Signature Assignment - Mejia-2

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1 Signature Assignment Christina A. Mejia SLP 5115: Early Language Disorders University of St. Augustine for Health Sciences Dr. Ward August 9, 2023
2 Client: Varie US Clients (VS) DOB: 7/4/2017 Parents: George & Martha Clients Clinician: Christina Mejia CASE HISTORY Health/Physical Development: VS was born during the end of the second trimester at 26 weeks. Before he was discharged home, he stayed in the NICU for three months. He required feedings through G-tube and needed to be placed on oxygen. During his NICU stay, Theo was diagnosed with bronchopulmonary dysplasia, gastrostomy dependence, GERD and faced challenges with feeding. As of 10/27/2015, he showed no signs of difficulty with hearing or vision. He has shown difficulties with eye tracking, feeding and communication. Cognitive Development: VS’ screening results were a Cognitive Standard Score of 84, indicating his cognitive development abilities are below average range. There are concerns with some of his cognitive milestones not being met. He shows challenges with the ability to focus on objects within his environments. Communication: VS received a total language score of 59. His expressive language skills consist of canonical syllables with either no or little syllable repetition. He is able to turn-take with sound-making, but is not able to imitate the following sounds /g, k, m, b/. He shows variation with expressive language through laughing, making raspberries and gurgles. Self-Care Adaptive Skills: VS has refused feeding accompanied with oral preparatory delays as a result of his feeding aversion. His caloric intake is considerably low and a concern. During the month of March 2015, he has not made the transition from smooth to lumpy foods as he gags and chokes. Gross/Fine Motor Development: VS received placement in the average range with his Standard Score of 87. He exhibited the ability to move his head side to side but showed difficulties with eye tracking. His evaluation of motor development resulted in a score of 83. His strength and balance take significant effort, and he tries to move throughout his home. As of March 2015, VS shows no concern with crawling, using a pull method to stand, but he cannot successfully cruise. He exhibits behaviors that are motor compensation behaviors and does not have all of his foundational skills.
3 Socioemotional Development: His expressive development is a strength where he laughs and smiles. His Social-Emotional Standard Score of 103 indicates he is within the average range. As of March, 2015, VS produces sounds and attempts eye contact. Caregiver’s Concerns: Finances have been indicated to be a concern due to the reduction of hours the father is receiving. This has extended issues to lack of transportation, the need to feed VS and their other children and having hospital bills to pay. They have concerns with his communication development and being able to share these issues with his grandparents. They are concerned with receiving resources for infant/toddler stimulation groups. Questions to ask: 1. Has VS received a comprehensive eye exam? 2. Does VS alternate his gaze between something he wants or showing? 3. Does VS respond to a stimulus such as a sound, and does he make eye contact in the direction of the sound? SERVICES Functional Communication Functional communication is how children use either symbols or actions to express their basic needs and wants. Before children can use language to communicate, they use presymbolic communication which includes bodily movements, facial expressions, and gestures to interact in meaningful ways (Owens, 116). The first example of functional communication was in VS’- Typical Language Development Simucase. He was expressing his wants by raising his pitch while babbling “ba da da.” He also communicated through the form of using body language such as waving his arm up and down and briefly made eye contact towards the end of the video. The second example of functional communication was in VS’-Typical Language Development: Variegated Babbling Simucase. VS maintained eye contact with the caregiver Martha while expressing himself when he babbled “la da da.” Family Centered Family Centered Intervention places an emphasis on the role of the family’s involvement in their child’s development. A key component of family-centered intervention is the “family’s daily routines,” that can be done with both the parent and child such as feeding (Owens, 64). This type of intervention takes place in “natural learning environments,” such as the home where routines are completed on a daily basis (Owens, 64). The first example of functional communication was in VS’- Typical Language Development Simucase. He was expressing his wants by raising his pitch while babbling “ba da da.” He also communicated through the form of using body language such as waving his arm up and down and briefly made eye contact towards the end of the video. The second example of
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4 functional communication was in VS’-Typical Language Development: Variegated Babbling Simucase. VS maintained eye contact with his caregiver Martha while expressing himself when he babbled “la da da.” Generalization Generalization is when a child is able to learn a specific skill during a therapy session, and is then capable of applying the learned skill in a different environment. The purpose behind generalization is to help the child transfer a skill beyond a therapy setting and apply the learned skill in real-life situations. To simplify the definition, it means to carryover (Owens, 64). The first example of generalization was in VS’- Typical Language Development: 1 Step Directions simucase. His caregiver Martha asked Riley to close the drawer and repeated the direction until the child completed the task. By reciting “close the drawer,” this can be carried over into a different scenario such as closing the drawer’s in school, or closing clothing drawers at home. Another example of generalization that could be used as a way to practice these phrases in different settings such as at home, day care, or in school would be a two word phrase such as “All done.” This could be used when they are done eating, putting on their shoes or putting away toys. To keep your child motivated during this type of practice, you can use objects such as “toys, food, or everyday items” that are in your child’s interest to keep their engagement (Owens, 64). This example was seen in VS’-Typical Language Development: 1 Step Directions simucase when Martha waited until VS was done putting away the tupperware and closed the drawer and said “All done,” before positively praising VS. ASSESSMENT Speech-language screeners, evaluations, and assessments There is a differentiation between a speech-language screener, evaluation, and assessment. A screener is the initial step that clinicians take to determine if a child needs to be further evaluated and referred for intervention. A screener serves the purpose of detecting potential communication delays or disorders and/or deficits in “feeding and swallowing development” (Owens, 143). A screener is used to build connections between families and an SLP. They are informative sessions that can be in the form of a standardized test, or a report completed by a parent. There is an emphasis on the screening measures being “valid, reliable, sensitive, specific and representative” (Owens, 144). A screening includes the obtaining of information from parents and/or teachers who can speak on the child’s language skills, a proper hearing screening, parent questionnaire, play-based observation and an “informal language sample” (ASHA). If a child passes their screening, parents will be informed that it is a “general estimate of the child’s performance” at that time, and that there should be progress monitoring with the suggestion of further evaluation if concerns continue or new concerns come up (Owens, 144). If a child does not pass their screening, they will receive an evaluation. An evaluation is done to determine if the child does have a disability or delay, and their eligibility for early intervention services ( Küpper, 5). It is a comprehensive assessment that provides details regarding a child’s strengths and weaknesses in their overall communication development. An
5 assessment is defined as the “ongoing process” of determining a child’s needs as well as keeping in mind the primary concerns of the family and the extent of early intervention services (Owens, 450). Rather than a test-based assessment, SLP’s obtain “early communication data” through an assessment that features a play component (Owens, 99). An assessment is “not used to highlight what is wrong,” but it is used as a tool that defines the level of support the child needs (Owens, 98). The role of parents and caregivers in assessment Parents and caregivers play an important role and contribute to the progression of their child's communicative development. They spend the most time with their child, which makes them a valuable resource who provides reliable information. Parents and caregivers understand their child the best and can provide insight into the “conditions of their child’s interactions” (Owens, 101). The benefits of family involvement in the assessment process include an increase in understanding of their child’s strengths and weaknesses and the potential shortening of an assessment because of thorough information that is provided. By implementing a parental role throughout an assessment, it makes them feel like an equal contributor to the process and may increase the likelihood of following the suggested recommendations. Importance of knowing developmental milestones when providing a screener, assessment, and/or evaluation. It is crucial for a speech-language pathologist to know developmental milestones when providing a screener, assessment, and/or evaluation. ASHA states that milestone checklists are just one component of what is “recommended for developmental surveillance during early childhood” (ASHA). Having a clear understanding that developmental milestones are an evidence-based reference point helps the clinician to compare the client’s behaviors and performance to others of the same age. It helps identify any signs of delays and/or speech and language difficulties. Knowing age-appropriate milestones helps determine if further evaluation is needed. If it is needed, clinicians will carefully select appropriate and individualized methods and assessments to determine services (ASHA). An SLP is also an educator who communicates their findings in a parent-friendly manner. SLPs show they are the trusted professionals when informing families on their child’s abilities in comparison to age-appropriate norms. It is used to help both professionals and families make informed decisions that are in the child’s best interest (Owens, 97). Importance of differential diagnosis and knowledge of developmental milestones when assessing for speech-language abilities As children learn to communicate, they transition from non-symbolic to symbolic behaviors. SLP’s should be able to identify age-appropriate means of communication. For instance, children use gestures to communicate their wants and needs. Our textbook indicates
6 that “gestures are used as a bootstrap for spoken language” (Owens, 130). Children incorporate recognitory gestures around 12 months , and gesture-word combinations around 16 months (Owens, 130). This is helpful to know while working with a child who is not gesturing because it could provide insight into the child’s cognitive abilities and their gestural development. Knowing symbolic behaviors and developmental norms can aid an SLP in differentiating “normal variations in language development from language delay or language disorder” (ASHA). It is important to make an accurate diagnosis because each case is not “one size fits all.” As an SLP, it is our job to recognize developmental milestones to make appropriate classifications of the speech sound disorder or delay prior to creating effective intervention plans. Two parent-questionnaires which will be used in this diagnostic: The CSBS DP Infant-Toddler Checklist is a parent report completed through direct interaction with the child (Carey). It is 1 of 3 components of a standardized measure that determines “communicative competence of infants and toddlers” (Brookes). The purpose of the questionnaire is to detect if there are any signs of delays in “social communication, expressive speech/language, and symbolic functioning” in children who are 6-24 months (Brookes). The checklist measures the following language predictors: emotion and use of eye gaze, communication, sounds, words, objects and understanding of words. There are approximately 24 questions and the responses are scored as 0 points for Not Yet, 1 point for Sometimes, and 2 points for Often. The seven individual cluster scores range in total possible points from 6 to 11 points. The responses should be recorded when a child is between 6 and 24 months, and this will determine if a referral for an evaluation is needed. Check all of the choices that best describe the child's behavior, and if you feel unsure about a response, select the closest response. Children at this age are not expected to exhibit all of the behaviors on the checklist. The second questionnaire used is the MacArthur-Bates Communicative Development Inventories (CDI) - Third Edition. It is an updated parent-informant measure that evaluates developmental language and communication in children who are 8-37 months. The purpose of the parent-completed assessment is to obtain data on their child’s language milestones (Brookes). The reports are used to help SLPs identify language delay and implement an effective therapy plan. There are three forms including: Words and Gestures form for 8-18 months. This is used to document the child’s communicative/symbolic gestures and is used as a measure of emerging receptive and expressive vocabulary (Brookes). The second form is Words and Sentences for 16-30 months. It is used to measure expressive language. Lastly CDI-III is for 30-37 months, and is used to measure expressive vocabulary and grammar (Brookes). Information is gathered through the infant form which is an 89-word vocabulary list. There are two components, 1) comprehension and 2) production. The toddler form consists of a 100-word vocabulary list. The parent is to record if a child can combine words and the response options are “Not Yet,” “Sometimes,” and “Often.” Caregivers are to check off phrases, gestures and words that their child understands. The first section consists of 3 "yes or no" questions, the second section consists of 12 questions that have the options of not yet, sometimes, and often. The final section consists of a vocabulary checklist where you will mark whether a child understands, understands and says, or does not understand or say.
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7 Two assessments which will be used in this diagnostic: The first assessment that will be used is the Peabody Picture Vocabulary Test - 5th Edition. It is used to test receptive vocabulary skills in conjunction with the expressive vocabulary test. It measures English vocabulary word knowledge, and requires the client to choose one of four pictures corresponding to the word that was presented verbally by the clinician. The second assessment that will be used is the Preschool Language Scale (PLS-5). It is used to determine if a child has either a receptive or expressive language delay or disorder. Auditory Comprehension looks at: gesture, play, semantics, language structure, integrative language, emergent literacy, following directions and pointing to pictures. Expressive Communication looks at: vocal development, social communication, semantics, language structure, integrative language, emergent literacy, naming objects and grammatical markers. Explain procedures used to analyze a language sample and the results of the LSA. SUGAR is a method that speech-pathologists use to analyze a language sample. It is an efficient tool used to identify intervention targets. The procedures include taking note of the client’s total word count. The next step is dividing the average length of their sentences by the total number of utterances. The next procedure is calculating the number of words per sentence. The last procedure is calculating the total number of clauses per sentence. Results 1. VS’ TNW was 182. The mean for children ages 4;0-4;5 is 261.4. Since his TNW was 182 and one standard deviation below the mean equates to 185.98, this places the client more than 1 standard deviation below the mean (Sugar Language, n.d.). 2. VS’ MLU was 3.8. The mean for children ages 4;0-4;5 is 5.79. Since his MLU was 3.8 and one standard deviation below the mean equates to 4.13, this places the client more than 1 standard deviation below the mean (Sugar Language, n.d.). 3. VS’ WPS was 4.05. The mean for children ages 4;0-4;5 is 6.48. Since his WPS was 4.05 and one standard deviation below the mean equates to 5.07, this places the client more than 1 standard deviation below the mean (Sugar Language, n.d) 4. VS’ CPS was 1.05. The mean for children ages 4;0-4;5 is 1.19. Since his CPS was 1.05 and one standard deviation below the mean equates to 1.04, this places the client 1 standard deviation below the mean (Sugar Language, n.d.) The sub-analysis shows that VS omits “articles” such as the and a. Out of 50 utterances, the client shows use of articles only twice throughout the language sample when the mean target is 14.5 (Sugar Language, n.d.). The mean target for possessive pronouns is 7.24, and the client used two. The mean target for adjectives is 6.11, and the client did not produce any. The mean target for descriptors is 4.65, and the client produced one. Both infinitives and progressive -ing were close to their mean targets. The mean target for infinitives is 4.72, and the client produced four. The mean target for progressive -ing is 2.31, and the client produced two. The mean target for pronouns is 32, and the client surpassed this with 48.
8 PRESYMBOLIC INTERVENTION Provide an analysis of the observed presymbolic early communication intervention 1. Analyze the child’s progression of the following: a. Vocal imitation and Shaping (e.g., Owens [2018] p. 215-217); In VS’ Early Intervention video, the clinician promotes vocal imitation when she models “sound-making during play” (Owens, 214). The start of the video begins with the clinician using easy-to-say consonant-vowel combinations such as “in” and “down.” After observing and rewatching the video, you can hear the clinician intentionally enunciate the word “down.” Once the clinician clearly states “down,” VS drops a toy in the yellow bucket and mimics her vocalization. He repeats the same vocal imitation when the clinician states “in” as he puts an object in the bucket, and shortly after at 19 seconds of the video, VS vocalizes “in.” This can also be seen in VS’ second video, Early Intervention Activity 2, the clinician states “in” as VS puts the blocks into the toy giraffe’s neck. After two models by the clinician, VS inserts another block and states “in” on his own. An example of shaping can be seen in VS’ Early Intervention video at the 58 seconds mark when VS vocalizes twice what sounds like “in”, and the clinician reinforces him by saying “good job.” b. Joint Attention Intervention (e.g., Owens [2018] p. 224-226); Joint attention is referred to as an engaged activity where both “partners are observing and interacting with the same object or event” (Owens, 222). This can be seen in VS’ Early Intervention Video, when the clinician asks VS if he’s ready as she raises the object in the air as his eyes follow the toy. She then drops the bucket and says “down.” Joint attention is embedded throughout the activity, and when she models the act of dropping the toy, VS takes his turn to raise an object in the air as the clinician is narrating the action. Although there is not an object that could be seen in VS’ Typical Language Development: Variegated Babbling video, the short clip shows the beginning stage of transferring eye gaze from a person to an object. The child’s attention was focused on the person behind the camera while saying “lalala,” as they smiled and maintained eye contact throughout the interaction. c. Motor Imitation Intervention (e.g., Owens [2018] p. 227-228). Motor imitation intervention can be seen in VS’ Early Intervention Video Activity 2, when VS becomes upset and knocks over the toys. He pairs vocalization with the action of putting an object into the giraffe's neck. 30 seconds into the video, the clinician states “put away,” as she grabs the square toy and puts it away, then VS grabs a toy and he states “in.” The same style of intervention was used in his first video when the clinician was using the different shapes and yellow bucket as she would drop an object into a bucket as a way to get him to imitate her action.
9 2 measurable intervention goals for pre-symbolic interaction ASHA indicates that between the age of 7 months to 1 year, the child should point to objects. The first goal is: VS will point to make a choice in 3/7 trials, during structured play time when two toy objects are held in front of him with verbal prompts in the next 4 sessions across 2 months. ASHA states that a child ages 7 months to 1 year should babble longer strings of sounds.VS’ second goal is: VS will produce long babbling strings of sounds including consonant-vowel combinations in 4/10 trials during vocal play sessions using toys that capture his attention over the course of 4 sessions across 2 months. SYMBOLIC INTERVENTION 1. EVALUATE the following: a. Types of language the client is using (for both clients) i. In VS’ simucase videos, you can observe he is at the illocutionary stage of communication. VS uses vocalizations, eye gaze and gestures. In VS’ Typical Language Development: Jargon simucase, VS maintains eye contact on a desired object as she swings it around in front of the adult. In Chapter 5, Singleton mentions how children around 8-10 months begin using deictic gestures and they show objects “to engage the adult partner in an interaction” (Singleton, 98). We can see that VS is at their appropriate gestural development stage, and this will contribute to their language development. In VS’ 1 Step Directions and Early Pretend Play and Following Directions he produces vocalizations after being praised for following directions. ii. In VS’ simucase videos, we can see his communication progression over the course of the three videos. Specifically in Object Identification where he is now 8-months old, once the adult asks to be given glasses, he produces vocalizations. In Early Intervention: Reading Aloud and Promoting Pre-Literacy, we can now see his progression to being able to produce utterances that coincide with the appropriate response his mother was looking for. Martha read “You need to take a —” and VS vocalized “bah” for “bath.” b. Types of language facilitation strategies used by the SLP (for both clients) i. In VS’ 1 Step Directions simucase, Martha facilitated communication by giving him instructions to follow such as “put the tupperware away” and when VS completed the task, he was instructed to “close the drawer.” When VS does not close the drawer after the first instruction to do so, Martha says “all done” and “close the drawer” once more before praising him at all. She does not say “good job” when VS first puts the tupperware away and claps, she extends the opportunity to continue following directions when she asks him to “close the drawer.” In Early Pretend Play
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10 and Following Directions the SLP facilitated language through directed play. The SLP asks VS to “give the lion a bite,” and this presents an opportunity for VS to babble as well as follow the SLP’s directions. ii. In VS’ Early Intervention: Reading Aloud and Promoting Pre-Literacy, Martha uses reading to facilitate language. She provides ample time for VS to complete her sentences. An example of this is when she says “It’s time to go night night” and VS responds “Na na.” As his mother is reading, she provides a pause for him to respond and throughout the video, VS produces utterances whether they are inaudible vocalizations or can be understood such as “boo” for book.” WRITE 2 measurable intervention goals for symbolic interaction, one for each child 1. VS will follow 1-step directions with no verbal prompts in 6/10 trials over 4 consecutive sessions. 2. VS will use appropriate vocalizations paired with gestures to request an object in 4/6 trials over 3 consecutive sessions. RECOMMENDATIONS Provide recommendations to caregivers to facilitate language and communication. The following recommendations are to ensure VS reaches his communication goals of pairing actions with vocal imitations. One way this could be implemented at home is using his favorite toys whether that be through cars, animal toys or play-sets. If you are using his grocery play-set, as he picks up an object, you can state what the object is as he grabs it. For instance, if he picks up a juice box, you can say “juice.” This scaffold of modeling the appropriate name for the object is a learning opportunity for him to identify an object correctly. The second way you can scaffold is through providing extended wait time. The third scaffold that could be used is the nonverbal cue of gesturing, or pointing. You can implement both extended wait time and pointing during an activity of using pictures. You can hold up a picture, point to it, and make eye contact with the child. Ways to build vocal imitations during actions is through the incorporation of play and verbal play. You can use an activity such as “peek-a-boo,” so they can imitate facial expressions such as covering their eyes. To help develop language skills, you can use mouth movements paired with sound effects so VS can learn to imitate different sounds. Another activity could be through using toy animals, and you can grab one stuffed animal and make the animal noise. If VS’ favorite toy is playing with cars, you can grab the object and match it with the sound it makes such as “vroom,” and VS may replicate the sound while playing. To extend an interaction, If VS picks up the juice, imitates what you said by saying “juice,” you can extend it by saying “that is juice.” When VS is playing with cars, and he may say “car go,” you can say “the car is going.” If VS grabs a toy doll and either makes a crying sound or says “baby cry,” you can say “the baby is crying.” To build on VS’ pre-literacy skills, books of interest can be used. Ways you can s caffold an interaction can be beginning with 1) reading aloud with enthusiasm, where you can implement animated voices, facial expressions and gestures to create an engaging activity. 2) As you read, you can point to objects or pictures so your child can connect words to an image to help them further develop their vocabulary. 3)Another scaffold you can use is when Ivan picks
11 up an object such as a toy car, you can say “car.” This creates an opportunity for him to learn the name of the object by you labeling the object correctly. Aside from reading, ways you can create interactions are through daily joint activities. You can describe what you are doing such as 1) brushing your teeth, 2) when you are both getting dressed or 3) as you eat at the dinner table. You can also incorporate object identification here to teach VS to associate words with actions and/or objects. To further promote language development, if you are cooking while VS is watching, you can state “pouring milk” or “cutting strawberries. ”To continue working on extending his utterances, when Ivan says “boo” for “book,” you can extend it by saying “that is a book.” If he knows when it is time for bed, and you hear him murmur “na na” for “night night,” you can say, “It is time to go night night.”
12 References: American Speech-Language-Hearing Association. (n.d.-a). Frequently asked questions: CDC and AAP Developmental Milestones updates . American Speech-Language-Hearing Association. https://www.asha.org/practice/Frequently-Asked-Questions-CDC-and-AAP-Development al-Milestones/#:~:text=ASHA%20understands%20that%20families%20want,are%20pres ented%20as%20a%20range. American Speech-Language-Hearing Association. (n.d.). Late language emergence . American Speech-Language-Hearing Association. https://www.asha.org/practice-portal/clinical-topics/late-language-emergence/#collapse_5 Canivez, G. L., & Graham Laughlin, T. (2021). Peabody Picture Vocabulary Test, Fifth Edition. The Twenty-First Mental Measurements Yearbook . Carey, K. T. (2005). Communication and Symbolic Behavior Scales Developmental Profile: First Normed Edition. The Sixteenth Mental Measurements Yearbook. CSBS DP infant-toddler checklist - autism alert. (n.d.). https://www.autismalert.org/uploads/PDF/SCREENING--DEVELOPMENTAL%20DEL AY%20&%20AUTISM--CCBS%20DP%20Infant-Toddler%20Checklist.pdf CSBS DPTM. Brookes Publishing Co. (2018, August 14). https://brookespublishing.com/product/csbs-dp/
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13 CSBS DPTM. Brookes Publishing Co. (2018, August 14). https://products.brookespublishing.com/MacArthur-Bates-Communicative-Development- Inventories-CDI-Third-Edition-Print-Set-P1469.aspx Crais, E. R. (2011). Testing and Beyond: Strategies and Tools for Evaluating and Assessing Infants and Toddlers. Language, Speech & Hearing Services in Schools, 42(3), 341–364. https://doi.org/0161-1461(2010/09-0061) Hutchins, T. L., & Suen, H. K. (2014). MacArthur-Bates Communicative Development Inventories, Second Edition. The Nineteenth Mental Measurements Yearbook. Jr, O. R. E. (2017). Early language intervention . Pearson. Küpper, L. (Ed.). (2014). Screening, evaluation, and assessment procedures (Module 4). Building the legacy for our youngest children with disabilities: A training curriculum on Part C of IDEA 2004 . Washington, DC: National Dissemination Center for Children with Disabilities. MacArthur-Bates Communicative Development Inventories (CDI), Third Edition Print Set. Shop Brookes Publishing. (n.d.). https://products.brookespublishing.com/MacArthur-Bates-Communicative-Development- Inventories-CDI-Third-Edition-Print-Set-P1469.aspx?gclid=CjwKCAjwp6CkBhB_EiwA lQVyxbmvwlgiEw4QEAuXqvytPk68zWNOSBUBgxnaYQvwdiwdPClOM2XeXRoCXJ oQAvD_BwE
14 McKnight, T., & Shapley, K. L. (2014). Preschool Language Scales, Fifth Edition. The Nineteenth Mental Measurements Yearbook. Owens, R. E. (2018). Early language intervention for infants, toddlers, and preschoolers . Pearson. Peabody Picture Vocabulary Test: Fifth Edition. PPVT-5 Peabody Picture Vocabulary Test Fifth Edition. (n.d.). https://www.pearsonassessments.com/store/usassessments/en/Store/Professional-Assessm ents/Academic-Learning/Brief/Peabody-Picture-Vocabulary-Test-%7C-Fifth-Edition/p/10 0001984.html Preschool language scales: Fifth edition. PLS-5 Preschool Language Scales 5th Edition. (n.d.). https://www.pearsonassessments.com/store/usassessments/en/Store/Professional-Assessm ents/Speech-%26-Language/Preschool-Language-Scales-%7C-Fifth-Edition/p/10000023 3.html?tab=overview Singleton, N. C., & Shulman, B. B. (2020). Language development: Foundations, processes, and clinical applications . Jones & Bartlett Learning. Sugar language . SUGAR Language. (n.d.). https://www.sugarlanguage.org/