We examined the value of prelinguistic behavioral testing with the CSBS in predicting later language level after cochlear implantation as reflected in RDLS scores. Correlative analysis suggests that early CSBS testing may provide useful clinical information. Poor CSBS scores may serve as a precaution: if children lack an appropriate prelinguistic behavioral repertoire, the emergence of age-appropriate formal language may be at risk. Observations suggest that symbolic prelinguistic behaviors are necessary, but not sufficient, for the development of strong linguistic skills.
The variability of behavioral measures in very young deaf children poses challenges in designing objective measures with predictive value for later language level. As deaf children undergo implantation at younger ages, tools for assessing baseline status of the ability to communicate with predictive value become harder to find. Assessing the language skills of a deaf child who has been diagnosed as having a severe-to-profound hearing loss requires evaluation of communication skills that are subserved by mid- and high-frequency hearing, sensory capabilities that are invariably absent in young candidates for cochlear implantation.
A thorough speech and language assessment is a crucial component of the cochlear implant candidacy process because it guides consideration of both the appropriateness of surgical intervention and the format for postimplantation rehabilitation. Therein lays the challenge: to reliably assess a child's communication skills at an age when communication behaviors are difficult to quantify reliably.
If valid baseline metrics could be found, results could serve as a baseline measure of communication, predict further growth, and direct the course and intensity of therapy. Because of their young age and lack of auditory experience, most deaf children enter an evaluation of cochlear implant candidacy with little or no formal language, signed or spoken. Ideally, at least rudimentary communication patterns develop between the child and caregiver in naturally occurring situations such as mealtimes and in play.
Observation of the child in a play interaction can lend considerable insight into communication skills. Prelinguistic communication behaviors, such as pointing, gesturing, object manipulation, affective signaling, turn-taking, and joint attention, can be assessed in play. Verbalizations and imitations may also be analyzed as approximations of true words. In a play environment, receptive and expressive language can be evaluated when the examiner gives directions, asks for labels, and encourages verbal interactions.
Without access to sound, rudimentary means are used to establish a topic and to maintain an interaction, often with a physical object used to cue the interaction. For example, a child may request milk by holding a cup toward his or her mother or engage in a playful exchange when bubbles are blown by looking toward the bubbles and then giggling and looking at his or her mother.
Both examples offer information about the child's ability to connect socially and to communicate basic needs and emotions. Data can be gleaned through observation of a child's variety of strategies and number of exchanges. For the very young child with hearing loss who lacks proficiency in sign or spoken language, play offers a practical and theoretically compelling vehicle with which to observe natural interactions.
In the present study, we used the Communication and Symbolic Behavior Scales CSBS to assess constructs related to modeling communication behaviors reflecting communicative function, gestural means, vocalizations, and verbalizations. Later, when the child is a cochlear implant user, it is imperative to assess his or her skills in developing linguistic abilities. Activation of the cochlear implant should allow the child access to auditory information and provide benefit from verbal language models.
Language therapy in the context of home or school experience can support receptive and expressive language growth of the new implant user. However, to gauge a child's progress, formal evaluations are needed. For example, a measure that indicates that a child is not making 6 months' progress in 6 months' time can prompt critical assessment of the environment in which the device is being used, as well as possible changes in device programming. Information gathered in subsequent testing after implantation can direct language intervention, particularly when baseline preintervention information is available.
The objective of the present study was to investigate the relationship between prelinguistic communication behaviors in implantation candidates and subsequent language development after cochlear implant use.
B. Nonlinguistic/prelinguistic communication, social development, and language development
We evaluated metrics that are amenable to early childhood stages, when candidacy evaluation for cochlear implantation in prelingual deafness is commonly performed, and later, with cochlear implant experience. We determined the predictive validity of prelinguistic communication behaviors in forecasting language outcomes after implantation. The present study included 18 profoundly deaf children who underwent implantation at the average age of All children were prelingually deaf and participated in a preimplantation trial period with binaural hearing aids. The children in the study presented without gross motor difficulties, and English was the primary language in all of the households.
The Transition From Prelinguistic To Linguistic Communication: Issues and Implications
Cognitive levels were not assessed. Given the range of developmental levels of the subjects, speech recognition levels were classified for means of comparison. Therapeutic intervention varied. All children participated in weekly postimplantation therapy with an oral re habilitation specialist for at least 12 months.
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Some children continued therapy for longer periods. Family involvement and support crossed a wide range. Therefore, the variation in the intensity of both formal rehabilitative and informal family-based communication training was considerable, as is representative of all cases involving children who receive implant services in our center and educational training in our school. However, all children received school-based support of their spoken language learning.
The central research question we pursued related to within-subject baseline vs posttreatment scores using age-appropriate tests. Thus, we believe that this analysis withstands potential intersubject variability in experience and environmental factors related to oral language learning. The CSBS assesses communicative, social-affective, and symbolic abilities of children whose functional communication age is between 8 months and 2 years.
A structured play session is videotaped, and the child's behaviors are analyzed to assess communicative function, noting gestural means, vocalizations, verbalizations, reciprocity, social-affective signaling, and symbolic expressions in play.
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Standard scores are compared to norms for hearing children based on chronological age or language stage. Six months after activation and at subsequent 6-month intervals , each child was tested using the RDLS. The RDLS measures verbal comprehension and expressive language abilities in children between the ages of 12 months and 5 years.
Expressively, each child's responses are analyzed with respect to the structure, vocabulary, and content of the message. Visual inspection of Figure 3 shows that the regression pattern of pointing in ASL is remarkably similar to the regression of intonation in English except that the regression of pointing begins at the onset of language and the regression of intonation begins at the onset of gestures.
This suggests that the underlying causes of regressions are universal violation of a relation between forms and functions but the linguistic context that precipitates the regression and the timing of the events may vary across languages such as ASL, English, or Italian.
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To support the hypothesis, the following literature review examines the functional developmental of gestures and intonation in the late prelinguistic and early linguistic periods. Intonation signals such intentions primarily by the direction of pitch change in utterance-final position.
The related term, pragmatics, is a branch of semiotics the study of signaling systems in which communication is defined in relation to the expectations and intentions of the participants with respect to what is being communicated. Collectively, PSAs constitute a small-scale but systematically functional mode of communication that could be considered the beginning of language acquisition e. As early as five weeks, infants communicate with caregivers by eye contact, smiling, cooing, and facial expression. To study the transition from pre-intentional to intentional communication and from nonverbal to verbal, interactions, Bates et al.
This is consistent with studies of hand preference Bates et al. This is provocative because the right-hand preference implies lateralization to the left hemisphere — the region of the brain that is specialized for language. Table 1 lists examples of speech acts in a developmental framework adapted from Clark All five examples illustrate referential and social intent.
Line 1 is an example of a protodeclarative. Lines 2 and 3 illustrate gestures with deictic words that some infants use in intermediate stages of the acquisition of deixis e. The next 2 lines 4 and 5 illustrate referential intent entirely by vocal means.
Line 5, the meaningful counterpart of line 4, illustrates referential intent by intonation and words. The comparison between intonation and gesture shows that the two systems differ markedly in form but they have the same pragmatic function. The cross-modal representation of pragmatics in one-year-olds has an exact counterpart in models of adult communication. The relation between forms and functions as hypothesized by the Gestural Complex is schematically depicted by the intersection of two circles in Figure 4.
The upper circle gestures overlaps with the lower circle intonation and the domain of overlap is pragmatics. Summarizing, intonation and gestures reflect a pattern in which the two forms are similar to one another by virtue of having the same pragmatic function. This violation of the preferred pattern explains the regression of intonation in English in the same way that a similar violation a form-function relation accounts for the regression of pointing gestures in ASL. Petitto explored the implications of her ASL study for the relation between verbal and nonverbal communication. She observed that the regression in ASL occurred at about 12 months — a milestone in which deaf infants began to produce their first single signs.
Petitto interpreted this co-occurrence as evidence that regressions signal a sharp break between prelinguistic and linguistic periods. However, visual inspection of the regression patterns in English and ASL Figure 3 suggests that regressions hence major developmental advances may occur at milestones other than first words or signs. In fact, the hypothesis of the present study is that the regression of intonation in English occurs within the prelinguistic period and before language. If this hypothesis is statistically supported, the results would challenge claims that the periods preceding and following language are autonomous.
The children were from predominately middle class homes and European backgrounds. The children and their families were recruited by a newspaper advertisement in the vicinity of Lafayette, Indiana. The participants met the following selection criteria: 1 between 8 and 16 months of age, 2 no unusual prenatal, sensory, or developmental concerns, 3 from English-speaking homes General American dialect , and 4 hearing within normal limits, defined as 20 dB HL or better at Hz, Hz, Hz, and Hz American National Standards Institute [ANSI], Thresholds at 30 dB or better at Hz were accepted if all other findings of visual reinforcement audiometry and bilateral tympanometry were within normal limits.
Spontaneous speech samples were audio- and video-taped in a university laboratory context. Each child interacted with his or her mother and an experimenter in an informally structured play setting. The hearing screening immediately followed the experimental play session. Monosyllables were selected because they constituted the only utterance type based on length and stress pattern that all 60 children produced at least once in falling and rising contours. The pitch range of each analyzed contour was expressed in semitones. For each child, the average pitch range of falling and rising contours meeting the selection criteria yielded the measure of intonation for that child the dependent or predicted variable.
The independent variables were based on categories assessed by the MacArthur Communicative Development Inventories CDI : Words and Gestures form, a parent report instrument that has been validated as a measure of communication development in young children Dale, Bates, Reznick et al; ; Fenson et al. Dale et al.
smylekraft.com/wp-content/rootsweb/3308-singles-muensterland-ahaus.php They found that parent report was comparable in accuracy and validity to intensive laboratory observations. The scoring categories of the CDI address comprehension phrases and words , vocabulary comprehended and produced , and nonverbal skills First Communicative Gestures, Games and Routines, Actions with Objects, Pretending to be a Parent, and Imitating other Adult Actions. Games and Routines refer to social action games like Peek-a-Boo.
Actions with Objects include skills like drinking from a cup, combing or brushing own hair, etc. The last two categories are devoted, respectively, to activities sometimes called symbolic play, pretend play, and tool use. The last three categories were combined in a single category called Later Gestures.
The following three phases of the posited regression trace the logic of the predicted inverse relation between intonation and early gestures, the heart of the statistical evidence.
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