Beruflich Dokumente
Kultur Dokumente
Communication and
Continuing
Nursing
Cognitive Disorders in
Education
Series
Infants and Toddlers
Frances Scheffler Jeanel Burgess
Donald Vogel Tara Conneally
Rachel Astern Kathy Salerno
Pediatric nurse practitioners (PNPs) have a primary role in providing parent-inclusive well-child physical
and developmental examinations. Although routine physical examinations are well defined, developmental
assessments, including communication and cognition, are not. Currently a number of developmental
screening tests exist; however, none have become established as the “gold standard” for the primary
health care professional as none are convenient or time-efficient to employ. In particular, there is a need
for a screening tool that PNPs can use to evaluate early development in their youngest patients. This
article offers a screening instrument capable of being easily completed through parent interview in a
routine integrated well-child exam. The screening includes questions that probe communication and
cognition in infants and toddlers, and identifies atypical behaviors that are considered by developmental
specialists to be “red flags” and precursors to later communication and cognitive disorders. A brief
description of the nature of communication and cognitive disorders in young children is included.
Screening for Communication The tool is intended to quickly screen PNP can suggest the parent seek a full
and Cognition in Infants and infants and toddlers ages 6 to 24 assessment by a speech-language
Toddlers (SCCIT) months for the most common behav- pathologist or other developmental
Presented here is the Screening for ioral precursors to later communica- specialist.
Communication and Cognition in tion and cognitive delays or disorders. Administration of the SCCIT. The
Infants and Toddlers (SCCIT), which Results can aid the PNP and parent in SCCIT is designed to be kept as a
is designed to be used by PNPs during determining if a more thorough evalu- cumulative record posted in each
any or all well-baby examinations. ation is warranted. In that case, the child’s medical file (see Figure 1). The
Is baby quiet DDST; Rossetti Babies are expected to gurgle, coo, babble, or Language delay, cognitive delay
too often? utter other noises besides crying. Babbling is an (e.g., autism), speech delay (e.g.,
important precursor for speech development. cerebral palsy)
Has baby had Usually includ- It is important to pay attention to the language Speech delay, language delay
3 or more ear ed in case histo- development of children with middle ear fluid
infections ry questions: because although it is not conclusive, some
over the last 6 not included in researchers have found a negative effect on lan-
months? language tests. guage development (Bess, 1985; Hooper,
Ashley, Roberts., Zeisel, & Poe, 2006).
Does baby Quick Screen Abnormal prosody has been identified as a fea- Autism, cerebral palsy, traumatic
have an for Voice ture of autism (Paul, 2005). Deficient respiration, brain injury, some developmental
unusual Evaluatione abnormal laryngeal function can result in voice syndromes
voice? disorders in some infants.
Are there con- DDST; REEL-3; Paul (1991) considers children to have a lan- Language delay, language disor-
cerns about Rossetti guage delay if they produce less than 10 intelli- der, cognitive delay, cerebral
how many gible words by age 18-23 months. Parents have palsy
words baby been found to reliably identify problems in their
says? young children (Stokes, 1997). Thal and Bates
(1988) consider a language delay present when
no two-word combinations are used by 18-24
months.
Does baby fin- MCHAT Repetitive/stereotypic behaviors involving Autism, hearing impairment
ger-fidget for hand/finger mannerisms are often found in chil-
long periods dren with autism (see Prater & Zylstra, 2002 for
of time? a review).
Does baby MCHAT; DDST; Children with autism have been found to dis- Hearing impairment, autism
look at you as REEL-3; Rossetti play less eye gaze directed to people (Wetherby,
you talk? Gaze Prizant, & Hutchinson, 1998). Joint attention is
toward an important for language development (Wetherby
object you et al., 1998).
point to?
Does baby REEL-3; Rossetti This represents evidence of the emergence of Late talkers, language disorders,
say 15 or early expressive language development. cognitive disorders, hearing
more words? impairment, cerebral palsy
Are baby’s REEL-3; Rossetti Mothers and other caregivers should under- Hearing impairment, speech dis-
words under- stand baby’s utterances. A parent’s or caregiv- orders (e.g., cerebral palsy), lan-
stood most of er’s difficulty in understanding baby suggests guage disorders
the time? atypical speech development.
Does baby REEL-3; Rossetti By 24 months of age, baby is expected to have Hearing impairment, speech
say 50 words at least 50-word vocabulary and combine words delays and disorders, language
or more and into short sentences. delays and disorders, cognitive
combine delays and disorders
words into
sentences?
a
DDST: The Denver Developmental Screening Test (Frankenburg & Dodds, 1975).
b
Rosetti: The Rosetti Infant-Toddler Language Scale (Rosetti, 1990).
c
MCHAT: The modified checklist for autism in toddlers (Robbins, Fein, Barton, & Green, 2001)
d
REEL-3: Receptive-Expressive Emergent Language Scale (3rd ed.) (Bzoch, League, & Brown, 2000).
e
Quick Screen for Voice Evaluation (Lee, Stemple, Glaze, & Kelchner, 2004).
18 questions are divided into two sec- considered appropriate when three or visits should be seen by a develop-
tions with indicators for six age levels more alerts (i.e., any combination of mental specialist (e.g., speech-lan-
(i.e., 6 months, 9 months, 12 months, three YES and/or NO responses) are guage pathologist) who could use
15 months, 18 months, 24 months). accrued during a single visit or over more thorough instruments to deter-
Part A includes 9 questions and is for- two or three visits. mine the child’s potential to develop
matted to reveal alerts if YES respons- Rationale for three alerts to indi- normally or atypically.
es are offered during any visit. Part B, cate a referral. The items on this test Item analysis of the SCCIT:
also contains 9 questions and is for- are the most compelling ‘red flags’ Validity and reliability. Each of the
matted to reveal alerts if NO respons- known as indicators for referrals. A questions included on the SCCIT is
es are offered during any visit. Referral child whose parent has expressed evidence-based as reported in pub-
to a speech-language pathologist or concerns that included three problems lished tests or research and was
other qualified specialist should be in one visit or one problem over three selected for its value as a proven indi-
Questions
1. Language may best be defined 5. Infants and toddlers can be 8. What similarities did Neal et al.
as: screened for delays and disorders identify between parent and staff
a. oral expression using consonants in communication and cognition concerns?
and vowels to form words. by questions that probe for: a. Parents and staff were positive
b. symbolic representation of a. the absence of typical behaviors about family centered care.
thoughts. at expected ages. b. Parents and staff were congruent
c. problem solving skills. b. the presence of atypical in concern about pain
d. fast-mapping skills. behaviors. assessment.
e. None of the above c. concerns raised by parents about c. Parents and staff were congruent
their child’s development. in concern over privacy.
2. Speech may best be defined as: d. All of the above d. None of the above
a. oral expression using consonants e. None of the above
and vowels to form words. 9. Which statement best describes
b. symbolic representation of 6. Which of the following is NOT the major differences between
thoughts. true of family centered care? parent and staff concerns identi-
c. facial expressions. a. Recognizing parents as fied in the study?
d. body gestures. information sources a. Families were overall more
e. None of the above b. Limiting parent involvement in negative than staff.
care b. Staff were overall more negative
3. Preschool-aged children who c. Respecting the diversity of than families.
have delays in communication: families c. Families were more concerned
a. may ignore or misunderstand d. Building on family strengths with the environment.
parental instructions. d. Staff were more concerned about
b. may show slow vocabulary 7. Which of the following best de- pain assessment.
growth compared to same-age scribes why family centered care
peers. is important? 10. What can hospitals do to improve
c. may be very shy. a. Families are responsible for family centered care?
d. may be overly aggressive (bite or hospital bills. a. Assess the current state of care
kick). b. Consumers demand family b. Involve staff and parents in plans
e. All of the above centered care. c. Educate staff involved in care
c. Families are a constant source of d. All of the above
4. Behaviors in infants and toddlers support.
that are considered precursors to d. None of the above
communication and cognitive
delays and disorders include:
a. ignoring loud sounds.
b. minimal babbling.
c. minimal interest in toys and
objects.
d. lack of joint attention.
e. All of the above
Plan to Attend!
24th Annual
Pediatric Nursing
Conference
June 26-28, 2008
Las Vegas Hilton Hotel
Las Vegas, NV