The goal of these "Guidelines for Best Practices in Determining Eligibility Based on Children's Communication Skills" is to offer the evaluation team support in their decision-making regarding a child's need for early intervention services based on communication development. In Wisconsin, communication is defined in HFS 90 [HFS 90.08 (7)(c)3.] as follows:
Communication development, as evidenced by understanding, expression, quantity and quality of speech sounds or words, and communicative intent through gestures.
Communication
development includes the acquisition of communications skills during preverbal
and verbal phases of development; receptive and expressive language, including
spoken, non-spoken and sign language means of expression; oral-motor development;
auditory awareness skills and processing; the use of augmentative communication
devices; and speech production and awareness. To determine eligibility
the team must consider a number of components of communication including:
Receptive language - understanding, comprehension, receptive language,
auditory awareness skills and processing;
Expressive language - expression, production, social language (pragmatics);
Speech, voice, fluency - quantity and quality speech sounds and words;
and, Oral-motor development - the structure and function of the speech
mechanism for feeding and speech development.
In these guidelines:
These guidelines are written to be useful to the entire team, including parents, but some components are specifically intended for speech-language pathologists. The guidelines were developed to help individuals who work with young children and their parents consider the many facets of a comprehensive communication evaluation.
Receptive language is a term that is synonymous with language comprehension or understanding of what is spoken, written, or signed. It refers to the child's ability to get meaning from language. The development of receptive language for the spoken word is dependent on the development of auditory perception and auditory processing skills. Auditory perception refers to the identification, interpretation, or organization of sensory data received through the ear. Auditory processing refers to the ability to fully utilize what is heard.
Receptive language has its foundations in the infant's social interactions. The infant learns to recognize the human voice, to differentiate speech from nonspeech sounds, and to begin to associate meaning to the sounds heard during the first months of life. Understanding words generally begins with understanding commonly spoken, familiar people and object names or routines (e.g., bye). In the first year of life, children come to understand words related to people and objects that are present in their environment. In the second year of life, the child begins to understand words spoken without the support of context. For example, when the caregiver says, "Go get your shoes" the child may go to another room to retrieve them. At the end of the second year, children are beginning syntactic understanding of two-word relations and early question comprehension begins. Table 1 is a summary of receptive language development in typically developing children.
Table 1: Receptive language development in typically developing children.
| Approximate Age Range | Receptive Language Skills |
|---|---|
| 8-12 months: Comprehension of routines | Understands a few words in context (e.g., plays peek-a-boo when mom says words and models gestures, responds to direction "splash" if in tub) |
| 12-18 months: Lexical guides to context-determined responses | Understands
single words for objects in immediate environment Will get an object if told to when object is in view Will perform some actions (e.g., kiss, hug, pat) with verbal instruction alone Knows names of familiar people Average receptive vocabulary size:
|
| 18-24 months: Lexical comprehension but context determines sentence meaning | Understands
two-word combinations similar to those produced including:
Does not process three-term relations (e.g., agent-action-object) fully Average receptive vocabulary size: 150-500 words |
| 24-42 months: Contextinfluenced comprehension | Understands
three-term relations (agent-action-object) but has difficulty using word
order to identify agent versus object in improbable (e.g., Baby feeds mother)
or neutral (e.g., Horse pushes cow) sentences Understands who, what, where, and whose questions |
| 42-48 months: Emerging syntactic comprehension | Understands
word-order cues to agent-action-object relations Understands how questions Average receptive vocabulary size: 1,000-3,000 words |
Birth to 18 Months
A child learns to use language to interact with others and to communicate more efficiently and effectively. The form and complexity of the child's communication skills change substantially during the first three years of life. Additionally, research has consistently demonstrated that a child begins to communicate long before producing his or her first word.
At birth, the child's behavior is best described as nonintentional (i.e., not purposeful or goaldirected) and noncommunicative. In fact, the word, "infant" comes from the Latin "infans," which means, "not speaking" (Owens, 1996). Until the age of approximately 9 months, the typically developing child's behavior is considered nonintentional (not purposeful) and noncommunicative (lacking communicative intent); however, the primary caregivers respond as though the child's behaviors are intentional and communicative. For example, when the infant goos and coos, the caregiver is likely to respond as though the infant is conveying a message. Such responses from the caregiver are important to the child's learning to communicate nonlinguistically via the use of eye contact, gestures, and vocalizations (in isolation and in combination). As the child progresses through this stage of development, his or her behavior becomes increasingly more intentional (i.e., purposeful and goal-directed). The infant's prelinguistic behavior is used primarily for four purposes: relief from discomfort; attainment of desired ends; reestablishment of proximity; and initiation, maintenance, and termination of an interaction (McLean & Synder-McLean, 1978).
Gradually, the child expresses these purposes through the use of nonlinguistic and then linguistic communicative behavior. Beginning at approximately 9 months of age the child continues to use nonlinguistic behaviors, but uses the behaviors to intentionally communicate a message. By the age of approximately 12 to 18 months, the child has begun to use single words to communicate messages that had previously been communicated nonlinguistically. Word combinations begin to emerge when the child is approximately 18 to 24 months old, reflecting beginning use of grammar.
Appendix 1 provides a summary of expressive language development for typically developing children from birth to 18 months. 18 to 36 months
During this period, children progress from producing single words to using simple sentences to express a variety of meanings. They also express a greater range of communicative intentions (greeting, requesting, commenting). Although there is considerable variability of vocabulary size in young children, this variability greatly decreases during the third year of life. The communication development in this period is dramatic and for ease of discussion, the period is discussed in two stages.
18 to 24 months:
Paul (2001) describes a significant increase in the frequency of both nonverbal and verbal communication in children between 18 and 24 months of age. In addition, children increasingly use words over preverbal communication. The child of about 18 months produces an average of two communicative acts/per minute to express an intention through words, gestures or vocalizations; a child of 24 months produces an average of five. (Wetherby, Cain and Walker, 1988; Paul and Shiffner, 1991). The communicative intentions that are expressed most frequently include requesting information, answering questions, and acknowledging what was said. The ability to combine words is one of the hallmarks in language production typical of the 18 to 24 month range.
Other notable aspects of children's language in this range:
Vocabulary Size
| Approximate Age | Approximate Number of Words in Expressive Vocabulary |
|---|---|
| 18 months | 50 |
| 20 months | 150 |
| 2 years | 20-300 |
Adapted from Reed, V. A. (2005). An introduction to children with language disorders (3rd Ed) Boston, Pearson Education, Allyn & Bacon.
Two-word combinations emerge to express meaningful relationships including (Brown 1973):
Range of Mean Length of Utterance (MLU) in morphemes*
*A morpheme is the smallest unit of meaning, e.g. "ball" equals one morpheme, "balls" equals two morphemes
24 – 36 months:
Major developments in children's language at this stage include: talking about absent events and objects; using language in pretend play; using grammar; and beginning to participate in conversations.
Vocabulary Size
300-1000 words (Reed, 2005)
Expansion of meaningful relationships
During this stage, children use phrases and short sentences and begin to incorporate the following grammatical features:
Children's ability to produce sounds and make their speech clear develops quickly over the first three years of life. The way children speak is more than the words, gestures, and expressions they use. What sounds they make and how they make the sounds influences their ability to be understood by others.
Speech sound development proceeds over time during the infant and toddler years. In infancy, there are stages of normal non-cry development (See Appendix 2). As children develop, so does their ability to master vowels and consonants of the language. There is a range when individual children may master particular sounds. Kent (1999) summarizes the approximate ages of speech sound mastery (75% or better) based on several studies of children's acquisition of consonant sounds:
Children's speech sound development is affected by their ability to coordinate the oral motor system (i.e., lips, tongue, palate, larynx, respiration) and to learn the underlying rule system related to sounds (i.e., phonology). According to Linder (1993), by two years of age 50%-65% of words will be understood by unfamiliar adults. By the age of three most children's speech is understandable to familiar adults and about 75% of utterances produced by 3-year-olds are intelligible to unfamiliar listeners (Vihman & Greenlee, 1987). In Table 2 below, Sanders (1972) summarizes children's acquisition of consonant sounds.
Voice is sound produced by the vibration of the vocal folds and modified by the resonators (e.g., sinus cavities) and shaped by the articulators (e.g., lips and tongue). Voice characteristics include pitch, volume, and quality.
Young children learning language demonstrate normal developmental disfluencies (interruptions to the flow of talking), which most often disappear as their expressive language skills mature. These developmental disfluencies are characterized by:
Differentiating children whose stuttering-like disfluencies (SLD) will naturally resolve versus those whose stuttering will persist is an important question. The Illinois Longitudinal Study (Yairi & Ambrose, 2005) focused on this question and followed 89 children with an average age of onset 33 months. Several findings about which children persisted in stuttering included: 1) about 20 % of children persisted in their stuttering which is consistent with other data; 2) their age of onset was slightly later; 3) girls tend to resolve their stuttering and did so faster than boys; and 4) predictions of who will recover based on measuring stuttering-like disfluencies alone is difficult. They suggest that the best predictor is a decrease in all SLD types, which approach normal limits within 6 to 8 months following onset.
The following are examples of how the changes in the anatomy and physiology of the infant over the first year of life affect vocal output. Little is known as to what effect, if any, crying has on later speech development.
Respiratory Subsystem:
Laryngeal Subsystem
Upper Airway
Communication evaluation should be completed within a multidisciplinary context that evaluates the child across all developmental domains. It is recommended that communication evaluation include consideration of the child's:
When communication delays are the primary concern of the parent or referring source, a speech- language pathologist should be a member of the team.
In evaluating a child who has a possible communication delay, it is important that the evaluation team not rely solely on test scores but gather and use information from observations, interviews and records as well as their clinical judgment. Evaluation tools and procedures should be individualized age-appropriate, and culturally sensitive for the child and family.
It is recommended that the evaluation of young children with possible communication delays include both standardized tests and alternative evaluation approaches. Standardized tests are important because of the objectivity and structure they offer to the evaluation process, even though standardized test scores alone are insufficient to make a determination of delay. Alternative approaches, such as an analysis of samples of the child's speech and language, are important because many dimensions of communication are not easily measured using standardized tests (such as pragmatics, discourse, voice, fluency, and oral-motor skills).
It is recommended that an evaluation of a child with a possible communication delay include the following components:
Standardized tests of expressive and receptive language are recommended as part of the evaluation. It is important that these tests be appropriate for the age, language, socio-economic status, etc, and include both norm-referenced and criterion-referenced measures, as described below:
Samples of the child's spontaneous speech and language should be collected in natural contexts. The language samples are used to determine language level and to describe language form, content, and use. Language measures derived from spontaneous language samples may be useful as a quantitative method for assessing language problems in young children. The sample can also be used to make decisions about speech development including developing a sound inventory, completing a babbling analysis, categorizing sound errors and/or patterns of errors, and making judgments about intelligibility.
Another important component of the evaluation is the observation of the primary caregiver's communicative interactions with the child. Language is a social tool for the child; thus, it is important to examine the child's communicative environment. Observation of the communicative behavior of the caregiver and child will be used to determine the characteristics of the communicative environment that might influence the child's communication (e.g., opportunities for the child to communicate, communicative behaviors of others during interactions with the child) as well as ways in which the child's communication skills might influence his/her communication environment.. These observations can also be organized to gain information about the child's ability to understand language e.g., vocabulary, directions, etc.
Interviews with caregivers are essential. The caregivers' concerns and comments about the child's communication abilities, strengths, and challenges are critical to the evaluation process. These interviews can be conversational in tone but should be organized to gain the caregiver's perspective across all areas of communication.
In each evaluation for determining eligibility based upon the child's communication skills, it is necessary to rule out hearing loss as a contributing factor. For example, otitis media with effusion is commonly associated with reduced hearing acuity. When present at critical milestones of speech and language development, the otitis media with effusion can negatively affect the child's communication development. A child of any age can have a hearing evaluation. The nature and importance of an audiological evaluation should be discussed with the child's family and physician and referrals should be made as appropriate.
A child with communication delays or disorders might have difficulties with receptive language function. Consequently, it is important to assess the child's receptive language skills. Such an assessment should address (1) the child's ability to attach meaning to single words and to word combinations, and (2) the extent to which the child relies on nonlinguistic cues to attach meaning to linguistic input.
There are few standardized measures of receptive language available for children from birth to three years of age. (See Appendix 3 for a list of Evaluation Tools and Methods.) Some receptive language assessments are based primarily on parent report. Receptive language measures based on parent report can be less reliable than measures of expressive language because of the variability in the caregivers' interpretations of the questions (Dale, 1991). Other measures use primarily elicitation tasks in which the child is instructed to respond to verbal instructions. Many young children do not respond to such tasks because the tasks are somewhat structured and contrived rather than naturalistic.
Therefore, to supplement the findings of standardized receptive language measures, the speechlanguage pathologist (SLP) should incorporate informal assessments of the child's receptive language skills. Through observation of the child, the SLP can determine the child's skills in understanding single words and word combinations with and without the support of nonlinguistic cues. The SLP can observe the child's responses during interactions with family members and other caregivers. In addition, informal tasks, such as those described by Miller and Paul (1995) can be used to assess the child's comprehension of single words and specific semantic relations, grammatical forms, and syntactic constructions. It is important to remember that a child's incorrect response or lack of response does not conclusively indicate comprehension difficulties.
The evaluation of expressive language in young children can be less complicated than receptive language because this more readily observed. The key to evaluating expressive language is collecting and analyzing authentic samples of the child's use of expressive language. The language samples should be obtained though observations during interactions with parents, family members and other caregivers. The evaluation of expressive language between birth and 36 months of age should focus on a variety of behaviors, including:
Children with a language delay may be producing few, if any, intelligible words. The language sample focuses on the child's use of prelinguistic, nonlinguistic and early linguistic behaviors. For the emerging and developing language stages, sample analysis includes the size and extent of vocabulary, the intentions expressed, the basic semantic roles (the various meaning relationships expressed), and grammar development.
Standardized assessments of expressive language can be used to supplement the results of the language sample analysis. Such assessments can include parent report and/or elicitation tasks. The context for elicitation tasks tend to be structured and less naturalistic than the context for a language sample. However, standardized assessments can provide additional information about the child's expressive language skills. (See Appendix 3 for a list of Evaluation Tools and Methods.)
Many factors influence and can interfere with the development of intelligible speech in young children. A child's speech development and intelligibility can be affected by: 1) hearing loss; 2) speech motor control problems; 3) delays or disorders of the sound system; 4) cranial facial anomalies; 5) voice disorders; and 6) fluency problems. If a child's speech intelligibility is decreased, the evaluation should measure how much the clarity of the message is affected and attempt to disambiguate the factors contributing to the decreased intelligibility.
Methods for Evaluation of Speech Intelligibility
There are several ways to quantify speech intelligibility depending on the age and the amount of speech produced by the child.
1. Percent Intelligible Words – This intelligibility measure is generally derived from analysis of spontaneous speech that is audio taped. A useful method is to obtain a 100 word sample and calculate the percent of intelligible words by having an unfamiliar listener write down the words understood.
| # of intelligible
words X 100 = Percent of Intelligible Words # of total Words |
2. Percentage Consonants Correct (PCC) – (Shriberg and Kwiatkowski, 1982b) compares child's pronunciation with the adult form in terms of the proportion of correct consonants to the number of possible consonants.
Their scale classifies a level of delay based on percentage of consonants correct:
Degree Percentage of Correct Consonants (PCC)
|
<>3. Speech intelligibility 5-pt rating scale (Ray, 2000) – This measure uses a 5-point rating scale to determine level of intelligibility
| Rating | Description | Percentage |
|---|---|---|
| 4 | Normally intelligible | 100% |
| 3 | Minimally impaired | 70 - 90% |
| 2 | Mildly impaired | 50 - 70% |
| 1 | Moderately impaired | 30 - 50% |
| 0 | Severely impaired | 10 - 30% |
Methods for Evaluation of the Speech Sound System
In making a decision about whether a speech delays exists, it is important to collect a sample of the child's speech. With infants and toddlers this sample is generally collected in a play situation while interacting with the caregiver, speech-language pathologist or other early interventionist. The speech sample is collected similarly to the collection of the language sample. It is analyzed from a different perspective i.e., instead of looking at word use and grammar, speech sounds and how they are produced are analyzed. For children between two and three years of age, a standardized measure (e.g., Goldman-Fristoe Test of Articulation –2) may be used to collect an inventory of speech sounds. See Table 2, "Sanders (1972) Consonant Acquisition," for a summary of speech sound mastery.
One resource for evaluating the early speech sound development of infants and toddlers is the Language Production Scale from "Assessing Prelinguistic and Early Linguistic Behaviors in Developmentally Young Children" by Olswang, L., Stoel-Gammon, C., Coggins, T., and Carpenter,
| # of correct
consonants X 100 = PCC # of consonants |
P., 1987. This scale includes methods for completing a babbling analysis to measure the phonetic complexity of babbled utterances. An outline of the information about this scale is found in Appendix 4. Another portion of the scale is the Early Meaningful Speech Analysis which is based on a sample of 100 fully or partially intelligible utterances produced by the child. From this sample relevant analyses are completed to: 1) describe the child's phonetic inventory; 2) compute PCC (described above); 3) measure occurrence of simplification patterns or phonological processes; 4) count the number of different words produced; and 5) measure length of utterance and word meanings expressed.
Methods for Evaluation Speech Motor Control System
Another potential cause of speech intelligibility problems in infants and toddlers is weakness and/or coordination difficulties of the speech motor control system (SMCS). Caregiver interviews and observation of the child in conjunction with elicitation tasks can be useful in determining whether the SMCS is contributing to speech delays or a breakdown of intelligible speech. Signs that implicate the SMCS as a contributing factor to the intelligibility concerns include:
There are two major types of speech motor disorders that affect speech production and influence intelligible speech. These speech motor disorders are dysarthria and developmental apraxia of speech (DAS). Below are definitions for each of these speech motor disorders, associated characteristics and methods to include in evaluation.
1. Dysarthria a collective term for a group of motor speech disorders resulting from neuromuscular dysfunction. There are different types of dysarthria affecting one, several or all major subcomponents of speech production: respiration, phonation, resonance and articulation. In infants and toddlers dysarthria is frequently associated with cerebral palsy or progressive neurological disease (Marquardt, 2000). Some characteristics often used for diagnosis include:
2. Developmental apraxia of speech (DAS)
Developmental apraxia of speech (DAS) is defined as an inability or difficulty with carrying out purposeful, voluntary movements for speech in the absence of a paralysis of the speech musculature. Most definitions focus on the articulatory aspects of the disorder and the inability to sequence speech movements (Strand, 1998). There is controversy as to whether DAS exists as a specific deficit because speech is a complicated fine motor activity that is continuously interactive with cognitive and linguistic processing.
Strand (1998) and Shriberg, Aram, & Kwiatkowski (1997) indicated that speech-language clinician "don't have good diagnostic markers" related to Developmental Apraxia of Speech (DAS); however, a differential diagnosis (to determine whether the intelligibility problem is due to other factors than DAS) is essential. Some characteristics often used for diagnosis include:
A factor frequently associated with DAS is disturbance with prosody, including slower rate, inappropriate or longer pauses, reduced stress variation, and errors in syllabic stress.
Methods for evaluation for Dysarthria and DAS
The following communication evaluation information should be collected:
Cranial Facial Anomalies – Cleft Lip & Palate
For children with an identified cleft lip and/or palate the speech-language pathologist must determine the extent to which the cleft contributes to the child's articulation or phonological errors and overall intelligibility. Approximately one in about 800 babies is born with a cleft lip or palate. Roth and Worthington (1996) define cleft palate and or lip as a congenital malformation that results from the failure of oral structures at midline to fuse during the first trimester of pregnancy. Children with cranial facial anomalies are generally followed by an interdisciplinary team with expertise in these disorders. Surgery for cleft lip is generally done when the infant is about 10 weeks old. Repairing a cleft palate is a more extensive surgery and is usually done when babies are between nine to 18 months of age.
Canady, Karnell, and Marsh (1999) report that children with a cleft lip only, with no other problems, should have normal or close to normal speech development. They further state that approximately 80 % of infants born with clefts of the palate develop normal speech once their palates are repaired. Additionally, children with clefts of the palate are at increased risk for language and cognitive delays or disorders. With the cleft of the palate the most significant speech problem may be velopharygeal incompetence resulting in audible nasal emission, hypernasality, and articulation errors especially of fricatives (e.g., f, s, z), affricatives (e.g., ch, sh) and plosives (e.g., p, b, m).
Submucosal clefts in children may go undetected at birth and often are difficult to detect in children of any age. Hypernasal resonance may be the hallmark for this type of cleft. An oral motor evaluation is essential and the palate should be palpated (midline from front to back of palate) to determine whether the submucosal cleft exists. Submucosal clefts are the most common association with syndromes and a referral for genetic counseling may be warranted.
<>Methods for evaluation of children with cranial facial anomalies
The following communication evaluation information should be collected:
Considerations for Evaluating Voice
If voice concerns arise or are already documented via medical history, consideration of outside referral for evaluation may be appropriate. Evaluation of a child with vocal concerns will involve a case history (previous voice and speech history; medical information and testing, behavioral factors), otolaryngological report and recommendations pertaining to appropriate leading to counseling and planning. Depending upon the child's past medical contacts and the nature of the concern, the appropriate specialty (Otolaryngology, Speech Pathology, and other medical specialties) may apply. See Appendix 5 for more detailed descriptions of voice characteristics and pathologies.
Considerations for Evaluating Fluency
The incidence of children under the age of three who are diagnosed as having stuttering-like disfluencies (SLDs) is difficult to determine. The incidence of preschool children (age 2 through 5) is considered to be less than 1%. With the mean age of onset being 32.76 months, a significant number of the less than 1% would be over the age of three, leaving a very small number of children under the age of three. The first step in early identification is to be able to make the differential diagnosis between normal developmental disfluencies and stuttering-like disfluencies.
Evaluators should collect a thorough child and family history to determine:
This information is critical to making sound decisions regarding eligibility.
Following a multidisciplinary evaluation, referrals may be appropriate to determine underlying or associated medical, genetic, environmental factors
Late Talkers
In young children, language skills change dramatically during the child's first three years. It is important to recognize that it is often difficult to determine the reason for or extent of a communication disorder in young children, particularly less than 24 months of age with no other apparent developmental concerns. Some children, in absence of any other developmental problems, may eventually catch up to their peers and thus may seem to "outgrow" their communication delay. (New York State Department of Heath, Early Intervention Program, Clinical Practice Guideline, Quick Reference Guide, Communication Disorders, Assessment and Intervention for Young Children)
One area of discussion among experts in the field of speech-language pathology is the extent to which speech and language intervention is necessary for young children age 18 to 36 months who have an expressive language delay but no other developmental problems. The term, "late talkers" is one of the terms that have been used to describe these children. o date, no clear predictors have been established to indicate long-term outcomes for "late talkers" (Ellis Weismer, 2000, p. 161). An important consideration is that there is a certain degree of variation in the timing of language development in typically developing children in this age range. Some experts maintain that children with milder language delays may catch up with typically developing peers by 48 months of age, especially if efforts are made to facilitate language development, such as increasing social interactions and involvement in play groups. However, experts also suggest that beginning speech and language therapy by 24 months is important for those children who have more severe delays and those who appear at increased risk for continued delays.
Several studies suggest that many children who only have an expressive language delay at 24 months (but have some words and no other apparent developmental problems) will gradually "catch up" to a functional language level that is more typical of their peers. (Fischel, et al., 1989; Paul, 1991; Paul and Alforde, 1993; Rescorla and Schwarz, 1990; Thal and Tobias, 1994) One of these studies (Rescorla and Schwartz, 1990) found that children at age 24 months who had a vocabulary of fewer than 30 words continued to have problems in the future. In contrast, in the group of children with milder delays (such as a 30-50 word vocabulary, or over 30 words but no word combinations), some continued to have problems, but a large percentage also caught up with typically developing peers at 4 to 5 years of age.
While no single known factor can reliably predict later language status even for well-defined groups of children and certainly not for a individual child, (Ellis Weismer, 2000, Thal & Katich, 1996), Olswang, et al. (1998) identified several factors noted in these studies that appeared to predict which children with language delays at 18 to 24 months would still have delays at 36 to 48 months old. These predictors of future language delay are listed in Table 2 below. Based on this evidence, Olswang (1998) has suggested using these predictors to determine which language-delayed 24 month olds are likely to attain normal language development on their own, and which children are likely to have ongoing language problems and would benefit from speech/ language intervention. The Birth to 3 Program has incorporated many of these considerations into the chart on page 21. (Adapted from Clinical Practice Guideline, Quick Reference Guide, Communication Disorders, Assessment and Intervention for Young Children, New York State Department of Heath, Early Intervention Program)
Table 2
Predictors and risk factors of language change in toddlers
PREDICTORS
SPEECH
Language Production
Language Comprehension
Phonology
Imitation
NON-SPEECH
Play
Gestures
Social Skills
RISK FACTORS
Otitis Media
Heritability
Parent Needs
Olswang, L. B., Rodriguez, B., Timler, G. (1998). Recommending Intervention for Toddlers with Specific Language Learning Difficulties: We May Not Have All the Answers, But We Know a Lot. American Journal of Speech-Language Pathology, 7
| Receptive language delay >25% | Intelligibility concerns (voice, fluency, & quality of speech sounds) | Frustration during communication | Regression in child's communication over the past three months | Oral motor concerns | Family history of language impairment | Birth or health history associated with increased risk of poor language development (1) | Communication environment is not conducive to facilitating language acquisition (2) | RECOMMENDATION: Watch and See (3) | RECOMMENDATION: Eligible |
|---|---|---|---|---|---|---|---|---|---|
| No | No | No | No | No | No | No | No | Yes | No |
| Yes | No | No | No | No | No | No | No | No | Yes |
| No | Yes | No | No | No | No | No | No | No | Yes |
| No | No | Yes | No | No | No | No | No | No | Yes |
| No | No | No | Yes | No | No | No | No | No | Yes |
| No | No | No | No | Yes | No | No | No | No | Yes |
| No | No | No | No | No | Yes | No | No | No | Yes |
| No | No | No | No | No | No | Yes | No | No | Yes |
| No | No | No | No | No | No | No | Yes | No | Yes |
2 Examples: Few conversational initiations, interactions with adults more than peers, difficulty gaining access to activities, parent interaction style more directive than responsive
3 Each of these factors would help the team in determining whether the child should be eligible for early intervention services. When the child displays a delay only in expressive language and there are no other factors present, a "watch and see" approach is recommended.
"Watch and see" means that
CHILDREN FROM HOMES IN WHICH ENGLISH IS NOT THE PRIMARY LANGUAGE
Many families are living in the United States with limited or no English skills. At the same time, there are a number of resources being developed to meet the needs of these families. Wisconsin's Birth to 3 Program respects individual differences and requires that programs communicate with families in their preferred language, to the extent possible. A child and family's proficiency in English should be considered before any evaluation is conducted. This consideration will give the clinician information regarding evaluation protocols and tests to use, and whether a monolingual clinician, bilingual clinician, or a monolingual clinician using an interpreter would be "best practice" when conducting an evaluation.
Early Identification
It is important to ask more than whether or not the parent can speak English. More appropriate inquiries should explore how often English is spoken to the child and how often the parent talks to child in the non-English language.
The evaluation team should consider the use a standardized test if a valid instrument exists in the family's language. There are few choices available. Many instruments are literal translations of English tests that have not been validated for use in other languages. The use of non-standardized assessment, interviews, and observation are generally preferred methods. Appendices six and seven cite several references and websites for evaluation tools and methods for children who are English language learners.
Since a child should be assessed in the primary or dominant language of the home [HFS 90.08(7)(d)1], the eligibility criteria are the same as for a native English-speaking child. The child would have to show a significant language delay in their primary or dominant language. Wisconsin's Birth to 3 Program does not serve children if they are only significantly delayed in their second language. Other programs may be available to enhance those skills.
When assessing bilingual children, it is important for clinicians to be cognizant of second language acquisition. Second language acquisition is similar to, although not identical to, first language acquisition and because acquisition is a developmental process, children need adequate time to acquire a second language: 1-2 years for conversational skills (grammar, basic vocabulary, pronunciation), and 5-7 years to develop the academic linguistic proficiency (literacy, problem-solving, and critical thinking skills) needed for academic success (Moore & Beatty, 1995.) The development of competence in English is a function of the level of competence previously developed in the first language (Ortiz, 1994.)
It is the responsibility of the Birth to 3 team to raise families' level of awareness about second language acquisition and bilingual issues and how they can best support their child's development. The parents should be supported for acknowledging the importance of the child's language development and then encouraged to communicate with the child in their native language, to enhance the child's intellectual, cognitive, and linguistic development (Moore & Beatty, 1995). Learning a second language is easier for children if they have a good language base in their first language. (Erickson, 1992) According to Ortiz (1994), "…the native language is the foundation upon which English competence is built."
Guidance for using an interpreter during communication evaluations
An interpreter is under the supervision of the speech pathologist at all times. An interpreter's activities should be reviewed and assigned by the clinician. The following "best practice" list should be considered when using an interpreter (Moore & Beatty, 1995):
STRATEGIES FOR CHILDREN FOUND NOT ELIGIBLE FOR THE BIRTH TO 3 PROGRAM
While evaluation and team consensus may indicate that the child is not eligible for early intervention services at this time, the child and the family may benefit from additional information. Sharing resources and strategies for facilitating speech development may be appropriate.
The following actions may be appropriate depending on the family's interests:
References
Brown, R. (1973). A first language: The early stages. Cambridge, MA, Harvard University Press.
Canady, J. Karnell, M. & Marsh, J. (1999). Cleft lip and cleft palate: The first four years. New York: The Smile Train.
Dale, P. (1991). The validity of a parent report measure of vocabulary and syntax at 24 months. Journal of Speech and Hearing Research, 34, 565-571.
Ellis Weismer, S, (2000). Language for children with developmental delay. In D. Bishop & L. Leonard (Eds.). Speech and language impairments: From theory to practice, 157-176.
Erickson, J.G. (1992). Multicultural considerations—A building blocks module. Silver Spring, MD: American Speech Language Hearing Association.
Fischel, J.E., Whitehurst, G.J., Caulfield, M.B., & De Baryshe, B.D. (1989). Language growth in children with expressive language delay. Pediatrics, 82, 218-227.
Kent, R. (1999). Motor control: Neurophysiology and functional development. In (Eds.) A. Caruso and E. Strand. Clinical Management of Motor Speech Disorders in Children. NY: Thieme Medical Publishers, Inc. (pp. 29-71).
Leddy, M., Rosin, P. & Miller, JF. Improving the speech intelligibility of young children with Down syndrome. 2-hour seminar ASHA Convention, Chicago, IL, November 13, 2003
Linder, T. (1993). Transdisciplinary Play-Based Intervention. Baltimore, MD: Paul H. Brookes
Marquardt, T. (2000). Dysarthria. In R. Gillam, T. Marquardt, & F Martin (Ed.), Communication Sciences and Disorders: From science to clinical practice. San Diego: Singular Publishing Co.
Moore, S. M., & Beatty, J. (1995). Developing cultural competence in early childhood assessment. Boulder, CO: University of Colorado at Boulder.
New York State Department of Heath, Early Intervention Program, (1999). Clinical Practice Guideline, Quick Reference Guide, Communication Disorders, Assessment and Intervention for Young Children.
Olswang, L. B., Rodriguez, B., Timler, G. (1998). Recommending Intervention for Toddlers with Specific Language Learning Difficulties: We May Not Have All the Answers, But We Know a Lot. American Journal of Speech-Language Pathology, 7 (1), 23-32
Olswang, L., Stoel-Gammon, C., Coggins, T., and Carpenter, P., (1987). Language Production Scale in "Assessing Prelinguistic and Early Linguistic Behaviors in Developmentally Young Children" Published by the University of Seattle.
Ortiz, A. (1994). Second language acquisition, assessment and instruction. Paper presented to Boulder Valley Public Schools, Boulder, CO.
Owens, R. E., Jr. (1996). Language development: An introduction. Boston: Allyn and Bacon.
Paul, R. (2001). Language disorders from infancy through adolescence: Assessment and intervention. St. Louis, MO: Mosby.
Paul, R. (1996). Clinical implications of the natural history of slow expressive language development. American Journal of Speech-Language Pathology, 5 (2), 5-21.
Paul, R., & Shiffner, M. (1991). Communicative initiations in normal and late-talking toddlers. Applied Psycholinguistics, 12(4), 419-431.
Paul, R. & Alforde, S. Grammatical Morpheme Acquisition in four year olds with normal, impaired, and late-developing language. Journal of Speech and Hearing Research 36, 1271-1275. 1993.
Ray, J. (2000). Treating phonological disorders in a multilingual child: A case study. Poster session presented at the American Speech-Language-Hearing Association convention, Washington, D.C..
Reed, V. A., (2005). An introduction to children with language disorders – Third Edition. Boston, MA: Allyn & Bacon.
Rescorla, L., & Schwartz, E. (1990). Outcome of toddlers with specific expressive language delay. Applied Psycholinguistics, 11, 393-407.
Roth, F. and Worthington, C. (1996). Treatment Resource Manual for Speech-Language Pathology. San Diego, CA: Singular Publishing Group, Inc.
Sanders, E. (1972). When are speech sounds learned? Journal of Speech and Language Disorders. 37, p.62.
Shriberg, L.D., & Kwiatowski, J. (1982). Phonological disorders II: A conceptual framework for management. Journal of Speech and Hearing Disorders, 47, 242-256.
Shriberg, L. Aram, D. & Kwiatkowski, J. (1997). Developmental apraxia of speech: I. Descriptive and theoretical perspectives. Journal of Speech & Hearing Research, 40. 273-285.
Shriberg, L. Aram, D. & Kwiatkowski, J. (1997). Developmental apraxia of speech: II. Toward a diagnostic marker. Journal of Speech & Hearing Research, 40. 286-312.
Strand , E. (1998). Treatment of Developmental Apraxia of Speech. Workshop. Madison, WI.
Thal, D. & Tobias, S. (1994). Relationships between language and gesture in normally developing and late-talking toddlers. Journal of Speech & Hearing Research, 37:157-170.
Thal, D.J., & Katich, J. (1996). Predicaments in early identification of specific language impairment: Does the early bird always catch the worm? In K.N. Cole, P.S. Dale, & D.J. Thal (Eds.), Assessment of communication and language, (pp.1-28). Baltimore, MD: Paul H. Brookes.
Vihman , M. & Greenlee, M. (1987). Individual differences in phonological development: Ages one to three years. Journal of Speech & Hearing Research, 30, 503-521.
Wetherby, A., Cain, D., Yonklas, D., & Walker, V. (1988). Analysis of intentional communication of normal children from the prelinguistic to the multiword stage. Journal of Speech and Hearing Research, 31, 240-252.
Yiari, E. & Ambrose, N.G. (2005). Early childhood stuttering for clinicians by clinicians. Austin, TX: Pro-Ed
Appendix 1
A Summary of Expressive Speech and Language Development For Typically Developing Children Birth to 18 months
Newborn:
One Month:
Two Months:
Three Months:
Four Months:
Five Months:
Eight Months:
Nine Months:
Ten Months:
Eleven Months:
Twelve to Fourteen Months:
Fifteen to Eighteen Months:
Based on Owens, R. J, (1996) and Paul, R (2001)
Stages of Normal Noncry Vocal Development in Infants/Toddlers
Evaluation Tools and Methods
| Tool | Use | Author | Publisher |
|---|---|---|---|
| Assessing Linguistic Behaviors (ALB): Assessing Prelinguistic and Early Linguistic Behaviors in Developmentally Young Children | Observational and Structured scales; assessment of cognitive antecedents, play, communicative intention, language production and comprehension | L. Olswang, C. Stoel-Gammon, T. Coggins and L. Carpenter | University of Washington Press, Seattle. Out of Print, 1987 |
| The Clinical Assessment of Language Comprehension (CALC) | Auditory comprehension of syntax, comprehension and vocabulary, standardized and yields percentile score. Normed | J.R. Miller, J. Gidden, and J. Stark | Riverside Publishing Company, 1983. |
| Communication and Symbolic Behavior Scale (CSBS) | Contains Infant-Toddler Checklist, caregiver Questionnaire and Behavior Sample. | Amy M. Wetherby & Barry M. Prizant, | Paul H. Brookes Publishing Company, New York, 1993. |
| Ages and Stages Questionnaire (ASQ) | Screener. A parent-completed, norm-referenced child-monitoring system. | Diane Bricker | Paul H. Brookes Publishing Company, New York, 1993. |
| Early Language Milestone Scale (ELM) Screener. Normed. Yields percentiles | James Coplan | SuperDuper Publications, Greenville, South Carolina, 19--. | |
| Mac Arthur Communicative Developmental Inventory | Screener. Parent-report instruments used to determine child's comprehension and production vocabularies for using words and gesture and production vocabulary for word combinations; from first non-verbal gestural signals through expansion of early vocabulary to grammar. | Fenson, Dale, Resnic, Thal, Bates, Harung, Pethick, & Reilly, | Singular Publishing. 1993 |
| Pre-School Language Scale–4 (PLS–4) | English, Spanish: evaluation of young child's receptive and expressive language: birth to 6.11, contains expanded coverage of language skills and new norms between 0–2.11. Normed | Irla Lee Zimmerman, Violette G Steiner. & Roberta Evattt Pond | Psychological Corporation, 2002 |
| Receptive-Expressive Emergent Language Scale – Third Edition (REEL-3) | Assess language development birth to 36 months. Parent Interview. Expressive and language ages | Kenneth Bzoch. Richard League, & Virginia Brown, | Pro-Ed, 2003 |
| Reynell Developmental Language Scales Qualitative and quantitative assessment of expressive and verbal comprehension in children 1–7 years; designed for those thought to show some language deficit, suitable for hearing impaired children. Normed. | Joan K. Reynell & Christian P.Gruber. | Slosson Educational Publications, Inc., 1990. | |
| Rossetti Infant-Toddler Language Scale | Informal Communication and Interaction measure: Interaction Attachment, Pragmatics, gesture, language Comprehension and Language Expression yielding age ranges. Criterion referenced | Louis Rossetti | LinguiSystems, Inc., 2005 |
| Sequenced Inventory of Communication Development Revised (SICD-R) | Receptive and Expressive Scales. Four to 48 months. Normed. Spanish translation available. | Donna Lee Hendrick,, Elizabeth Prather, and Annette, Tobin | Pro-Ed, 1984 |
| Test of Early Language Development – Third Edition | A standardized measure of receptive and expressive language Ages: 2-0 through 7-11 Administration Time: 20 minutes | W. Hresko. K. Reid, & Donald Hammill | AGS, 1999 |
| Clinical Assessment of Language Comprehension | A series of non-standardized tasks to assess young children's receptive language | Jon F. Miller & Rhea | Paul Brookes, 1995 |
| Goldman-Fristoe Test of Articulation- Second Edition | GFTA-2 is a systematic means of assessing an individual's articulation of the consonant sounds of Standard American English. It provides a wide range of information by sampling both spontaneous and imitative sound production, including single words and conversational speech. | Ronald Goldman & Macalyne Fristoe | AGS, 2000 |
References for Evaluation Tools and Methods
Evaluation Tools and Methods
Bzoch, K., & League, R. (1991). The Receptive-Expressive Emergent Language Scale. Gainesville, FL: Language Education Division, Computer Management Corporation.
Goldman, R., & Fristoe, M. (2000). The Goldman-Fristoe Test of Articulation—Second Edition. Circle Pines, MN: AGS Publishing
Hedrick, D., Prather, E., & Tobin, A. (1995). Sequenced Inventory of Communication Development-Revised. Austin, TX: Pro-Ed.
Hresko, W., Reid, K., & Hammill, D. (1991). Test of Early Language Development. (Third edition). Austin, TX: Pro-Ed.
Linder, T. (1993). Transdisciplinary Play-Based Intervention. Baltimore, MD: Paul H. Brookes Publishers.
Miller, J.F. (1981). Assigning a Structural Stage Procedure: Appendix B in Assessing Language Production in Children: experimental procedures. Baltimore: University Park Press.
Miller J. F. and Paul, R., (1995). The Clinical Assessment of Language Comprehension, Paul H. Brookes Publishing Co., Baltimore. Zimmerman, I., Steiner, V., & Pond, R. (2002). Preschool Language Scale-4. San Antonio, TX: Psychological Corporation.
Language sampling
Crais, E. R. & Roberts, J.E. (1991). Decision Making in Assessment and Early Intervention Planning, Language, Speech and Hearing in the Schools, 22, 19-30
Leadholm, B. & Miller, J. F. (1995) Language Sample Analysis: The Wisconsin Guide Madison, WI: Department of Public Instruction
Miller, J.F. (1981). Assigning a Structural Stage Procedure: Appendix B in Assessing Language Production in Children: experimental procedures. Baltimore: University Park Press.
Rescorla, R., (1991). Identifying Expressive Language Delay at Age Two, Topics in Language Disorders, 11(4), 14-20.
Rescorla, R., (1989) The Language Development Survey: a Screening tool for delayed language in Infants and Toddlers, Journal of Speech and Hearing Disorders, 54, 587-599.
Production
Miller, J. & Leadholm, B., (1992). Language sample analysis guide: The Wisconsin Guide for the identification and description of language impairment in children. Madison: Wisconsin DPI.
Pragmatics
Linder, T. (1993). Transdisciplinary Play-Based Intervention. Baltimore, MD: Paul H. Brookes
McLaughlin, S. (1998). Introduction to Language Development. San Diego, CA: Singular Publishing Group, Inc.
Whitehurst, J., Fischel, J., Lonagin, C., Valdez-Menchaca M. Arnold, D., Smith M., (1991). Treatment of early expressive language delay: If, when and how, Topics in Language Disorders, 11, (4) 55-68.
Comprehension
Miller, J. & Paul, R. (1995). The Clinical Assessment of Language Comprehension. Baltimore, MD: Paul H. Brookes
Language Production Scale
From "Assessing Prelinguistic and Early Linguistic Behaviors in Developmentally Young Children" by Olswang, L., Stoel-Gammon, C., Coggins, T., and Carpenter, P., 1987.
VOICE
The speech component of the young child's communication evaluation should address voice production (elements such as phonation [the ability to produce voice], pitch, loudness, quality and prosody). Voice and resonance disorders are commonly seen in the pediatric population, which receives speech-language pathology services. (Johnson and Jacobson, 1998) In the general population, estimates for the incidence of voice and resonance problems in children range from 6 to 9 percent. Voice disorders have a variety of causes; voice disorders in children can be organic (physical) and either congenital or acquired.
Producing Voice
Phonation is the production of sound via a vibrating mechanism (the vocal folds) and shaping of the oral cavity by placing of the articulators (lips, tongue). Phonation attempts typically result in adequate voicing and duration for speech. When problems in resonance are noted, the quality of phonation should be assessed.
Perceptual Characteristics
Perceptual characteristics of the voice involve and are influenced by airflow, the loudness that is achieved, vocal fold mechanics and phonation. When vocal fold mechanics are involved, the following may be perceived: hoarseness, breathiness, glottal fry or hard glottal attacks, diplophonia, and inappropriate loudness, whispered speech (aphonia-lack of vocal fold vibration) or dysphonia (abnormal vocal quality in the absence of a vocal fold pathology).
Vocal Pathology Conditions
A variety of vocal pathologies can occur in children. Usually vocal pathologies are perceived by abnormalities in the quality or efficiency of the voice during speech. Examples include: roughness, strain, nasality, unusual prosody (rhythm, inflection, pacing), effort in speaking, breathiness, abnormal duration (maintaining sound). Vocal fold nodules can occur due to misuse of the voice.
When nodules are present, pitch or loudness may be affected and typically both vocal folds are usually affected.
When airway obstruction is the problem, there may also be a condition of the larynx such as a laryngeal web, hemangioma, subglottic stenosis or bilateral vocal fold paralysis.
Resonance Characteristics
Hypernasality is typically perceived as too much resonance in the nasal cavity during speech. This difference in voice quality is a result of velopharyngeal incompetence (VPI) of the soft palate, but can also occur through a large fistula (opening) in the palate resulting in inappropriate nasal sound during speech. Hypernasal voice may also increase in connected speech due to the additional demands it places on the velopharyngeal mechanism.
Other forms of resonance abnormality include hyponasality and denasal speech. A reduction in nasal resonance during speech occurs as a result of blockage in the nasopharnx or entry to the nasal cavity, called "cul-de-sac resonance". Muffled speech can occur in a child with very large tonsils and adenoid hypertrophy with mixed resonance (i.e., when both hypernasal and hyponasal speech are produced), indicating velopharyngeal incompetence and significant nasal air blockage.
Other Conditions
References
Boone, D.R. and Mc Farlane, S.C., (1988). The Voice and Voice Therapy, Englewood Cliffs, N.J.: Prentice-Hall, 1988
Johnson, A. and Jacobson, B.H. (Eds) (1988).Medical Speech-Language pathology: a practitioner's guide. Alex F.., NY: Thieme.
Tomlin, J.B., Morris, H.L., & Spriesterbach, D.C. (2000). Diagnosis in Speech-Language Pathology, San Diego, Singular.
Additional References
American Speech-Language-Hearing Association. (1981). Guidelines for the employment and utilization of supportive personnel. ASHA, 23(3), 165-169.
American Speech-Language-Hearing Association, Committee on Supportive Personnel. (1988). Utilization and employment of speech-language pathology supportive personnel with underserved populations. ASHA, 30 (11), 55-56.
American Speech-Language-Hearing Association, Committee on the Status of Racial Minorities. (1985). Clinical management of communicatively handicapped minority language population. ASHA, 27(6), 29-32.
Anderson, N.B. (1992). Understanding cultural diversity. American Journal of Speech Language Pathology, 1 (2): 11-12.
Culturally and Linguistically Appropriate Services, University of Illinois at Urbana-Champaign, Champaign, IL http://clas.uiuc.edu/
Curlee, R. (1993). Stuttering and related disorders of fluency. New York: Thieme.
Curlee, R., & Yairi, E., (1997). Early intervention with early childhood stuttering: A critical examination of the data. American Journal of Speech –Language Pathology, 6, 8-18.
Deal, V.R., & Rodriquez, V.L. (1987). Resource guide to multicultural tests and materials in communicative disorders. Rockville, MD: American Speech-Language-Hearing Association.
Fenson, L., Dale, P.S., Reznick, J.S., Thal, D., Bates, E., Hartung, J.P., Pethick, S., & Reilly, J.S. (1993). Mac Arthur Communicative Development Inventories. San Diego, CA: Singular Publishing Group, Inc.
Grunwell, P. (1982). The development of phonology: A descriptive profile. First Language, 3, 161- 191.
Hamayan, E.V., & Damico, J.S. (Eds.) (1991). Limiting bias in the assessment of bilingual students. Austin: Pro Ed.
Hart, B., & Risley, T.R. (1995). Meaningful differences in the everyday experience of young American children. Baltimore, MD: Paul H. Brookes.
Johnson, J.M., Watkins, R.V., & Rice, M.L. (1992). Bimodal bilingual language development in a hearing child of deaf parents. Applied Psycholinguistics, 13, 31-52.
Jones, M.L., & Quigley, S.P., (1979). The acquisition of question formation in spoken English and American Sign Language by two hearing children of deaf parents. Journal of Speech and Hearing Disorders, 44, 196-208.
Kayser, H. (1993). Hispanic cultures. In D.E. Battle (Ed.), Communication disorders in multicultural populations, (pp. 114-152). Boston: Andover Medical Publishers.
Kayser, H. (Ed.). (1995). Bilingual speech-language pathology: An Hispanic focus. San Diego: Singular Publishing Group, Inc.
Kelly, D., (1998). A clinical synthesis of the "Late Talker" literature: Implications for service delivery. Language, Speech, and Hearing Services in the Schools, 29, 76-84.
Kwiatowski, J., & Shriberg, L. D. (1992). Intelligibility Assessment in developmental phonological disorders: Accuracy of caregiver gloss. Journal of Speech and Hearing Research, 35, 1095-1104.
Langdon, H.W. (1988, June). Working with an interpreter/translator in the school setting. Presentation at State Conference for School Superintendents. Dimensions of appropriate assessment for minority handicapped students: Recommended practices. Tucson, AZ: University of Arizona.
Langdon, H.W. (1992a). Interpreter/translator process in the educational setting: A resource manual. Sacramento, CA: Resources in Special Education.
Lowe, R.J. (1994). Phonology: Assessment and intervention applications in speech pathology. Baltimore, MD: Williams and Wilkins.
Mallory, B.L., Zingle, H.W., & Schein, J.D., (1993). Intergenerational communication modes in deaf-parented families. Sign Language Studies, 78, 73-92.
Matsuda, M., & O'Connor, L.C. (1993). Creating an effective partnership: Training bilingual communication aides. Presentation at the annual convention of the California Speech, Language and Hearing Association, Palm Springs, CA.
Mayberry, R., (1976). An assessment of some oral and manual-language skills of hearing children of deaf parents. American Annuals of the Deaf, 121, 507-512.
McCathren, R., Warren, S. & Yoder, P. (1996). Prelinguistic predictors of later language development. In K. Cole, P. Dale, & D. Thal (Eds.). Assessment of communication and language. Baltimore, MD: Paul H. Brookes.
Medina, V. (1982). Interpretation and translation in bilingual B.A.S.E., San Diego CA: Superintendent of Schools, Department of Education, San Diego County.
Monahan, D. (1986). Remediation of common phonological processes. Austin, TX: Pro Ed.
Nippold, M.A., & Schwartz, I.E. (1996). Children with slow expressive language development: What is the forecast for school achievement? American Journal of Speech- Language Pathology, 5 (2), 22-25.
Nippold, M.A., & Schwartz, I.E. (1996b). Slow expressive language development: A call for more data. American Journal of Speech-Language Pathology, 5 (2), 29-30.
Omark, D.R., & Watson, D.L. (1981). Assessing bilingual exceptional children: In-service manual. San Diego, CA: Los Amigos Research Associates.
Ortiz, A., & Wilkinson, C. (1990). AIM for the best: Assessment and intervention model for the bilingual exceptional student. Austin, Texas: University of Texas at Austin.
Paul, R. (1997). Understanding language delay: A response to van Kleeck, Gillam, and Davis. American Journal of Speech-Language Pathology, 6 (2), 40-49.
Paul, R., & Shriberg, L.D. (1982). Associations between phonology and syntax in speech delayed children. Journal of Speech and Hearing Research, 25, 536-547.
Paul, R., Hernandez, R., Taylor, L. Johnson, K. (1996). Narrative development in late talkers: Early school years. Journal of Speech, Language, and Hearing Research, 39, 1295-1303.
Rescorla, L., Roberts, J. & Dahlsgaard, K. (1997). Late talkers at 2: Outcome at age 3. Journal of Speech, Language, and Hearing Research, 40, 556-566.
Roth, Froma P. & Worthington, (2005) Treatment Resource Manual for Speech-Language Pathology (Third Edition), Thomson Delmar Learning
Ruscello, D.M., St. Louis, K.O., & Mason, N. (1991). School-aged children with phonologic disorders: Coexistence with other speech/language disorders. Journal of Speech and Hearing Research, 344, 236-242.
Schiff-Myers, N.B., (1982). Sign and oral language development of preschool hearing children of deaf parents in comparison with their mothers' communication system. American Annals of the Deaf. 127, 322-32.
Stoel-Gammon, C. (1991). Normal and disordered phonology in two-year-olds. Topics in Language Disorders,11, (4), 21-32.
Schwartz, R.G., Leonard, L., Folger, M., & Wilcox, M. (1980). Evidence for a synergistic view of language disorders: Early phonological behavior in normal and language disordered children. Journal of Speech and Hearing Disorders, 45, 357-377.
Van Kleeck, A., Gillam, R.B., & Davis, B. (1997). When is "watch and see" warranted? A response to Paul's 1996 article, "Clinical implications of the natural history of slow expressive language development." American Journal of Speech-Language Pathology, 6 (2), 34-39.
Watson, M., Jayaram Murthy, S, Wadhwa, N. (2003). Phonological Analysis Practice, Eau Claire, WI: Thinking Publications
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Whitehurst, G. Lonigen, C., Valdez-Menchaca, M., Arnold, D. Smith, R, (1991). Treatment of early expressive language delay: If, when, and how. Topics in Language Disorders, 11 (4), 55-68.
Whitehurst, G.J., & Fischel, J.E. (1994). Practitioner review: Early developmental language delay: What, if anything, should the clinician do about it? Journal of Child Psychology and Psychiatry, 35, 613-648.
Winitz, H. (1975). From syllable to conversation. Baltimore, MD: University Park Press.
Yairi, E., & Ambrose, N. (1992). A longitudinal study of stuttering in children: A preliminary report. Journal of Speech and Hearing Research, 35, 755-760.
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Websites
Communication and Communication Evaluation
ASHA http://www.asha.org/default.htm
Tests found at http://www.linguisystems.com/age.php?age=1
(Linguisystems): Differential Assessment of Autism and Other Developmental Disorders
(Richard and Calvert) (age 2-8)
• Found at: http://www.linguisystems.com/age.php?age=1
EOWPVT Expressive
One-Word Picture Vocabulary Test, 2000 Edition (age 2-18)
• Publisher: Academic Therapy Publications = http://www.academictherapy.com/
GFTA-2 Goldman-Fristoe
Test of Articulation-2 (age 2-21)
• Publisher: American Guidance Service AGS = http://www.agsnet.com/
KLPA-2 Kahn-Lewis Phonological Analysis – Second Edition (age 2-21) • Publisher: The Riverside Publishing Company = http://www.riverpub.com/
REEL-3 Receptive-Expressive Emergent Language Test – Third Edition (Bzoch, League) (age B-3) • Publisher: Pro-Ed = http://www.proedinc.com/
The Rossetti Infant-Toddler Language Scale (Rossetti) (age B-3) • Publisher: Linguisystems = http://www.linguisystems.com/age.php?age=1
ROWPVT Receptive One-Word Picture Vocabulary Test, 2000 Edition (Academic Therapy Publications) (age 2-18) • Publisher: Academic Therapy Publications = http://www.academictherapy.com/
TELD-3 Test of Early Language Development (Hresko, Reid, Hammill) (age 2-7) • Publisher: Pro-Ed = http://www.proedinc.com/
PLS-4 Preschool Language Scale-4th Edition (B-6:11) • Publisher: A Harcourt Assessment Company http://www.harcourt.com/bu_info/harcourt_assessment.html
MICS (Raack) • Publisher: (?) Community Therapy Services = http://clas.uiuc.edu/special/evaltools/cl01610.html
Including ELL (English Language Learners) parents in their child's education:
http://www.gse.harvard.edu/hfrp/projects/fine/resources/digest/parents.html
http://www-tcall.tamu.edu/newsletr/jun98/jun98e.htm
Assessment of ELL children includes:
http://www.cal.org/resources/faqs/rgos/special.html
Involving Immigrant Parents of Students with Disabilities in the Educational Process (Includes assessment)
http://journals.cec.sped.org/EC/Archive_Articles/VOL.34NO.5MAYJUNE2002_TEC_Article-9.pdf
http://www.ncela.gwu.edu/enews/outlook/2002/08.htm
Evaluation and Instructional Services for ESL Program/Special Education Students
http://www.slc.sevier.org/esleval.htm
Educating Students With Limited English Proficiency (LEP) and English Language Learners (ELL)
http://www.pde.state.pa.us/k12/cwp/view.asp?A=11&Q=45272&eslNav=%7C4974%7C
Bilingual Special Education
http://www.teachervision.fen.com/page/6048.html
Learning Disability or Language Development Issue?
http://www.everythingesl.net/inservices/special_education.php
Sites for Spanish Speaking Families
Bebe Web - La Pagina del Bebe http://almez.pntic.mec.es/~lperez18/
Cyber Padres - Informacion de todo para Padres http://www.cyberpadres.com/
El Primer ano Del Bebe http://www.uwex.edu/ces/flp/parenting/spanish.html
Huggies in Mexico http://www.huggies.com.mx/
Mi Pediatra http://www.mipediatra.com/
Reading Rockets http://www.colorincolorado.org/
U.S. Department of Education - Resources en Espańol http://www.ed.gov/espanol/bienvenidos/es/index.html
The Education Trust http://www2.edtrust.org/edtrust/spanish
SchwabLearning http://www.schwablearning.org/espanol/index.asp