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Infants and Children with Developmental Disabilities Emergent Literacy and Reach Out and Read. Monica H. Ultmann, M.D. Director, Center for Children with Special Needs and Division of Developmental Behavioral Pediatrics Floating Hospital for Children
Monica H. Ultmann, M.D.
Center for Children with Special Needs
Division of Developmental Behavioral Pediatrics
Floating Hospital for Children
at Tufts Medical Center
Clinical Professor of Pediatrics
Tufts University School of Medicine
“scaffolding” child development.
Involves all domains of child development:
Has experience with books
Gains fine motor skills for scribbling and drawing
Adult interactions and role modeling in literacy activities.
Availability of books and writing material for hands-on experiences.
Adults who value literacy interactions and the child’s reading efforts.
Limited interactive, sensory, or cognitive skills
Altered communicative intent
Physical barriers to exploration
Significant time devoted to physical care and therapies
Attachment issues and parent/child interactions
Caregiver insights, attitudes, and involvement
Misunderstanding or underestimating child’s abilities, thus limiting
their access and experience with books, toys, games, and writing
How a child’s hearing loss impacts the attainment of new developmental milestones depends on several important factors:
How a child’s vision loss impacts the attainment of new developmental milestones depends on several important factors:
Expect children with visual impairment to:
4 years, 10 months
Hydrocephalus with shunt placement
Small eyes, cataracts, congenital glaucoma, strabismus, nystagmus
Some functional vision in the right eye, wears glasses: reaching for objects, and recognizes some large objects, and colors.
Visual acuity approximately 20/1000 in the right eye
Mild developmental delays before shunt placement.
Received EI services with a low vision specialist and mobility expert
Now in a half day early childhood special education setting for her therapies (OT, S/L, and vision/mobility) and a half day regular pre-K setting.
Repeat your child's strings of sounds (e.g., "dadadada, bababa") and add to them.
Talk to your child during daily routine activities such as bath or mealtime and respond to his or her questions.
Talk to your child and name objects, people, and events in the everyday environment.
Draw your child's attention to print in everyday settings such as traffic signs, store logos, and food containers.
Introduce new vocabulary words during holidays and special activities such as outings to the zoo, the park, and so on.
Read picture and story books that focus on sounds, rhymes, and alliteration (words that start with the same sound, as found in Dr. Seuss books).
Reread your child's favorite book(s).
Focus your child's attention on books by pointing to words and pictures as you read.
Provide a variety of materials to encourage drawing and scribbling (e.g., crayons, paper, markers, finger paints).
Encourage your child to describe or tell a story about his/her drawing and write down the words.
A neurodevelopmental disorder most often evident by three years of age involving delays in the following areas:
Prevalence- Most recent CDC estimates (2009)- 1/100-150, 8 year olds
23 months old
Language regression and “withdrew into his own little world”
at 18-20 months.
Now babbles strings of consonant sounds; 4 words.
Improved eye contact with family; fleeting with strangers
Significant delays in imitation skills, no pointing
Improving attention for activities of interest, otherwise short,
in constant motion
Lines up and looks at toys at angles, spins.
CAT/CLAMS: Visual Motor DQ 90
Language DQ 58
Childhood Autism Rating Scale: 41 (severe)
Head circumference >97th percentile
Expressive: verbal (words, phrases, rhyming,
nonverbal (gestures, pointing)
Receptive: Understanding directions, the storyline in books.
Pragmatics: the social context of language
Atypical Language: echolalia (immediate and delayed)
tactile abilities and preferences
mouthing, tearing pages
factors similar to those identified in young, typically functioning children.
Of special note:
Incorporating shared reading time as an anticipated part
of the daily routine (“sensory diet”, bedtime)
Rhyming, alliteration, and singing
Books with a tactile component
Capturing the child’s attention
needs of the child with time for activities of mutual pleasure- shared
reading, story-telling, playing interactive games- at the
developmental level of the child promoting emergent language
and literacy and joint and individual attention.
with the child to encourage emergent literacy- reading in
standers, rhymes with stretching activities, positioning with
reading to encourage joint attention.
resources where they can learn how to engage their child in language,
literacy, and play activities at home.
needs (story boxes or tactile experience books for children with visual
Council on Children with Disabilities, Section on Developmental Behavioral Pediatrics, Bright Futures Steering Committee, Medical Home Initiatives for Children with Special Needs Project Advisory Committee: “Identifying Infants and Young Children with Developmental Disorders in the Medical Home: An Algorithm for Developmental Surveillance and Screening.”Pediatrics: 118: 405-420, 2006.
DA Koppenhaver, PP Coleman, SL Kalman, DE Yoder: “The Implications of Emergent Literacy Research for Children with Developmental Disabilities.”American Journal of Speech-Language Pathology: 1: 38-44, 1991.
SE Gurry and AS Larkin: “Literacy Learning Abilities of Children with Developmental Disabilities: What Do We Know?”Currents in Literacy: Volume 2 Number 1 (http://www.lesley.edu/academic_centers/hood/currents/v2n1/gurry_larkin.html)
JM Stratton: “Emergent Literacy: A New Perspective” (http://www.braille.org/papers/jvib0696/vb960305.html)
A Kurtz: “Literacy and Developmental Disabilities” (http://www.ccids.umaine.edu/resources/fcmaine/litdd.html)
FP Roth, DR Paul, A-M Pierotti: “Emergent Literacy: Early Reading and Writing Development:(http://www.asha.org/public/speech/emergent-literacy.htm)