Pediatrics- Dev speech & lang disorders and treamtent

What are the three groups of children with developmental speech & lang disorders?

1. Children w/ primary speech and/or language disorders

2. Children w/ language learning disorders

3. Children w/ speech and/or language disorders that are associated with another disorder

Children who have a primary speech and/or language disorder means

that disorder is their major diagnosis

Children with language learning disorders tend to be

school aged children w/ past speech and language disorder

What does it mean for a child to have speech and/or language disorders associated with another disorder?

It means the child’s major diagnosis is something like ASD, ID, Cleft Palate, and the speech/language disorders are secondary

How far below the mean does a child’s articulation or language have to be to be considered disordered?

Greater than one standard deviation

The average range on a normal distribution is from ____ to ____

85 to 115

If someone has an intellectual disability, it is good to compare their articulation and language skills to ______ age and _______ age

chronological, mental

According to the normal distribution, ____% of a population will be in normal range

60%

The average person deviates from the mean by ____ points / one standard deviation

15

Where the client falls on the normal distribution determines

Diagnosis

The normativist believes that

A child only has an impairment if non-experts can tell they have a disorder

The problem with normativist POV is that

The child’s problem isn’t always a language disorder, but could instead be an issue with their home life or shyness.

The neutralist believes that

Language disorders in children are identifiable using standardized testing and observation of the impact of their deficit on their daily functioning

Do most SLPs take a normativist or neutralist approach?

Neutralist

Normativists don’t believe in

the normal distribution

The world health organization (WHO) uses a holistic framework when assessing the

impact of a speech & lang impairment on an individual’s life

The WHO looks at which factors when determining impact of a speech & lang impairment on child’s life?

1. Body structure and function

   1. Physical, physiological, and/or psychological function (tells us if they are diff from peers)

2. Activities and participation

   1. Daily living needs and execution of specific tasks (impact on daily life)

3. Contextual factors

   1. Environment (What people or things make things easier or difficult)

What factors are involved in the etiology of language disorders?

1. Biological factors

2. Cognitive factors

3. Behavioral factors

4. Environmental factors

Biological factors are

differences in genetic risk and neurological structure and function associated with disorder

Cognitive factors are

Differences in perception and information processing associated with a disorder

Behavioral factors are

Overt differences in behavior that characterize the disorder

Environmental factors are

External experiences that either increase risk of disorder or that are protective in the face of biological risk

Sometimes the cause of a language disorder is _______, but sometimes there are _____ potential _____

unknown, multiple, causes

There is no proof that there is a gene that impacts

behavioral features

Biological factors are only connected to behavioral factors through

cognitive factors

Language processing is usually in the ____ hemisphere

left

Twin studies showed that identical twins are more likely to

share developmental language disorder

Genetics influences cognitive traits which influences

language skill

Cognitive traits are studied through

marker tasks (genetically influenced but related to language skill)

Some skills are highly _____ and others are more highly influenced by _____ ______

heritable, environmental factors (e.g., auditory processing)

Synaptic pruning results in

specialized neural networks

Synaptic pruning occurs between _____ and _____ _______

infancy, middle childhood

Individuals with ASD tend to have less

neural pruning

Functional specialization is

specialized networks become more “in tune” to processing particular types of input

Language processing is _____ lateralized in most adults

left

Lesions in certain brain areas are associated with

specific types of speech and language difficulties

Brain structure in developmental language disorders is not caused by any

gross lesion in language areas of the brain

There is no perfect relationship between _____ and _____ of the brain and DLD

structure and function

DLD means

developmental language disorder

Environmental factors alone cannot account for

DLD (unless child is in very poor environment)

The relationship between SES and DLD

Higher SES develop language easier but that advancement isn’t sustained over time. You can’t tell a difference between a high SES and low SES adult

More errors may be seen in a bilingual child, but

won’t see delay if learning 2 languages

Cognitive models of DLD are

• auditory processing accounts

• Limited processing capacity

Auditory processing model

Difficulties perceiving brief/rapidly presented sounds causes difficulties in perceiving and categorizing phonemic contrasts, which causes language impairment

Auditory processing model is called into question because

• Not all children with language disabilities have auditory processing deficits, and vice versa.

• Working on one (perceiving rapid sounds) doesn’t help the other (processing/categorizing phonemic contrasts)

Limited processing capacity model says

there is limited capacity of storing and processing information (ability to store info while processing info)

Performance on a non-word repetition task tells us about the trade off between

storage and processing

Nonword repetition tasks performance is related to

language ability

Top down processing involves

higher levels of processing to start

Bottom up processing involves

Lower level processing to start

procedural memory systems are used for

rule based learning (sounds and grammar)

Declarative memory systems are used for

knowledge based learning (vocabulary)

Language disability is due to deficits in

procedure based learning (someone w/ language disability may also have difficulty with gross motor tasks like throwing a ball)

There is potential for declarative memory to compensate for deficits in

procedural memory

Children who struggle with both procedural memory and declarative memory will not

use declarative to compensate for procedural

Phonetic disorders are ______ based

motor

Phonetic disorders are also called

articulation disorders

A child with a phonetic disorder will have ____ stimulability

poor

A child with a phonetic disorder _____ discriminate the target vs the error sound

can

In phonemic disorders, a child is typically

stimulable

In phonemic disorders, the child ______ discriminate target vs. error

cannot

Phonemic disorders are ____ based disabilities

rule (so, there will be errors in many different places)

Errors tend to be ____ across word positions in phonetic disorders

consistent

Errors tend to be _______ across word positions in phonemic disorders

inconsistent

How do you choose which sounds to work on first in phonetic TX?

1. Sounds that impact intelligibility most greatly (high freq. sounds)

2. Most freq. sounds

3. Sounds for which errors are conspicuous (sound errors that are made in natural speech)

4. Developmentally earlier sounds

What are the most frequent sounds?

N, S, T

There are 8 ____, _____, and _____ sounds

early, middle, late

The 8 early sounds are mastered by age

3

The 8 middle sounds are mastered by age

5 ½

The late 8 sounds are mastered by age

7 ½

The 8 early, middle, and late sounds are based on

spontaneous speech, which reflects how children produce speech sounds

With the phonetic approach, you start with the _____ motor commands and make things _____ difficult

simplest, more

Phonetic approach steps

Isolation → syllables → words → phrases → semantics → discourse

Children need to get __% accuracy three times in a row before moving on to a different objective

90

Not all sounds can be produced in _____ easily

isolation

Stops might be easier to ______ with a central vowel or with aspiration

coarticulate

If accurate production of a sound isn’t achieved in 5-10 mins, proceed with

1. Auditory stimulation / imitation

2. Phonetic placement method

3. Sound modification method

Auditory stimulation is the

fastest way to elicit the target sound if it works

The phonetic placement method is when

The clinician instructs the client on how to position the articulators in order to produce the target sound

Sound modification method is based on

deriving the target sound from a phonetically similar sound that the client can produce (ex: sloppy t), then adjustments are made until the target sound is achieved

When at the syllable level, practice the target sound in

nonsense syllables (to practice same motor skill in different variations)

What factors impact the articulatory complexity of words?

1. length

2. position of sound w/in word (initial is easier than final)

3. Syllable structure (open is easier than closed)

4. Syllable stress (stressed is easier than unstressed)

5. Coarticulation factors (avoid words w/ sound in it in multiple places, avoid clusters, avoid words with other troublesome sounds in it)

6. Familiarity (more familiar is easier)

When working at the phrase and sentence level, work on ______ before _______

structured, unstructured

Carrier phrases can involve

1. client inserting the word w/ target sound to complete a carrier phrase

2. Using a carrier phrase with the word w/ target sound already in it

When at the spontaneous speech level, start by

giving very short amount of time and tell them what you are listening for. Then fade out the cue that you are listening, and vary the settings.

Recommended dismissal criterion

50% accurate production in spontaneous conversation

Reevaluations are needed to ensure that

• production accuracy has improved on its own

• production has continued to generalize across situations

Types of phonemic treatment are

1. minimal pair contrast therapy

2. maximal oppositions approach

3. multiple oppositions approach

4. metaphon therapy

5. cycles approach

The adult phonological system consists of

1. Phoneme inventory

2. Allophonic rules

3. Phonotactic rules (what order you can put phonemes in in words)

Minimal pair contrast therapy involves 3 variations

1. minimal oppositions

2. maximal oppositions

3. multiple oppositions

In minimal contrast therapy, a child displays perception through

pointing to a picture of the target sound (e.g., point to cat)

In minimal contrast therapy, a child displays production through

producing both members of a minimal pair verbally (e.g., cat and rat)

Minimal oppositions approach is where contrasts differ

by one feature (voice, place, manner)

Maximal oppositions (complexity approach) uses

larger and more complex contrasts and focusing on more complex targets, which enhances learnability and improves generalization

AKA uses two phonemes that are as different as possible

The maximal oppositions approach is largely supported by

research

The empty set method of the maximal oppositions approach is when

You teach two new sounds (sounds child cannot produce at all) that differ in voice, place, and manner

In the empty set approach, the sounds should represent _____ and _____

obstruents (stops, fric, affric) and sonorants (Liquids, glides, nasals)

Children with severe to profound phonological impairments should use the

multiple oppositions approach

Multiple oppositions approach simultaneously contrasts

several target sounds

Phoneme collapse

Multiple phonemes collapsed into a single sound