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

CHAPTER 2: Typical and Disordered Communication 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 Explain the role of culture and environment in communication Describe what is involved in human communication Demonstrate how communication disorders may be classified Name some types of communication disorders Discuss and estimate the frequency of occurrence of communication disorders Describe in general the assessment and intervention process Outline Human Communication Communication Through the Lifespan Communication Impairments Deciding Whether There is a Problem Intervention with Communication Disorders Human Communication Communication Exchange of ideas between sender(s) and receiver(s) Sociolinguistics How cultural identity, setting, and participants influence communication Cultural identity Language and cultural communities Human Communication Means of Communication Language A socially shared tool used to represent concepts. Symbols are arbitrary. Grammar: Rule of a language Linguistic intuition: Recognition of “right” and “wrong” grammar by native speakers Generative: Each utterance is freshly created Dynamic: Languages change over time Three primary components: Form, Content, Use Human Communication Form Phonology: Sound system of a language Phonotactic rules: How sounds may be arranged in words Morphology: The structure of words Morphemes: Smallest grammatical units Free morphemes: May stand alone as a word Bound morphemes: Change the meaning of original words and can only be attached to free morphemes Syntax: How words are arranged in a sentence and the ways in which one word may affect another Human Communication Content Semantics: The content or meaning of language Semantic features: The pieces of meaning that define a particular word Human Communication Use Pragmatics Refers to how and why we use language Pragmatic ruse vary with culture Human Communication Speech Acoustic representation of language Articulation: The way speech sounds are formed Fluency: The smooth, forward flow of communication Influence by rhythm and rate (components of prosody) Human Communication Voice Can reveal things about the speaker and message Overall loudness and loudness patterns are important Pitch: Perception of how high or low a sound is Habitual Pitch: Basic tone an individual uses most of the time Intonation: Pitch movement within an utterance Human Communication Nonverbal Communication Suprasegmentals and nonvocal and nonlinguistic communication Artifacts: How you look, your clothes, your possessions, music you listen to, etc. Kinesics: Body language Explicit: Clearly defined Implicit: Movements are more general or subtle Space and Time Proxemics: Physical distance between people Tactiles: Touching behaviors Chronemics: Effect of time on communication Communication Through the Lifespan Early communication between infants and caregivers fosters speech/language development. Complicated by physical, cognitive, and social development The key to becoming a communicator is being treated as one. The process of learning speech and language is social Speech and language changes until the end of life A competent communicator adapts Communication Impairments Disorders of Speech (articulation, voice, resonance, fluency) Oral neuromotor patterns of control and movement Language impairment Feeding and swallowing disorders Cognitive and social communication deficits Hearing and processing difficulties Communication Impairments May be categorized according to whether reception, processing, and/or expression are affected Etiology: Cause/origin of a problem Congenital: Present at birth Acquired: The result of illness, accident, or environmental circumstances Severity (mild to profound) Communication Impairments Variations in communication are not impairments Dialects Differences that reflect a particular regional, social, cultural, or ethnic identity Holistic approach is needed for diagnosis and treatment Communication Impairments Language Disorders Disorders of Form: Errors in sound use (phonology) Incorrect use of past tense or plural markers (morphology) Incorrect word order and run-on sentences (syntax) May be due to sensory limitations, perceptual difficulties, limited exposure to correct models, etc. Communication Impairments Language Disorders Disorders of Content Limited vocabulary, misuse of words, word-finding problems Difficulty understanding and using abstract language May be due to limited experience, concrete learning style, strokes, head trauma, or illness Communication Impairments Language Disorders Disorders of Use May stem from limited or unacceptable conversational, social, and narrative skills; deficits in spoken vocabulary; immature or disordered phonology, morphology, and syntax Might include difficulty staying on topic, providing inappropriate or incongruent responses to questions, or continually interrupting Communication Impairments Speech Disorders Disorders of Articulation Articulation: The actual production of speech sounds Differentiate between disorders of phonology Causes include neuromotor problems such as CP, physical anomalies such as cleft palate, and faulty learning Dysarthria: Caused by paralysis, weakness, or poor coordination of the speech musculature Apraxia: Due to neuromotor programming difficulties Communication Impairments Speech Disorders Disorders of Fluency The smooth, uninterrupted flow of speech is affected Developmental disfluency: Speech patterns common to young children Fillers: “er,” “um” Hesitations: Unexpected pauses Repetitions: Sounds or words are repeated “g-g-go” Prolongations: Excessively long duration “wwwell” Stuttering: When these speech behaviors exceed or are different from the norm or are accompanied by excessive tension, struggle, or fear Communication Impairments Speech Disorders Voice Disorders Congenital conditions are rare Vocal abuse: Excessive yelling, screaming, or loud singing; can result in hoarseness or another disorder Physical tension, coughing, throat clearing, smoking, and drinking alcohol can disrupt the voice Can result in pathology such as polyps, nodules, or ulcers Communication Impairments Hearing Disorders Deafness Primary sensory input for communication is not auditory Congenital or acquired Interventions: Total communication is considered the most effective Assistive listening devices, cochlear implants, auditory training are helpful Communication Impairments Hearing Disorders Hard of Hearing Depend primarily on audition for communication Hearing loss may be temporary or permanent Categorized in terms of severity, laterality, and type Severity: Mild to profound Laterality: Bilateral or unilateral Type: Conductive, sensorineural, or mixed Communication Impairments Hearing Disorders Auditory Processing Disorders May have normal hearing but difficulty understanding speech Etiology may be due to tumor, disease, brain injury, or unknown factors Can occur in children or adults Communication Impairments How common are communication disorders? Variability is the norm “Typical” means “like most others of the same group” Most communication disorders are secondary to other disabilities Communication Impairments Prevalence: The number/percentage of people within a specified population who have a particular disorder or condition at a point in time 17% of U.S. population has a communication disorder 11% have a hearing loss 6% have a speech, voice, or language disorder 6-10 million Americans have swallowing disorders 3-10% have a voice disorder Language disorders occur in 8-12% of preschoolers 5-10% of older adults have language disabilities secondary to stroke or dementia Deciding Whether There is a Problem May be a referral from another professional or concerned adult May be from a screening Adults may refer themselves Deciding Whether There is a Problem Assessment of communication disorders: The systematic process of obtaining information from multiple sources, through various means, and in different settings to verify and specify communication strengths and weakness, identify possible causes of problems, and make plans to address them Diagnosis: Distinguishes an individual’s difficulties from the broad range of possible problems Deciding Whether There is a Problem Assessment Goals Determining what exactly is wrong Diagnostic therapy: Working with the client over time to better determine strengths and weaknesses Determine severity Etiology Predisposing causes Precipitating factors Maintaining or perpetuating causes Recommendations Prognosis Deciding Whether There is a Problem Assessment Procedures Authentic data Norm referenced tests Criterion referenced tests Dynamic assessment Speech or language sampling Evidence-Based Practice ASHA assessment guidelines are discussed later Intervention With Communication Disorders Culturally responsive interventions Influenced by nature and severity, age and status of the client, environmental considerations, and personal/cultural characteristics National Center for Treatment Effectiveness in Communicative Disorders through ASHA Intervention With Communication Disorders Objectives of Intervention Should show improvement and generalize What has been learned should be automatic Client must self-monitor Client should make optimum progress in the minimum amount of time Intervention should be sensitive to the personal and cultural characteristics of the client Intervention With Communication Disorders Target Selection Personal needs and potential for intervention to generalize Likelihood of success and typical behaviors of others at the client’s age and gender Baseline Data Measurement of the client’s accuracy before beginning intervention Intervention With Communication Disorders Behavioral Objectives A statement that specifies the target behavior in an observable and measurable way A: Actor B: Behavior C: Condition D: Degree Intervention With Communication Disorders Clinical Elements Direct Teaching Behavior modification (stimulus and reinforcement) Incidental Teaching Counseling Family and Environmental Involvement Intervention With Communication Disorders Measuring Effectiveness Post-therapy tests Effective therapy shows generalization, self-correction, and automaticity Follow-up and Maintenance Return if there is a need Regular follow-up can be established Booster treatment Summary Communication is an exchange of ideas that is strongly affected by culture and environment. Language is the primary vehicle of human communication. The components of language are Form (phonology, morphology, syntax), Content (semantics), and Use (pragmatics). Any aspect of communication can be impaired. About 17% of Americans have a communication impairment. Assessment and treatment influence one another. Successful intervention uses a team approach Online Resources The ASHA website (www.asha.org) discusses various disorders that affect children and adults. Evidence based practice: http://www.asha.org/members/ebp/ Dynamic assessment: http://www.asha.org/practice/multicultural/issues/Dynamic-Assessment