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The Ins and Outs of Early Intervention

Spotting Them Sooner

Published October 30, 2015 3:32 PM by jasna cowan

By Jasna Cowan, M.S., CCC-SLP

Once, in an IEP meeting for a local school district, I raised concerns that the child being discussed had pragmatic language delays. The psychologist for the meeting responded that the child was too young to be evaluated in his pragmatic language skills, which surprised me, because I evaluate pragmatic language skills in babies and toddlers all the time.

I may not use a standardized test tool, but I definitely mention the way the child interacts with me in my reports and evaluate four key areas.

SEE ALSO: Language Therapy in Schools

1: I examine eye gaze or the ability to sustain eye gaze. Eye gaze is an indicator that can go along with joint attention. How many times is the child checking in with you or their parent in a play interaction? Do they use it to request objects that you are holding? Did the child even notice you when you arrived? Do they use better eye gaze from certain distances?

Some kids may use very little eye gaze when they're closer to you and more when playing farther away, all of which is noteworthy.

2: I look at the type of interaction the child has in play. I just recently saw a toddler that showed and gave toys to me every minute or so in play, but when I initiated or gave toys to him, he had a hard time understanding how to reciprocate. Then there’s the kiddo who reciprocates initiations or questions, but generally only once and he never initiates. A child with difficulty initiating is usually very prompt dependent and needs to be shown the way to initiate verbally, and possibly even nonverbally.

3: I measure a young child’s body proximity and nonverbal communication. Of course, all toddlers are just starting to learn about people outside their own family, but when I meet one who immediately sits in my lap or stands very close to me in an initial assessment, it’s worth noting.

It could be a sensory seeking behavior or early signs of understanding social rules. Parents who say "he will go with anyone" or "he's not afraid of strangers" could be describing a child with delays in this area.

4: I evaluate a child's ability to use language for communicative purposes. I remember so clearly one child I saw years ago that would indicate his needs by naming the color of the object he wanted. He was a "labeler,” but not necessarily a "communicator." 

This area is completely missed on some of the standardized testing that we have for toddlers and a parent who reports that their child has 30-50 words is not giving enough information. My second question to that parent is twofold: Exactly how many words and what are they?

A parent who reports that their child says colors, letters, numbers and shapes, but lacks basic communication words like "mom,” "dad," "more,” "no,” "mine” or "eat" may be reporting social or pragmatic delays. A "labeler" learns to name things in books or pictures, but may not understand the functionality of using words with family members’ names to communicate.  

I recently saw a child, who knew and named every animal possible when shown pictures. She knew more animals than I think I had in my repertoire, but to get her mother's attention, she cried. And to request a toy her mother had in her hands, she grabbed and pulled.

These kinds of communication discrepancies point to a pragmatic language delay. And yes, I believe even a toddler can be evaluated for that.

It may not be a quantitative standardized measure, but these interactions definitely can be reported as a qualitative measure to describe a child's overall communication skills.

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Great article! We always use the MacArthur-Bates CDI with families to get an inventory of gestures and words.

Terri November 5, 2015 4:00 PM
Windsor, Ontario

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