Lang Disorders Final

assessment

any in-depth evaluation assessing hearing, speech, language, etc.

more comprehensive than just a screening

why conduct an assessment?

to gain an in-depth look into abilities/disabilities, compare with peers & standards, gain data, make a diagnosis

screening

pass/fail, looking for a disorder's presence, simple pre-assessment technique, anyone can do

diagnosing

labeling a disorder based off of criteria/symptoms, only within-scope professionals can do

sensitivity

proportion of impaired people correctly diagnosed as impaired

exclusionary measure

when screened: those who should fail do fail

specificity

proportion of TD people correctly diagnosed as NOT impaired

when screened: those who do pass should pass

validity

accuracy of measurement claims

types: face, construct, content, criterion-related

reliability

consistency & accuracy of measurement

types: test-retest, inter-rater, internal consistency, split-half

How do sensitivity and specificity assessments change depending on if you are conducting a screening assessment or conducting a diagnostic assessment?

when screening: maximize sensitivity though specificity will suffer, DO NOT balance sensitivity & specificity

when diagnosing: maximize AND balance sensitivity & specificity

What is a cut-off score on an assessment, how is it used, how does it impact sensitivity
& specificity?

how many standard deviations below the mean qualifies for distinction

used in diagnosing individuals when compared to the abilities of typical others

meant to maximize & balance sensitivity & specificity

What is a standardized, norm-referenced assessment?

- formal administration & scoring

- test scores compared to peers’ lang skills

- SD scores, Z scores, percentile ranks, scaled scores indicate ability

- COMPARING w/ typical peers

Main characteristics:
Reliability
Validity (diagnostic accuracy)
Clear test procedure & scoring criteria
Standard error of measurement (central tendency & variability)
Norm referenced scores

Strengths/ Weaknesses of standardized norm referenced tests

offer meaningful interpretation, clear terms, same for everyone

don't account for context, require compliance from kids, not useful for goal setting, often invalid for diverse populations

What are examples of meaningful scores on standardized, norm-referenced assessments that allow you to determine how well a child performed compared to others of a similar chronological age?

What is an example of a not meaningful score (uninterpretable to determine how a child performed) until you convert this score to a meaningful score?

a clear, converted score shows how many SDs away from the mean (-/+) a kid's score is AKA how typical they are

a raw score is not meaningful as it hasn't yet been converted, sometimes it's based on number correct OR incorrect

How low is “low enough” to be considered language impaired on a standardized, norm-referenced assessment?

every SNRA is different, but generally -1 SD and below away from the mean is considered impaired

sensitivity & specificity matter depending on if its a screening or diagnostic

What is acceptable (aka: fair) diagnostic accuracy for sensitivity & specificity?

80-89% sensitivity & specificity

Criterion-referenced assessments

CRA probe data, determine level of performance, observe specific behaviors

Establish baseline, NOT comparing to typical peers

What is a basal? Example? How to interpret?

entry level when giving an assessment (not always question #1, consider age)

reduce fatigue, frustration, time waste --> use to interpret LOWEST level of ability

ex:) Bob is 19 years old. For people 18+, the assessment basal is set at question #6. You begin by asking Bob question #6.

What is a ceiling? Example? How to interpret?

stopping point when giving an assessment

reduce fatigue, frustration, time waste --> use to interpret HIGHEST level of ability

ex:) Bob got 6 questions in a row wrong. Bob gets the 7th wrong & hits the ceiling, the assessment ends here.

How is language sampling used as a method of assessment?

Asking open-ended questions gets more language out of the kid & analyze more as much as possible

Why do we repeat aloud what a child says after they say it when we are gathering a language sample from the child?

Their response may confirm or deny your interpretation, also good for audio/video recording to have it twice

What do you do when conducting a language sample when the utterance is not fully intelligible?

Mark it as XXX then don't count that utterance in your MLU analysis

Minimum number of fully intelligible utterances that we want to conduct MLU analysis

50

Why do SLPs count morphemes instead of words when determining the length of children’s utterances?

each morpheme is a unit of meaning which tells us how much word meaning the kid understands & can produce

What is MLU?

average number of morphemes per utterance

direct index of length & indirect index of complexity

Brown's 14 grammatical morphemes

1. progressive -ing
2. plural -s
3. preposition in
4. presposition on
5. possessive -s
6. regular past -ed
7. irregular past
8. regular 3rd person present
9. articles
10. contractible copula
11. uncontractible copula
12. contractible auxiliary
13. uncontractible auxiliary
14. 3rd person irregular

2 ways to increase MLU

add free morphemes

add bound morphemes

MLU is sometimes referred to as a general indicator of expressive morphosyntax development. Why?

Utterance length & morphosyntactic complexity are linked in early stages of development

selective mutism

complex social anxiety disorder only presenting in certain social situations

impacting academic & social-emotioanl development

How does selective mutism differ from extreme shyness?

shyness if voluntary, selective mutism is INVOLUNTARY

What happens when selective mutism progresses?

becomes progressive mutism when a kid experiences such intense anxiety they cannot speak to anyone at all

If a child is not talking at all in any environment with any person, can they have selective mutism?

yes, but this is more indicative of traumatic (after sudden trauma) or progressive mutism

When considering the expressive and receptive vocabulary skills of a child with WFD, what gap do we see?

WFD presents w/ more of a receptive <--> expressive language gap than would be expected

described as slow/inaccurate retrievers

What are the 3 types of profiles of children with word finding disorder? (consider accuracy and speed in your response)

1: slow (4 sec delay) and inaccurate retriever
“….exponent” for coefficient after 4 sec delay

2: fast (no delay), but inaccurate retriever
“exponent” for coefficient (no delay)

3: slow (4 sec delay), but accurate retriever
“….coefficient” for coefficient after 4 sec delay

What is an example of a semantic substitution?

Sub of words that are related to the target word in meaning

“exponent” for coefficient

OR

Sub of words that frequently co-occur with other words in a sentence or content area

“light switch” for light bulb

What is an example of a form substitution that involves phonology (sometimes referred to as a phonemic substitution)?

Sub that represents only some of the sounds of the target word
“circumer” for circumference

iconic gestures

a mime of the target word’s function or an action associated with the target word (e.g., mime for writing) --> WFD

frustration gestures

any non-verbal indication that the student is searching for the target word (e.g., finger snapping) --> WFD

What is developmental language disorder (DLD)?

A language problem in the absence of other clearly identified problems

TD in all other areas

In order to be diagnosed with DLD, what must be ruled out that could explain their language learning difficulties?

intellectual disability, autism spectrum disorder, hearing impairment, acquired language impairment

Kids w/ ASD & kids w/ DLD are heterogeneous. What do I mean by this?

they're all different across a spectrum of abilities

no 2 kids w/ the same diagnosis are actually the same

Which carries the greater risk for poor long-term outcomes: Kids w/ DLD who have a mixed receptive and expressive language disorder OR kids w/ DLD who have an expressive language disorder only?

kids w/ mixed receptive/expressive disorder AND DLD are at higher risk for poor outcomes

What is a late talker?

not reaching typical language milestones on time:

talking very little, not combining 2 word utterances, no vocab growth spurt, fewer than 50 words in vocab at 2 yrs old

What do I mean by “late bloomer”?

kids who are delayed in language but have no disorder

spontaneous recovery will occur at some point

What percent of late talkers end up being a late bloomer? What percent of late talkers end up having DLD?

50% become late bloomer // 50% develop DLD

What domains of language are particularly challenging for children with DLD relative to the other language domains of Bloom and Lahey’s model?

most deficient: morphosyntax, semantics

less deficient: pragmatics, phonology

How common is DLD? More or less common than ASD? What is one reason why few people know about it despite how common it is?

DLD is more common than ASD

most prevalent com disorder in kids --> 7% of pediatric pop.

these kids BLEND IN --> parents/teachers may see good receptive language & not notice problem with expressive

Why should we not consider only providing treatment to children whose language ability is significantly below their cognitive ability?

kids w/ TD cognition can still have lang problems & still need our help

What are the 3 clinical markers for DLD?

verb tense morphology
nonword repetition
sentence recall

How has the criteria for the diagnosis of ASD changed with the latest edition of the DSM, the DSM-V?

old DSM: PPD-NOS, Aspergers, Autistic Disorder all separate
1. impaired social interactions
2. difficulty w/ com
3. repetitive patterns/behaviors,

new DSM: all under Autism Spectrum Disorder
1. impaired daily functioning
2. symptoms present since early childhood
3. restricted/repetitive patterns (more detailed criteria)
4.

What is the difference between ASD and Social Communication Disorder?

kids w/ ASD have repetitive patterns & disruptive behaviors, kids w/ SCD do NOT

Be able to identify exemplars of jargon, echolalia, and stereotyped vocalizations seen in ASD.

atypical semantic expressions

Describe the variability in language skills observed in ASD? What domain of language is always affected (has deficits) in children with ASD? What is most predictive of the long-term language skills of children with ASD?

language abilities can be high <----> low functioning

greatest deficits in pragmatics
semantics predicts future language skills

What is the common screening measure used to screen children for ASD? What is the gold standard diagnostic measure used to assist in the diagnosis of ASD?

M-CHAT = best screening

ADOS-2 = gold standard assessment

Most children with AAC have hypersensitive or hyposensitive sensory functioning. How do these differ?

hypersensitive = HIGH sensitivity to stimuli, super alert/aware

hyposensitive = LOW sensitivity to stimuli, not alert/aware

Differentiate the main purposes of intervention (prevention, remediation, compensation)

prevention- for kids at risk, maximizes potential to avoid later problems

remediation- correct current deficits, meets specific goals to correcting undesired behaviors

compensation- introduces strategies
manages symptoms, but doesn’t eliminate

What is the relationship between risk and prevention?

Prevention works to minimize risk of disorders occurring

What is the relationship between progressive neurological diseases and maintenance?

these diseases progress w/ age

can't be cured but can be maintained over time

Explain the differences between facilitation, maintenance, & induction

facilitation- generate positive progress

maintenance- keep progressed skills where they are

induction- achieving mastery w/ intervention

What are the 3 M’s of writing goals?

1. measurable
2. masterable
3. meaningful

What is the zone of proximal development and why is it important for language intervention?

ZPD is what is reasonably achievable for a kid & it's necessary to make progress w/o burnout

Differentiate among child-centered, clinician-directed, and hybrid approaches to intervention

child-centered- fewer instances of imitation, looks a lot like play

clinician-directed- high level of imitation, takes longer to generalize

hybrid- manipulates environment to achieve greater number of exemplars

Differentiate between multidisciplinary, interdisciplinary, and transdisciplinary intervention approaches.

multidisciplinary- several professionals working independently

interdisciplinary- professionals working under one case manager

transdisciplinary- professionals working under a service provider

Why do we care about generalization of language skills learned in intervention?

skills learned in therapy must generalize to real life so kids can have good com, strong relationships, etc.

What are ways to promote generalization?

make it relevant to their interests, fun, engaging, give parents education/counseling

What can we do to increase the child’s ability to meet our goals of intervention, for example, how can we modify linguistic stimuli to enhance the learning of children with language impairments?

provide relevant, engaging Tx within the ZPD

Be able to understand the vocabulary in the multidimensional model of intervention.

holistic model incorporating several methods to address all aspects of a disorder

ID what is and what is not a pragmatic language deficit.

pragmatic deficit = social difficulties w/ eye contact,

NOT a pragmatic deficit = cultural difference

Differentiate the holophrastic from the telegraphic stage of language development

Holophrastic Stage: producing 1 word utterances w/ communicative intent

Telegraphic Stage: producing 2+ words in connected, meaningful speech

Differentiate mental age and chronological age, and why we use chronological age as a basis of reference for determining if a child has a language impairment.

mental age = TD or impaired

chronological age = time since birth

we use chronological age bc it allows us to measure by milestones & compare peers

agent + action

Mommy sit

action + object

Go car

agent + object

Baby book

action + location

Go park

entity + location

cup table

possessor + possessed

My teddy

entity + attribute

crayon big

demonstrative + entity

that toy

At the MLU stage of 2, what is typically absent from children’s morphology? (what words or word parts do they tend not to use)?

not using articles, possessive -s, 3rd person irregular, regular/irregular past tense, copula/auxiliary verbs

When does expressive syntax occur in a child’s utterances?

Starting w/ single words at 12 months old

Why are words and concepts not synonymous?

some concepts have no words associated w/ them --> lexical gap

What is fast mapping? Why is it important for a child learning language?

process of rapidly learning a new word, simply from contrasting a familiar word & an unfamiliar word

this is how kids build phonological memory for words

What is the word naming explosion? Is it present in all children who are typically developing?

at 18 months old, kids learn 10 new words every day

50-100 words a month (mostly nouns)

some typical kids don't have this

shape bias

relating shape & form to object name meaning

taxonomic assumption

labels should be extended to same kind of thing, rather than an unrelated object

ex:) relating a dog to another dog, bone to dog, etc.

mutual exclusivity assumption

only one name for each thing

whole object assumption

words refer to an entire object, not its features

under-extension/under-generalization

Using a word too narrowly

ex:) only family cat is a “cat”, only white cats are “cats”

Likely due to conservative understanding of words as heard

over-extension/over-generalization

Using a word too broadly, common at 1-3yrs.

ex:) every character on TV is “Big Bird”

More common than underextension

Likely due to lack of semantic meaning