Transcript
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