Intro to comm disorders FINAL

SLP 150 CSUM FALL 26

Congenital disorder

Disorder present at birth

Acquired disorder

A disorder that develops after birth

Developmental disorder

A disorder that emerges during the course of development

Organic conditions

A medical problem exists that is physically & medically present

Functional conditions

A condition occurs due to a certain behavior

Speech

Involves producing sounds or HOW you say it

Language

Involves using a structured system to express & understand meaning or WHAT you say

Evidence-based practice

Consists of a rationale for doing certain practices taking into account current based evidence, clinical expertise, & client values

ASHA Code of Ethics

4 pillars

1. Do no harm

2. Do your best

3. Represent us well

4. Work as a team

Outer ear

Includes: ear canal, tympanic membrane

Middle ear

Includes: 3 ossicles (tiny bones) 1. malleus (hammer) 2. incus (anvil) 3. stapes (stirrup)

Inner ear

Includes: semicircular canals, cochlea, auditory nerve

Conductive hearing loss

When sound is not conducted effectively through outer & middle ear resulting in reduction of sound heard

Causes & characteristics of conductive hearing loss

Causes: ear infection, earwax buildup, foreign objects in ear canal, malformations

can be fixed by medical or surgical intervention, typically temporary not always

characteristics: muffled or quite sound, can hear if loud enough

Sensorineural hearing loss

Most common type, results from damage to cochlea or auditory nerve which causes reduction in loudness, speech perception, and ability to distinguish sound from background noise 

Causes & characteristics of sensorineural hearing loss

Causes: aging, loud noise exposure, genetics, illnesses/infections, head trauma, stroke

Typically treated w/ amplification (hearing aids, cochlear implant, etc)

Characteristics: muffled speech/sounds, hard to hear high frequency sounds

Mixed hearing loss

Conductive & sensorineural crossed

Causes: blockage, age, infection, head trauma & more

Characteristics: reduced volume heard, reduced clarity

What are the types of energy involved in the process of hearing?

1. acoustic energy: sound waves are carried through the outer ear & hit eardrum

2. mechanical: the sound waves hitting ear drum cause ossicles to vibrate

3. hydraulic: sound transmits to the inner ear (cochlea)

4. neural: sound reaches acoustic nerve which transmits data to brain

Cochlear implant

Helps w/ severe profound sensorineural hearing loss by detecting sound w/ a magnetic piece that attaches to the head & ear.

This stimulates the auditory nerve w/ electrical impulses.

Surgery is needed

What is the impact of hearing loss?

Children are not immersed in speech and language as they cannot distinguish speech sounds & mimic their own to develop oral speech. This means they are not taught speech & language and may have developmental delays.

Stuttering

A disruption in process of ongoing speech marked by: increased frequency & duration (more than 3 stutters within 100 words)

What are some atypical types of stuttering? 

Monosyllabic whole word repetitions: He-he-he hit me

Sound repetitions: p-p-p-pet

Syllable repetitions: ba-ba-ba-bay

Audible sound prolongations: sssssss-snow

Inaudible sound prolongations: g---irl

Stuttering secondary behaviors

Physical behaviors to prevent a disfluency (stutter) or to escape from the middle of one

Includes: eyeblinks, tension, lip/face tremors, head jerks, abnormal breathing, fist cleaning, grimacing, & more

Developmental disfluency

Occurs when the speech mechanism of young children is immature and cannot keep up with their thoughts and makes them seem to stutter

Includes: hesitations, repetitions, filler words, buying time to not lose control of ocnvo

It is normal & typically occurs at ages 2-5 which expectations for children to grow out of it.

What are the differences between true stuttering and developmental disfluency?

True stuttering

• more frequent

• lasts longer

• occurs within words

Developmental disfluency

• younger kids (preschool age)

• hesitations

• whole word repetitions

Phases of stuttering

1. Unaware, unemotional, any word (2-6yrs) 

2. Chronic, self-image, content words (5-8yrs) 

3. Trouble sounds, circumlocutions (talk around or describe by not saying actual word), substitutions (8+) 

4. Fearful anticipation (emotional reaction), avoidance (8+) 

Risk factors of stuttering

• NOT causes

• Genetic predisposition

• Rapid parental speech rates

• Too complex/sophisticated input

• Frequent interruptions

• Tension/stress during communication

Speech sound disorders

An impairment of an individual’s sound system that results in significant problems w/ one’s speech sound production

3 types of speech sound disorders

1. articulation: difficulty physically producing a particular speech sound

2. Phonological: difficulty understanding or using the sound patterns of a lang

3. childhood apraxia of speech: a motor-planning/programming difficulty affecting the movements needed for speech

How can consonants be described?

Voice: wether or not vocal folds are vibrating 

Place: Point of constriction in vocal tract 

Manner: How air flow is constricted in vocal tract

How can vowels be described?

Advancement: point of “major” constriction 

Height: how “closed” or “open” sound is 

Lip configuration: rounded vs retracted (unrounded)

Tenseness: degree of muscle tension

Protoword

When children map meaning onto babbling productions

Why is babbling important?

Impacts later language as children who babble w/ MORE V than c show LESS language growth. Those who babble w/ more complex, diverse C show MORE lang growth.

Phonological processes

Patterns of sound errors that typically developing children use to simplify speech as they are learning to talk.

They’re consider a disorder when they persist beyond a certain age.

articulation processes

A physical or motor-based difficulty producing individual speech sounds (consonant & vowels)

What categories of phonological processes exist? 

1. Assimilation

2. Syllable structure

3. substitution

Assimilation

When a sound becomes the same or similar to another sound in the word

ex: cup - kuk, down - nown

Syllable structure process

When the change of a sound affects syllable structure of a word

• cluster reduction: consonant cluster simplified into a single consonant (spoon - poon)

• weak syllable deletion: banana - nana

• final consonant deletion: leaf - lea

Substitution

When one sound is substituted for another

• Fronting: sound made in back of mouth (velar) replaced with/ sound made in front of mouth (ex: alveolar)

  • Ex: monkey – montey

• Stopping: fricative &/or affricate replaced w/ stop 

  • Ex: vacuum – bacuum

• Gliding: liquid replaced with/ glide 

  • Ex: tree – twee

• Deaffrication: affricate replaced w/ fricative 

  • Ex: watches - watsez

Childhood apraxia of speech

a rare motor speech disorder where a child's brain struggles to coordinate the complex mouth, jaw, lip, and tongue movements needed for clear speech

Typical milestone for language development: infant

Birth -1yr

• become intentional communicators

• between 1-4 mo take control of sounds

• develop a lexicon (mental dictionary

• around 10-11mo understand abt 10 words

• say 1st word around 12mo

Typical milestone for language development: toddler

1-3yr

• lexicon grows

• begin to combine words to create 1-4 utterances

• at least 75% intelligible 

Typical milestone for language development: preschool

3-5yrs

• lexicon continues growing

• MLU increases

• refine grammatical morphemes

• articulation continue to become more clear, some phonological processes resolved  

What is MLU?

Mean length utterance used to track syntax growth & to compare developmental norms

• divide total morphemes by total utterances

Brown’s morphemes

Brown identified 14 English morphemes that children generally master in a predictable sequence, defined as reaching 90% correct usage in obligatory contexts

• tracks how children acquire English grammar

Brown’s stages of development

Brown grouped language development into five stages using MLU (the average number of morphemes per utterance)

Language disorder

When someone exhibits significant & persistent difficulties w/ comprehension &/or expression of spoken language or written language when compared to other children at similar age w/ similar linguistic & cultural background

CAN CO-OCCUR w/ other disabilities (cerebral palsy, autism, SLI, ADHD, & TBI)

Specific language impairment (SLI)

Child who presents w/ a language disorder who otherwise developed typically

Intellectual disability

Mental abilities significantly below what is expected of their age (typically IQ under 70)

characteristics:

• child under 18

• difficulty w/ adaptive, practical, everyday skills needed to function

• language skills tend to match mental abilities

Cerebral palsy

Brain damage prior to, during or immediately after birth which causes a loss or impairment of motor function

• May impact muscle control, muscle coordination, muscle tone, reflex, posture, balance, & fine motor skills

How to evaluate language disorders?

Referral

Evaluation

• History

• Interview/parent feedback, teacher, previous therapists

• Observation

• Formal testing

• Informal testing

diagnosis

Autism spectrum disorder (ASD)

A developmental disorder which includes significant difficulties in social interaction, communication, engagement in repetitive behaviors & overly restricted interests

• Lang skills almost always affected

• Considered a “spectrum” disorder

• no single cause identified

• risk factor: genetics, children born to older parents, exposure to certain drugs during pregnancy

Autism symptoms & signs

Impacts:

1. social skills (unusual body language, facial expressions, avoiding eye contact etc)

2. communication (odd rhythm/tone, word repetition, trouble conversing, etc)

3. behavior (hand flapping, obsessive attachment to objects, disinterest)

4. sensory (extra sensitive to senses)

5. emotional (difficulty regulating & expressing emotions)

6. cognitive (abstract thinking, symbolic, & language difficult)

What does AAC stand for?

Augmentative alternative communication used for individuals with complex communication needs & who cannot meet daily communication needs w/ current methods of communication

Neurodiversity

A difference in brain function & behavioral traits are normal variations of human genome 

• Not something needs to be CURED 

• Humans think & learn in diff ways but none are WRONG 

• Relates to: ASD, ADHD, dyslexia, Tourette syndrome, stuttering, etc

AAC purpose

To enable individuals to efficiently & effectively engage in variety of interactions & participate in activities

Who uses AAC?

Those who have:

• Apraxia

• ALS (intellectual disabilities) 

• Aphasia 

• Autism 

• Cerebral palsy 

• Traumatic brain injury (TBI)

Unaided communication

Requires no external device

• natural speech

• ex: facial expressions, gestures, sign language

• vocalizations

• manual signs

• using one’s own body

Aided communication

Requires some type of external assistance

• real objects

• black & white line drawings

• speech generating device

• low or high tech

• ex: picture boards, communication books

Dynamic display

selecting a symbol can bring up a different screen or set of options

Static/fixed display

symbols stay in same locations & do not change automatically

What is scanning?

Options are presented one at a time or in a sequence & the person signals when desired option appears

What is direct selection?

The person directly chooses a symbol or option by touching a picture, pointing, or using eye gaze

Digitized voices

Recorded human speech is played back

Synthesized voices

A computer generates speech electronically from text or language-processing rules

Speech generating device

a specialized electronic system that produces spoken words or phrases for individuals who cannot speak or have severe speech impairments

Low tech AAC

No batteries or electronic speech output needed such as picture board

High tech AAC

electronic systems such as iPads or speech generating device

Feature matching

Choosing an AAC system based on the individual’s abilities, needs, preferences, environment, and communication goals

AAC treatment goals

1. meet unmet communication needs

2. increase communication competence

3. increase participation in society

Language difference

A variation related to someone’s language, dialect, cultural background

Language disorder

Difficulty learning or using language that cannot be explained by language or cultural differences

Cultural competence

Involves understanding & appropriately responding to unique combination of cultural variables: ability, age, beliefs, ethcnity, experience gender, gender identity, ling background, national origin, race, religion, sexual orientation, & socioeconomic status  

How do cultures differ?

Language, beliefs, attitudes, goals, independence vs group reliance, change vs tradition, etc

What linguistic variables do we need to keep in mind?

• accents

• grammar/syntax

• code-switching

• slang

• regional dialects

What areas do other cultures have specific views on?

1. education

2. healthcare

3. disability

4. gender roles

5. authority

6 components of the cultural competence continuum

1. Destructiveness: Harm cultures

2. Incapacity: Can't or won't serve cultures well

3. Blindness: Ignores cultural differences

4. Pre-competence: Recognizes the problem

5. Competence: Adapts services appropriately

6. Proficiency: Continuously improves and advocates

Multicultural assessment

Don't rely on one standardized test or one language alone. Consider:

• The client's language and cultural background.

• Language history and exposure.

• Interviews with the family.

• Natural language samples and observations.

• Skills across the languages the client uses.

Ethnographic interview

An interview that helps SLP understand client’s cultural & linguistic background, daily communication, family practices, & experiences

Dynamic assessment

Looking at what a person learns with support

Test → teach → retest

Should a child who is language delayed only use one language?

No, it is best to expose to as many languages as possible

For a typically developing bilingual child, what do you know about what is

expected for receptive and expressive language skills?

May look delayed in expressive language but demonstrates normal to above normal receptive language & vocab knowledge

Common underlying proficiency (CUP)

Skills & knowledge developed in one language can support learning & usage of another language

If there is a language disorder, will it exist in only one language or in both?

Appears in both languages because they share an underlying proficiency 

An error must be seen in both languages

• if only shown in 1 language & not the other it means person is getting acclimated to BOTH

Is testing in only one language appropriate?

NO, consider all languages client uses

What happens if we don’t give someone a full opportunity to show all of their language knowledge?

Some people could be mislabeled

• an ELL mislabeled for language disorder when needs more time to understand English

How do we gather information beyond standardized tests?

• research culture

• dynamic assessment

• ethnographic interview

• language samples

• interpreter support when needed

When should we consider testing a child for a language delay or disorder?

Shown deficits in both languages

Working with interpreters

A trained interpreter can help an SLP communicate with a client & assess a language the SLP does not speak.

Family members may provide: useful background

• relying on them as interpreters can create issues w/ accuracy, confidentiality, bias, or role boundaries

Whenever possible, use a qualified interpreter

What is a benefit of including family and using their language knowledge for intervention?

Can help carry intervention strategies into daily life at home

Which language should we use for treatment with children?

Use dominant language

• parent involvement/training

• early intervention techniques

• literacy

Which language should we use for treatment with adults?

Use both/all languages, include profiles of language learning & loss

• supports communication in diff environments, relationships, & daily activities

What strategies can we incorporate in treatment with kids? (multiculturalism & bilingualism)

• Establish mutually acceptable goals

• Consider RTI approach

  • Response intervention (provide support & see response)

• Make activities culturally acceptable

• Goal is not to correct or make them mainstream

  • Your goal is not to “correct” their cultural preferences 

Bilingual SLPs

An SLP who reads, writes, & speaks proficiently in a 2nd language

• may still help clients even if their own speech reflects their native language

• Having an accent or language difference does not automatically make someone an ineffective clinician

How many hemispheres are in the brain?

2, left & right hemisphere

How many lobes are in the brain?

4 lobes

1. frontal (front of brain by forehead): planning, movement, speech production

2. parietal (at top): sensory processing & spatial awareness

3. temporal (on the side by ears): hearing & lang comprehension aspects

4. occipital (back part): vision

Brain stem

Located at base of brain, connecting the brain with spinal cord

• supports essential functions such as breathing & heart rate

CVA

means cerebrovascular accident AKA stroke

Nerves

carry messages from the brain to the body & sends instructions from brain to muscles

Ischemic stroke & causes

A blood vessel supplying the brain becomes blocked, reducing blood flow & oxygen to brain tissue

causes: a clot BLOCKS blood flow (fatty plaque)