Human Communication Disorders Exam 2

anatomy

study of structures of body and relationship of structures

physiology

study of functions of organism and bodily structures

respiratory

moves air into and out of body like a mechanical pump for life-sustaining processes like gas exchange, coordination with swallowing, coughing, and driving force for speech production

supply oxygen to blood

remove excess carbon dioxide

driving source for speech production

laryngeal

larynx is an air valve that protects lower airways and is a sound generator for speech

upper airway system

includes pharynx, velopharynx, and oral and nasal cavities;

serve important roles in feeding/swallowing, resonance, and articulation

pulmonary apapratus

consists of pulmonary airway and lungs

encased by structures of chest wall

rib cage wall, diaphragm, abdominal wall, abdominal content

pulmonary apparatus and chest wall are linked together by fluid membranes

lungs

organs of breathing

a pair of irregular cone-shaped spongy structures that are highly elastic and can change in size and shape to allow us to breathe

trachea

tube composed of 16-20 C-shaped cartilages interconnected by fibrous tissue and muscles that extends from larynx down through neck into torso

divides into left and right main-stem bronchi, and further divisions

successive branches terminate at alveoli, which are tiny air sacs where gas exchange occurs

diaphragm

dome-shaped muscle of inspiration

composed of a think, flat, nonelastic central tendon and a broad rim of muscle fibers that course upward and insert into edges of central tendon

central tendon is in contact with each lung

when it contracts during inspiration, pulls downward and forward and flattens, enlarging the thorax vertically

lungs expand due to pleural linkage

abdominal wall

vertebral column at back that extends from the bottom of rib cage wall to coccyx and pelvic girdle

covered by broad sheets of connective tissue

contraction pulls lower ribs and sternum downward and forces abdominal wall inward in expiration

assist diaphragm’s movement back to relaxed position

inspiratory msucles

generally above diaphragm

expiratory msucles

generally below diaphragm

external intercostals

muscle of inspiration

eleven paired muscles in spaces between outer portions of ribs

elevate rib cage when they contract

sternocleidomastoid

muscle of inspiration

raises sternum and clavicle, elevating the rib cage

scalene muscles

muscle of inspiration

contraction of this raises first 2 ribs

internal intercostals

muscle of expiration

eleven paired muscles in internal portions of rib interspaces

pull downward on rib cage when they contract, decreasing size of thorax

resting tidal breathing

breathing to sustain life

inspiration

motor commands from respiratory brainstem centers activate diaphragm and possible external intercostals

diaphragm contracts, chest wall expands, lungs expand, alveolar pressure decreases

causes air to rush in and equalize with atmospheric pressure

approximately 0.5 L of air is inhaled during quiet breathing

expiration

decreases size of rib cage wall, compression of lungs, increase in pressure in lungs, air rushes out to achieve equilibrium with atmospheric pressure

expiration during quiet breathing is passive

swallowing during expiratory phase

larynx

prevent foreign objects from entering trachea and lungs

air valve located within front of neck composed of cartilages, muscles, and other tissue

primary sound generator for voice and speech production

sits between trachea and pharynx

appears to be suspended from hyoid bone, and U-shaped, free-floating structure

thyroid, cricoid, and arytenoid cartilages, attached by joints, ligaments, and membranes

epiglottis

large, leaf-shaped cartilage attached at is lower end to the thyroid cartilage and at its midportion to body of hyoid bone

assist in preventing food from entering larynx and lower airways during swallowing

vocal folds

housed in larynx

attached at front near midline of thyroid cartilage and at back of vocal process of arytenoid cartilages via the vocal ligament

made of mostly muscle and a vocal ligament that runs through it near it inner edge from front to back

abduct (open) during respiration

adduct (close) during phonation

outer layer of vocal folds is a thin, stiff epithelial tissue

3 layers of lamina propria, an innermost layer of muscle

ventricle folds aka false vocal folds

glottis

space between vocal folds

intrinsic laryngeal muscles of larynx

both points of attachment are within larynx

critical for phonation and modifying pitch and loudness

extrinsic laryngeal of larynx

support and stabilize larynx and serve a role in changing its position in neck

supplementary laryngeal muscles of larynx

generally have 1 point of attachment on hyoid bone

upper airway system

oral cavity

nasal cavities

pharyngeal cavity

form vocal tract

mandible

allows it to move up and down, forward and backward, side to side, for chewing

mastoid process

attachment for sternocleidomastoid and other neck muscles

styloid process

origin of muscles important for chewing, swallowing, and speech production

teeth

biological function is for chewing food

minor role in speech sounds

oral cavity

lips, cheeks, front teeth, and front portions of alveolar processes of maxilla and mandible

anterior faucial pillars form back of oral cavity

hard palate and velum make up top of mouth

tongue makes up most of floor

tongue

structure within oral cavity important for swallowing and speech production

muscular hydrostat- no bone or cartilage

divided into 5 parts- body, root, dorsum, blade and tongue tip

intrinsic muscles of tongue

superior longitudinal- pulls lateral margins of tongue up

inferior longitudinal- shortens tongue and pulls tongue tip down

transverse and vertical muscles- narrows and elongates or broadens and flattens tongue

extrinsic muscles

styloglossus, palatoglossus, hyoglossus, and genioglossus

responsible for changing position of tongue in oral cavity

pharynx

tube made of tendon and muscle that starts at base of skull and extend down to larynx

opens at front and connects from top to bottom with nasal cavities, oral cavity, and entrance to larynx

pharynx is continuous with esophagus, contact is broke during swallowing and regurgitation

velum

soft palate- located in pharynx

muscles:

palatal levator- forms bulk of velum and pulls velum upward and backward

uvulus- shorten and lifts velum

glossopalatine- pulls velum down and forward

pharyngopalatine- pulls velum down and backward

paltal tensor- open eustachian tube

swallowing and speech- elevates and decouples nasal cavity from pharyngeal cavity, leading to velopharyngeal closure

prevents food and liquid from coming out of nose during swallowing

speech production process

begins with phonation

air pressure build up beneath adducted vocal folds (alveolar pressure)

once vocal fold vibration is established, laryngeal muscular contractions are not needed

air pressure from below displaces lower edges of each vocal fold laterally- followed by lateral displacement of upper edges

elastic properties results in vocal folds colliding

pattern of movement of vocal folds during vibration is called vertical phase difference

sound modification

movement of tongue, lips, and larynx change shape of vocal tract and modify sound

language impairments

heterogenous groups of developmental and/or acquired disorder and/or delays

affects use of spoken or written language for comprehension and/or production

may involve form, content, and/or function of language

birth to 4 months pre-language development

first year- learning to communicate

after birth- infants become actively involved in a reciprocal process with family

caregivers exaggerate facial expression and voice to maintain the infant’s attention

infant responds with eye contact or vocalizing

first 3 months- caregivers’ responses teach children the signal value of specific behaviors and infants learn stimulus-response sequence

3-4 months- rituals and game playing emerge

6-12 months pre-language development

better speech perception at 6 months is related to better word/phrase understanding and production late

8-9 months- infants develop intentionality mostly through gesture; eye contact, consistent sound/intonation patterns for specific intentions, persistent attempts to communicate

8-10 months- perceptual ability is usually restricted to native language’s speech sound

12 months- first meaningful word used to express an intention occur

representation

process of having 1 thing stand for another

symbolization

using an arbitrary symbol to stand for something

18 months to 2 years toddler language

18 months- children produce about 50 single words and begin to combine words predictably

18-24 months- 3-4 word combinations

use- may use a single word for a variety of purposes

content and form- rapid increase in vocab, ability to comprehend words is gradual and context-specific

by age 2- expressive vocab is 150-300 words

lexicon in toddler langauge

lexicon- personal dictionary

larger vocabs related to more grammatical structures

frequency of caregiver child-directed speech is an important predictor of lexical development as well as quality

expressive language use affects expressive vocab development

early word combinations follow predictable word order patterns

child’s short utterances represent interaction of syntactic knowledge, cognitive ability, communicative goals, and conversations structure

examples of early intentions of children

wanting demand- says name of desire item with insistence voice, accompanied by a reaching gesture

protesting- says “no” or name of item while pushing it away turning away, and/or making a frowning face

content questioning- asks “what?” or “that"?” or “wassat"?” while pointing and/or looking at an item

verbal accompaniment- speech accompanies some action such as “whe-e-e” when swung or “uh oh" when something spills

greeting/farewell- waves hi or bye with accompanying words

preschool language developmetn

can recount past and remember short stories due to increased memory

substitution- ex. doggies are yucky, kitties are yucky

can notice patterns and use them to produce more complex language

reformulating- when caregivers repeat the child’s utterance in mature form

use in preschool language development

children introduce topics and maintain them for 2-3 turns with caregiver,

begin to consider listener needs,

4-year-olds tell simple sequential stories about past events

content in preschool language development

vocab- grow to 300 words by age 2, 900 words at age 3, and 1500 words at age 4

may comprehend 2-3 times more than that in context

fast mapping- inferring meaning from context and using word in a similar manner

acquire locational terms, temporals, quantitatives, qualitative, familial terms, and conjunctions

expressive language skills are related to vocab growth

important factor is a child’s conversational experience with adults

form in preschool language development

changes in form are dramatic

90% of adult syntax is acquired by age 5

language becomes more complex it gets older and is calculated in MLU in morphemes

by age 3, most utterances contain a subject and a verb

articles, adjectives, auxiliary verbs, prepositions, pronouns. and adverbs are added

adult-like negative, interrogative, and imperative sentences evolve

what and where develop, followed by who, which, and whose and then when, why , how

form compound and complex sentences

bound morphemes are added: present progressive -ing, plural -s, possessive ‘s or s’, past tense- ed

school-age and adolescent language development

most communication occurs outside of home

status within social groups partly determined by communication skills

means of communication changes as children learn to read and write

metalinguistic skills enable child to consider language in abstract, make judgements about its correctness, and create verbal contexts

complex forms and subtle linguistic uses are learned

semantic and pragmatic development blossoms

use in school-age and adolescent language development

conversational skills continue to develop

narratives expand into mature storytelling

effectively introduce new topics, continue/end conversations

make relevant comments and adapt roles and modds

teens demonstrate more affect and discuss topics infrequently mentioned at home

number of turns on topic increases greatly

interrupting increases but is to ask questions or move a conversation along

narratives (oral and written) gain needed elements

content in school-age and adolescent language development

1st graders- expressive vocab of 2,600 words and understand 8,000 roots and 14,000 when derivations are included

receptive vocab grows to 30,000 words by sixth grade and 60,000 words by high school

definitions become more dictionary-like, related to acquisition of metalinguistics

acquire multiple meanings

figurative language- sayings that do not always mean what they seem to mean, as in idioms; correlates with literacy skill

form in school-age and adolescent language development

age 5- children use most verb tenses, possessive pronouns, and conjunctions

some difficulty with multiple auxiliary verbs and limited use of comparatives and superlatives, relative pronouns in complex sentences, gerunds, and infinitives

gradually add passive sentences, reflexive pronouns, conjunctions such as although and however, and variations of compound and complex sentences

morphological development focuses on derivational suffixes

development of prefixes un-, ir-, and dis- will continue

language disorders

children who lag behind in early communication development are likely to have later language disorders

children with expressive vocab delays at 24 months are at increased risk for later speech/language problems

language growth of those with typically developing language (TDL) slows at age 7, but at age 5 with language disorders

children with language disorders have poorer academic, attainment, fewer social relationships, less independence, peer neglect, bullying problems, and poorer employment

risks factors for becoming a late talker (language disorder)

being aboy

low SES

not being an only child

older maternal age at birth

moderately low birth weight

low quality parenting

receipt of no daycare or for less than 10 hour/week

hearing or attention problems

sustained attention deficits in children with language impairment (LI)

risk factors for language disorder

being male

having ongoing hearing problems

having a more reactive temperament

coming from a low SES background

exhibiting poor early communication skills

having a family history

having a low IQ

developmental language disorder (DLD)

no obvious cause

under identified or identified late

children with DLD seem otherwise typical

many children with DLD are in the low normal range for nonverbal intelligence

5 risk factors- late language emergence, maternal education level, 5-min Apgar score, birth order, biological sex

life span issues in developmental language disorder (DLD)

high risk for reading disorders

low academic achievement and increased risk for stopping education at high school

peer relationship difficulties

heightened risk for peer victimization and bullying

increased risk for being identified as having ADHD

increased social anxiety

perceived more negatively by teachers and peers

less independent than peers

increased emotional difficulties may arise from deficitis in both language and social cognition

young adults with history of language disorder are less socially confident

brain imaging indicates brain symmetry and less efficient patterns of functioning

children with DLD show marked deficits in working memory and executive function

language characteristics in developmental language disorder (DLD)

become adult with poor language skills

use single words and combine words later

language growth is less advances and slows more in preadolescence

deficit in detecting regularities in language, possibly related to reduced working memory

children may shorten their own sentences by omitting elements such as morphological endings

deficits in recognizing and expressing emotion\

social perception skills affect communication

have limited semantic knowledge, which contributes to frequent word errors

more effortful cognition during language comprehension

comprehension and production of complex syntactic structures is restricted and related to memory

morphological endings and shorter words are especially difficult

pragmatic problems result from inability to sue effective forms to accomplish their intentions

social communication disorder (SCD)

social communication is ability to communication with a variety of partners in various situations

behaviors vary by culture, situations, and partners

SCD- persistent difficulty in social use of verbal and nonverbal communication

ASD- social communication problems are on of defining features

SCD does not include presence of restricted and repetitive interests and behavior (RRIBs) seen in ASD

SCD can limit effective communication and social participation

pragmatic language disorder- 7.5% of kindergarteners

lifespan issues of social communication disorder (SCD_

infants- may prefer aloneness and not respond to or irritate others

slow to develop language and may fall behind in emotional understanding and expression

diagnosis of SCD is rare before age 4

mild SCD- may not be diagnosed until adolescence

preschool and school-age children with SCD may be socially isolated

poor language skills result in difficulties with literacy

bullied by others because of their lack of social skills

language characteristics (SCD)

problems communicating for social purposes, including deficits in interactional skills, social cognition, pragmatics, and language

difficulty adjusting language to different partners

cooperative tasks may be difficult (play and conflict resolution)

social cognition involves understanding and regulating emotions as they affect others

theory of mind- evolving notion that others have a mind and emotions that differ from our own and these must be considered in communication

inappropriate or inadequate greetings

difficulty producing and comprehending narratives

awkward engagement in all aspects of conversation

poor repair of communication breakdown

inadequate/ineffective/confused verbal and nonverbal signals used to regulate conversational interaction

misinterpretation of verbal and nonverbal signals of others

difficulty understanding ambiguous or figurative language and info not explicitly stated

autism spectrum disorder (ASD)

must have all-

persistent problems in social communication and interaction across different contexts

restricted, repetitive patterns of behavior, interests, or activities characterized by 2 or more of the following:

stereotypical or repetitive motor movements, use of objects, or speech

excessive reliance on routines, ritualized patterns of behavior or resistance to change

highly fixated and restricted, abnormally intense interests or focus

hyper or hyposensitivity and reactivity to environmental input or unusual interest in sensory info

• Motor patterns of behavior may include rocking and fascination

with lights or spinning objects

• May insist on certain routines

• May be preoccupied with specific objects, foods, or clothing

• May have adverse reactions to sounds or textures

• Incidence is 1 in 44 children

• Boys are four times more likely to display ASD characteristics

• Approximately 25% of children with ASD exhibit Intellectual

Developmental Disorder (IDD)

• Primary cause is biological

At least 15% have a genetic mutation not inherited from

their parents

• Incidence is higher in those with a family history of autism

• The average medical expense for a family of a child with AS

D is $4110–$6200 annually

• Intensive intervention may cost an additional $40,000–

$60,000 annually

• Overall processing is a gestalt in which unanalyzed wholes

are stored and later reproduced in identical fashion

lifespan issues of autism spectrum disorder (ASD)

Eye and face detection processing of children with autism may be delayed, explaining in part failure to bond with caregivers

• Identified by age 2–3 years

• Positive emotional behavior or affect by the mother and use of multimodal initiations and responses are associated with positive communication indicators in infants with ASD

• School-aged children may be included in regular education or special education classes

• Those who are mildly impaired may live on their own and hold competitive employment

• Many with severe ASD require lifelong supervision

language characteristics of autism spectrum disorder (ASD)

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

• 25–60% of individuals with ASD remain nonspeaking

• Some have immediate or delayed echolalia

• Prosodic features are often affected, often having a mechanical quality

• Pragmatics and semantics are more affected than form

• Some use entire verbal routines, called formula

• Those with good language can still misinterpret subtleties of language

intellectual developmental disorder (IDD)

• Neurodevelopmental disorder characterized by intellectual difficulties and difficulties in conceptual, social, and practical areas of living

• Approximately 2.5% of the population are individuals with IDD

• Range of severities are based on daily living skills and IQ • Children with profound IDD often have multiple disorders, such as CP and seizure activity

• Children with severe to profound IDD more often have chromosomal syndromes, such as Down syndrome and fragile X syndrome

Causes of IDD can be biological or socioenvironmental

• Prevalence of mild to moderate IDD among children of color from low SES backgrounds is more than twice as high as that among children from middle or high SES backgrounds

• Some children with IDD do not rely on organizational strategies that link words and concepts together nor do they rehearse information for retrieval

• Individuals with IDD have more difficulty with auditory input

life span issues of identity developmental disorder (IDD)

Sometimes identified early due to physical anomalies, at-risk indicators, or delayed development

• Early intervention is best

• Some children are not identified until age 2 or 3

• Depending on severity, the child may attend a regular education class with special services, a self-contained, special classroom, or developmental centers for profound IDD with other disabilities

• Children who cannot reside at home live in community residences

• In adulthood, living and working arrangements vary widely

language characteristics of identity developmental disorder (IDD)

Children with Down syndrome (DS) and fragile X syndrome (FXS) have moderate to severe language delays

• Boys with FXS make phonological errors similar to those of younger typically developing youth

• Those with DS have more significant phonological differences

• Boys with FXS produce longer, more complex utterances than do boys with DS

• Children with IDD are less likely to request clarification

• Children with IDD produce shorter, more immature forms • In later development, paths differ more from typical development

learning disabilities

Learning disability (LD) is a neurodevelopmental disorder that becomes evident during the school-age years and will most likely persist into adulthood

• Six categories of characteristics

• Motor

• Attention

• Perception

• Symbol

• Memory

• Emotion

• Dyslexia: Difficulties with accurate or fluent word recognition, poor spelling, and deficits in coding abilities

Approximately 5–15% of school-age children have LD

• About 80% of these children also have a reading disorder • LD affects males four times as frequently as females

• Some children become fixed on a single task for behavior and repeat it compulsively (perseveration)

• Children with perceptual disabilities often confuse similar sounds, similar-sounding words, and similar-looking printed letters and words

• Some children exhibit word-finding problems

• Emotional problems are usually a reaction to frustration

Possible biological causal factors

• Socioenvironmental factors may account for some behaviors

• Organization is too inefficient for easy retrieval, so memory is less accurate

• Attention-deficit/hyperactivity disorder (ADHD): Underlying neurological impairment in executive function that regulates behavior, resulting in impulsiveness

• ADHD is not a learning disability, but children with ADHD often experience problems in social relationships explained in part by their pragmatic problems

• Less accurate in their interpretations of speech

life span issues of learning disabilities (LD)

May exhibit little interest in language or books

• Linguistic demands of the classroom are often well above language abilities, resulting in academic underachievement • May require the services of special educators, SLPs, and reading specialists

• Can be successful in the regular classroom if adaptation is made

• Some seem to outgrow aspects of their disability

• Some require lifelong adaptations or experience significant difficulties

language characteristics of learning disabilities (LD)

All aspects of language can be affected, spoken and written

• Deducing language rules is difficult

• Oral language development may be slow

• Frequent communication breakdown is possible

• Word finding problems may exist, resulting in the child needing more time to respond

brain injury

Can result from traumatic brain injury (TBI), stroke, congenital malformation, convulsive disorders, or encephalopathy

• TBI is the leading cause of disability and death in children and adolescents in the United States

• At greatest risk are those age 0–4 and 15–19

• Approximately 1 million children and adolescents in the United States are living with TBI-related injury

• May be localized or diffuse brain damage as the result of external force

• Variables include the site and extent of lesion, age at onset, and ate of the injury

• Some fully recover, some remain in a vegetative state • People with TBI exhibit a range of cognitive, physical, behavioral, academic, and linguistic deficits

• Children with TBI tend to be inattentive and easily distractible

• Children with TBI may have difficulty perceiving relationships, making inferences, and solving problems

• Memory is also affected

• Social disinhibition

• Psychological maladjustment or acting out behaviors

Other characteristics:

• Lack of initiative

• Distractibility

• Inability to adapt quickly

• Perseveration

• Low frustration levels

• Passive-aggressiveness

• Anxiety

• Depression

• Fear of failure

• Misperception

life span issues of brain injury

• May be unconscious after an accident

• Disorientation and memory loss can occur after regaining consciousness

• May be accompanied by physical disability and personality changes

• Neural recovery is unpredictable and irregular

• Young children often recover quickly

• But there are difficulties learning new information • May have severe, long-lasting problems

• Older children have more to recover from memory but less new information to learn

language characteristics of brain injury

Language problems can occur even after mild injuries

• Some deficits can remain long after the injury

• Particularly in pragmatics

• Language comprehension and higher functions such as figurative language and dual meanings are often impaired

• Language form is relatively unaffected

• Utterances are often lengthy, inappropriate, and off topic, and fluency is disturbed

• Word retrieval, naming, and object description difficulties may be present

• Narration may be difficult

other language disorders

Includes

• Late talkers

• Childhood schizophrenia

• Selective mutism

• Otitis media

• Children who received cochlear implants

• Those who have been exposed to alcohol and drugs in utero

• Those who have experienced abuse and neglect

• Most early language delay is due to environmental factors such as poverty and/or homelessness

• Approximately 55% of children with schizophrenia have language abnormalities, especially in pragmatics

• In selective mutism, children do not speak in specific situations although they speak in others

• The effect of chronic otitis media can be delayed language development

• Children who receive cochlear implants have relatively typical language development; there are different rates of language growth depending on when the implant was placed

• In fetal alcohol spectrum disorder (FASD), language problems include delayed language development, echolalia, and comprehension problems

Children with prenatal cocaine exposure (PCE) have mild but persistent deficits in syntax and phonological processing, adversely affecting reading

• Maltreated children demonstrate consistently poorer language skills with respect to receptive vocabulary, expressive language, and receptive language; pragmatics is the most affected area of language

assessment

Distinguish between children who have a disorder and those who do not

• All areas of concern should be identified and described as accurately as possible

assessment of English learners and nonmainstream dialectual speakers

Children who are English learners (Els) accounted for approximately 10.2% of the students enrolled in U.S. public schools

• In preschool Head Start programs, approximately 30% of children use a language other than English

• Many children speak nonmainstream American English (NMAE) dialects

• Assessment of children with culturally and linguistically diverse backgrounds must recognize the risk for language disorder

• Children from low SES backgrounds with poorer maternal education may have increased incidence of language disorder

• ELS and children with dialectal differences are more likely to be identified as needing special education services

Deciding whether a child has a language disorder or difference can be difficult

• A comprehensive assessment can reduce potential misdiagnosis

• Diagnosis should included

• Published tests in both languages, if possible

• Spontaneous and elicited language samples in various settings and with different partners

• Dynamic assessment procedures that are more open ended and include descriptions of use of English and the child’s first language

• In dynamic assessment, procedures are modified to explore optimal strategies to enhance a child’s performance

• For children speaking NMAE, the challenge is to differentiate dialectal differences from language disorders

• The Diagnostic Evaluation of Language Variation (DELV) has been developed for and normed on NMAE speakers

• Dialectal scoring: An alternative procedure that accounts for language variations

referral and screening

Referral may occur at any point in the lifespan

• Parents can be effective referral sources for more severe language problems

• Screening tests are used to determine the presence or absence of a language problem

• Surveys and parental questionnaires are effective tools

• Referral and evaluation may occur within an interdisciplinary team

case history and interview

Administering a case history questionnaire and conducting a parent or teacher interview are the first steps

• Questions relate to

• Language development

• Language environment of the home

• Possible causes for language impairment

observation

As many contexts as possible

• Behaviors observed vary with the age of the child and the reported disorder

• Note interests, topics, style, and methods of communicating

• Note parental sensitivity to child’s communication attempts and parental responding to these attempts

• Hypotheses about a child’s language disorder are formed during observation

• Confirmed or negated throughout the rest of assessment

testing

• Standardized tests are appropriate for determining if a problem exists; less useful in identifying specific language deficits

• More descriptive measures, such as language sampling, allow exploration of a child’s strengths and weaknesses

• Use a series of testing tasks

• Combination of using children’s books, such as shared story retelling in which a familiar story element is altered and comprehension questions, may be effective in identifying around 96% of children with language disorders

Test methodology varies widely

• Unfamiliar tasks may prejudice results against the child

• Dynamic assessment: Probe performance to identify possible intervention procedures

• Interpret test scores cautiously

sampling

• Language sample analysis (LSA) is flexible, can be repeated as often as needed, and may be the only way to capture some concerns

• Engage child in challenging conversation

• Narratives or stories are especially helpful for exhibiting deficits in school-age children

• Pose peer-conflict resolution problems to elicit grammatically complex utterances with adolescents

• Collect at least two samples of the child interacting with different partners, locations, and activities or topics

• The language sample is recorded and carefully transcribed

• Most SLPs collect 50 utterances or less

• Longer samples of up to 30 minutes have been suggested for very young children

• Language transcript can be analyzed in several ways

• Mean length of utterance (MLU) in morphemes

• Average number of clauses per sentence

• Number of different words used within a given period of time

• MLU is a reliable and valid measure of general language development through age 10 for children with DLD

• SLP analyzes the sample for all aspects of form, content, and use appropriate for the particular assessment

• With Els the SLP might consider code switching, dialect, English proficiency, and contextual affects

• May also collect samples of written language

intervention

Multiple intervention methods are needed

• Intervention goals should focus on stimulating language development beyond the immediate target

• The most effective intervention approach for older school age children and adolescents with deficits in syntax is an integrated one in which naturalistic stimulation approaches are supplemented with deductive teaching procedures where the child is presented with a rule and models

• SLPs can include other individuals who work with the child

Techniques such as Teach-Model-Coach-Review are effective in teaching adults to be language teachers

• Preschool staff being trained to respond to children’s initiations, to engage children, to model simplified language, and to encourage peer interactions has a significant effect on children’s language production

• With school-age children, the SLP can use a variety of models

• Individual and group sessions

• Within and outside the classroom

• Teachers and aides can be trained to help children participate

considerations for children with culturally and linguistically diverse backgrounds

Cultural congruency: Synchrony of intervention strategies and techniques with the cultural values, beliefs, and behaviors of a community and is important in providing appropriate and effective services

• Maintaining the heritage language is frequently important for the family and community

• Intervention in both home and school languages and support of both have been shown to have positive effects

language target selection and sequence of teaching

The goal is the maximally effective use of language to accomplish communication goals within everyday interactions

• Using the same assessment results, SLPs might differ in target selection

• The child’s abilities are an important determinant of the method selected

• Training should be within meaningful contexts when possible

evidence-based intervention principles

Targets should not focus exclusively on one deficit area

• The interrelatedness of all areas of language and the importance of communication in context necessitate a holistic approach

• Lack of direct empirical evidence should not automatically rule out a teaching approach but should be grounds for suspicion

intervention procedures

Teaching is a systematic analysis of what a child is lacking that results in their failure to succeed

• SLP enhances teaching by anticipating the types of support a child likely needs and types of errors the child is likely to make

• Explicit instruction: Makes a child consciously aware of the underlying language pattern

• Children are more likely to acquire, maintain, and generalize novel grammatical forms when taught with explicit instruction

• Combining implicit and explicit approaches is beneficial when teaching children with significant weaknesses in language

• Success occurs when language features generalize to a child’s everyday environment

• The level of a child’s active engagement is directly related to their language gains

• More active involvement results in more stable generalization

Basic tenets of good teaching behavior

• Model the desired behavior

• Cue the child to respond

• Respond to the child in the form of reinforcement and/or corrective feedback

• Plan for generalization of the learned feature to the everyday environment

intervention through lifespan

• Early intervention, especially for children with IDD and ASD, can be very beneficial

• Initial training might target presymbolic communication skills and cognitive abilities

• Parents might be trained to treat their child’s behaviors as having communicative value or to interpret consistent behaviors as attempts to communicate

• May attempt to establish an initial communication system by using A AC

• Early symbolic training can focus on comprehension, vocabulary acquisition, semantic categories, word combinations, and early intentions

• Preschool children usually work on language form in conversations and narratives

• Intervention with school-age children may focus on pragmatics and semantics

• Academic skills might be targeted

• Adolescents may continue to exhibit language impairments and be in need of services

• Adults with severe ASD or IDD will most likely require continued intervention

• Individuals with LD may require additional support in postsecondary education