Introduction to Communication Disorders: A Lifespan Evidence-Based Perspective 5th Edition

CHAPTER 4: Childhood Language Impairments Introduction to Communication Disorders: A Lifespan Evidence-Based Perspective 5th Edition Owens, Farinella, & Metz Developed by Sarah A. Dachtyl, Ph.D., CCC/SLP Chapter Learning Goals Characterize language impairment Describe the disorders associated with language impairment Explain the process of assessment in language impairment Describe the overall design of language intervention Outline Language Development Through the Lifespan Associated Disorders and Related Causes Aspects of Language Affected Assessment Intervention Language Development Through the Lifespan Pre-language Caregivers talk to infants as if they understand Reciprocal relationship begins early Eye gaze, rituals, and game playing by 3-4 months Caregiver-child interaction can be disrupted Intentionality (8-9 mos)—share through gestures Phonetically consistent forms or protowords: Consistent vocal patterns Learning language is strongly related to cognition Representation Symbolization Language Development Through the Lifespan Toddler Language Have 50 single words and combine them at 18 mos 3- and 4-word combinations appear soon after Use May use a single word for various purposes Content and Form By 2, have an expressive vocabulary of 150-300 words Children with larger vocabularies use a greater range of grammatical structures Lexicon: Personal dictionary Early word combinations follow predictable word-order patterns Language Development Through the Lifespan Preschool Language Can recount the past and remember short stories because of increased memory May use substitution Form hypotheses about language and use this to produce more complex language Caregivers provide feedback and models such as repeating the child’s utterance in mature form or reformulating it Language Development Through the Lifespan Use Children introduce topics and maintain them for 2-3 turns with caregivers Begin to consider the needs of the listener 4-year-olds can tell simple sequential stories Content 2 yrs: 300 words 3 yrs: 900 words 4 yrs: 1,500 words Fast mapping Learning relational words and phrases Language Development Through the Lifespan Form About 90% of adult syntax is acquired by age 5 Mean length of utterance (MLU) By age 3, most utterances contain a subject and verb Articles, adjectives, auxiliary verbs, prepositions, pronouns, and adverbs are added Adult-like negative, interrogative, and imperative sentences What and where, followed by who, which, and whose, then by when, why and how By the end of preschool, children form compound and complex sentences Bound morphemes are added Language Development Through the Lifespan School-Age and Adolescent Language Most communication occurs outside the home Means of communication changes with reading and writing development Metalinguistic skills Many complex forms and subtle linguistic uses are learned Semantic and pragmatic development blossoms Language Development Through the Lifespan Use Conversational skills develop Make relevant comments and adapt roles and moods Teens demonstrate more affect and discuss topics infrequently mentioned at home Number of turns on topic increases Interrupting increases but function is to move the topic along Narratives gain additional elements Language Development Through the Lifespan Content First graders Expressive vocabulary of about 2,600 but may understand 8,000 roots and 14,000 with derivations Receptive vocabulary grows to 30,000 by 6th grade and 60,000 words in high school Definitions become more dictionary-like Multiple word meanings Figurative language Language Development Through the Lifespan Form By age 5, children use most verb tenses, possessive pronouns, and conjunctions Limited use of comparative –er and superlative –est, relative pronouns used in complex sentences, gerunds, and infinitives Gradually add passive sentences, reflexive pronouns, conjunctions such as although and however, and variations of compound and complex sentences Morphological development - derivational suffixes Development of prefixes continues into adulthood Associated Disorders and Related Causes Intellectual disability Learning disabilities Specific language impairment Autism spectrum disorder Brain injury Neglect and abuse Fetal alcohol syndrome and drug-exposed children Other language impairments Associated Disorders and Related Causes Risk factors for LI: male, ongoing hearing problems, more reactive temperament Protective factors: more persistent and sociable temperament and higher levels of maternal well-being Genetic factors Sustained attention deficits in children with LI Late talkers at 24-31 months still have weaknesses in language in late adolescence Children with LI have poorer outcomes in literacy, mental health, and employment Associated Disorders and Related Causes Intellectual Disability Substantial limitations in intellectual functioning Significant limitations in adaptive behavior Originates before age 18 Severity can be based on IQ and ranges from mild to profound Newer severity ratings are based on the amount of assistance needed for daily tasks Causes can be biological or socioenvironmental Various processing deficits Associated Disorders and Related Causes Intellectual Disability Lifespan Issues Infants may be identified early (at birth) Early intervention is best Severity determines placement in educational programs Only children with the most profound ID accompanied by other disabilities are placed institutions In adulthood, living and working arrangements vary widely Associated Disorders and Related Causes Intellectual Disabilities Language Characteristics Children with Down syndrome and Fragile X have moderate to severe language delays Boys with FXS make phonological errors similar to younger TD children Boys with FXS produce longer, more complex utterances than those with DS Language comprehension and/or production can be below the level of cognition Children with ID produce shorter, more immature forms Later, paths differ more from TD Associated Disorders and Related Causes Learning Disabilities Heterogeneous group of disorders manifested by significant difficulties in the development and use of listening, speaking, reading, writing, reasoning, or mathematical abilities >75% have difficulty learning and using symbols 3% of all individuals have LD Six categories of characteristics 80% have some form of reading problem Possible biological and neurological factors Socioenvironmental factors Associated Disorders and Related Causes Learning Disabilities Lifespan Issues As preschoolers, may exhibit little interest in language or books Linguistic demands of the classroom are well above oral language abilities Many require special education Can be successful in the regular education classroom with adaptations Some seem to outgrow aspects of their disability although some require lifelong adaptations Other adults continue to have difficulty Associated Disorders and Related Causes Learning Disabilities Language Characteristics All aspects of language can be affected Deducing language rules is difficult Cluttering Overuse of fillers and circumlocutions associated with word-finding difficulties, rapid speech, and word and phrase repetitions, along with lack of awareness Can occur in some children with LD Associated Disorders and Related Causes Specific Language Impairment Typical nonverbal intelligence but deficits in a variety of nonverbal tasks Language performance is significantly lower than nonverbal intelligence Affects more males than females Increased prevalence in families Do not have perceptual difficulties May have marked deficits in working memory Suggests limited capacity for language processing Associated Disorders and Related Causes Specific Language Impairment Lifespan Issues Preschool children with SLI are perceived negatively by peers Poor social skills Many are later identified as having LD Later academic difficulties, especially with language-based activities Many adolescents with SLI perceive themselves negatively and are less independent Associated Disorders and Related Causes Specific Language Impairment Language Characteristics Difficulty extracting regularities from language Difficulty registering different contexts for language Difficulty constructing word-referent associations Pragmatic problems – inability to use language effectively Deficits in recognizing the impact of and expressing emotions Difficulty with grammatical markers Expressively, may speak more slowly and with frequent speech disruptions Problems with morphology and less efficient use of syntax to aid vocabulary knowledge Lexical competition Associated Disorders and Related Causes Autism Spectrum Disorder Motor patterns – rocking, fascination with spinning objects Certain routines, objects, foods, clothing Adverse reactions to some sounds or textures Incidence is 1 in 88 children Boys are 5 times more likely to exhibit ASD characteristics Most have IQs above 70 25% also exhibit ID Primary causes are biological Eye and face detection processing may be delayed Overall processing is gestalt Associated Disorders and Related Causes Autism Spectrum Disorder Lifespan Issues Identified by age 2 or 3 Failure to meet certain milestones School-aged children may be included in regular education classes or be in special education classes depending on severity People who are mildly involved live on their own and hold competitive employment Many have adult life patterns similar to those with ID Associated Disorders and Related Causes Autism Spectrum Disorder Language Characteristics Communication problems are one of the first indicators 25-60% remain nonspeaking Often lack typical intonation Immediate or delayed echolalia Deficits in pragmatics persist Some use entire verbal routines called formuli Those how have good language might still misinterpret the subtleties of conversation Associated Disorders and Related Causes Brain Injury Can result from TBI, stroke, congenital malformation, convulsive disorders, or encephalopathy Among children, the most common form is TBI TBI: Diffuse brain damage as a result of external force Approximately 1 million children and adolescents in the US have experienced TBI Variables include site and extent of lesion, age at onset, and age of the injury Exhibit a range of cognitive, physical, behavioral, academic, and linguistic deficits Social disinhibition Associated Disorders and Related Causes Brain Injury Lifespan Issues May be unconscious after the accident Disorientation and memory loss Physical disability and personality changes Neural recovery can be unpredictable and irregular Young children can recover quickly but experience difficulties learning new information and may exhibit severe, long-lasting problems Older children have more to recover but less new information to learn May be subtle cognitive/social impairments Associated Disorders and Related Causes Brain Injury Language Characteristics Language problems are evident even after mild injuries Some deficits (pragmatics) remain long after the injury Language comprehension and higher functions such as figurative language and dual meanings are also often impaired Language form is relatively unaffected Word retrieval, naming, object descriptions, and narration may be difficult Associated Disorders and Related Causes Approximately 900,000 children in the US are maltreated each year Child-mother attachment is more significant in language development than maltreatment Lifespan Issues Recurring physical, psychological, and emotional problems May abuse their own children later Language Characteristics Pragmatics is the greatest difficulty Less talkative Less likely to volunteer information or discuss emotions Utterances are shorter and less complex Associated Disorders and Related Causes Fetal Alcohol Syndrome and Drug-Exposed Children One in every 500-600 live births is a child with FAS or other fetal drug exposure Low birth weight and CNS problems Hyperactivity, motor problems, attention deficits, and cognitive disabilities Mean IQ is borderline ID Effects of drugs on the fetus vary with drug, manner of ingestion, and the age of the fetus Those exposed to crack have low birth weight, small head size, and are jittery and irritable Associated Disorders and Related Causes Fetal Alcohol Syndrome and Drug-Exposed Children Lifespan Issues Preterm babies are more likely to die during infancy and experience developmental difficulties Caregiver-infant bonding may be disrupted Can result in poor academic achievement and antisocial behavior Children with FAS have significantly more and longer instances of passive/disengaged and irrelevant behavior in the classroom compared to TD peers Associated Disorders and Related Causes Fetal Alcohol Syndrome and Drug-Exposed Children Language Characteristics FAS: Delayed development of language, echolalia, and comprehension problems Drug exposure leads to few vocalizations, inappropriate gestures, and language deficits As preschoolers, they exhibit word-retrieval problems, short sentences, and inappropriate turn taking and topic maintenance Problems with abstract meanings, multiple meanings, and temporal and spatial terms They are behind their peers in reading and other academic tasks Associated Disorders and Related Causes Other Language Impairments Children with nonspecific language impairment have a general delay in language development, nonverbal IQ of 86 or lower, and no sensory/perceptual deficits Child health is an important factor in late talkers; most early language delay is due to environmental factors Childhood schizophrenia uncommon; delay in pragmatics In selective mutism, children do not speak in specific situations The effect of chronic otitis media can be delayed language Children who receive cochlear implants have relatively typical language development; depends on age of implantation Aspects of Language Affected Language impairments can also be characterized by the language features affected SLPs assess many language features to determine where to begin intervention Assessment Distinguish between children who have a disorder and those who do not Should be sufficiently broad and deep so all areas of possible concern are identified and described as accurately as possible Assessment Bilingual Children, English Language Learners, and Dialectal Speakers 21% of US school-age children speaks a language other than English at home ELLs and children with dialectal differences are more likely to be identified as needing special education services Diagnostic methods vary widely Includes published tests, language samples, and dynamic assessments Assessment Referral and Screening Referral may occur at any point in the lifespan Parents can be effective referral sources for children with more severe language problems Screening tests are used to determine the presence or absence of a language problem Surveys and parental questionnaires are effective Referral and subsequent evaluation may occur within an interdisciplinary team Assessment Case History and Interview Language development, language environment, possible causes for language impairment Observation As many contexts as possible Note interests, caregiver communication style, and method of behavior control Fully describe events preceding and following behaviors or language features Assessment Testing Standardized tests Descriptive tests allow determination of strengths and weaknesses Dynamic assessment Test scores should be interpreted cautiously and should not be the only factor in diagnosing language impairments Assessment Sampling Engage child in challenging conversations to reveal difficulties Variety of discourse types Collect samples with different partners, locations, and activities or topics Narratives can be helpful with certain populations Peer-conflict resolution problems Can be analyzed in several quantitative and qualitative ways Code switching May collect written samples Intervention Multiple intervention methods Telepractice Should focus on stimulating language acquisition beyond the immediate target Can include other individuals who work with the child in training Intervention Target Selection and Sequence of Training Goal is the effective use of language to communicate in everyday interactions Child’s abilities determine method Training should be in meaningful contexts Evidence-Based Intervention Principles Targets should not focus exclusively on one deficit area Intervention Procedures Anticipate the types of support a child is likely to need and the types of errors they are likely to make Intervention Basic tenets of good teaching behavior Model the desired behavior Parallel sentence production Cue the client to respond Rated from least to most intrusive and supportive Respond to the client in the form of reinforcement and/or corrective feedback Gentle reminder to instruction Rely less on direct forms as the feature is produced more correctly Plan for generalization Intervention Through the Lifespan Early intervention can be very beneficial Initial training might target presymbolic communication skills and cognitive abilities Parents might be trained Early symbolic training may focus on vocabulary, semantic categories, word combinations, and early intentions Preschool children usually work on language form in conversation and narratives Intervention Through the Lifespan Intervention with higher functioning children might focus on pragmatics and semantics Academic skills might be targeted Can supplement with computerized programs Adolescents may continue to need services Adults with ASD or ID will most likely require continued intervention for language and communication deficits Individuals with LD may require additional support in postsecondary education Summary Language impairments are very complex Each child is unique SLP attempts to find the most efficient and effective method for teaching new skills via assessment and repeated assessment during intervention Online Resources ASHA website for the responsibilities of an SLP in various disorders: www.asha.org and type “scope of practice” in the search field. National Institutes of Mental Health (NIMH): www.nimh.nih.gov/index.shtml Merrill website: http://merrill.ku.edu Autism Spectrum Disorder Foundation: www.myasdf.org/site/ National Institute of Child Health and Human Development: www.nichd.nih.gov Learning Disabilities Association: www.ldaamerica.us