalistic observation, and
interviewing significant others
Principles of assessment
A variety of instruments or tools may
be used in assessment, and should
be selected based upon a childs
developmental level, the purpose of
the assessment, and the assessment
strategies used
Considerations in designing and
implementing Ax (Kelly & Rice, 1986 in Owens, 2004)
Childs chronological and functional
age
Childs sensory systems
Caregiver concerns
Status of childs psychological
functioning
Childs interests and materials
available
Childs activity level
Use knowledge of Typical
Development
We need to know our norms
Have them handy
Use them in preparing an
assessment
Use them in talking to parents after
an assessment or in a report
Process of assessment
(Owens,
2004)
Referral, Questionnaire and
Interview
Observation
Conv
ersati
Formal
Testing
onal
Lang
uage
Samp
ling
Process of assessment
Interview and/or questionnaire
Observation
in a naturalistic environment
Standardised tests
Criterion based measures
Language sampling
Play assessment
Hearing screening
Assessment of toddlers
What questions do we want to be
able to answer by the end of the
assessment process?
Interview and/or
questionnaire
Involves caregivers
(e.g., parents, teachers, grandparents)
Source of information on childs
functioning
Provides opportunity to document
factors that may affect language
development
Purpose to gather information
Ask questions about:
Prenatal, perinatal, and postnatal medical history
Medical history that could affect speech and language
development (e.g., hospitalisation, ear infections,
feeding problems)
Family history of language or literacy difficulties
Any known conditions?
Developmental history
Speech and language development (e.g., age of babbling,
first words, word combinations, longer sentences)
Motor development (e.g., sitting, walking, toilet training)
Eating and drinking development - any feeding difficulties?
Child's educational history
Ask questions about:
The childs current communication:
Routine language use - Elicit examples of the
childs communicative attempts
(e.g., Tell me about what happens when)
What motivates the child to communicate?
How does the child communicate?
With whom does the child communicate?
What does the child do when communication fails?
Impact of language difficulties?
Ask questions about:
How does the child communicate?
Does the child use vocalisations, gestures, eye
contact, or other means of communication?
Who understands the childs communication efforts?
Does the child play alone or with others?
Does the child demonstrate any turn-taking
behaviours?
Does the child ever initiate communication? How?
In which situations?
Which situations seem to be high-communication
contexts?
Which caregivers seem to engage in the most
interaction with the child?
Ask questions about:
Does the child
Make wants known?
Request help?
Point to objects or actions, name, or both?
Request information?
Seek attention?
Demonstrate emotion?
Protest?
How and when?
Get examples
Family-Centred Practice Basic
Principles
Support, trust & respect parents
Use strengths-based approach
Understand & accept parents perceptions
& experiences
Dont overwhelm them with professional
language!
See Paul (2012, Appendix 6.1) for further
suggestions
21
What do you want to know
Eg A parent has said that their 2;7 year old boy
doesnt talk enough for his age. He seems to
understand everything. Hes mainly using words
and is slower than his sister was. He attends day
care 5 days a week and spends a fair amount of
time watching Into the Night Garden.
What do you want to know more about? That is,
what do you want to ask more questions about or
clarify?
(Think about how you ask these questions)
Early stages of
communication
Pre-intentional - 0-8 mths
Pre-linguistic - 9-18 mths
Emerging - 18mths 3yrs
Areas for Assessment of Preintentional children
Feeding & Oral-Motor Development
Vocal Development
Intentional communication
Hearing
General Development
Parent-Child Communication
24
Areas for Assessment of Prelinguistic children
Prelinguistic behaviours joint
attention, turn-taking, imitation
(motor and sound), vocalisations
Communicative intentions or
functions
Gestures
Play
Parent-child interactions
For toddlers with little language
By examining the childs prelinguistic
skills, we can identify the childs
unique profile of communication
strengths & challenges. This profile
can then be used to facilitate decision
making in both assessment and
intervention Crais, Watson & Baranek,
2009, p. 96
Toddlers communicating
What do you notice in this recording
What communication skills do you
notice?
Is she typically developing?
Http://www.youtube.com/watch?v=GARBeOrfhFo
http://www.youtube.com/watch?v=fsDqd5TxNTw&feature=related
Development of Joint Reference
(Owens, 2011)
Phase 1
8 wks: Visual tracking of caregivers
movements
12 wks: Infant attends to utterances
addressed to him/her
4 mths: Infant follows caregivers line of
regard
6 mths: infant responds to object name
28
Development of Joint Reference
(Owens, 2011)
Phase II
7 mths: Infant established joint reference
by pointing
8 mths: infant points or reaches & shifts
gaze between object & caregiver
Phase III
8 12 mths: Reaching, requesting,
pointing & showing; gesture alone &
gesture + vocalisation
29
Assessing Joint Attention
Observe child and parent with different
toys/objects/books
Mundy et al (2003). Manual for the
abridged Early Social Communication
Scales (ESCS)
http://www.ucdmc.ucdavis.edu/mindinstitu
te/ourteam/faculty_staff/ESCS.pdf
Initiating & responding to joint attention
Initiating & responding to behavioural requests
Initiating & responding to social interaction
30
Assessment of Vocalisation
Developmental vocal assessment (See
Paul, 2012 p.195)
Suggestion of +- 50 70 comfort
state vocalisations; can be collected
in 20 minutes; may need more than 1
session if infant is fractious
Vocalisation = vowel- or consonant-like
elements produced on exhalation
31
Assessment of Vocalisation
Failure of canonical babbling by
10 months predicts delays in the
acquisition of words & word
combinations in 2nd year of life
(Oller at al, 1998)
Rate of vocalisation (# of
vocalisations # of minutes)
should increase steadily (no norms
available)
If no change in vocalisation rate
32
Assessment of Vocalisation
Does child produce multisyllabic
babbling?
16 months: more consonants than
vowels expected
Babble by 12 months have sentencelike intonation & prosody
If there is evidence of gesture use, the
infant might not be pre-intentional
33
Three aspects of communicative
intentions to assess
1. Range of communicative functions
2. The frequency of communication
3. Forms of communication
The means by which the child attempts
to communicate a message
Range of communicative functions
Proto-imperatives: To get an adult to do or not
do something
Requests for objects
Requests for action
Rejections or protests
Proto-declaratives: To get an adult to focus on
an object or event by showing off or showing or
pointing out objects for the purpose of
establishing social interaction or joint attention
Comments
Communicative Intentions
(Owens, 2010)
Before 24mths:responding to Qs;
continuance; declaring; making choices;
labelling/naming; protesting/denying;
repeating;
2436mths:greeting/calling; predicting;
replying (without prompt); requesting
assistance/ clarification/ information/
objects;
36mths+:expressing feelings, giving
reasons, hypothesizing;
The frequency of intentional
communication
Changes over the age range
18 months: 2 instances of intentional communication per
minute
24 months: 5 instances of intentional communication per
minute
(Chapman, 2000)
Children with mild to moderate ID in the pre-linguistic
period who produced less than 1 proto-imperative
every 5 minutes unlikely to develop functional
speech one year later (Yoder, et al. 1998)
Therapy to focus on increasing the frequency of nonverbal
communication, particularly proto-imperative
Forms of intentional communication
Children increase the sophistication
of the forms of communication they
use as they progress through
emerging language periods
Note the forms of communication
Gesture, pointing, reaching
Eye gaze
Vocalisation
Development of communicative
intent nonpurposeful
Stage
Behaviour
Example
Pre-intentional
Reflexive behaviour that
expresses inner state and
serves as signal for adult
who interprets it. Not
directed at others; no
anticipation of others.
Cry, posture change,
facial expression
Reach for object
Unintentionalintentional
Behaviour is goal oriented
(reaching for object) but is
not intended to be
communicative. Not
directed at others; no
anticipation of others.
Reach for object, look
at or regard object
Development of communicative intent purposeful
Stage
Behaviour
Example
Nonconvention
al
Nonconventional gestures, usually
physical contact, used with intent
of affecting adult. Demonstrates
intention to communicate by
eliciting behaviour, checking adult
attending, and anticipating
outcomes. Persistence or
frustration if goal unmet.
Tug, push away,
pull
Conventional
Standard gestures and
vocalisation used with intention of
affecting adults behaviour.
Alternating
gaze, hand
object, point,
wave, shake
head
Concrete
Limited use of iconic symbols to
represent the environment. Range
Point, reach,
offer, request
Development of communicative
intent - symbolic
Stage
Behaviour
Example
Abstract
Limited use of arbitrary symbols,
used individually, to represent the
environment. Limited to the here
and now. Still heavy reliance on
gestures and vocalisation.
Symbols
Formal
Rule-bound symbol combinations;
referent need not be present.
Language is primary means of
communicating.
Combination of
symbols
Owens, R. E. (2011). Language development: An introduction (8th ed.). Boston, MA:
Pearson Education.
Assessment of Communicative
Intention: How
Observation of play/interaction with
items in the Ax context
Observing child around eating
times/with food
Parental report
Elicited play (if intentional behaviours
not observed or reported)
Communication temptations
42
Communicative Intentions
https://www.youtube.com/watch?
v=nQxDG4LD1Eo
How can we elicit them if we havent seen them?
Communication temptations
Think of 3 possible activities to tempt a child to
demonstrate different communicative functions or
intentions that might work in an Ax setting
Gestures in the Prelinguistic & Emerging
Language Stages (Capone & McGregor, 2004)
Deictic showing, giving, pointing
Symbolic play schemes - actions
depicting object functions
Representational a form is used
to stand for a referent
Gesture & Language
8 -12 mths: gesture
predominates
12- 18 mths: gesture + word like
vocalisations
18 24 mths: conventional words
& combinations; increased range
of functions
Observation - Development of gestural
behaviour
Gestural
Factor
Consequence
Frequency
Toddlers with disability use fewer gestures
Type
Onset of pointing predicts language development
Communicativ
e function
Limited variety of gestures (especially for joint
attention and social interaction) in 18-24 month olds
is associated with later diagnosis of autism and
developmental disabilities
Coordination of By 15 months, typically developing toddlers
gesture with
combine gesture with gaze and/or vocalisations;
gaze and
Lack of this coordination is associated with language
vocalisation
delay and/or autism
Transition from
contact to
distal gestures
Failure to acquire gestures to indicate objects at a
distance is associated with developmental disorders;
it is frequently seen in autism
Transition to
words
Children who predominate in using gestures to label
objects after 20 months may have language delay
Gesture observation
Therefore, what are we looking for?
Frequency
Type
What is the function or purpose
Is it with gaze or vocalisation
Contact or distal
With or instead of words
Need context to answer these
Play observation
Why is this important?
Natural context for language
Encourages language production
May elicit specific linguistic structures
E.g., more likely to produce spatial terms in
play with objects than in conversation
Play observation: Milestones
6-12 months
Handles objects with simple motor
schemes
(e.g. banging, mouthing)
Drops objects
Bangs two objects together
Acquires objects on own
Gives object to another
Pushes a ball
Play observation: Milestones
By 12 months
Uses some toys appropriately without
mouthing or banging
Explores moving parts of toys
Finds a hidden toy
Is aware objects exist when not seen
Play observation: Milestones
By 18 months
Dumps objects out of containers
Places objects into containers
Hands toy to adult for assistance
Attends to operating components of toys (e.g.,
buttons)
Discovers how to use toys through exploration
Uses toys appropriately (e.g., pushes car)
Engages in symbolic play with self (e.g., eats
pretend food)
Play observation: Milestones
By 24 months
Engages in symbolic play with toys (e.g.,
brushes dolls hair)
Combines two toys in sequenced actions
(e.g., pours from pot to cup)
Imitates familiar routines (e.g., sweeps)
Refers to toys not present
Uses books and other literacy props in
play (e.g., pretends to write)
Play observation: Milestones
By 30 months
Represents personally experienced
events, including those that occur
infrequently (e.g., going to doctor)
Re-creates sequences during play (e.g.,
takes babys clothes off, puts baby in
bath, dries baby, dresses baby)
Uses lots of language during play
Play observation: Milestones
By 36 months
Engages in role play with toys and other
children
Uses toys to act out scenarios or plays
Acts out scenarios in which child was not
directly involved (e.g., fire fighter
fighting a fire)
Engages in highly imaginative play (e.g.,
exploring planets on a spaceship)
Assessment of Play
Symbolic Play Test
1979)
(Lowe & Costello,
Communication and Symbolic
Behaviour Scales (CSBS) (Wetherby &
Prizant, 2003)
Play Scale (Carpenter 1987)
Symbolic Play Scale Checklist
(Westby 1980)
56
Speech Pathology and Play
Assessment
What is our role in assessing play?
Why do we need to consider play?
Need to consider symbolic play
development and also social play
development
Spontaneous and elicited play
For children with ASD
(Prelock,
2006)
In what ways does the child use objects?
In what ways does the child explore objects?
How does language affect the childs play?
How does the social context affect the
childs play?
How does the chlds independent play look
cf peer play?
Does the play look different in structured vs
unstructured situations, prompted/elicited
vs spontaneous?
Materials
Need to consider the toys used in a
play assessment
2 years blocks, pull and wind up toys,
dolls
3 years books, clothes, puppets, barn
with animals
5 years + toys with many pieces, action
figures
Older children
Parent-Child Interactions
Formal or informal analysis
Characteristics of typical mother infant
communication: (Rossetti 2001)
Short utterance length with simple syntax
Small core vocabulary
Topics limited to here and now
Heightened facial expression and gesture
Meaningful responses turntaking and
prolonging
Frequent verbal rituals
What should we look for in parent-child interactions?
(Paul & Norbury 2012)
Pleasure and positive affect
Responsiveness to childs cues of readiness to
interact
Acceptance of babys overall style and temperament
Reciprocity and mutuality
Appropriateness of choice of objects and activities for
interactions
Lang stimulation and responsiveness
Encouragement of joint attention and scaffolding the
childs participation
Areas to assess in children with
Emerging Language (approx 18mth-3yrs)
Areas to assess in toddlers:
Communicative intentions/pragmatics
Gesture
Play
Comprehension
Expression (lexical, semantic-syntactic)
Phonology/speech
Language sampling
Spontaneous or elicited sample of childs,
speech, language, and communication
Where: Home, classroom/preschool, clinic
With whom: Parent, sibling, therapist
Activity: Conversation, play, or recall of event
Materials?
Quantitative and qualitative information
Advantages
Language in a naturalistic context
unique opportunity to survey
vocabulary, grammar, and pragmatic
skills in more naturalistic contexts
Useful way to document change
What can it sample?
Pre-linguistic skills
Vocabulary
Grammatical complexity
Syntactic structures and sentence
length
Pragmatic functions
Consider conversational partners
Use familiar conversation partners
with young children
Instruct caregivers to be
nondirective, interested, and
responsive
E.g., talk about what they and the child
are doing
What to use to get the best sample
Low structure interactions (follow childs
lead)
Toys that allow multiple episodes with
symbolic play toys that lend themselves to
pretending
Mix of familiar and non-familiar toys
Interesting toys
Books
More on the how of language sampling next
week
Ax task
Look at DVD of Jack 2;1 years
What pre-linguistic, play, gesture and
communicative intentional
observations can you make?
Assessment Tools for Emerging Language
MacArthur-Bates Communicative Development
Inventories (Fenson et al, 1989)
Preschool Language Scale-4 and 5 (Zimmerman et al,
2004, 2011)
Reynell Developmental Language Scales III (Edwards
et al, 1999)
Expressive One Word Picture Vocabulary Test
(EOWPVT)& Receptive One Word Picture Vocabulary
test (Brownell, 2000)
Rossetti Infant-Toddler Scale (Rossetti, 2006)
Receptive-Expressive Emergent Language Scale 3 rd
ed (REEL-3)(Bzoch, League & Brown, 2003)
Communication and Symbolic Behaviour Scales
(CSBS) Normed Edition (Wetherby & Prizant, 2003)
70
Assessing Comprehension
Standardised tests
comprehension and expression subtests, eg PLS-5, Reynell III
single-word vocabulary, e.g. Peabody Picture Vocabulary, CSBS
Probe (criterion referenced tasks)
Does the child understand any words without the support of
non-linguistic cues?
Can the child understand sentences?
Can the child respond to different questions?
Does s/he understand semantic relations?
Parent report on language checklists elicit specific examples
Observe responses in conversation - dont rely on this alone
71
Strategies for Assessment of
Comprehension (Miller & Paul, 1995)
Comprehension of single words without
non-linguistic cues [12 18 mth level of
functioning]
Nouns 6 to 8 objects (Instruction: Give me
X, Show me X)
Verbs kiss, pat, throw, push,etc. (Instruction:
Do X)
Comprehension of two-word semntic
relations, e.g. action-object (Kiss the
doll) [18 24 mth level of functioning]:
72
Strategies for Assessment of
Comprehension (Miller & Paul, 1995)
Comprehension of three-word
semantic relations, e.g. agent-actionobject (Let the doll sit on the chair)
[24 36 mth level of functioning]
If successful at last level, use a
standardised test
73
Assessment of Receptive
Language
Common comprehension testing pattern
at this stage:
Simple Nouns (with gesture if required)
Simple verbs (with gesture if required)
Action object semantic relations (unusual
associations first e.g. hug the shoe)
Agent - action object (known vocab items
then more difficult but age appropriate
items)
Think about information carrying units or
key words
After this use a standardised test
74
Assessment of Expressive Vocabulary
Some info from standardised
assessments PLS 4/5
Identify vocabulary from recorded
language sample
Parent report MacArthur CDI;
Vineland Adaptive Behavior Scales
Communication Domain; informal;
What do we do when the parents report
is quite different from what we see in a
session in terms of number and types of
words?
75
Assessing Syntax-Semantics
Frequency of word combinations
Frequency of single vs. 2 word combinations
(>50% of utterances should be 2-word
combinations by 24 months)
TTR
Parental diary
Semantic relations expressed
Brown (1973)
Developmental Sentence Analysis (Lee,
1973)
Lahey (1988) content/form assessment
76
Assessing Syntax-Semantics
MLU will be either 0 1at this stage
and is very easy to compute
Probably wont use complex
grammatical analysis (particularly
under 50 words usually there are
few 2 word combinations under 50
wrds)
77
Diagnosis informed by
considering..
Childs performance compared to
standardized normative data
Childs performance on criterionreferenced tasks
Conversational partners perspective
Communicative expectations
Functional language skills
78
Homework Task
Plan an assessment of 2;4 year old:
What communicative intentions, gestures,
play, receptive language, expressive
language, sounds/phonology would you be
looking for?
Ideas for eliciting or probing for those areas
in terms of what equipment or strategy you
might use. How will you try to elicit
behaviours if you dont see them?
References
Crais, E., Watson, L., & Baranek, G. (2009). Use of gesture development in profiling childrens
prelinguistic communication skills. American Journal of Speech-Language Pathology, 18 (1), 95108.
Haynes, W. O., Pindzola, R. H. (2008). Diagnosis and evaluation in Speech Pathology (7th edition).
Boston: Allyn and Bacon.
Miller, J. & Paul, R. (1995). The clinical assessment of language comprehension. Baltimore, MD:
Paul H. Brookes.
Owens, R. E. (2011). Language development: An introduction (8th ed.). Boston, MA: Pearson
Education.
Owens, R. E. (2004). Language disorders: a functional approach to assessment and intervention
(4th edition). Boston: Allyn and Bacon.
Paul, R., & Norbury, C. F. (2011). Language disorders from infancy through adolescence: Listening,
speaking, reading, writing, and communicating (4th ed.). St. Louis: Mosby Elsevier.
Prelock, Patricia A (2006).Autism spectrum disorders : issues in assessment and intervention. ProEd, Austin, Tex
Yoder, P., Warren, S., & McCathren, R. (1998). Determining spoken language prognosis in children
with developmental disabilities. American Journal of Speech Language Pathology, 7, 77-87.
Early Intervention Training Institute Newsletter (1998). Downloaded August 2013.
http://www.einstein.yu.edu/uploadedfiles/Centers/childrens-evaluation-rehabilitation/
EITI%2005%201997%201998%20Winter.pdf
