Communication-based assessment of developmental age for young children with developmental disabilities

Patterns of Cognition, Communication, and Adaptive Behavior in Children With Developmental Disabilities

Young children with developmental disabilities (DD) exhibit a range of strengths and weaknesses in cognitive, language, and adaptive skills. Identifying individual patterns of abilities across these domains is important for informing interventions. This study examines how 129 toddlers with significant developmental delays and less than 10 spoken words perform across different developmental domains and assessment methods (i.e., caregiver report and clinician-administered tests). Children exhibited statistically and clinically meaningful strengths and weaknesses across developmental domains, which may have important implications for differential interventions. Caregiver-reported and clinician-rated measures of cognition, language and adaptive functioning were highly related. However, the relation between caregiver report and clinician ratings was weaker for a subgroup of children with relatively more limited expressive language compared to other children in the sample.

Approaches to communication assessment with children and adults with profound intellectual and multiple disabilities

Communication assessment of people with profound intellectual and multiple disabilities (PIMD) has seldom been investigated. Here, we explore approaches and decision making in undertaking communication assessments in this group of people. A questionnaire was sent to UK practitioners. The questionnaire elicited information about assessment approaches used and rationales for assessment choices. Fifty-five speech and language therapists (SLTs) responded. Findings revealed that the Preverbal Communication Schedule, the Affective Communication Assessment and the Checklist of Communication Competence were the most frequently used published assessments. Both published and unpublished assessments were often used. Rationales for assessment choice related to assessment utility, sensitivity to detail and change and their applicability to people with PIMD. Underpinning evidence for assessments was seldom mentioned demonstrating the need for more empirical support for assessments used. Variability in practice and the eclectic use of a range of assessments was evident, underpinned by practice-focused evidence based on tacit knowledge.

Predictors of receptive and expressive vocabulary development in children with Down syndrome

PURPOSE

There is a lack of longitudinal data on predictors of vocabulary development in children with Down syndrome (DS). In typically developing children, many internal and external predictors of vocabulary development have been determined before. The purpose of the present study was to investigate the role of these variables in the receptive and expressive vocabulary development of children with DS.

METHOD

The present study used a longitudinal design in young children with DS to study the vocabulary development over a period of 1.6 years and investigated the possible predictive role of child-related and environmental variables.

RESULT

Receptive vocabulary development was best predicted by the adaptive level of functioning and early receptive vocabulary skills. Expressive vocabulary development was best predicted by the adaptive level of functioning, receptive vocabulary, maternal educational level, level of communicative intent of the child, attention skills and phonological/phonemic awareness.

CONCLUSION

A wide range of internal and external predictors for vocabulary development of children with DS was found. Predictors resemble those predicting vocabulary development in peers with typical development between 1 and 6 years of age, as identified in other studies.

Parental directiveness and responsivity toward young children with complex communication needs

PURPOSE

The aim of the present study was to determine if parent responsiveness to their children with complex communication needs (CCN) during naturalistic play changed over an 18-month period and determine if any such changes were influenced by the child's overall level of receptive and expressive language development, motor development or differing play contexts. This longitudinal information is important for early intervention speech-language pathologists and parents of children with developmental disabilities for whom the use of parent-directed responsivity interventions may be encouraged.

METHOD

Over an 18-month period, 37 parents of young children who had physical and/or neurological disabilities participated in three home-based parent-child play episodes. Videotapes of each play episode were extracted and coded.

RESULT

Results indicated parents who were initially responsive showed a significant tendency to continue to be so. Early on, parents were significantly more likely to be directive during object play than social play and significantly more likely to interact responsively during social play than object play.

CONCLUSION

Parents of children with developmental disabilities were not consistently less responsive to their children based on motor or language capabilities. Previous reports of higher parental directiveness with children who have developmental disabilities may be attributable to object-based play interactions.

Comprehension of spoken language in non-speaking children with severe cerebral palsy: an explorative study on associations with motor type and disabilities

AIM

To assess spoken language comprehension in non-speaking children with severe cerebral palsy (CP) and to explore possible associations with motor type and disability.

METHOD

Eighty-seven non-speaking children (44 males, 43 females, mean age 6y 8mo, SD 2y 1mo) with spastic (54%) or dyskinetic (46%) CP (Gross Motor Function Classification System [GMFCS] levels IV [39%] and V [61%]) underwent spoken language comprehension assessment with the computer-based instrument for low motor language testing (C-BiLLT), a new and validated diagnostic instrument. A multiple linear regression model was used to investigate which variables explained the variation in C-BiLLT scores. Associations between spoken language comprehension abilities (expressed in z-score or age-equivalent score) and motor type of CP, GMFCS and Manual Ability Classification System (MACS) levels, gestational age, and epilepsy were analysed with Fisher's exact test. A p-value <0.05 was considered statistically significant.

RESULTS

Chronological age, motor type, and GMFCS classification explained 33% (R=0.577, R(2) =0.33) of the variance in spoken language comprehension. Of the children aged younger than 6 years 6 months, 52.4% of the children with dyskinetic CP attained comprehension scores within the average range (z-score ≥-1.6) as opposed to none of the children with spastic CP. Of the children aged older than 6 years 6 months, 32% of the children with dyskinetic CP reached the highest achievable age-equivalent score compared to 4% of the children with spastic CP. No significant difference in disability was found between CP-related variables (MACS levels, gestational age, epilepsy), with the exception of GMFCS which showed a significant difference in children aged younger than 6 years 6 months (p=0.043).

INTERPRETATION

Despite communication disabilities in children with severe CP, particularly in dyskinetic CP, spoken language comprehension may show no or only moderate delay. These findings emphasize the importance of introducing alternative and/or augmentative communication devices from early childhood.

Validating dynamic assessment of triadic gaze for young children with severe disabilities

PURPOSE

This research investigated the use of a dynamic assessment (DA) to identify differences among young children with severe disabilities, which would predict progress in learning behaviors indicating coordinated joint attention (CJA).

METHOD

Six children 10-24 months of age were enrolled in a 16-week treatment for behaviors indicating CJA, specifically triadic gaze (TG), which is a 3-point gaze shift between object and adult. An initial static assessment documented the children's eligibility for the study and their baseline performance of TG. DA procedures were then implemented to determine each child's performance with examiner support in producing behaviors suggesting joint attention (i.e., tracking, gaze toward an object or an adult, scanning between objects, scanning an object and adult, and TG).

RESULTS

Results demonstrated differences among children during the DA via a DA score and a behavioral profile. These results were predictive of differences among children in subsequent learning of TG.

CONCLUSION

These data support the validity of DA for describing heterogeneity among young children with severe disabilities who look similar on static assessment but appear differentially ready to learn behaviors associated with joint attention. This knowledge will assist clinicians in planning more efficacious services for young children who struggle to communicate and are at risk for extended therapeutic needs.