abc of imp - fcei 2012 of imp.pdf · the relationship between obligatory cortical auditory evoked...

The ABC of IMP: IMPlementing the

Infant Monitor of vocal Production . . FCEI 2012, Bad Ischl, Austria

Robyn Cantle Moore, PhD.

The Impetus

An obligation

� A family-centred approach imperative.� Parent knowledge & autonomy the focus.� Distinct strategies needed:

(a) to guide professionals(b) to support parent understanding &

expand skills.� Ensure benefits of earlier identification

do not dissipate.

Précis

Infant Monitor of vocal Production (IMP)Cantle Moore (2004, 2006, 2008).

� AAAAuthentic assessment procedure.

� BBBBasic (foundational) evaluation instrument.

� CCCCriterion referenced clinical tool.

AAAAuthentic assessment

� A systematic process of observation.

� An account of naturally occurring behaviours.

� An evaluation derived from the informed

opinion of a familiar observer / parent.

Advantages of authentic assessment

� More thorough & extensive sampling of

behaviour than ‘one-off’ / direct elicitation.

� Evaluates levels of functional ability.

� Consistent with family-centred practice and

upholds parent autonomy.

What? Why? When?

Pitfalls of authentic assessment

� Accuracy of parent perception is variable.

� “Informed opinion” can be reliable and valid if structured by procedure (Bagnato et al., 2008)

e.g., using face-to-face interview /probe question technique (Ching & Hill, 2007; Sparrow et al.,

1984; Robbins et al., 1991).

� Process guides parent to reflect and evaluate, thus enhancing informed opinion.

Expectations and challenges

� PROMPT INFORMATIONVisually literate

Experiential learners – “do something / discover”Feedback – “how’s it going? / Why?”

Make own decisions – “I think / believe..”(McQueen, 2010; Oblinger & Oblinger, 2005; Ryan, 2009).

Gen X Gen Y have different experience / different expectations.

The IMPreport

for parents

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BBBBasic evaluation instrument

(Kuhl, 2004).

PerceptionPerception

ProductionProduction

1 2 3 4 5 6 7 8 9 10 11 12

Universal speech production

Language specific speech production

First words

Non-speech sounds

Vowel-like sounds

‘Canonical babbling’

MONTHSMONTHS

Universal speech perception

Language specific speech perceptionPhonetic contrasts all languages

Language specific vowels

Language specific sound combinations

Native language consonants

Typical infant vocal development (Birth – 12 months)

Adapted from: Oller (2000) Nathani, Ertmer, & Stark (2006)

“Pre-Linguistic”

INTEGRATIVE BABBLE

LEVEL 5

Advanced Forms

“Pre-Lexical”

CANONICAL BABBLE

LEVEL 4

Basic Canonical Syllables “emergence is striking”

LEVEL 3

Expansion

LEVEL 2

Control of Phonation

EXPANSION

“Gooing”

PRIMITIVE

ARTICULATION

12

11

10

9

8

7

6

5

4

3

2

1

0

Months of Age

LEVEL 1

Reflexive

PHONATION

Vowel-like sounds

Non-speech sounds

‘Canonical babbling’

Language specific speech production

First words

Kuhl (2004)

Stages of infant vocal production

An educational strategy

� To engage parents in the nature and pace of

>12mth auditory-vocal development .

� To give value to parent observations of a

baby’s vocal ability.

� To encourage parents to descriptively report,

reflect on, and evaluate baby’s vocalizations.

A clinical tool

� To document hierarchical changes. (Nathani, Ertmer, & Stark, 2006; Oller, 2000).

� To demonstrate transition / / or lack of timely transition, to an Audition-Production Loop.

(Koopsman-Van Beinum et al., 2001; Mayne et al., 1998; O’Donoghue et al., 1999; Oller et al., 1985; Stoel-Gammon, 1989)

� To illustrate steady/accelerating/slowing rate of vocal progress >12mth HAge.

IMP examines the emergent relationship

SPEECH

AUDITORY PERCEPTION

RECEPTION

ORO-MOTOR ORGANIZATION

EXPRESSION

AUDITORYPROCESSINGCAPACITY

A diagnostic aid

� Impact of ANSD on auditory processing. (Rance & Barker , 2008; Sirimanna , 2010)

� Environmental inconsistency / opportunity. (Hart & Risley, 1995; Huttenlocher ,1998; Moeller et al., 2009)

� Oro-motor challenges to speech production. (Davis & Velleman, 2000; Evans Morris 1982; Maassen, 2002)

� Developmental – not related to hearing loss. (Riou et al., 2009)

CCCCriterion referenced clinical tool.

A typical IMP presentation takes 15 minutes:1 2 3 4 5 6 7 8 9 10 11 12BaselineBaseline

AGE IN MONTHS

“Pre-Linguistic”

INTEGRATIVE BABBLE

LEVEL 5

Advanced Forms

“Pre-Lexical”

CANONICAL BABBLE

LEVEL 4

Basic Canonical Syllables “emergence is striking”

LEVEL 3

Expansion

LEVEL 2

Control of Phonation

EXPANSION

“Gooing”

PRIMITIVE

ARTICULATION

12

11

10

9

8

7

6

5

4

3

2

1

0

Mont hs of Age

LEVEL 1

Reflexive

PHONATION

Adapted from: Oller (2000) Nathani, Ertmer & Stark (2006)

Stages: IMP Baseline

� Physical / “anatomical drivers”(Ingram, 1989; Oller, 2000; Vihman, 1996).

and maturation of the vocal system.

(Koopsman-van Beinum et al., 2001).

� Consistencies across languages (MacNeilage et al., 2000).

and in the presence of hearing loss. (Moore et al., 2007).

IMP: Question 3

Playful “cooing” (Ingram, 1989) and the emergence of

throaty consonantal sounds – [g] or [k] – (Roug, Landberg &

Lundberg, 1989) may give the impression of primitive syllables (Koopmans-van Beinum & Van der Stelt, 1986).

Video: Baseline parent interview

Integrity of the Audition-Production Loop

Beginnings of the Audition-Production Loop

BASELINEPhysiological Control

“Pre-Linguistic”

INTEGRATIVE BABBLE

LEVEL 5

Advanced Forms

“Pre-Lexical”

CANONICAL BABBLE

LEVEL 4

Basic Canonical Syllables “emergence is striking”

LEVEL 3

Expansion

LEVEL 2

Control of Phonation

EXPANSION

“Gooing”

PRIMITIVE

ARTICULATION

12

11

10

9 8 7 6 5 4 3 2 1 0

Months of Age

LEVEL 1

Reflexive

PHONATION

Adapted from: Oller (2000) Nathani, Ertmer & Stark (2006)

IMP Question 13

IMP Question 16

IMP Question 10

IMP Question 7

Transition to the Audition-Production Loop

Video: Transition stage, generic example

http://www.youtube.com/watch?v=ytWPh6oNthM&feature=related

IMP: Question 10

The first consonant + vowel (CV) combinations around 6

months of age may be a ‘by-product’ of motor practice (Oller,

2000). Early CV often accompany more frequent production of

labial consonants [b], [m] in sound play (Ingram,1989).

Video: Transition to A-P Loop interview

Integrity of the Audition-Production Loop

Beginnings of the Audition-Production Loop

BASELINEPhysiological Control

“Pre-Linguistic”

INTEGRATIVE BABBLE

LEVEL 5

Advanced Forms

“Pre-Lexical”

CANONICAL BABBLE

LEVEL 4

Basic Canonical Syllables “emergence is striking”

LEVEL 3

Expansion

LEVEL 2

Control of Phonation

EXPANSION

“Gooing”

PRIMITIVE

ARTICULATION

12

11

10

9 8 7 6 5 4 3 2 1 0

Months of Age

LEVEL 1

Reflexive

PHONATION

Adapted from: Oller (2000) Nathani, Ertmer & Stark (2006)

IMP Question 13

IMP Question 16

IMP Question 10

IMP Question 7

Integrity of the Audition-Production Loop

What do you hear?

LISTEN…

Can you describe it?

� Did the infant seem to ‘talk’ to himself

while playing alone? What did he do?

IMP: Question 13

Pre-lexical babble has rhythmic timing and is voluble (Oller et

al., 1985; Stoel-Gammon, 1989). Babble variety & complexity reflects

biomechanical “frame” theory (Davis et al., 2005).

Documenting CV babble variety

Interpreting the IMP

TYPICALTYPICAL

Interpreting sequential IMP results

Sequential scoring graphic: Case Study 53

“Sam”

1 1

13

Innate Transition to A-P Integrity of A-P Loop Loop

Sequential ranking graphic: Case Study 53

“Sam”

“Sam”

1 1

13

Sequential scoring graphic: Case Study 4

“Larry”

1 1

13 21

ANSD /Change in hearing?

Oro-motor challenges?

Other developmental concerns?

Environmental inconsistency?

Innate Transition to A-P Integrity of A-P Loop Loop

Sequential scoring graphic: Case Study 4

“Larry”

“Larry”

1 1

13 21

Scatter plot of scores: Normal Hearing

100

80

60

40

20

0

MONTHS HEARING AGE

3 4 5 6 7 8 9 10 11 12 13

IMP

%Q

.Ceiling &

Ranking

Vocal Proficiency

Ranking > 80%

Ranking 50-80%

Ranking < 50%

NORMAL HEARING (n=14)(R2 = 0.710)

Transition to A-P Integrity of A-PLoop Loop

Scatter plot of scores: Hearing Aided

100

80

60

40

20

0

MONTHS CHRONOLOGICAL AGE

3 4 5 6 7 8 9 10 11 12 13

IMP

%Q

.Ceiling &

Ranking

Vocal Proficiency

Ranking > 80%

Ranking 50-80%

Ranking < 50%

BILATERAL HEARING AIDED (n=41)(R2 = 0.207)

Transition to A-P Integrity of A-PLoop Loop

Scatter plot of scores: C-Implanted

100

80

60

40

20

0

MONTHS CHRONOLOGICAL AGE

3 4 5 6 7 8 9 10 11 12 13

IMP

%Q

.Ceiling &

Ranking Vocal Proficiency

Ranking > 80%

Ranking 50-80%

Ranking < 50%

COCHLEAR IMPLANTED (n=12)(R2 = 0.427)

Transition to A-P Integrity of A-PLoop Loop

Transition to A-P Loop

100

80

60

40

20

0

3 4 5 6 7 8 9 10 11 12

Normal hearing

Hearing aided

Cochlear implanted

MONTHS HEARING AGE

TREND OF SCORES AT EQUIVALENT HEARING AGE

Normal hearing (n=14) : Bilateral hearing aided (n=41) : Cochlear implanted (n=12)

Transition to A-P Integrity of A-PLoop Loop

IMP

%Q

.Ce

iling & R

ankin

g

Thankyou for listening

Online IMP training is free of charge, however you are required to register before you can access the training modules . We also ask that you share data collected using the IMP via the online form, available within the training website.

Go to http://www.ridbcrenwickcentre.com/imp to register. Once registered, you will receive an email containing your login credentials.

Questions?

Contact:

Dr Robyn Cantle MooreRIDBC Renwick Centrerobyn.moore@ridbc.org.au

RIDBC Renwick Centre for Research and Professional EducationAdministered by the Royal Institute for Deaf and Blind Childrenin affiliation with The University of Newcastle, Australiawww.ridbcrenwickcentre.com/imp/

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