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FIRST WORDS Project
Model Demonstration Project
http://firstwords.fsu.edu
Amy M. Wetherby, Ph.D.Project Director
NECTAS Child Find
Teleconference
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Need to Improve Early Identification of Developmental DisabilitiesPercentage of Population Receiving Special Education or Early
Intervention Services in 1997/98:
School-Age Children
6 to 18 years 10.95%
Preschool Children
3 to 5 years 4.79%
Infants and Toddlers
Birth to 2 years 1.70%
(US DOE, 1998)
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Communication and language problems are the most common symptom in young childrenDisability Category % ServedSpecific Learning Disabilities 51.1Speech or Language 20.8Mental Retardation 11.6Serious Emotional Disturbance 8.7Multiple Disabilities 1.8Hearing Impairments 1.3Orthopedic Impairments 1.2Other Health Impairments 2.2Visual Impairments 0.5Autism 0.5Deaf-blindness 0.1Traumatic Brain Injury 0.1
(US DOE, 1998)
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Improving Early Identification
A child’s rate of language acquisition may be solidified by 2 to 3 years based on the rapid maturation of the brain.
Instead of waiting to see if a child is late in talking, it is important to evaluate skills that are early indicators of language development.
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Prelinguistic Predictors of Persisting Language ProblemsSOCIAL COMMUNICATION
Emotion and Use of Eye GazeUse of CommunicationUse of Gestures
EXPRESSIVE SPEECH AND LANGUAGEUse of SoundsUse of Words
SYMBOLIC CAPACITYUnderstanding of WordsUse of Objects
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Profile Distinguishing Autism Spectrum and Delayed Language in Young Children (Wetherby, Prizant & Hutchinson, 1998)EMOTION AND USE OF EYE GAZE
Weakness in gaze shifts/shared positive affect; excess negative affect
USE OF COMMUNICATION Weakness in joint attention; comparable in behavior regulation
USE OF GESTURES Weakness in conventional & distal gestures; poor coordination of
gestures and sounds
USE OF SOUNDS Comparable limited consonant inventory & syllable structure
SYMBOLIC CAPACITY Weakness in language comprehension and pretend play;
comparable constructive play
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Evaluation versus Assessment
Evaluation for Identification Screening Diagnostic testing Determining initial and continuing eligibility
Assessment for Educational Planning Profiling strengths and needs Monitoring changes with treatment
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Recommended Practices for Evaluation and Assessment of Young Children
Utilize multiple sources of information (parent report, observation & sampling)
Gather information from multiple observations
Provide information about child’s growth rate and capacity for development
Allow families and professionals to gather and share information to build consensus about strengths and needs
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FIRST WORDS ProjectEvaluation Model
Step One: Brief Parent Report Infant/Toddler Checklist for Communication and
Language Development
Step Two: More Detailed Parent Report CSBS-DP Caregiver Questionnaire Ages and Stages Questionnaires
Step Three: Child & Family Evaluation CSBS-DP Behavior Sample of child interacting with
caregiver and clinician
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CSBS Developmental Profile:
BehaviorSample
Warm-upCommunicative Temptations (Wind-up toy,
Balloon, Bubbles, Jar, and Toys in Bag)Sharing BooksSymbolic Play (feeding set) Language Comprehension (object names,
person names, and body parts)Constructive Play (stacking blocks)Caregiver Perception Form (caregiver rates how
typical child’s behavior is during sample)
(Wetherby & Prizant, 1998)
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CSBS Developmental Profile
Measurement Parameters for Checklist, CQ & BS
Emotion and Use of Eye GazeUse of CommunicationUse of GesturesUse of SoundsUse of WordsUnderstanding of WordsUse of Objects
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CSBS Developmental Profile
Correlations for Three Measures
Checklist and CQr=.92 p< .0001 n=129
CQ and BSr=.78 p< .0001 n=127
Checklist and BSr=.72 p< .0001 n=114
(Wetherby & Goldstein, 1999)
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CSBS Developmental Profile
Correlations for Test-Retest of the Three Measures
Checklist 3 month retest intervalr=.88 p< .0001 n=108
CQ 4 month retest intervalr=.87 p< .0001 n=112
BS 4 month retest intervalr=.80 p< .0001 n=26
(Wetherby & Goldstein, 1999)
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Correlations for CSBS-DP and MacArthur CDI Vocabulary Production at 24 months
Mean Initial Age 21 months 15 months
ChecklistUse of Words r= .65 r= .60TOTAL r= .44 r= .50CQUse of Words r= .80 r= .73TOTAL r= .65 r= .64BSUse of Words r= .58 r= .67TOTAL r= .65 r= .64
(Wetherby & Goldstein, 1999)
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Possible Outcomes of Children Late in Talking
Late Bloomer
Impairment in one or more of the following: Hearing
Speech
Language
Communication
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Accuracy of Diagnosis at Age 2
Diagnosis of Specific Language Impairment
About half of children identified as late talkers at age 2 receive a diagnosis of specific language impairment at age 3
Children who are delayed in expressive language only are very likely to catch up on their own
Children who are also delayed in receptive language, use of gestures, and play are more likely to have persisting language problems
(Paul, 1991; Rescorla, 1991; Thal, Tobias, & Morrison, 1991)
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Accuracy of Diagnosis at Age 2
Diagnosis of Autistic Disorder
72% of children diagnosed at age 2 retained that diagnosis at age 3
94% retained diagnosis of ASD at age 3
Diagnosis of Atypical Autism (PDD-NOS)
42% of children diagnosed at age 2 retained that diagnosis at age 3
74% retained diagnosis of ASD at age 3
(Lord, 1995; Lord & Risi, 2000)
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Clinical Features of Autism Spectrum in Young Children
Social Impairments were prominent at 24 months
Communication Impairments were prominent at 24 months
Restricted Repertoire of Activities and Interests were not prominent until 36 months
(Lord, 1995; Stone, Lee, Ashford, Brissie, Hepburn, Coonrod, & Weiss, in press)
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Markers Based on CHAT at 18 months
Proto-declarative pointing
Gaze-monitoring
Pretend play
12 of 16,000 failed these 3 key items and 10 received diagnosis of autism (.06%).
22 of 16,000 failed 2 of the 3 items and 15 were developmentally delayed without autism (.08%).
(Baron-Cohen, et al., 1992; 1996)
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Features Distinguishing Autism Based on Home Videotapes at 12 months
Pointing
Showing
Looking at Others
Orienting to Name
Only the latter two distinguished children with autism from children with developmental delays.
(Osterling & Dawson, 1994; 1999)
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Practice Parameters for Screening and Diagnosis of Autism Spectrum
Absolute Indications for Immediate Further Evaluation:
No babbling by 12 monthsNo gesturing (pointing, waving bye-bye) by 12
monthsNo single words by 16 monthsNo 2-word spontaneous (not just echolalic) phrases
by 24 monthsANY loss of ANY language or social skills at ANY age
**********
Child Neurology Society and American Academy of Neurology(Filipek, Accardo, Baranek, et al., 1999)
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Linking to Intervention
We are now serving a small proportion of young children needing services
Improving early identification efforts will increase the need for early intervention, …..so be ready to expand services
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FIRST WORDS Project Menu of Service Options
Preventative Family Education/Support Services
Intensive, Individualized Early Intervention
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Preventative Family Education/Support Servicesparent education group meetings in
the communityinfant/toddler peer play groupscaregiver education modules for
families and service providersparent support and networking
groupsresource and referral database
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Intensive, Individualized Early Intervention
individualized intervention through a family-guided assessment of the child’s communication and the communicative environment
parents are essential partners in the identification of specific concerns, intervention planning, and evaluation of outcomes
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