Steven F. Warren

Newborn Screening for Developmental Disabilities: Reframing Presumptive Benefit

A fundamental tenet of newborn screening is that screening should lead to a proven benefit for the infant. The standard is usually construed as medical benefit that significantly improves a childs health. Screening for many conditions that cause developmental disabilities does not currently meet this standard. We argue for expanding concepts of presumptive benefit. Newborn screening provides access to early intervention programs that are shown to positively influence child development and support families. Consumers want information about their childrens health and their own reproductive risk, and they have a broader view than policymakers of what constitutes a treatable disorder. Newborn screening provides other societal benefits that, in the absence of data showing harm and with appropriate attention to ethical and legal issues, warrant consideration of an expansion of targets for newborn screening.

Facilitating Early Language Development with Milieu Intervention Procedures

The lexical, semantic, and pragmatic effects of milieu language intervention procedures implemented to teach basic lexicon and early relational semantic forms was investigated. The subjects were two young children with mild mental retardation in the early stages of productive language development. After a baseline period, the subjects received four training sessions weekly in a small group interactive play situation. Experimental control was demonstrated by within-subject multiple baseline designs across training targets. Generalization was measured along a variety of dimensions. Results indicated that one subject expanded his basic lexicon and began to generatively produce both action-object and agent-action combinations in nonobligatory conversational situations as requests for objects/actions and as declaratives with different adults. The other subject began to generatively produce both agent-action-object and adjective-noun combinations in nonobligatory conversational situations as requests and declaratives with different adults and in different settings. Both subjects began to respond correctly to probe questions for each target form. The results further support the use of milieu language training procedures to enhance the acquisition and generative use of basic lexicon and relational semantic forms. The results also suggest that systematic adult commenting and the childs spontaneous imitation may further facilitate the effects of milieu language teaching.

Facilitating Self-Initiated Proto-Declaratives and Proto-Imperatives in Prelinguistic Children with Developmental Disabilities

This study tested the effects of 2 prelinguistic communication interventions on generalized use of communication for two major pragmatic functions: proto-imperatives and proto-declaratives. Outcomes were measured immediately following intervention, and 6 months later. Fifty-eight children with developmental disabilities in the prelinguistic communication period of development were assigned randomly to either a treatment or contrast intervention. In families with high responsivity to childrens communication acts at the pre-treatment period, the prelinguistic milieu teaching (PMT) treatment facilitated post treatment increases in generalized use of self-initiated proto-imperatives and self-initiated proto-declaratives. In families with low responsivity to childrens communication acts, the responsive small group (RSG) comparison intervention facilitated post treatment increases in generalized use of self-initiated proto-imperatives. Weaker evidence at the 6-month follow-up suggests some effects of RSG on self-initiated proto-declaratives.

Facilitating Basic Vocabulary Acquisition with Milieu Teaching Procedures.

The generalized effects of milieu language intervention procedures on the acquisition and use of common nouns and action verbs was investigated using a multiple baseline design across subjects. The subjects were 5 young children with mild to borderline levels of mental retardation in the early one-word stage of productive language acquisition. After a baseline period, the subjects received three or four small group training sessions weekly. Milieu instruction was embedded in ongoing conversation between the trainer and the target child about the play activity at hand. Generalization was measured along a variety of dimensions. Results indicated that milieu training had a clear facilitative effect on the acquisition and generalized use of common nouns and verbs by 4 of the 5 subjects.

Determining Spoken Language Prognosis in Children With Developmental Disabilities

The purpose of this study is to predict which of 58 children (mean age=22 months) with developmental disabilities in the prelinguistic period of development would begin speaking 12 months after initial assessment. None of the children had severe or profound motor impairments. During the initial assessment period, children participated in a structured and unstructured communication sample with a project staff member. Also, at the time they entered the study, a mother-child interaction session was conducted to measure maternal responses to child communication acts, and mothers filled out a vocabulary checklist. Twelve months later, the structured and unstructured language samples were repeated. We labeled children with fewer than 5 different nonimitative spoken words in either communication samples as prefunctional speakers and those with 5 or more words in either sample as functional speakers. The results indicate that functional speakers scored significantly higher than prefunctional speakers on 5 var...

AN EXPERIMENTAL ANALYSIS OF A NEUROBEHAVIORAL MOTOR INTERVENTION

This study reports the effects of a neurobehavioral intervention approach on the motor skills of four children with cerebral palsy between 21 and 34 months of age. The intervention is based on the merging of neuromotor and behavioral approaches. The behavioral approach, using principles of ‘how to teach’, addressed motivational issues and allowed for precise definitions of expected outcomes which assisted in measuring acquisition and generalization of behaviors. The neuromotor approach provided ‘what to teach’ by focusing the intervention on underlying movement components (e.g., trunk rotation, weight bearing) rather than discrete milestone skills. The impact of the approach was assessed using a multiple‐baseline design replicated three times. The children demonstrated the movement component by using it to perform both a treated exemplar skill (i.e. a motor skill requiring the movement component for execution) and an untreated exemplar skill.

Stability of Maternal Reports of Lexical Comprehension in Very Young Children With Developmental Delays

The MacArthur Communication Development Inventory: Infant Scale (CDI/I) is among the strongest measures of early lexical comprehension (Fenson et al., 1994). The present study examined the stability of CDI/I results over a 2-week period in a sample of 17 mothers of children with developmental delays. Test-retest stability was computed for total number of words understood (i.e., summary-level stability) and for word-by-word agreement (i.e., item-by-item stability) across a 2-week interval. Results indicated that although there was excellent summary level stability, there was, in many cases, inadequate item-by-item agreement between the two testing occasions. The degree to which mothers were consistent on an item-by-item basis varied as a function of the types of words they were reporting on, the occupational status and educational level of the mothers, and the extent to which mothers confidently interpret nonlinguistic child behavior. These data illustrate that the CDI/I can be used to identify overall voc...

The Social Basis of Language and Communication in Severely Handicapped Preschoolers

This paper proposes that primary social relationships between child and caregiver are a critical context for language learning. Language is viewed as one behavior on a continuum of communication behaviors, all of which stem from early social interactions. Current assumptions about the nature of language and the processes involved in language learning are discussed. Particular attention is given to the effects of severe handicaps on the social processes underlying language acquisition. Recent studies of mother-child interaction and incidental language teaching are cited in support of this viewpoint. A model for communication intervention based on progressive teaching exchanges is proposed.

Enhancing Engagement in Early Language Teaching

Attentional engagement plays a fundamental role in language learning. When the rate and quality of engagement are high, other processes critical for language development function at an optimal level. Thus, children who have attentional disorders and delays such as those associated with mental retardation and some learning disabilities will typically have trouble acquiring language. Fortunately, there are certain features of the language learning process that can be used purposely to enhance engagement. Among the most important elements of fostering language development are the adults ability to follow the childs attentionallead and the provision of a degree of moderate novelty in the language learning context.

Predicting Children's Response to Prelinguistic Communication Intervention

The present study tested the hypothesis that pretreatment level of play would predict the rate of increase in prelinguistic, intentional requesting during prelinguistic communication intervention. The participants were 8 children with developmental disabilities. A negative relation was found between the amount of person-only engagement observed during baseline sessions and later rate of change in the number of prelinguistic, intentional requests children made to interventionists during the intervention period. In contrast, a positive relation was found between the amount of transitional or symbolic play observed during baseline sessions and the rate of increase in the number of prelinguistic, intentional requests children directed to interventionists. The implications of the results for individualizing interventions and for predicting childrens responses to prelinguistic communication intervention are discussed.