No.511, 3A Main, 5th Cross, OMBR Layout, Bangalore – 560 043

Alphonsa Joseph-PsychologistBhuvaneshwari- Speech –Language Pathologist

Dealing with Behavioural Challenges in Early Learning

IDENTIFYING AND IDENTIFYING AND PROVIDING FOR CHILDREN PROVIDING FOR CHILDREN WITH SPECIAL NEEDSWITH SPECIAL NEEDS

DAY 2- 28DAY 2- 28THTH December-2013 December-2013

ContentsContentsInformation processing skills-

attention,memory, Behavioural manifestations of

information processing skillsLanguage and learning

Information processingInformation processingAttention: auditory, visualAuditory- listening skillsMemory- sensory register, short

term – working memory ( phonological loop), long term memory.

Learning stylesLanguage and communication

ATTENTIONATTENTIONAuditory- localization, auditory

figure ground ( hearing in noise)Visual – discrimination, closure-

drawings- symbolic representation

Motor planning- bilateral co-ordination, sensory integration

MEMORYMEMORYSensory register- sensori motor

play (object permanence) Levels of processing theory ( Craik

& Lockhart, 1972)- i) perception ii) structural features ( symbolic

representation) iii) Meaning or

semantic level ( elaboration)

Language ProcessingLanguage ProcessingTop down vs bottom up

approachEmergent literacy

DevelopmentChild Development

Change in the child that occurs over time. Changes follow an orderly pattern that moves toward greater complexity and enhances survival.

Developmental Delay

Slow or impaired development of a child <5 yrs old and is at risk of having developmental disability because of the presence of syndromes/metabolic disorders/ prenatal or postnatal problems.

Developmental Disability• Impaired functioning in one or

more areas of development such as physical, cognitive, social, emotional and communication due to various factors as assessed on standardized developmental tests.

Domains of Development

• Physical• Cognitive • Social/Emotional • Communication

Physical development

Reflexes Gross motor-principles,

milestones Fine motor Sensory Perfect synchronization –leads

to-Sensory integration Gaps in above areas lead to

sensory dysfunction

Cognitive development

Cognitive development is best understood in terms of Piaget's theory of cognitive development

Assimilation + Accommodation = Adaptation

Preoperational stage – according to Piaget, the stage that lasts from 2 to 7 during which children’s use of symbolic thinking grows, mental reasoning emerges, and the use of concepts increases

Operations are organized, formal, logical mental processes

Symbolic function – according to Piaget, the ability to use a mental symbol, a word or an object to represent something that is not physically present

Centration – the process of concentrating on one limited aspect of a stimulus and ignoring other aspects

Conservation – knowledge that quantity is unrelated to the arrangement and physical appearance of objects

Transformation – the process whereby one state is changed into another

Egocentric thought – thinking that does not take the viewpoints of others into account

Intuitive thought – thinking that reflects preschoolers’ use of primitive reasoning and their avid acquisition of knowledge about the world

Information Processing in preschoolers:

AttentionMemoryLess effective at using memory

strategies likeRehearsalOrganizingMore - Episodic memory >>

autobiographical memory

Social/Emotional Development

Social Emotional development is the ability to initiate and maintain relationships.

During this development a child learns how to approach other children, how to negotiate issues, how to take turns, and how to communicate effectively.

Key areas of focus- in social and emotional development:

SELF CONCEPT: Children develop their self-concept very early in life. We can provide and assist in enhancing a child’s self-concept by recognizing unique qualities that the child possesses and by paying attention to the child’s temperament (mood) to make sure that personalities are compatible.

Temperament – The tendency to react in a certain way to events.

Temperament shows by 2-3 months. Temperament may be inherited and/or due to prenatal conditions & environment.

There are three ratings of temperament: Flexible/Easy- have regular habits &

cheerful Fearful/Slow to warm up – take more

time to adapt Feisty/Difficult – irregular in habits &

withdraw or protest

SELF CONFIDENCE: Children with self-confidence have

a feeling of internal worth which in turn makes it easier for them to face challenges and to work with others. When children lack this confidence, their focus tends to be on failure rather than success.

SELF ESTEEM:

Compliment children often.

Encourage students to make nice comments about their peers.

Showing appreciation always helps in positive self esteem.

Encourage children to make choices.

Show importance in a child’s opinion by using active listening while they are speaking.

Explain reasons for your actions.

Encourage children to try new and challenging activities.

Tips that Enhance Social Growth

HONEST RECOGNITION AND PRAISE: Focus on being more specific when praising students. For example, instead of saying “good job”, draw attention to something specific that the child has done. Make students feel worthy to let them know they have a place in the classroom.

Tips that Enhance Social Growth

HONEST RECOGNITION AND PRAISE: Focus on being more specific when praising students. For example, instead of saying “good job”, draw attention to something specific that the child has done. Make students feel worthy to let them know they have a place in the classroom.

RESPECT: Show respect by offering choices and by respecting students’ decisions. By showing confidence in students ability to make decisions we foster their self- esteem. Make sure to explain reasons behind rules or decisions that are made. Do not talk about children in front of them unless they are included in the conversation.

COMPETENCE: Encourage students to make their own

choices and to be independent. Provide experiences and activities that foster success. Provide opportunities that are challenging, but not frustrating. Never be stereotypical. Allow equal access to all things in the classroom. Offer activities that foster creativity which allows students to express themselves. Present opportunities for students to interact with others and to discover how to get along with them.

Activity Communicate with another group

member to determine two qualities that you share and two qualities that you do not.

Communication Development Communication is the exchange of

information, the sending and receiving of messages, it is a two way interaction and requires participation of a sender and a receiver.

Example: When an infant cries, mother picks her up. The child calls the teacher and teacher

attends to her A child pulls mother’s dress to get

attention

Speech is a motor act. It is the most efficient and frequently used mode of language expression. Speech is produced with the help of speech mechanism structure like tongue, jaw, lips etc. in a complex co-ordination with nervous system. Communication involving speech is called verbal communication.

Some aspects of speech• 1) Articulation : Process of production of speech

sounds. • 2) Voice: Appropriate pitch, loudness and quality.• 3) Suprasegmental features: Refers to

features like tone, rhythm, stress, intonation etc which act upon words and also change the meaning of the sentences by using these features. The features like stress and intonation decide whether the sentence is a question, request or statement. Features also reflect attitude and emotions of a speaker

• 3) Fluency: Fluency of speech can be fast, slow. Etc.

Intelligibility How intelligible is your child’s

speech to a stranger during his early years? There is a broad range of normal, but typically a child at…

19 to 24 months of age is 25% to 50% intelligible

2 to 3 years, the child is 50% to 75% intelligible

3 to 4 years, the child is 80% intelligible 4 to 5 years, the child is 90% to 100%

intelligible

Sounds AGE CHILDREN BEGIN USING THE

SOUND

AGE 90% OF CHILDREN ARE

USING THE SOUND

/p/, /m/, /h/, /n/, /w/

< 2 years 3 years

/b/ 2 years 4 years/k/, /g/, /d/ 2 years 4 years/t/, /ng/ 2 years 6 years/f/ ,/y/ 2 years 6

months 4 years

/l/ 3 years 6 years

Articulation Development

Articulation Development

Sounds AGE CHILDREN BEGIN USING THE

SOUND

AGE 90% OF CHILDREN ARE

USING THE SOUND

/r/, /s/ 3 years 8 years/ch/, /sh/ 3 years 6

months 7 years

/z/ 3 years 6 months

8 years

/j/ 4 years 7 years/v/ 4 years 8 years/th/ 4 years 6

months8 years

/zh/ 6 years < 8 years

Language is a shared code or system that presents concepts and ideas through the use of arbitrary symbols. Language is a vehicle for communication which has systematic, rule-governed, arbitrary symbols which are meaningful and shared by a community. Typically we use oral and written language to communicate . Other types of languages include sign language, Bliss symbols etc.

LANGUAGE• The major components of language are • FORM Deals with structure of

language, how to form words and sentences grammatically.

• CONTENT Deals with meaning of language, what to say, or the content of the message.

• USE Deals with the usage of language where, when, with whom and for what purpose language in used.

LANGUAGE• These major components are further subdivided into

the following:• 1) PHONOLOGY Studies the range of speech sound

a native speaker uses while speaking and shows how they are produced e.g. /p/ /b//m/ etc.

• 2) MORPHOLOGY Deals with the rules for combining speech sounds to form words.

• 3) SYNTAX Refer to the grammatical aspect of a language, and describes the rules that speakers use in forming sentences.

• 4) SEMANTICS Include meanings as well as rules for linking meaning with words.

• 5) PRAGMATICS Refers to the use of language appropriately depending on situations.

STAGES IN THE DEVELOPMENT OF LANGUAGE

I Preverbal stage• Pre-verbal communication is well established

before the emergence of a child’s first words. The infant is also vocalizing from the first months of life and that these vocalization are quickly integrated with non-vocal signals in communicative exchanges.

• There are 5 recognizable stages of vocal development that precede the emergence of clearly identifiable words. They are defined by the most predominant vocalizations and there is considerable overlap from one stage to the next.

• Stage-1: reflexive crying and vegetative sounds. (0-8 weeks)

• These vary from crying and fussing, to burping swallowing, spitting up and have no communicative significance.

• Stage-2: Cooing and Laughter (8 – 20 weeks)• These sounds occur when the infant is content

and contain both vowel and consonant elements. From about 12 weeks the frequency of crying decreases and the primitive vegetative sounds of stage – 1 begin to die out. Instances of sustained laughter occur from 16 weeks.

• Stage – 3: Voice Play (16 – 30 weeks)• This stage is marked by longer continuous bursts of

vocalizing of either vowel or consonant sounds. Towards the end of the stage, the infant may produce combinations of sounds, which vary in pitch and mark the onset of babbling.

• Stage – 4: Reduplicated Babbling (25 – 50 weeks)• It is defined as a series of consonant vowel

syllables with the same consonant being repeated for e.g. nana or adah –adah. While reduplicated babbling is not used systematically to

communicate with adults, towards the end of this stage it may become part of repetitive imitation games.

• Stage – 5: Non reduplicated Babbling• Here vocalizations take the form of

vowel consonant vowel (VCV) e.g. ada, ana, CVC form e.g. mam, geg and in a simple sequence; both the consonants and vowels may change. The child may also introduce changes in stress and intonation, consequently the babbling “sounds just like a foreign language “ and is often referred to as expressive jargon.

II. First Words• By the age of 1 to 1 ½ years most of the children say their

first words. Change from the stage of jargon speech to first words stage is marked by the presence of self made words (ideomorphs) i.e. before producing adult like word child uses different self made syllables and words to denote different objects and actions. Child forms his own words. These are self-made words, which are called as ideomorphs. These words have different origins arising in the child’s daily life set. Some of the common sources include:

• Pointing /aaa/ need that object • Imitating sounds in the environment /bow wow/dog

barking • Self imitation /dhub/fallen down • Imitation of adult /chichi – (i hate it)

• First words do not sound like adult words. They are mostly single syllables but are repeated e.g. da-da, papa, mama. The child produces the same word but with many intonations to look like a question, request, demand etc. depending on the situation. The child uses one word like a sentence. Often an appropriate gesture will accompany the utterance. Important objects, events and persons from a child’s daily experience are only uttered first. Children target objects or people for their first words.

• As speech develops the child is still coming to terms with the phonological system for combining sounds and there are numerous instances of apparently inconsistent errors. Irregularities in pronunciation are extremely common in pre school children and do not on their own indicate any cause for concern.

III. COMBINING WORDS• Children string 2 or more words together around

18 months of age. This tends not to happen suddenly. There is usually a transitional period in which words are brought together. Two word sentences emerge and these combinations seem to include a great deal of objects. They point to them and name them (demonstrative) and they talk about where the objects are (location), who owns them (possession) and who is doing this to them (agent-object). They also talk about actions performed by people (agent-object) and oriented towards certain location (action-location).

• What children mean when they use the word?• The meaning intended by children by using the words or gestures can

be called as SEMANTIC INTENTIONS. It may be assumed that children do not start with the adult meanings. They have to work towards developing the adult meanings depending upon their experiences in hearing and also using the word in different situation.

• The common strategies children use while developing meanings of the words are:

• Under Extension• Child may use a word to mean only one thing and not class of

similar things e.g. using ‘doggie’ to mean only the pet dog and not other dogs or using ‘chokie’ to mean chocolate the child likes and not other chocolates.

• Over Extension• A Child may use a word to mean more than what adults mean, e.g.

“ball” to indicate moon. On repeated using of the words and depending upon the adult reactions, the child gradually approximates adult meanings.

FUNCTION OF FIRST WORDS

Sl. No. Function Example Gloss

01. Instrumental

(I want /need)

More I want some more

02. Regulatory

(Do as I tell you)

Book Let’s look at a book

03. Interactional

(You and me)

Dada Dada (nice to see you)

04. Personal

(I like)

That That’s nice

05. Imaginative

(Let’s pretend)

Rah Let’s pretend to be a line

06. Heuristic

(Tell me why)

Adah? What’s that

07. Informative

(I’ve got something to tell you)

Bird There’s a bird outside

• Objects, people and actions and their interrelationships preoccupy the child at this stage, which actually are the experiences that the child has gone through so far.

• Some of the common word combination which represent a small group of meanings (semantic relations) include:

• Semantic Relation Example - Utterance • Agent + action Mummy come• Action + object drink milk• Agent + object mummy sock• Action + location sit – chair, toy - floor• Possessor + Possession my teddy • Entity + attribute crayon big • Demonstration + entity that money• As seen, these semantic electrons are telegraphic in nature

but they turn into more grammatical sentences gradually.

IV Sentence Development• The first signs of communication occur

during the first few days of life when an infant learns that a cry will bring food, comfort or a diaper change. The newborn baby recognizes important sounds in his/her environment. As the child grows up they begin to sort out the speech sounds that make up words in a language. Research has shown that most babies recognize the basic sounds of their language by six months of age.

• As the speech mechanism and voice mature, an infant is able to make controlled sound.

• The baby has moved from the first stage of crying to the second stage of differential crying to the third stage of cooing. Babies babble at around 4-5 months, which is nonsense speech but may reflect adult intonation patterns.

• Children then go through the stage of echolalia, when they repeat words, but without knowing the meaning.

• By the time they reach the end of their first year, they may be able to say a few words. By eighteen months of age, they can say 8-10 words.

• By age two, they may be putting words together to make a two-word sentence. They begin to use complex sentences by 4 - 4½ years of age.

• Details of sentence development

• 16 – 20 months• - Two Word sentences emerge• - Types of sentences used are• : Agent + Action eg: mummy give• : Object + Action eg: ball throw• : Possessor + Possession eg:

mama ball

• 21 – 23 months• - Uses 3-word & 4-word sentences eg:

what is this?, where is the ball?• - Uses 2nd person pronoun ‘you’ to give

simple commands; eg you do it, • you throw the ball?• - uses few prepositional words; here,

there, in• - refers to self using name• - syntactical errors are seen

• 24 – 26 months• - Increased use of pronoun – I, he,

it, me• - increased use of preposition• - denials are expressed in

sentences

• 27 – 29 months• - uses negative imperative to prohibit action;

eg: don’t talk• - uses ‘if-then’ construction• - can quantify; little, all• - indicates increases in numbers – another• - indicates time – afterwards, later• 30 – 36 months• - uses questions to elicit reasoning; eg: why

didn’t you bring it• - uses several verb forms• - uses plurals in speech

• V DEVELOPMENT OF SEMANTIC LANGUAGE• Even before the child begins to speak, he/ she understands the

meaning of words and starts using gestures meaningfully. Children pick up new words at a fairly fast pace. They learn naming words, action words, describing words, pronouns, prepositions, quantifying words, questions, etc.

• They learn what to do to a word to change it from singular to plural. They learn how to use the correct prefixes & suffixes. They learn to use sentences to express themselves. Sentences become more complex in nature. Slowly, over time they decipher underlying or hidden meanings in a sentence. Older children enjoy humor which may be a pun on words. They understand sarcasm, they comprehend the connotation of gestures, facial expressions, changes in intonation patterns. The depth of feelings is expressed by using appropriate words.

• To conclude, we can say that the understanding of semantic content of a language is a continuous process. Comprehension of ‘slang’ and of common words used in technical jargon, for a different purpose would explain this phenomenon.

VI DEVELOPMENT OF PRAGMATIC LANGUAGE• Areas in Pragmatic Language• Topicalization – i.e. introducing, terminating and maintaining the

topic.• Conversational Ability – speaking & listening skills such as turn-

taking and changing the topic appropriately.• Use of register – manner in which an individual speaks to

another, i.e. tone of voice, respect in voice, formal or informal address.

• Use of Syntactic Forms to convey Pragmatic Information• Effective Language: message should be appropriate, should

convey what the • speaker wants to say• Non-verbal communication: use of appropriate facial expressions

and gestures.

11½ months - 2 yrs • denial of assertion• fictional event descriptions• ‘what and ‘where’ questions2yrs - 3 yrs • expresses ability / inability• takes permission

• 3yrs – 4 yrs• understands obligation• gives description• expresses contrastive statements

(what is the difference between a table & a chair)

• story completion achieved• identity & location concepts emerge• temporal & causal concepts emerge

• 4yrs – 5yrs• requests for clarification• requests for information, permission,

assistance• makes claims, gives warnings, protests• makes advanced requests for

information • follows directions• can take hints• makes predictions & inferences

5yrs – 7yrs• style & content of message changes depending on age, • gender, authority or familiarity7yrs – 10yrs• clarity in giving messages• ability to evaluate communication• adequacy of message• uses persuasion• maintains a topic• increase in length & complexity of narrative• uses tactful messages• resolves conflicts• gives comforting messages

Theories of Language Acquisition

• Various viewpoints• Behavioural• Nativism• Cognitive• Social-interactional

NATURE Vs NURTURE

PRESCHOOLERS• Gross motor• Fine motor• Language (Echolalia, Normal

Nonfluency)• Cognition (Animism,

egocentricism, lack of conservation)

• Behaviour/Play

Language delay• Failure to develop speech at the

expected age• Somewhat subjective• Usually associated with other

maturational delays• May also be associated with a

hearing impairment, mental retardation, emotional disturbance, or brain injury

• Often the result of environmental deprivation

Hearing Impairment

• Delay in Speech & Language• Limited babbling• Articulation, voice problems• Learning problems• Central auditory processing

problems???

Autism• Autism is a neurologically based Pervasive

Developmental Disorder that is usually evident by age three and varies from low to high functioning.

• Lack of eye contact• Aloofness, solitary play, poor social skills• Poor communication intent• Echolalia• Mutism• Pronoun reversal• Sensory integration issues, stereotypic behaviour,

perseverations, behavioural issues• Oro motor problems (apraxia present sometimes)

Mental Retardation

• Delay in motor milestones• General slowing of cognitive

abilities• Below average IQ• Characteristics depend on the

severity• Down's syndrome

ADD/ADHD

• Attention Deficit Hyperactivity disorder• Attention Deficit Disorder• Inattention, Impulsivity, Hyperactivity• Medication prescribed to some• Behavioural excesses, learning problems,

reading/writing issues, pragmatic difficulties• ADHD is a neurobiological disorder that

causes developmentally inappropriate levels of inattention, hyperactivity and impulsivity.

SLI & LD

• Specific Language Impairment• Learning Disability• Oral language, Written Language

Continuum???• Exclusion criteria• Less than 50 words at 2 years of

age• Pure Language Disorder• Reading, Writing, Arithmetic issues• Average/above-average IQ

Cerebral Palsy

• Non progressive neurological disorders

• Affects motor skills, feeding, communication, speech, language and sometimes cognition.

• Different types of cerebral palsy.

Various developmental disabilities Autism Spectrum Disorders Intellectual Disabiity Hearing Impairment Visual Impairment Cerebral Palsy Syndromes Learning Disability AD/HD Delayed/Inadequate Speech & Language/SLI Conduct, Behavioural & Emotional Disorders

Intervention for children at risk (3 to 7 years)

Complaints:Withdrawn social behaviorDelayed language (immediate

echolalia)Gross & fine motor in-coordinationPoor attention & concentrationFeeding issuesBehavioral issues

Piagetian Principles Perception (sensory processing,

sensory reorganization, sensory exploration) is an active, rather than passive learning process

Perceptual development permits the development of symbolic, representational systems.

Symbolic functioning includes all mental behavior concerned with aspects of reality that are not immediately present.

Language differs from other forms of symbolic functioning because it is a social communication system, rather than an isolated internal system such as imagery.

Language as a social system is the end result of communicative, cognitive, social, play and imitative development.

Language as a symbolic function represents the child’s reality-the child’s experiences.

Kephart’s Perceptual Training Approach (Kephart, 1971)- 2 assumptions:

a) Visual motor abilities are essential to cognitive development and academic success;

b) These visual motor processes are trainable.

Concept formation - dependent on the manipulation of perceptual data that rests on the development of basic motor patterns

PostureLateralityDirectionality

Body image

Tactile, kinesthetic, visual and auditory information received from the developing perceptual system are compared with existing motor information- result is ‘perceptual-motor match”

Faulty perceptual-motor match leads to sensory integration problems.

Auditory processing abilities-informal training- top down or bottom up approach depending on the individual child.

Role of ParentsImportance of careful observation of

play behavior.Handling temper tantrumsHow to communicate with children,

obtain knowledge about the stages of language development and provide adequate speech stimulation.

Modifying feeding habits, including weaning bottle feeding and introduction of food of varied consistency, texture and temperature and setting up a feeding routine.

Family and marital counseling done as and when required.

Schooling issues were addressed.

Case studies & Case studies & assessmentassessmentKnox cubeBGTVisual memoryAuditory & phonological

processingExpressive languageOro-motor skills

THANK YOU!