CSDS 214: Exam #2 Language Disorders Associated With Other Conditions

Medical Diagnosis DSM-5 ASD

Deficits in social communication

Restricted, repetitive patterns of behavior

Symptoms present in the early developmental period

Symptoms cause clinically significant impairment in social, occupational, or other important areas of functioning

Disturbances not explained by IDD

ASD Deficits in Social Communication Disorder

All of the following must be exhibited:

Deficits in social-emotional reciprocity (conversational turn taking)

Deficits in nonverbal communicative behaviors

Deficits in developing, maintaining, and understanding relationships

ASD: Restricted, Repetitive Patterns of Behavior, Interests, or Activities

At least two of the following:

Stereotyped/repetitive speech, movements, or use of objects

Insistence on sameness (refers to having a strong preference for predictable routine or the same things every day)

Restricted interest

Hyper- or hyporeactivity to sensory input

ASD: California ED Code Eligibility Criteria

5 CCR § 3030: Autism means a developmental disability significantly affecting verbal and nonverbal communication and social interaction, generally evident before age three, and adversely affecting a child's educational performance. Other characteristics often associated with autism are engagement in repetitive activities and stereotyped movements, resistance to environmental change or change in daily routines, and unusual responses to sensory experiences.

Emotional disturbance alone does not = autism eligibility (can also exist but can’t be the main reason for their struggle)

Could be eligible if characteristics observed after 3yo

Medical diagnosis does not mean they automatically qualify for services within the school

Development of ASD

More severe ASD often diagnosed in preschool

Signs become pronounced between 18 and 36 months of age

Demographic Risk Factors of ASD

Being male

Family history of ASD

Chromosomal disorder

Born to older parents

Preterm birth

Other developmental, psychiatric, neurologic, chromosomal, and genetic diagnoses

Behavioral Risk Factors of ASD

Lack of early gesturing

Presence of repetitive motor behaviors

Neurological Risk Factors of Language Disorders associated with ASD

Atypical lateralization for speech

Increased brain growth

Language Characteristics for Language Disorders Associated with ASD

Communication problems are often one of the first indicators of possible ASD

Poor social interaction, language and communication skills

May demonstrate immediate or delayed echolalia (repetition of previous utterance)

At one extreme end are children whose language structure is within normal limits

The other extreme end are children who remain nonverbal

Not all children with ASD have a language disorder

Pragmatics in Language Disorders Associated with ASD

Deficits in joint attending

Difficulty initiating and maintaining a conversation

Limited range of communication functions

Difficulty matching form and content to context

Immediate and delayed echolalia and routinized utterances

Frequent asocial monologues

Difficulty with stylistic variations and speaker-listener roles

Semantics in language disorders associated with ASD

Word-retrieval difficulties

Inappropriate answers to questions

Syntax/Morphology in language disorders associated with ASD

Morphological difficulties

Construction of sentences with superficial form

Less complex sentences than mental-age-matched peers developing typically

Over-reliance on word order

Phonology in language disorders associated with ASD

Variable within individual child, often disordered

Developmental order similar to typically developing children

Least affected aspect of language

Comprehension in language disorders associated with ASD

Impaired comprehension, especially in connected discourse (i.e. conversations)

Biological Factors for language disorders associated with ASD

Individuals with ASD have abnormal brain patterns

Neuroimaging reveals abnormalities in primary sensory areas of the brain

Studies have suggested a genetic link; likely that several genes are involved

Social-Environmental Factors for language disorders associated with ASD

Parental behavior can result in positive outcomes

Processing Factors for language disorders associated with ASD

Children with ASD have difficulty analyzing and integrating information

Overall processing has been characterized as “gestalt”

Difficulty identifying relevant contextual information

Learning Disability

Educational term

Specific learning disorder (SLD) is the medical term used

a neurodevelopmental disorder that becomes evident during school age; will likely persist into adulthood

Define Learning Disability

Involving one or more of the basic psychological processes

Affects the understanding/use of spoken and/or written language

May be manifested in the imperfect ability to listen, think, speak, read, write, spell, do mathematical calculations

Motor/Attention difficulties in Learning Disability

Usually involve hyperactivity

Difficulty attending and concentrating

Short attention span, inattentiveness, easy distraction

May demonstrate perseveration

Perceptual Difficulties in a Learning Disability

Not sensory or reception disorder - it is perceptual

Interpretational difficulties

Difficulty in figure-ground perception and sensory-integration

Memory/Emotional Difficulties in a Learning Disability

Include short-term and long-term storage and retrieval

Not a causal factor

May exercise poor judgement, have unusual fears, and/or adjust poorly to change

Pragmatics in Language Disorders Associated With Learning Disability

May have difficulty with give-and-take of conversation and form/content of language

Synthesizing of language seems to be difficult

Problems with morphological markers

Semantics in Language Disorders Associated With Learning Disability

Word-finding is a problem

Conjunction confusion

Syntax/Morphology in Language Disorders Associated With Learning Disability

Difficulty with negative and passive constructions, relative clauses, contractions, and adjectival forms

Difficulty with verb tense markers, possession, and pronouns

Able to repeat sentences but often in reduced form

Article confusion

Phonology in Language Disorders Associated With Learning Disability

Inconsistent sound production

Comprehension in Language Disorders Associated With Learning Disability

Wh- question confusion

Receptive vocabulary similar to peers

Poor strategies for interacting with printed information

Confusion of letters that look similar

Possible Biologic Causal Factors in Language Disorders Associated With Learning Disability

LD occur more frequently in families with a history of the disorder

Suggested that a breakdown occurs along the neural pathways

Possible Social-Environmental Causal Factors in Language Disorders Associated With Learning Disability

Successes or failures have great influence on future interactions

Possible Processing Causal Factors in Language Disorders Associated With Learning Disability

Information is poorly attended to, poorly discriminated, and poorly organized

About Dyslexia

characterized by difficulties in fluent and/or accurate word recognition and in spelling

Found among males at twice the rate as females

Common Elements of Dyslexia/Specific Learning Disorder With Impairment in Reading and Writing

Comparable verbal IQ and/or listening comprehension

Below average word reading

Nonsense word reading below real-word reading

Well below average phonological processing scores

Overview Attention-Deficit/Hyperactivity Disorder

More children being labeled ADHD

ADHD not a learning disability

Most likely a disorder in executive function

Most common neurobehavioral disorder

Prevalence in the U.S. is 5-7%

Language Characteristics of ADHD

Increased risk for language disorder

Children with ADHD without language disorder tend to have pragmatic and expressive language deficits

Possible Causal Factors of ADHD

Exact cause is not clear

Possible risk factors

Blood relatives with ADHD - genetics

Exposure to environmental toxins - prenatal environment

Maternal drug or alcohol use - prenatal environment

Premature birth

Brain injury

Overview of Intellectual Developmental Disorder (IDD)

IDD is a neurodevelopmental disorder

More common term in educational settings is intellectual disability

Range of severity from mild to profound

Exact number of individuals who have intellectual disability is unknown

Three Aspects of Language Disorders Associated with IDD

Deficits in intellectual functioning

Deficits in adaptive functioning

Onset during childhood

Adaptive functioning

how independent they can be in daily living

Language Characteristics of Language Disorders Associated with IDD

Language is often one of the most impaired areas

Children with IDD vary in their communication abilities

Two genetic disorders - Down Syndrome and FXS

Pragmatics in Language Disorders Associated with IDD

Boys with FXS perform differently in conversation than boys with DS

Children with FXS demonstrate impaired pragmatic language

Semantics in Language Disorders Associated with IDD

Children with DS produce fewer words, fewer different words, and shorter utterances

Males with FXS perseverate more than children with DS

Syntax/Morphology in Language Disorders Associated with IDD

Children with IDD seem to use more immature language forms than their peers with TDL

Children with FXS show syntactic growth during preschool years, but plateau or decline during school age

Possible Causal Factors of Language Disorders Associated with IDD

Factors for IDD are many and varied

For many children, the cause of IDD is unknown

May be stable and nonprogressive or may worsen with time

Possible Biological Causal Factors of Language Disorders Associated with IDD

Most likely a factor for a majority of children with IDD

Possible Social Environmental Causal Factors of Language Disorders Associated with IDD

More difficult to identify

No evidence that mothers interact less

Processing Factors of Language Disorders Associated with IDD

Children with IDD do not seem to process information in the same manner as mental-age-matched peers with TDL

Attention

Discrimination

Organization

Memory

Transfer

IDD Processing factors - attention

can sustain attention as well as mental-age-matched peers; difficulty in scanning and selection of stimuli

IDD Processing factors - discrimination

difficulty identifying relevant stimulus cues

IDD Processing factors - organization

difficulty developing organizational strategies

IDD Processing factors - memory

poorer recall compared to individuals developing typically

IDD Processing factors - transfer

the more severe a person’s IDD, the weaker that person’s transfer abilities

ID: California Ed Code Eligibility Criteria

5 CCR § 3030

Intellectual disability means significantly subaverage general intellectual functioning, existing concurrently with deficits in adaptive behavior and manifested during the developmental period that adversely affects a child's educational performance.

About Language Disorders Associated With Neurocognitive Disorders - TBI

Leading cause of disability and death in children and adolescents in the US

Diffuse brain damage as a result of external physical force

Between 3.2 and 5.3 million individuals in the US living with TBI-related disability

TBI category not widely recognized in special education

Severity may range

Severity of symptoms is not the sole prognostic indicator

TBI results from impact to the head and has one or more of the following consequences:

Loss of consciousness

Posttraumatic amnesia

Disorientation and confusion

Neurological signs

Individuals with TBI often experiences deficits in one or more cognitive domain including

Attention

Executive function

Learning and memory

Language

Perceptual-motor

Social cognition

Common symptoms of TBI include disturbances in the following:

Emotional function

Personality changes

Physical symptoms

Neurological symptoms

Orthopedic injuries

Emotional lability

Social disinhibition

PTSD

Language Characteristics for Language Disorders Associated With Neurocognitive Disorders

Language deficits are usually evident even after mild injuries

Pragmatics in Language Disorders Associated With Neurocognitive Disorders - TBI

Difficulty regulating amount and manner of conversational participation

Semantics in Language Disorders Associated With Neurocognitive Disorders - TBI

Word retrieval, naming, object description difficulties

Syntax and Morphology in Language Disorders Associated With Neurocognitive Disorders - TBI

Language form is relatively unaffected

Possible Causal Factors for Language Disorders Associated With Neurocognitive Disorders

Biological and physical factors are involved in TBI

All aspects of organization may be affected

Memory deficits in storage and retrieval

Language Disorders Associated With Less Frequent Disorders

Late Language Emergence

Social-Emotinal/Behavioral Disorders

Emotional Disturbance

Childhood Schizophrenia

Selective Mutism

Otitis Media

Deafness

Late Language Emergence

Approximately 10-15% of young children are late talkers

Approximately half will catch up to their peers with TDL

Having a language onset that is delayed relative to their age; there is variation in how this is defined

If they are delayed, does that persist, or do they catch up to their peers

Risk of being a later talker at 24 months significantly associated with

Being male

Being a twin, triplet, etc.

Being from lower socioeconomic background

Having low birth weight

Having young mother

Having lower quality parenting

Experiencing attentional difficulties

Receiving less than 10 hours of daycare per week

Social-Emotinal/Behavioral Disorders

Emotional disturbance means a condition exhibiting one or more of the following characteristics over a long period of time and to a marked degree that adversely affects a child's educational performance:

(A) An inability to learn that cannot be explained by intellectual, sensory, or health factors.

(B) An inability to build or maintain satisfactory interpersonal relationships with peers and teachers.

(C) Inappropriate types of behavior or feelings under normal circumstances.

(D) A general pervasive mood of unhappiness or depression.

(E) A tendency to develop physical symptoms or fears associated with personal or school problems.

(F) Emotional disturbance includes schizophrenia. The term does not apply to children who are socially maladjusted, unless it is determined that they have an emotional disturbance under subdivision (b)(4) of this section.

SEBD: Examples of Diagnoses

DSM-5-TR™ (2022):

Schizophrenia Spectrum and Other Psychotic Disorders

Bipolar and Related Disorders

Depressive Disorders

Anxiety Disorders

Obsessive-Compulsive and Related Disorders

Trauma- and Stressor-Related Disorders

Etc.

Selective Mutism

Relatively rare

Girls twice as likely as boys to be affected

Related factors include social anxiety, extreme shyness, language disorder, second language learning

SEBD: Selective Mutism DSM-5-TR™ Criteria

The child shows consistent failure to speak in specific social situations in which there is an expectation for speaking (e.g., at school), despite speaking in other situations.

The disturbance interferes with educational or occupational achievement or with social communication.

The duration of the disturbance is at least 1 month (not limited to the first month of school).

The failure to speak is not attributable to a lack of knowledge of, or comfort with, the spoken language required in the social situation.

The disturbance is not better explained by a communication disorder (e.g., child-onset fluency disorder) and does not occur exclusively during the course of autism spectrum disorder, schizophrenia, or another psychotic disorder.

Models of Disability

Medical models

Social models

Social relational models - Also sometimes referred to as biopsychosocial models

Medical models

identifying the disability within the individual

what skill/area is affected -

we intervene based on what is needed in that area

can sometimes get too caught up in this to see environmental impacts

Social models

Distinguish their impairment from the challenges they are experiencing as a result of their environment and their impairments.

A child can use their AAC, but in the classroom the teacher speaks too fast

What is happening in the environment that is limiting their participation, provide accommodations to help them meet their needs

Social relational models

Also sometimes referred to as biopsychosocial models

We don’t have to choose between the person and the environment

A combination of social relationships, environmental demands, biological characteristics

Could have a language problem in addition to environmental challenges

ICF Framework

Condition

Body Functions & Structure, Activities, Participation

Environmental Factors and Personal Factors

Condition

Disorder/disease

Body Functions and Structure

Impairment

Activities

limitation

Participation

Restriction

Environmental factors

can impact success

are the environmental factors barriers or facilitators

how is the environment set up

support system?

Personal factors

Personality

overall health

Home life