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FIRST WORDS Project

FIRST WORDS Project. Model Demonstration Project http://firstwords.fsu.edu Amy M. Wetherby, Ph.D . Project Director NECTAS Child Find Teleconference. Need to Improve Early Identification of Developmental Disabilities.

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FIRST WORDS Project

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  1. FIRST WORDS Project Model Demonstration Project http://firstwords.fsu.edu Amy M. Wetherby, Ph.D. Project Director NECTAS Child Find Teleconference

  2. Need to Improve Early Identification of Developmental Disabilities Percentage 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)

  3. Communication and language problems are the most common symptom in young children Disability Category % Served Specific Learning Disabilities 51.1 Speech or Language 20.8 Mental Retardation 11.6 Serious Emotional Disturbance 8.7 Multiple Disabilities 1.8 Hearing Impairments 1.3 Orthopedic Impairments 1.2 Other Health Impairments 2.2 Visual Impairments 0.5 Autism 0.5 Deaf-blindness 0.1 Traumatic Brain Injury 0.1 (US DOE, 1998)

  4. 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.

  5. Prelinguistic Predictors of Persisting Language Problems • SOCIAL COMMUNICATION • Emotion and Use of Eye Gaze • Use of Communication • Use of Gestures • EXPRESSIVE SPEECH AND LANGUAGE • Use of Sounds • Use of Words • SYMBOLIC CAPACITY • Understanding of Words • Use of Objects

  6. 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

  7. 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

  8. 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

  9. 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

  10. CSBS Developmental Profile: Behavior Sample • Warm-up • Communicative Temptations (Wind-up toy, Balloon, Bubbles, Jar, and Toys in Bag) • Sharing Books • Symbolic 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)

  11. CSBS Developmental Profile Measurement Parameters for Checklist, CQ & BS • Emotion and Use of Eye Gaze • Use of Communication • Use of Gestures • Use of Sounds • Use of Words • Understanding of Words • Use of Objects

  12. 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)

  13. 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)

  14. 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= .50 CQUse of Words r= .80 r= .73TOTAL r= .65 r= .64 BSUse of Words r= .58 r= .67TOTAL r= .65 r= .64 (Wetherby & Goldstein, 1999)

  15. Possible Outcomes of Children Late in Talking  Late Bloomer Impairment in one or more of the following: • Hearing • Speech • Language • Communication

  16. 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)

  17. 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)

  18. 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)

  19. 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)

  20. 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)

  21. Practice Parameters for Screening and Diagnosis of Autism Spectrum Absolute Indications for Immediate Further Evaluation: • No babbling by 12 months • No gesturing (pointing, waving bye-bye) by 12 months • No single words by 16 months • No 2-word spontaneous (not just echolalic) phrases by 24 months • ANY loss of ANY language or social skills at ANY age ********** Child Neurology Society and American Academy of Neurology (Filipek, Accardo, Baranek, et al., 1999)

  22. 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

  23. FIRST WORDS Project Menu of Service Options • Preventative Family Education/Support Services • Intensive, Individualized Early Intervention

  24. Preventative Family Education/Support Services • parent education group meetings in the community • infant/toddler peer play groups • caregiver education modules for families and service providers • parent support and networking groups • resource and referral database 

  25. 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 Back to Public Awareness Child Find

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