Language Nutrition for Language Health How to talk to children with - - PDF document
Language Nutrition for Language Health How to talk to children with autism and developmental disabilities Heidi M Feldman MD PhD Stanford University 19th Annual Developmental Disabilities: An Update for Health Professionals March 5, 2020 iversity
Heidi M Feldman MD PhD Stanford University 19th Annual Developmental Disabilities: An Update for Health Professionals March 5, 2020 iversity
Classroom observations Clinical visits with families
By the conclusion of this talk, participants will be able to
and children with autism
in autism
children
1.
Nutrition is important for physical development
2.
Language nutrition is important for language development
3.
Language nutrition is important for language development in children with autism
Adapted from the Asmussen et al., 2019
1 year 2 years 3 years 4 years
Recognizes name
First gestures ~50 words in their productive vocabularies Word combinations, increasing grammar complexity, questions and negations ~500 words in their productive vocabularies Narrative skills Preliteracy skills
Birth
First words
n = 4867, English‐speaking Frank, Braginsky, Yurovsky, & Marchman, 2016
600 400 200
16 18 20 22 24 26 28 30
n = 108, English‐speaking Pan, Rowe, Singer, Snow, 2005
Maternal depression Activities in the home environment Family income School district Caregiver
Caregiver education
Maternal depression Caregiver
Activities in the home environment Family income School district Caregiver education
13 13
(upper, middle, lower, welfare)
15 16 16
18
19
8am 12pm 3pm 8pm
1200 800 400
20
21
8am 12pm 3pm 8pm
30 20 10
22 22
Child language Language Nutrition
n = 106 Pickles et al,. 2017
Typical Typical/Mild delay Marked delay
Type Prevention Define Example Primary Prevention Asymptomatic individual gets treatment and never gets the condition Vaccination Secondary prevention Individual at early stage gets treatment and develops mild form of condition Mammography Tertiary prevention Individual with condition gets treatment and has a better functional outcome Early intervention
Question 1: Compared to language nutrition of healthy and typically developing children, what is the language nutrition to children with autism (and intellectual disability/global developmental delay)? Question 2: What is the strength of the association between features
autism? Question 3: To what extent can intervention change/improve language nutrition and thereby improve child language outcomes?
Question 1: Compared to language nutrition of typically‐developing children, what is the language nutrition to children with ASD?
30 30
Quantity Adult Word Counts in the Home
no differences
Quality Number of different words
no differences
Wh-questions More questions Fewer questions Sentence complexity More complex Less complex Interaction Directiveness Less directive More directive Joint engagement
no differences
Novel word teaching
no differences
31 31
Quantity Adult Word Counts at Home
no differences
Quality Descriptions
no differences
Encouragement Less encouraging More encouraging Interaction Directiveness Less directive More directive Joint engagement
no differences
Question 1: Compared to language nutrition of typically‐developing children, what is the language nutrition to children with ID and children with ASD? Question 2: What is the strength of the association between features
n = 55, children with FXS Brady et al., 2014
Age (months) Predicted rate
words High Sustained Responsivity Average Responsivity Low Sustained Responsivity Language nutrition Direction with child language Sentence complexity Positive Commenting on child’s attention Positive Expansions of child language Positive Engagement Positive Redirecting child’s attention Negative Telegraphic speech Negative
Question 1: Compared to language nutrition of typically‐developing children, what is the language nutrition to children with ID and children with ASD? Question 2: What is the strength of the association between features
Question 3: To what extent can intervention change/improve language nutrition and thereby improve child language outcomes?
ID and ASD: Roberts & Kaiser, 2011
Vocabulary raw mean difference, 95% CI Hedge’s g mean difference, 95% CI
ASD: Nevill et al., 2018
1 225 112.5
make a contribution over the other interventions.
than all 3 components
features, structured language rather than communication, lack of functional outcomes
nutrition and that those changes cause improve outcomes
improvements in quantity and quality of language input and quality
communication; goal of secondary/tertiary prevention
language nutrition
Sustained over time Model language nutrition Explicit Personal Training Caregivers and Children Together
Reassessment Customized Feedback Individualized Assessment
sentences
42 42
e.g,. Rowe, 2012; Rowe & Goldin‐Meadow, 2008
Use lots of words Add gestures Present with warmth and responsiveness
43 43
e.g,. Rowe, 2012; Rowe & Goldin‐Meadow, 2008
Use a wide variety of different words Use grammatical sentences Ask questions Talk about the past and future
Use lots of words Add gestures Present with warmth and responsiveness