Question
I'm working with a 10-month old infant who suffered an anoxic incident due to near drowning. She has little cause and effect awareness, no volitional vocalizations, and delayed latch to nipples. Her sound localization skills are inconsistent, but emergin
Answer
You're talking about two sets of skills here that are fairly intertwined. Cause and effect is a cognitive skill. The act of latching to the nipple is a motor skill. Knowing that you should latch to the nipple is a cognitive skill. Localizing to sound, attending and vocalizing are motor responses to what I'm going to call "cognitive events." That is, something happens that should trigger a response-- the nipple is presented, a dog barks, mom show a toy. She has to cognitively process these events, then plan and execute a motor response. I cross checked my developmental norms. These skills should all be mastered by three months, so you're describing quite a set back for this baby. It sounds like she has more issues than even the best speech pathologist can address alone.
Before you can form any appropriate goals you need to consider her cognitive and motor skills separately. There are many tests out there that will help you with this. The Rosetti is the first to come to my mind. Then, consult with the OT and PT. You may be seeing decreased muscle strength or decreased muscle control. Or both. Also pull in a developmental psychologist or an early childhood specialist. They will help you evaluate the cognition. When you get right down to it, all communication is a motor response to a cognitive event, so these are relationships you will want to foster for future children as well. Right now, you don't know if her problems are cognitive or motor, so you really don't have the information to develop an effective intervention plan.
Once you know if the diminished responsivity is a motor, cognitive or combined issue you can set some appropriate goals. There are a number of resources available to help guide these goals. I like the program called "Every Move Counts." It was designed for children with dual sensory impairment, but it goes down to the very basic level of cause and effect and helps you consider limited motor capacity. Charity Rowland (an SLP out of the Pacific Northwest) has some lovely advice about forming goals for children at this level. I suspect the OT and the early childhood specialist will also have some great advice about working with children functioning at this very young level.
Dr. Cheryl B.Gerard is an ASHA certified and state licensed speech language pathologist with 27 years of experience. She is a professor of communication disorders at Minot State University teaching in the areas of cleft palate and AAC. She regularly serves on the local child disability teams and supervises in the communication disorders clinic.