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Test Review of CELF-5 Metalinguistics: What SLPs Need to Know

In mid-2014, I purchased the Clinical Evaluation of Language Fundamentals®, Fifth Edition Metalinguistics (CELF®-5 Metalinguistics), which is a revision of the Test of Language Competence–Expanded.

Basic overview

Release date: 2014
Age Range: 9-21
Author: Elizabeth Wiig and Wayne Secord
Publisher: Pearson

Description: According to the manual CELF–5M was created to “identify students 9-21 years old who have not acquired the expected levels of communicative competence and metalinguistic ability for their age” (pg. 1).  In other words the test targets higher level language skills beyond the basic vocabulary and grammar knowledge and use.  The authors recommend using this test with students with “subtle language disorders” or “those on the autism spectrum”.

The test contains 5 subtests:

The Metalinguistics Profile subtest of the CELF-5:M is a questionnaire (filled out by caregiver or teacher) which targets three areas: Words, Concepts, and Multiple Meanings; Inferences and Predictions; as well as Conversational Knowledge and Use.  Its aim is to obtain information about a student’s metalinguistic skills in everyday educational and social contexts to complement the evidence of metalinguistic strengths and weaknesses identified by the other subtests that comprise the CELF-5:M test battery.

Questions address such topics as the child’s comprehension of idioms and abstract language, their predicting and inferencing abilities, their ability to deal with unpleasant situations, participate in group discussions, as well as understand jokes and sarcasm, just to name a few.  A maximum of four points  can be obtained on each of it 30 questions.  The following is the rating criteria:   a score of one  is obtained  when a child ‘never’ does something in a particular category (e.g., doesn’t get the punchline of jokes).  A score  of two  is given when a child is capable of  understanding or using  something ‘some of the time’. A score of three  is given when a child is able to understand or perform something ‘often’. Finally, a score of  four is given when a child is capable of comprehending something ‘always’ or ‘almost always’.

A word of caution,  when giving this profile  to either teachers or parents to fill out,  the SLP must ensure  that no overinflation or underestimation of scores takes place.  Frequently,  some parents may not have a clear understanding  of the extent of their child’s level of deficits.    Similarly, some teachers,  especially those who may not know the child very well,  or those who have worked with a child  for a very short period of time,  may overinflate the scores  when filling out the questionnaire.   However, the opposite may also occur.    A small group of  parents may  underestimate their children’s  abilities,   and provide poor scores   as a result  also not providing an objective picture  of the child’s level of deficits.  In such situations,  the best option may be for the SLP  to fill out the questionnaire   together  with the  parent  or teacher  in order to  provide explanations  of questions in a different categories.

The Making Inferences subtest of the CELF-5:M evaluates the student’s ability to identify and formulate logical inferences on the basis of existing causal relationships presented in short narrative texts. The student is visually and auditorily presented with a particular situation by the examiner. S/he is then asked to identify the best two out of four written answers for the ending and come up with her own additional reason other than the ones listed in the stimulus book.

On the multiple choice portion of the subtest errors can result due to provision of contradictory, unrelated and irrelevant responses. On the open ended questions portion of the subtest errors can result due to vague, confusing, incomplete, unlikely or illogical responses as well as due to contradictory and off topic answers.

 I must say that this is my least favorite subtest.   Here’s why.  In real life students are not provided with multiple choices  when asked to make  predictions or inferences.   That is why  I do not believe that performance on this subtest  is a true representation of the child’s ability in this area.

The Conversational Skills subtest of the CELF-5:M evaluates the student’s ability to initiate a conversation or respond in a way that is relevant and pragmatically appropriate to the context and audience while incorporating given words in semantically and syntactically correct sentences. S/he are presented with a picture scene that creates a conversational context and two or three words which are also printed above the pictured scene. S/he are then asked to formulate a conversationally and pragmatically appropriate sentence for the given context using all of the target words in the form (tense, number, etc.) provided.

Errors on this subtest can result due to pragmatic, semantic or syntactic errors. With respect to pragmatics errors can result due to illogical, nonsensical, vague or incomplete sentences as well as due to sentence formulation which does not take into account presented scenes. With respect to semantics errors can result due to missing or misused target words as well as due to vague, incorrect or misused verbiage. With respect to syntax errors can result due to use of sentence fragments, morphological misuse of target words (changing word forms) as well as syntact deviations on non-target words.

The Multiple Meanings subtest of the CELF-5:M evaluates the student’s ability to recognize and interpret different meanings of selected lexical (word level) and structural (sentence level) ambiguities. S/he are presented a sentence (orally and in text) that contained an ambiguity at either the word or sentence level. S/he are then asked to describe two meanings for each presented sentence.

Errors can result due to difficulty interpreting lexical and structural ambiguities as well as due to an inability to provide more than one interpretation to presented multiple meaning words.

The Figurative Language subtest of the CELF-5:M evaluates the student’s ability to interpret figurative expressions (idioms) within a given context and match each expression with another figurative expression of similar meaning given verbal and written support.

Errors on this subtest can result due to difficulty explaining the meanings of idiomatic expressions, as well as due to difficulty selecting the appropriate meaning from visually provided multiple choice answers containing related idiomatic expressions.

Based on testing the following long-term goal can be generated:

LTG: Student will improve his/her metalinguistic abilities (thinking about language) for academic and social purposes

It can also yield the following short-term goals

  1. Student will improve ability to make social inferences with an without written support
  2. Student will improve ability to to make social predictions with and without written support
  3. Student will produce (choose one/all: syntactically, semantically, pragmatically) appropriate compound and complex sentences with and without visual support
  4. Student will improve ability to explain context embedded multiple meaning words
  5. Student will improve ability to explain ambiguously worded language
  6. Student will improve ability to explain figurative language and idiomatic expressions

A word of caution regarding testing eligibility: 

What I am concerned about: 

  • It is rather costly with a sticker price of $376, which is far above other tests assessing similar abilities on the market.
  • Test administration begins at 9 years of age. However, metalinguistic abilities develop in children much earlier than nine years of age. Children and young as 6 years of age can present with glaring metalinguistic deficits but unless the examiner has access to another testing which could assess the children’s metalinguistic abilities we have to wait until the child is nine and is clearly behind his or her peers in their metalinguistic development in order to confirm the presence of deficits.
  • I also don’t understand the presence of visual and written stimuli on select testing subtests. Children are not provided with multiple-choice answers or written support in daily social and academic situations. As a result of the presence of these aids score overinflation may occur with those children who do well given compensatory strategies but who have difficulty generating novel spontaneous responses.
  • Similarly, I am concerned that higher functioning yet socially clueless students may be administered this test because the examiners may believe that it would accurately assess their higher functioning social pragmatic language abilities. However many higher functioning students will pass this test with flying colors, which is why I urge considerable caution when selecting student population for testing administration
    • Very Important: See the sensitivity and specificity details of CELF-5M above. 

Consequently the CELF-5: M administration is not for everyone. As mentioned before I would only administer portions of this test to higher functioning  (but not too high functioning) students undergoing language assessment for the first time or to higher functioning students receiving a re-evaluation, who have previously passed the Clinical Evaluation of Language Fundamentals-5 with ease. This test would not be appropriate for Severely Challenged and Challenged Social Communicators (see Winner, 2015)

I would also not administer this test to the following populations:

  • Students with intellectual disabilities
  • Students with severe language impairment and limited vocabulary inventories
  • English Language Learners (ELL) with suspected language deficits 
  • Students from low SES backgrounds*

I would not administer the CELF-5:M to the latter two groups of students due to significantly increased potential for linguistic and cultural bias stemming from lack of previous knowledge and exposure to popular culture as well as idiomatic expressions.

I would also not administer this test to Nuance Challenged Social Communicators (Winner, 2015). Specifically to Socially Anxious and Weak Interactive Social Communicators (Winner, 2015). These are the students with average or above average verbal language abilities most of whom did not have language delays when they were young. They have a ‘well-developed social radar’ and they’re highly aware of other people feelings and thoughts. However they have difficulties navigating subtle social cues of others. As a result this particular group of students tends to score quite on metalinguistic and social pragmatic testing of reduced complexity yet still present with pervasive social pragmatic language deficits.

Consequently, Clinical Assessment of Pragmatics (CAPs) administration would better suit their needs.

What I do like about this test:

This test allows me to identify more subtle language-based difficulties in verbal children with average to high average intelligence (or Emerging Social Communicators as per Winner, 2015) who present with metalinguistic and social pragmatic language weaknesses in the following areas:

  • Social predicting and inferencing
  • Conversational rules and breakdown repairs
  • Knowledge of high-level and abstract vocabulary words
  • Identification and usage of ambiguous and figurative language
  • Coherent and cohesive discourse and narrative formulation
  • Knowledge and use of multiple meaning words in a variety of conversational and text-embedded contexts

Overall, this is an nice test to have in your assessment toolkit. Consequently,if SLPs exercise caution in test candidate selection they can obtain very useful information for metalinguistic and social pragmatic language treatment goal purposes.

NEW: Need a CELF-5M Template Report? Find it HERE

3-1-19 Update: Since this review was written in October 2014, I have reviewed other tests, including the Clinical Assessment of Pragmatics (CAPs), which can be substituted and effectively used to delve into metalinguistic abilities of students with social communication difficulties. As such, while I still use the Multiple Meanings  and the Figurative Language subtests of the CELF-5M rather frequently due to its suitability for a select number of students that I assess, given its described limitations,  I would approach its purchase with caution, if it were the only test to be owned by the therapist for the purpose of assessment (it’s perfectly suitable as part of a battery but not as a standalone and only option).

Helpful Resources Related to Social Pragmatic Language Overview, Assessment  and Remediation:

 Disclaimer: The views expressed in this post are the personal opinion of the author. The author is not affiliated with Pearson in any way and was not provided by them with any complimentary products or compensation for the review of this product. 

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What are They Trying To Say? Interpreting Music Lyrics for Figurative Language Acquisition Purposes

Image result for music lyricsIn my last post, I described how I use obscurely worded newspaper headlines to improve my students’ interpretation of ambiguous and figurative language.  Today, I wanted to further delve into this topic by describing the utility of interpreting music lyrics for language therapy purposes. I really like using music lyrics for language treatment purposes. Not only do my students and I get to listen to really cool music, but we also get an opportunity to define a variety of literary devices (e.g., hyperboles, similes, metaphors, etc.) as well as identify them and interpret their meaning in music lyrics. Continue reading What are They Trying To Say? Interpreting Music Lyrics for Figurative Language Acquisition Purposes

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Dinner with Friends or the Value of Interdisciplinary Collaboration and Follow Up

Several months ago I had dinner with two of my colleagues, a pediatrician and a clinical social worker, to iron out the details of our upcoming conference presentation. As time went by we managed to discuss every topic under the sun, yet still the subject of our presentation was sadly not on the agenda. Exhausted from working at the hospital a full day and seeing private clients afterwards, I was getting distinctly antsy as the hand clock kept climbing closer to midnight.

The conversation began to feel more productive when we started to touch base on our mutual clients.   Mostly they wanted to hear from me, since they both share an office suite and I was the only one located off-site. So, even though we all individually frequently conferred via phone regarding clients, that was the first time all three of us got together in the same room to discuss them. Quickly, I rattled off each of my clients’ progress in therapy, until I got to D, and paused.  Oh, don’t get me wrong I am very proud of my work with D, whom I’ve been working with for several years, and who went from being limitedly verbal, severely echolalic, and “autistic like” at the age of 4-5 to fluent complex sentence speaker, fledgling problem solver, and a little charmer by the age of 6-5. Yet something was still bothering me regarding D’s performance that I couldn’t put my finger on. Despite the absence of a particular diagnosis (e.g., ASD) and significant gains, his issues with attention and cognition persisted, and his progress was still halting and inconsistent, even with rigorous language therapy and supplementary academic instruction at home 4 times a week.

In my desperation I have already considered and mentally rejected a number of referrals (“No it doesn’t seem to be a psychiatric issue”, “Yes he can benefit from a neurological but should I refer him to a psychological assessment first, could it be an IQ issue?” I pondered out loud as I shared my concerns with my colleagues.  Both of them haven’t seen him for about 6 months so the clinical social worker immediately whipped out his chart busily looking for appropriate information, while the pediatrician started to frown, searching her memory for an “appropriate entry.”  “Wait a second”, she said, “when I last saw him, during his physical exam I saw brown café au lait spots on his skin that I didn’t like at all, so I referred mom to get some blood work done but I haven’t heard from her since that time. Since you see her every week, can you please ask her to call me ASAP so I could remind her to do the blood test, as the information you are telling me makes it even more imperative that she follow up with the lab work.”

Right away, I became alert.  Though the pediatrician was not stating her suspicious explicitly, through years of working with medical professionals I was familiar with the implications of what café au lait spots can potentially represent and that is neurofibromatosis. It is a neurocutaneous syndrome that leads to benign tumor growths in various parts of the body and can affect the brain, spinal cord, nerves, skin, and other body systems.  In additional to all the medical implications of this syndrome (e.g., tumors becoming cancerous), it can also cause cognitive deficits and subsequent learning disabilities that affect appropriate knowledge acquisition and retention.

To me the situation was clear, no matter what the outcome, as the only team professional in contact with the parent at the time, it was my job to counsel the parent that she get in touch with the pediatrician so she can successfully pursue the recommended course of action.  It may not have been the position I wanted to be in but unfortunately I knew that if this matter was left unpursued, I was left with a whole host of unanswered questions regarding further treatment options for this child.

I use the above example to emphasize the value and importance of working as part of a team to treat the “whole” child.  Therapists specializing in working with children on the spectrum are most familiar with being part of a team, since they are just one of many professionals such as behaviorists, OT’s, psychologists or neurologists who are working with a child.  Being part of a team is also a much more acceptable practice when a child is treated in a hospital or a rehab setting and presents with a complex disorder (e.g., is medically fragile, has a genetic syndrome, etc).

However, in our field, even outside of specialty settings (hospital/rehab) we are frequently confronted with speech or language disordered clients who stump our thinking processes, and who require the team approach (including the involvement of specialized medical professionals).  Yet oftentimes that creates a significant challenge for many clinicians who are working contractually (through an agency) in school settings or in private practice.  Being part of a team when one is contractor or a sole practitioner in a private practice is a much more difficult feat, especially when the clinicians are just striking out on their own for the first time.

Both interdisciplinary and multidisciplinary teamwork is oftentimes so crucial in our field. Working as part of a team allows us to collectively pursue common goals, combine our selective expertise, initiate a discussion to solve difficult problems, as well as to have professional lifelines when working on difficult cases.   Different providers (neurologist, SLP, OT) see different symptoms as well as different aspects of the patient’s disorder. Consequently, different providers bring different perspectives to the table, which ultimately positively contributes to the treatment of the whole child.

Interestingly, many private speech language practitioners have wide referral networks (e.g., pediatricians, OT’s, PT’s and others who refer clients to them) yet when asked regarding frequency of contact with respect to conferences/discussions about the progress of specific clients, many clinicians draw a blank.

So how can we develop productive professional relationships with other service providers which go beyond the initial referral? I’ll be the first one to admit that it is not an easy accomplishment especially which it comes to physicians such as psychiatrists, neurologists, geneticists, or developmental pediatricians.  I can tell you that while some of my professional relationships came easy, others took years to attain and refine.

In my hospital setting I work as part of a team. However, when I first started out in private practice, in a fairly short period of time I ended up having a number of clients with complex diagnoses and no one to refer them to.  What complicated matters further that in contrast to them being referred to me by a pediatrician, these clients came to me first, since their most “visible issues” at the time were speech language deficits. I had to be the one to initiate the referral process to suggest to their parents relevant medical professionals, which needed to be visited in order to figure out why their children were having such complex language difficulties (among other symptoms) in the first place.

So here are a few suggestions on how to initiate and maintain professional relationships with medical service providers.

Start with doing a little research.  You have worked hard to build your practice and your clients deserve the best, so locate the best medical service providers in your area. In the past I’ve had some excellent recommendations from locally based colleagues who were active on the ASHA discussion forums, other client’s parents who already did the necessary legwork, or hospital based colleagues who recommended peers in private practice. Several times I actually liked the initial medical reports I’ve received on a client so much – that I’ve referred other clients to the same doctor.

When word of mouth fails to do the trick, I turn to “Google” to provide me with desired results.  Surprisingly, simply typing in “best _______in _____(name of state)” frequently does the trick and allows me to locate relevant professionals, after browsing through the multitude of web reviews.

Of course depending on the length of client treatment, you will have different relationships with different medical providers.   I have collaborated for years with some (e.g., pediatrician, psychiatrist), and only infrequently spoken with others (geneticist, otolaryngologist, pediatric ophthalmologist).

Typically, when I refer a client for additional testing or consultation, in my referral letter to the physician, I request to receive the results in writing, asking the physician to also include relevant recommendations (if needed). Oftentimes, I also try to set some time to discuss the findings in a phone call in case I have any additional questions or concerns. Of course, I also send the physician (and other providers working with the child) the information from my end (progress reports, evaluations) so all of us can have a more comprehensive profile of the client’s disorder/deficit.

After all, ST’s, OT’s and PT’s are not the only ones who are dependent on information from doctors in order to do our work better. There are times when physicians need information from us in order to move further in treatment such as order specific tests. For example, just recently a pediatrician used my therapy progress report in conjunction with another provider’s, to order an MRI on our mutual client.  The pediatrician had significant concerns over client’s development and presenting symptomatology, and needed to gather additional reports supporting her cause for concern in order to justify her course of action (ordering an MRI) to the HMO.

As mentioned previously there are numerous benefits to teamwork including the fact that it allows for appreciation of other disciplines, creation of functional goals for the child,  integration of interventions as well as “brings together diverse knowledge and skills and can result in quicker decision making” (Catlett & Halper, 1992).

Given the above, it is important that speech language pathologists help to coordinate care and maintain relationships with other medical and related professionals who are treating the child.  This will improve decision making, allow the professionals to address the child’s deficits in a holistic manner, an even potentially expedite the child’s length of stay in therapy.

References:

Catlett, C & Halper, A (1992) Team Approaches: Working Together to Improve Quality. ASHA: Quality Improvement Digest. http://www.asha.org/uploadedFiles/aud/TeamApproaches.pdf

National Institute of Neurological Disorders and Stroke (NINDS) Neurofibromatosis Information Page http://www.ninds.nih.gov/disorders/neurofibromatosis/neurofibromatosis.htm

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Early Intervention Evaluations PART III: Assessing Children Under 2 Years of Age

In this post, I am continuing my series of articles on speech and language assessments of children under 3 years of age. My first installment in this series offered suggestions regarding what information to include in general speech-language assessments for this age group, while my second post specifically discussed assessments of toddlers with suspected motor speech disorders.

Today, I’d like to describe what information I tend to include in reports for children ~16-18 months of age.  As I mentioned in my previous posts, the bulk of children I assess under the age of 3, are typically aged 30 months or older. However, a relatively small number of children are brought in for an assessment around an 18-month mark, which is the age group that I would like to discuss today.

Typically,  these children are brought in due to a lack of or minimal speech-language production. Interestingly enough, based on the feedback of colleagues, this group is surprisingly hard to report on. While all SLPs will readily state that 18-month-old children are expected to have a verbal vocabulary of at least 50 words and begin to combine them into two-word utterances (e.g., ‘daddy eat’). When prompted: “Well, what else should my child be capable of?” many SLPs draw a blank regarding what else to say to parents on the spot.

Image result for assessmentAs mentioned in my previous post on assessment of children under 3, the following sections should be an integral part of every early intervention speech-language assessment:

  • Background History
  • Language Development and Use  (Free Questionnaires)
  • Adaptive Behavior
  • Play Assessment (Westby, 2000) (Westby Play Scale-Revised Link)
  • Auditory Function
  • Oral Motor Exam
  • Feeding and Swallowing
  • Vocal Parameters
  • Fluency and Resonance
  • Articulation and Phonology
  • Receptive Language
  • Expressive Language
  • Social Emotional Development
  • Pragmatic Language
  • Impressions
  • Recommendations
  • Suggested Therapy Goals
  • References (if pertinent to a particular report)

In my two previous posts, I’ve also offered examples of select section write-ups (e.g., receptive, expressive phonology, etc.). Below a would like to offer a few more for this age group. Below is an example of a write-up on an 18-month-old bilingual child with a very limited verbal output.

RECEPTIVE LANGUAGE:

L’s receptive language skills were solid at 8 months of age (as per clinical observations and REEL-3 findings) which is significantly below age-expectancy for a child her age (18 months). During the assessment L received credit for appropriately reacting to prohibitive verbalizations (e.g., “No”, “Stop”), attending to speaker when her name was spoken, performing a routine activity upon request (when combined with gestures), looking at familiar object when named, finding the aforementioned familiar object when not in sight, as well as pointing to select body parts on Mrs. L and self (though identification on self was limited).  L is also reported to be able to respond to yes/no questions by head nods and shakes.

However, during the assessment L was unable to consistently follow 1 and 2 step directions without gestural cues, understand and perform simple actions per clinician’s request, select objects from a group of 3-5 items given a verbal command, select familiar puzzle pieces from a visual field of 2 choices, understand simple ‘wh questions (e.g., “what?”, “where?”), point to objects or pictures when named, identify simple pictures of objects in book, or display the knowledge and understanding of age appropriate content, function and early concept words (in either Russian or English) as is appropriate for a child her age.   

EXPRESSIVE LANGUAGE and ARTICULATION

L’s expressive language skills were judged to be solid at 7 months of age (as per clinical observations and REEL-3 findings), which is significantly below age-expectancy for a child her age (18 months). L was observed to spontaneously use proto-imperative gestures (eye gaze, reaching, and leading [by hand]), vocalizations, as well waving for the following language functions: requesting, rejecting, regulating own environment as well as providing closure (waving goodbye).

L’s spontaneous vocalizations consisted primarily of reduplicated babbling (with a limited range of phonemes) which is significantly below age-expectancy for a child her age (see below for developmental norms).  During the assessment, L was observed to frequently vocalize “da-da-da”. However, it was unclear whether she was vocalizing to request objects (in Russian “dai” means “give”) due to the fact that she was not observed to consistently vocalize the above solely when requesting items.  Additionally, L was not observed to engage in reciprocal babbling or syllable/word imitation during today’s assessment, which is a concern for a child her age.  When the examiner attempted to engage L in structured imitation tasks by offering and subsequently denying a toy of interest until L attempted to imitate the desired sound, L became easily frustrated and initiated tantrum behavior. During the assessment, L was not observed to imitate any new sounds trialed with her by the examiner.

During today’s assessment, L’s primary means of communication consisted of eye gaze, reaching, crying, gestures, as well as sound and syllable vocalizations.  L’s phonetic inventory consisted of the following consonant sounds: plosives (/p/, /b/ as reported by Mrs. L), alveolars (/t/, /d/ as reported and observed), fricative (/v/ as observed), velar (/g/ as observed), as well as nasal (/n/, and /m/ as observed).   L was also observed to produce two vowels /a/ and a pharyngeal /u/.  L’s phonotactic repertoire was primarily restricted to reported CV(C-consonant; V-vowel) and VCV syllable shapes, which is significantly reduced for a child her age.

According to developmental norms, a child of L’s age (18 months) is expected to produce a wide variety of consonants (e.g., [b, d, m, n, h, w] in initial and [t, h, s] in final position of words) as well as most vowels. (Robb, & Bleile,(1994); Selby, Robb & Gilbert, 2000). During this time the child’s vocabulary size increases to 50+ words at which point children begin to combine these words to produce simple phrases and sentences (as per Russian and English developmental norms).  Additionally, an, 18 months old child is expected to begin monitoring and repairing own utterances, adjusting speech to different listeners, as well as practicing sounds, words, and early sentences. (Clark, adapted by Owens, 2015)

Based on the above guidelines L’s receptive and expressive language, as well as articulation abilities, are judged to be significantly below age expectancy at this time. Speech and language therapy is strongly recommended in order to improve L’s speech and language skills.

Typically when the assessed young children exhibit very limited comprehension and expression, I tend to provide their caregivers with a list of developmental expectations for that specific age group (given the range of a few months) along with recommendations of communication facilitation. Below is an example of such a list, pulled a variety of resources.

Image result for milestonesDevelopmental Milestones expected of a 16-18 months old toddler:

 Attention/Gaze:

  • Make frequent spontaneous eye contact with adults during interactions
  • Turn head to look towards the new voice, when another person begins to talk
  • Make 3-point gaze shifts by 1. looking at a toy in hand, 2. then at an adult, 3. then back to the toy
  • Make 4-point gaze shifts if more than one person is in the room – by looking from a toy in hand to one person, then the other person, then back to the toy,
  • Spontaneously attend to book, activity for 2-3+ minutes without redirection

Reaching and Gestures:

  • Show objects in hand to an adult (without actually giving them)
  • Push away items that aren’t wanted
  • Engage in give and take games when holding objects with an adult
  • Imitate simple gestures such as clapping hands or waving bye-bye
  • Hand an object to an adult to ask for help with it
  • Shake head “no?”

Image result for playPlay Skills/Routines:

  • Attempt to actively explore toys (e.g., push or spin parts of toys, turn toys over, roll them back and forth)
  • Repeat interesting actions with toys (e.g., make a toy produce an unusual noise, then attempt to make the noise again)
  • Imitate simple play activities (adult bangs two blocks together, then child imitates)
  • Use objects on daily basis (e.g., when given a spoon or cup the child attempts to feed himself. When putting on clothes the child begins to lift his arms in anticipation of a shirt going on.)

 Receptive (Listening Skills):

  • Consistently follow 1 and 2 step directions without gestural cues
  • Understand and perform simple actions per request (“sit down” or “come here”) without gestures
  • Select objects from a group of 3 items given a verbal command
  • Select familiar puzzle pieces from a visual field of 2 choices
  • Understand simple ‘wh questions (e.g., “what?”, “where?”)
  • Point to objects or pictures when named
  • Spontaneously and consistently identify simple pictures of objects in book
  • Stop momentarily what he is doing if an adult says “no” in a firm voice
  • Identify 2-3 common everyday objects or body parts when asked

 Expressive (Speaking Skills): 

  • Produce a wide variety of consonants (e.g., [b, d, m, n, h, w] in initial and [t, h, s] in final position of words) as well as most vowels. (Robb, & Bleile,(1994); Selby, Robb & Gilbert, 2000).
  • Have a vocabulary size nearing 50 words (e.g., 35-40)
  • Imitate adult words or vocalizations
  • Attempt to practice sounds and words (Clark, adapted by Owens, 2015)
  • Appropriately label familiar objects (foods, toys, animals)

Related imageMaterials to use with the child to promote language and play:

  • Bubbles
  • Cause and effect toys
  • Toys with a variety of textures (soft toys, plastic toys, cardboard blocks, ridged balls)
  • Toys with multiple actions
  • Toys with special effects: lights, sounds, movement (push and go vehicles)
  • Building and linking toys
  • Toys with multiple parts
  • Balls, cars and trucks, animals, dolls
  • Puzzles
  • Pop-up picture books
  • Toys the child demonstrates an interest in (parents should advise)

Strategies:

  • Reduce distractions (noise, clutter etc)
  • Provide one on one interaction in a structured space (e.g., sitting at the play table or sitting on parent’s lap) to improve attention
  • Offer favorite activities and toys of interest initially before branching out to new materials
  • Offer favorite foods/toys as reinforcers to continue working
  • Offer choices of two toys, then remove one toy and focus interaction with one toy of interest
  • Try to prolong attention to toy for several minutes at a time
  • Change activities frequently, HOWEVER, repeat same activities in cycles over and over again during home practice in order to solidify skills
  • Label objects and actions in the child’s immediate environment
  • Use brief but loud utterances (2-3 words not more) to gain attention and understanding
  • Frequently repeat words in order to ensure understanding of what is said/expected of child
  • Use combination of gestures, signs, words, and pictures to teach new concepts
  • Do not force child to speak if he doesn’t want to rather attempt to facilitate production of gestures/sounds (e.g., use “hand over hand” to show child the desired gesture such as pointing/waving/motioning in order to reduce his/her frustration
  • Use play activities as much as possible to improve child’s ability to follow directions and comprehend language
    • Doll House (with Little People)
    • Garage
    • Farm, etc

Related imageCore vocabulary categories for listening and speaking:

  • Favorite and familiar toys and objects
  • Names of people in the child’s life as well as his own name
  • Pets
  • Favorite or familiar foods
  • Clothing
  • Body parts
  • Names of daily activities and actions (go, fall, drink, eat, walk, wash, open)
  • Recurrence (more)
  • Names of places (bed, outside)
  • Safety words (hot, no, stop, dangerous, hurt, don’t touch, yuck, wait)
  • Condition words (boo-boo, sick/hurt, mad, happy)
  • Early pronouns (me, mine)
  • Social words (hi, bye, please, sorry)
  • Early concepts: in, off, on, out, big, hot, one, up, down, yucky, wet, all done)
  • Yes/no

 Select References:

  • Owens, R. E. (2015). Language development: An introduction (9th ed.). Boston, MA: Allyn & Bacon.
  • Rescorla, L. (1989). The Language Development Survey: A screening tool for delayed language in toddlers. Journal of Speech and Hearing Disorders, 54, 587–599.
  • Rescorla, L., Hadicke-Wiley, M., & Escarce, E. (1993). Epidemiological investigation of expressive language delay
    at age two. First Language, 13, 5–22.
  • Robb, M. P., & Bleile, K. M. (1994). Consonant inventories of young children from 8 to 25 months. Clinical Linguistics and Phonetics, 8, 295-320.
  • Selby, J. C., Robb, M. P., & Gilbert, H. R. (2000). Normal vowel articulations between 15 and 36 months of age. Clinical Linguistics and Phonetics, 14, 255-266.

Click HERE for the Early Intervention Evaluations PART IV: Assessing Pragmatic Abilities of Children Under 3

Stay Tuned for the next installment in this series:

  • Early Intervention Evaluations PART V: Assessing Feeding and Swallowing in Children Under Two