Neuro Lang Disorders Exam #2

Intellectual Disability (ID)

-Originates before Age 18

-substantial limitations in intellectual

functioning

-significantly sub-average (2 SD below mean of 100).

Approximately 3 % of the population is below this

point = IQ of 68.

-This must co-occur with limitations in 2 or more

adaptive areas such as

-self help,

-language,

-academic learning

-**Must meet all criteria to be considered to be a

person with an intellectual disability

-1 to 3% of the population in U.S.

Intellectual Disability (ID) Language Characteristics

Language is often the most impaired area

• Typically developing children with same

mental age may exhibit stronger language

skills

—Prior to the age of ten, developmental sequence for children with ID is similar to Typically Developing (TD) Children, but slower

• Even when matched for mental age, ID children

will use more immature forms than TD

ID Characteristics: Specific

Language Areas: Pragmatics:

-Delayed; Less dominant conversational roles.

Can infer communicative intent from gestures.

ID Characteristics: Specific

Language Areas: Semantics

-More concrete. Slow vocab growth. Limited

use. Contextualized learning of vocab

ID Characteristics: Specific

Language Areas: Syntax/Morphology

- similar to TD preschoolers

-but slower; shorter, less complex sentences

ID Characteristics: Specific

Language Areas: Phonology

-Phonological development similar to TD

preschoolers, but rely on less mature forms

ID Characteristics: Specific

Language Areas: Comprehension

-Poorer receptive lang. skills, esp. Down’s

-Poorer sentence recall

-More reliance on context to make meaning

Possible Causal Factors of ID:

Biological (a factor for a majority of ID)

-Genetic and chromosomal (number, deletion,

defects) ( such as Down Syndrome, and

Fragile X Syndrome)

-Maternal infections (rubella, measles)

-Toxins and chemical agents (fetal alcohol

syndrome)

-Nutritional and Metabolic problems

-Gestational disorders (formation of brain or skull)

-Complications from pregnancy or during delivery

-neurological (including tumors)

Possible Causal Factors of ID

• Social-Environmental (epigenetic?)

-More difficult to identify

-May involve many interactive variables

-Deprivation, poor housing, diet, poor

hygiene, lack of medical care all can affect

development adversely, but the effect is

unknown and varies by child

Possible Causal Factors of ID: Processing Factors

-ID children seem to have differences in cognitive,

information processing abilities—attention,

discrimination, organization, memory, transfer--

that are not solely attributed to IQ).

-Children with ID do not seem to process

information in the same manner as TD peers.

i.e. reduced attention, discrimination,

organization, memory, and transfer are

necessary to learn.

Developmental Language Disorder

(DLD)

—Language performance scores are lower

than intellectual performance scores on

nonverbal tasks: Nonverbal IQ usually

above 85 and a low verbal IQ.

• Difficult to sometimes identify

—About 7.4% of Kindergarteners

• 2/3 of these kindergarteners will still have

difficulty with language as adolescents

—10-15% of all children may be “late” with

language development by 2 years (“Language

Delayed”).

• Many seem to “outgrow” this

• 20-50% have language problems persisting into

school.

Do not usually demonstrate the perceptual

difficulties of LD (learning disabled) or the

intellectual difficulties of ID (Intellectually

Disabled)

DLD Characteristics

• May appear delayed in usually one aspect

of language (usually “Form”-

syntax/morphology)

• May not possibly catch up without

intervention

• Expressive abilities are usually below

receptive

Other characteristics may vary– including:

• Perceived more negatively by teachers

and peers

• Behavior problems may emerge

• Groups: contribute little

• Later in school self-esteem becomes

affected

• May be primarily receptive or expressive or a

combination

• Usually language form (syntax/morphology)

stands out

• These characteristics may change as child

matures

• These early language delays can affect

later reading (decoding and

comprehension) and writing skills.

• Oral errors may appear in writing

DLD and Reading

Although DLD is not a reading disability,

50-75% of children with DLD also have

reading disabilities

DLD: Semantics

-slow vocabulary growth and lexical errors

-Less able to recognize physical features (color, size, and

shape), thematic elements within a topic (throw, hit,

catch go with game), and/or causation (who caused

something, who or what received something)

-New words are not learned and stored quickly

-Naming difficulties secondary to less elaborate storage of

words

DLD: Syntax/Morphology

-Fewer morphemes used correctly, affecting verb endings,

auxiliary verbs, infinitives, and irregular verbs.

- Also, difficulty using articles and prepositions.

- (Morphology errors are a HALLMARK of DLD, especially

past tense and use of the verb “to be.” )

Grammatical Morpheme problems are “hallmark”

issues of SLI

-Instead of age 4, may be age 7 by the time they master

verb tenses. Late appearance of past tense- ed.

Morphological marker problems may persist.

-Pronoun errors are also common

DLD: Phonology

-SLI children vocalize less and usually have

varied and less mature syllable structures

-Poor non-word repetition (biledodge,

viversumouge)

-Working memory may have limitations-

which may affect and create difficulty in

terms of short-term memory storage for

phonological representations

DLD: Comprehension

-Poor discrimination of units of short duration like

bound morphemes such as plural endings, etc..

-Ineffective sentence comprehension

-Reading errors are often not related to the text in

terms of actual decoding or meaning

-Series of events presented visually or verbally are

difficult to reconstruct (like event retell or story

retell)- difficulty with sequencing.

DLD: Pragmatics

Inability to use effective Form to accomplish

language intention can result in difficulties in

pragmatics……

-May act younger than age

-Less flexible with language use and don’t

understand communication breakdowns

-Trouble getting a turn to speak

-Inappropriate responses to topic

-Incomplete, confusing narratives

-Failure leads to decreased social interaction

Possible Effects of DLD?

• Less likely to interact

• Less successful at play interactions-particularly if

expressive language is significantly affected

• Fear of approaching others

• Reticence

• Often ignored by peers which leads to decreased

interactional opportunities

• May result in social skills problems more likely to

possibly be victimized by peers

• By Junior High, these kids perceive themselves

negatively scholastically and socially

• Oral and text based uses of cell phones: exchange text

messages less often than TD peers

DLD-Possible Causal Factors: Biological

-Neurological disorder suggested:

-brain asymmetry/different patterns of brain activation–

(per Owens)…. May have deficits in neural circuitry

responsible for procedural memory which is responsible

for learning and executing sequential cognitive

information such as language

-Strong familial connections: 60% with DLD have an

affected family member-- 38% have an affected parent

-Pre-term births: 32 weeks or less are at considerable risk

-Predominance of males over females

DLD-Possible Causal Factors: Social-Environmental

- While no one has suggested this is a cause, there is

some evidence that parental interaction with DLD

children is decreased

DLD-Possible Causal Factors: Processing Factors--Executive function weaknesses

-reduced processing and storage of phonological information (the building blocks) leads to inefficient recognition of different words, ability to produce nonsense words, etc., inefficient word learning, slow word recognition, ineffective comprehension of sentences. Problems with incoming info, with memory, and with transfer.

-Phonological Awareness difficulties are not as profound as those with Dyslexia, however….

-For many, but not all, Working memory deficits restricts information processing (difficulty comprehending longer and more complex utterances-Imagine having a rapid conversation with weak working memory. You can’t keep up—keep losing information as more comes in. Can’t relate new information to processed old information. Think about your experiences with other languages……). Orient more slowly to information, have more limited capacity to focus and refocus and shift focus

Language Learning Disability

Significant difficulty in acquisition and use

of listening, speaking, reading, writing,

reasoning, or mathematical abilities

• Presumed to be related to Central

Nervous System (CNS) dysfunction

• May occur across the lifespan

Most children with LD do not have all of

the characteristics listed above-variety

exists. For example:

• 15% have difficulty with motor learning

and coordination

• Approx 85% have difficulty learning and

using symbols—Some professionals

consider this group to have a language

learning disability (AAOPS, 2009)

Characteristics of Children with LD:

Six categories of characteristics

1. Motor

2. Attention

3. Perception

4. Symbol**** (pay particular attention to

this category)

5. Memory

6. Emotion

Signs of LLD/LD

• Talking about his ideas. It may seem like the words he needs are on the tip of the

tongue but won't come out. He might use vague words like "thing" or "stuff" and may

pause to remember words.

• Learning new words that she hears in class or sees in books.

• Understanding questions and following directions.

• Remembering numbers in order, like in a phone number.

• Remembering the details of a story plot or what the teacher says.

• Understanding what he reads.

• Learning words to songs and rhymes.

• Telling left from right. This can make it hard to read and write.

• Learning the alphabet and numbers.

• Matching sounds to letters. This makes it hard to learn to read.

• Writing. She may mix up the order of letters in words while writing.

• Spelling.

• Doing math. He may mix up the order of numbers.

• Memorizing times tables

Language Learning Disability: Motor

Usually involves hyperactivity—overactivity

characterized by constant motion.

• About 5% of children have hyperactivity.

• Nine times as prevalent in boys.

• Not all kids with hyperactivity have LD.

• Not all kids with LD have hyperactivity.

• May also involve poor sense of body movement,

poorly defined handedness, poor hand-eye

coordination, poorly defined concepts of space

and time

Language Learning Disability: Attention

• Short attention span and inattentiveness

• Easily distracted by irrelevant stimuli and

easily overstimulated

• Affects ability to learn and organize life

• Perseveration often is present—repeat

utterances over and over, appear

unaware.

• NOT to be necessarily confused with a

diagnosis of ADHD

Language Learning Disability: ADHD

• Why? ADHD itself is characterized by

overactivity/inability to attend for increased periods of

time, BUT without many of the associated difficulties of

LD.

• It is most likely linked to an Executive Functions

impairment of the brain in the area that regulates

behavior—particularly impulsivity. Think back to our

work on information processing/executive functions…

• Children with ADHD can often experience problems in

social interactions that is explained in part related to their

accompanying poor social skills which may be attributed

to their pragmatic difficulties.

Language Learning Disability: Perception

• USUALLY COMPROMISED IN LLD!!! (Not as severe in

DLD)

• Perceptual Difficulties are related to perceiving stimuli

that are heard, seen, or received through our senses.

• May include difficulties with:

-Confusion of similar sounds and words/Similar printed

letters and printed words

-Figure ground perception (isolate an auditory stimulus

against background noise)

-Sensory integration difficulties. Ability to make sense of

visual and auditory stimuli occurring at the same time.

Gestures, facial expressions, body language, intonation,

and verbal language work together to convey

information.

Language Learning Disability: Characteristics of Memory

• Short and long-term storage and retrieval

• Think back to information

processing/executive functions

• These kids often have difficulty

remembering directions, names, and

sequences.

• Word finding problems are common.

Language Learning Disability: Characteristics of Emotion

• Emotional problems may accompany LD, but are

not causal

• Often reaction to or accompany frustration

related to situational difficulties

• Common descriptors: Aggressive, Impulsive,

Unpredictable, Withdrawn, Impatient

• May demonstrate poor judgment, unusual fears

(Owen’s example of shoes), or adjust poorly to

change

Language Learning Disability: Characteristics of Symbol—This is the language piece—

• All aspects of language—spoken and written—

are affected (often the case with LD—85%)

• Remember, the difficulties are perceptual.

Language perception….

-Even though these kids play TV/Radio loudly,

squint and rub eyes when reading, etc., or may

have concomitant hearing or vision problems,

the problem is not sensory.

• May struggle with conversational turns, and form and

content of language.

• Synthesizing language rules is difficult, so delays in

acquiring morphological rules and complex syntax

development.

• Morphological errors and syntax errors are present in

both speaking and writing. Most common morphological

error is omission.

• Overall language development may be slow, resembling

language of younger children but with even less use of

mature structures

• Little preschool interest in books or language. Cannot

follow a story.

• Word finding is a particular problem during conversations

and narratives. This is a difficulty on its own and can be

complicated by associated lower vocabulary of LDs.

• Greater time needed to respond verbally

• When young, often struggle with literal meanings

• When older, the struggle moves on to multiple meanings

and figurative meanings: Think about the Amelia

Bedelia

The language demands of the classroom are

often too high for the oral language of these

children

• Many end up in Special Day Classrooms—

• Our assessment is VITAL!

• Underachievement of these kids further

underscores language-learning links.

• Oral language skills are single best indicator of

reading and writing success in school.

Symbol-Specific LLD Language

Characteristics: Semantics

-difficulty relating and comparing items,

difficulty with non-literal language and

multiple meanings, word finding difficulties,

confusion with meanings of conjunctions

(and, but, so, because, etc….)

Symbol-Specific LLD Language

Characteristics: Syntax/Morphology

-Difficulty constructing negatives (I not like milk, etc.) and

passives (Dad was chased by the dog), relative clauses

that modify noun phrases (The man who bought my

house), contractions (didn’t)

-Difficulty with tense markers (past and future), possession

(“John keys,” “mines house,” “hims keys”), and correct

pronoun use (he for she, she for he, etc….).

-Repeats sentences in reduced forms which indicates

difficulty learning sentence forms: “I went to the store to

buy milk”=“I went to buy milk” or “I went to the store.”

“The Coach gave the uniforms to the team that

won”=“The coach gave to the team that won”)

-Confusion with articles (“a,” “an,” “the”)

Symbol-Specific LLD Language

Characteristics: Phonology

-Inconsistent sound production, especially

as word complexity increases—

multisyllabics may be tough:

Chrysanthemum, aluminum, alligator, etc.

Problems with phonological awareness may

be likely

Symbol-Specific LLD Language

Characteristics: Comprehension

-Confusion with wh-questions (Who? What?

Where? When? Why?)

-Poor strategies for interacting with printed

information

-Confusion of letters that look similar (b/d)

and words that sound similar (plane/pain)

Symbol-Specific LLD Language

Characteristics: Pragmatics

-Turn taking may be a problem

Difficulty answering questions or requesting

clarifications

-Difficulty initiating or maintaining a

conversation

LD-Possible Causal Factors: Biological:

Heredity is indicated.

CNS dysfunction is also a factor-- success

of Ritalin with some students.

Dyslexia brain studies----all suggest

biological basis present

LD-Possible Causal Factors: Social Environmental Factors

—While the formal definition precludes environmental

causality, certain factors are important to

consider:

- Language and interactional difficulties of these

children can affect development

- Acting out in response to frustration, accusations

of not trying, learned helplessness, fear of trying,

attention seeking (even negative attention is

attention).

- Social successes and failures have a great

influence on subsequent interactions

LD-Possible Causal Factors: Processing Factors

-Several executive functions are involved

-Information that is poorly attended to and poorly

discriminated will be poorly organized

-Memory is related to storage and retrieval. These

kids have later and slower growth with respect to creation of necessary semantic networks, leading to slower and less accurate retrieval (think about RAN)

Disorders similar to LD

Fetal Alcohol Spectrum Disorders (FASD)

Alcohol-Related Neurodevelopmental Disorder

(ARND)

Disorders similar to LD: Fetal Alcohol Spectrum Disorders (FASD)

-6 in 1000 live births

• Life-long difficulties with

-attention

-memory

-executive functions in general

-learning

-behavior

-control

-mental health

-academics

• Mean IQ maybe in the borderline ID category (but range from 30 to

105)

• Concrete learners

• Poor problem-solving

• Difficulty generalizing

• Easily distracted, overstimulated, impulsive, perseverative

• Poor memory, interpersonal skills, and judgment

• Language development delayed, echolalia, language production

exceeds comprehension

• Language development delayed, echolalia, language production

exceeds comprehension

• Problems with word order, word meaning, turn taking in conversation

• Executive functions are interrupted. Limited in amount of

information they can process. Cannot easily formulate concepts or

regulate responses

• Often diagnosed with an LD and or ADHD

Disorders similar to LD: Alcohol-Related Neurodevelopmental Disorder

(ARND)

characterized by Central Nervous

System damage rather than growth deficiencies.

May not have distinct facial characteristics

How is DLD different from LLD?

—Unlike LLD, in DLD kids, the focus is on

language (particularly form) and other

disorders are excluded.

• LLD demonstrates diffuse weaknesses

across the systems of language and may

be associated with other

perception/cognitive impairment areas

(motor, attention, perception, memory,

emotion)

—Language perception/cognitive difficulties

are the essence of LLD.

• The ability to attend actively, be

responsive, and anticipate stimuli is also

compromised in LLD, not SLI.

—Language impacting the ability to learn is

evident in LLD (reading decoding and

comprehension, ability to access the

curriculum, etc.)

DSM-V Stands for

Diagnostic and Statistical Manual on

Mental Disorders

DSM- V : Autism Spectrum Disorder (ASD)

1. Deficits in social-emotional reciprocity.

- Abnormal social approach

- Failure of back and forth interactions

- Reduced sharing of interests, emotions, or affect

- Failure to initiate or respond to social situations

2. Deficits in nonverbal communicative behaviors used

for social interaction.

- Poorly integrated verbal and non-verbal

communication

- Deficits in understanding use of gestures, nonverbals

- Lack of nonverbals or expressions

3. Deficits in developing, maintaining, and

understanding relationships.

- Difficulty adjusting behavior to social context

- Difficulty in sharing imagination

- Difficulty in making and keeping friends

- An absence of interest in peers

A diagnosis of ASD contains elements of the

following

impairment in social interaction

-severely limited behavior, interest, and activity

repertoire

-Behaviors that include difficulties with social

relatedness, communication, and

restricted/repetitive/stereotyped patterns

-disturbances in responses to sensory stimuli

(hyper- and/or hypo- in hearing, vision, touch,

motor, smell, taste combined with self-

stimulation behaviors (“stimming”)

-disturbances in speech and language, cognition,

and nonverbal communication including mutism,

echolalia, and difficulty with abstract terms

-disturbances in capacity to appropriately relate to

people, events, and objects

-Lack of social behaviors, affection, and social play

Hyperlexia

-7:1 boys to girls

-Spontaneous ability to read, freq. by 2.5-3 years

-Little reading comprehension, however

-Intense preoccupation with letters and words

-Extensive word recognition/decoding by 5

-Language and cognitive disorders in reasoning

and perceiving relationships

-Delayed language, difficulty with connected

language in all modalities, difficulty integrating

language with context to make meaning

DSM-V criteria: Autism Spectrum Disorder (ASD)

Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or by history (examples are illustrative, not exhaustive:

– Stereotyped or repetitive motor movements, use of objects, or speech (e.g.,simple motor stereotypies, lining up toys or flipping objects, echolalia, idiosyncratic phrases).

– Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat same food every day).

– Highly restricted, fixated interests that are abnormal in intensity or focus (e.g., strong attachment to or preoccupation with unusual objects, excessively

circumscribed or perseverative interests).

– Hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects

of the environment (e.g., apparent indifference to pain/temperature, adverse

response to specific sounds or textures, excessive smelling or touching of

objects, visual fascination with lights or movement).

ASD-General Language

Characteristics

• First red flag is often communication problem (failure to

begin gestures or talking, noninterest in others, lack of

verbal responses)

• Poor social interaction, language, communication skills

• Articulation is not usually a concern, but speech can be

robot-like/ lacks prosody/rhythm

• 25% may have typical language, but 25-60%remains

nonspeaking. Augmentative and Alternative

Communication (AAC) may help some.

• Many demonstrate immediate or delayed echolalia.

Most go through at least one period of this.

ASD in months

-Before 18 months (rarely diagnosed) lethargic, prefer solitude, make few

demands OR highly irritable with sleeping problems and intense crying

-18-36 months: tantrums, repetitive movements, ritualized play, extreme

reactions to stimuli, lack of pretend and social play, joint attention and

communication difficulties including lack of gestures.

-In approx. 20% of cases, parents report typical development prior to 24

months, partic. with girls.

-Development seems to involve spurts and plateaus

-Sometimes self-injurious behaviors develop

ASD- Pragmatics—What does it look like?

-Decreased joint attention

-Difficulty initiating and maintaining conversations

-Limited overall communication functions

-Difficulty matching language form and context

-May perseverate and/or bring up inappropriate topics.

-Immediate and delayed echolalia

-Routinized utterances

-Few gestures, misinterprets gestures

-Overuse of question form

-asocial, solitary monologues

-Speaker listener roles not well developed

-Poor eye contact—seems to use peripheral vision

“Theory of Mind”

The ability to recognize that others have beliefs,

desires, intentions, emotions, and knowledge

that are different from one’s own……

• Directly related to pragmatics…ex. A False Belief Problem: The “Smarties” Task

ASD: Semantics

-Word finding

-underlying meaning of words is not used as

a memory aid

-inappropriate answers to questions

ASD: Syntax/Morphology

-Pronoun use and verb endings are affected

(The dog running)

-Superficial, structured sentences, with little

attention to meaning (Where you going?)

-Overly dependent on word order (The dog

chased the chicken as opposed to

passive)

ASD: Phonology

-Often disordered, but variable within the

child (some apraxia connection)

-This is the least affected aspect of language

in many cases

ASD: Comprehension

-Overall impaired. Most noticeable during

conversations

ASD Possible Causal Factors: Biological

-65% have abnormal brain patterns, hypergrowth at some periods,

longer axonal length, different volume at different points of

development, different patterns of network connectivity

-Incidence correlations found between autism and prenatal

complications, fragile X syndrome, Ritt syndrome, Tourette’s, and

family history of ASD.

-possible seizures

-Studies have found high levels of seratonin—a neurotransmitter,

abnormal cerebellum development (regulates incoming sensations),

multifocal brain disorders, neural subcortical impairment, etc.

-Some studies have suggested a multiple gene genetic link

-genetic and epigenetic??? May be genetic and interaction with

biological and environmental factors…

ASD Possible Causal Factors: Social-Environmental Factors

-Early studies blamed parents…

No basis for this!!!!

-There is no basis for this and subsequent

studies have found that these parents

frequently interact with their children at

appropriate language levels

-Consider the ramifications of such

studies

ASD Possible Causal Factors: Processing Factors

-difficulty analyzing and integrating information; fixate on one

aspect of incoming stimuli (attention) (usually unimportant and

minor). This impacts the ability to discriminate.

-Overall processing is “gestalt” and chunks are stored and

reproduced identically. (organization) Input never seems to get

taken in as a whole an analyzed into its parts. These children

frequently repeat agrammatical sentences and don’t correct

them.

-Very little of the world makes sense to these children. They

overload quickly….

-Storage of these gestalts may overload memory

-Can’t organize information on the basis of relationships between

stimuli because whole chunks are stored….

-Huge problems transferring or generalizing learned information

from one context to another.

Traumatic Brain Injury (TBI)

1 Million children and adolescents in U.S.

• Diffuse brain damage resulting from an

external physical force. Auto Accident,

bicycle accident, etc….

• Results range from full recovery to

vegetative state, depending on damage

• Long term disability is common

• Concussion is a TBI

TBI: Deficits

Cognitive, physical, behavioral,

academic, linguistic

TBI: Cognitive:

Perception, memory, reasoning,

problem solving may be affected. May be

permanent or temporary

TBI: Psychological maladjustment

may lead to

social disinhibition—A.K.A. acting out

• Lack of initiative, distractibility, inability to adapt

quickly to new situations, perseveration,

frustration, anxiety, depression

TBI: Severity range

Severity range from mild concussion to

severe TBI.

Mild TBI/Concussion

Moderate TBI: loss of consciousness or

posttraumatic amnesia for > 30 minutes

Severe TBI: Coma for 6 hours or longer

TBI Long Term:

• Even TBI in early childhood can have

impact in later life: social, academics,

behavior, attention

• 40% + of those incarcerated have a history

of TBI (TBI to prison pipeline)

• May seem to heal but there is a disruption

in development

• Parents may not see the connection, or

even report

Statistics indicate some populations at greater

risk for TBI:

• Lower IQ

• Social disadvantage

• Poorer schooling

• Behavioral and physical difficulties prior to injury

TBI: Variables affecting recovery:

• Degree and length of unconsciousness (milder and

shorter)

• Duration of amnesia (shorter)- Post traumatic ability

(better)

• Age at injury: This one is complex. Younger children

may face more complex problems. While they have less

to recover and more development to take place, they do

not have the benefit of the prior learning of older

children, adolescents, and adults. Their pattern of

development is interrupted.

• Age of injury: time since injury…..but still able to

improve…neuroplasticity

TBI: Cognitive-communication deficits

– Attention: sustained, selective, divided,

alternating

– Memory

– Executive functions

– auditory processing, processing speed

– And, of course, language…

TBI Language Characteristics: Semantics:

Word retrieval and naming deficits.

Vocabulary may be intact, but difficulty describing

objects. Automatized, over-learned language (“Hi,”

“How are you,” and contextualized language)

relatively unaffected.

TBI Language Characteristics: Syntax/Morphology:

Sentences may be lengthy

and fragmented

Note: Many children with TBI may be able to use

language effectively in academic settings until 3rd

Grade: higher language skills required to analyze and

synthesize then cause breakdowns

TBI Language Characteristics: Phonology

Few difficulties, although

Dysarthria or apraxia may exist secondary to

injury.

TBI Language Characteristics: Comprehension:

Problems due to inattention

and processing speed. Poor auditory

comprehension and reading comprehension.

Sentence comprehension secondary to syntax

and semantics problems. Routinized, everyday

comprehension (contextual again) unaffected.

Non-abstract vocabulary usually unaffected.

TBI Language Characteristics: Pragmatics:

THE HALLMARK OF TBI

Off topic, ineffectual, inappropriate comments.

Lengthy explanations. Appropriate eye contact.

Less complex narratives with reduced sentence

complexity, although story grammar and cohesion

may be intact.

TBI: Possible Causal Factors: Biological and physical factors

• Biological and physical factors cause the

language characteristics observed

• Information processing is affected,

particularly attention and organization,

storage, and retrieval.

• Long term memory prior to the trauma is

usually intact.

TBI Types

1. Penetrating

2. Non-penetrating

TBI: Brain Effects

1. Axonal Shearing

2. Hematoma

3. Swelling

4. Hemorrhagic Bleeds

Cerebrovascular Accident (CVA)

• Occurs when a portion of the brain is denied

oxygen. Usually rupture of blood vessel

(hemorrhagic) in children. Can be both

hemorrhagic or ischemic in adults.

• Damage is usually specific and localized

• Recovery patterns suggest that adjoining

portions of cortex augment the functioning of the

damaged portion

• Prognosis generally good for recovery or partial

recovery over time—depends on site and extent

of lesion

• Frequently found in children with:

congenital heart problems or blood vessel

malformations in the brain.

• Language difficulties common with left

hemisphere lesions—but remember! Any

brain damage, regardless of hemisphere,

has the ability to disrupt language.

CVA: Language Characteristics

• Language form (syntax) usually recovers quickly,

but may be less strong in presence of increased

linguistic demand

• Word retrieval at first may be extreme—both in

terms of speed and accuracy

• Language comprehension decrease at first.

Higher level academic and reading problems

may persist.

• Persistent subtle pragmatics difficulties

Common!!!!

Maltreatment: Neglect and Abuse

900,000 children in U.S. each year

Increased economic, social, health

problems and lower levels of education

and employment

Neglect and abuse are a sign of the

environment in which the child learned

language.

Connections to alcohol and drug use

by parents

Developmental difficulties across

lifespan can result—much of the data

is correlational only, however, as these

studies are newer…

• Many report that traumatized children

experience biological brain changes

characterized as hyperarousal

• The associated physiological changes

involves release of stress hormones and

they influence thoughts, feelings, and

actions. Leads to hyper-vigilant state—

apprehension, fear, attention difficulties,

restlessness.

• What does this do to information

processing??

Neglect and Abuse: Types

Physical Neglect: abandonment, improper

medical care, hygiene, etc..

Emotional Neglect: failure to provide a normal

living experience with attention and affection.

Physical Abuse: Bodily injury

Sexual Abuse: Nonphysical and physical

Emotional Abuse: Excessive yelling, belittling,

overt rejection

Neglect and Abuse: Language

Characteristics

Semantics: Limited expressive vocabulary, few decontextualized

utterances, more contextualized—”here and now” discussion.

Syntax/Morphology: Shorter, less complex utterances

Phonology: Similar to peers

Comprehension: Auditory and reading comprehension affected

Pragmatics: Hallmark!!!! Poor conversation skills, unable to discuss

feelings, short conversations, few descriptive utterances, language

used to meet an end/little social exchange or affect

Neglect and Abuse: Causal Factors — Biological

Biological: Poor maternal health,

substance abuse, poor pediatric services,

poor nutrition all affect brain development

and maturation. Physical abuse may lead to

neurological damage. Lack of environmental

stimulation—how does this affect brain

development?

Neglect and Abuse: Causal Factors — Social-enviormental

Learned strategies to cope/survive interfere with brain development in

areas of social-emotional learning. Interaction with these children is often reduced.

Neglect and Abuse: Causal Factors — Attachment theory

If insecure attachment occurs

secondary to abusive or neglectful parenting,

an apprehensive child may be the result.

Secure attachment is vital if effective interaction

is to take place that leads to effective language

learning.

For example, stimulus response may be nonexistent

with these children….

Selective Mutism

— Relatively rare

• Child does not speak in some situations (school,

etc.) but may speak normally in others.

• Girls nearly 2x as affected as boys

• Related factors: social anxiety, extreme shyness,

LI (30-50% may have LI), Second Language

Learning (silent periods).

• ASHA position paper recommends ruling out

emotional factors-school psychologist, etc.

• SLP services may be indicated

How does a SLP help children with Selective Mutism?

• Correct and Modify some language difficulties

• Teach compensation skills where appropriate

• Promote parent/caregiver/educator understanding

• It is a social language issue

• Know how to ASSESS!!!!

Dyslexia

Definitely related to difficulties with “symbols” .

• Specific to the phonologic core/phonological processing.

• 80% of children with LD have some form of reading problem.

• Dyslexia:15-17% of the total population

Dyslexia is characterized by

difficulties in accurate, fluent word recognition

when decoding words and spelling difficulties

Dyslexia is often associated with problems with:

-Phonological awareness

-Phonological memory

and

-Rapid Automatic Naming (RAN) deficits

Side note:

It is believed that decreased phonology,

specifically phonological

awareness/phonological memory leads

to trouble with phonics (sound-symbol

correspondence) can lead to decreased

reading fluency, which impacts reading

comprehension

It is also hypothesized that decreased

rapid naming, leads decreased reading

fluency, which impacts reading

comprehension

Language based issues may affect Dyslexia in

comprehension and/or speech sound

discrimination (SLP involved)

How is Visuospatial disorder associated with Dyslexia?

may affect letter-form

discrimination with relatively unaffected language

overall (not SLP focus)

Comparing children with dyslexia to their

Typically Developing peers, the following are

often noted:

• Comparable verbal IQ scores and/or listening

comprehension

• Below average word reading (decoding)

• Nonsense or non-real word reading is below

real word reading (word attack skills)

• Well below average phonological processing

scores

Echolalia is

the repetition of words, phrases, or sounds spoken by others, occurring as a normal developmental stage in toddlers or a communication strategy in autistic individuals. It is divided into immediate (instant repetition) and delayed (repeating later) types. It serves as a tool for processing, self-regulation, and communication, with a high prevalence (up to 91%) in autistic children

What is top-Down Processing?

With elaborate stimuli, such as language,

“… the brain activates higher level or top-level,

processes, such as linguistic and word knowledge…”

and analyzes the incoming information to see how it

“fits”. Language is “heard” in relation to guesses based

on previously stored linguistic information

Bottom-Up Processing is?

Brand new concepts, concepts unrelated to

stored info, and less complex stimuli are 1st processed

perceptually at bottom levels and are then forwarded to

working memory to be encoded and stored in long-term

memory

Information Processing Model- What are the 4 steps and roles of each?

1. Attention — Child may miss important stimuli, results in poor discrimination

2. Discrimination — ability to distinguish between a group of stimuli and decide if similar or not to model stored in working memory

3. Organization —

4. Memory/Retrieval

What is Information Processing?

System serves both language and

thought

• Individuals process information differently

• This is explained by structural differences in

the brain and/or learned differences

• Affects ability to attend, organize and

develop rules and strategies for processing

information