Language Disorders 3 Exam

hearing impairment

• a deficit in hearing sensitivity that can affect both loudness and clarity

• identified by type and severity

T/F: HI is the most common sensory defict in children

True

causes of HL in children

- congenital: genetics, prematurity, maternal rubella

- acquired: meningitis, OM, viral infections (CMV), trauma

prevalence of HL

- US: 1.7 per 1000 birth

- worldwide: 3.5 per 1000 births

- prevalence of hearing loss increases w/ age

- 20% of the US population aged 12+ have hearing difficulties severe enough to impact communication

Prevelance of HL in White Americans

29%

Prevelance of HL in Hispanics/Latinos

20%

Prevelance of HL in Asian Americans

20%

Prevelance of HL in Black Americans

19%

Noise-Induced HL: White v Black Americans

White Americans are more susceptible to noise-induced HL than Black Americans.

Ear Infections in Alaska Natives and American Indians

Alaska Natives and American Indians experience more frequent otitis media (OM).

T/F: more than 90% of children born with significant HL are raised by hearing parents.

true

what conditions may co-occur with HL?

ADHD, Autism, learning disabilities

conductive HL

• damage to outer/middle ear

• = decreased loudness of sound, but not clarity

• intervention (amplification) is usually effective

sensorineural HL

• damage to inner ear, cochlea, or auditory nerve

• = loss of loudness & clarity

• amplification helps w/ loudness loss but not clarity

mixed HL

both conductive and sensorineural HL

Degrees & Affects of HL on Language Development

• normal: -10-15dB

• mild 15-30 dB— hears vowels & consonants; w/ early intervention lang develops normally

• moderate 31-60 dB—hears vowels better than consonants; w/ early intervention lang develops normal/near normal

• severe 61-90 dB— can't hear most speech sounds; outcome depends on how early HL is detected/intervention

• profound (91-120 dB): can't hear spoken language; dev of spoken lang difficult; may need total/manual comm w/ CI

• total (120+ dB): no hearing, even w/ hearing aids; CI can help w/ variable results

otitis media (OM)

• infection in middle ear often w/ fluid in middle ear cavity

• prevalence: 70% of children will have at least one episode of OM before age 3, but many will have recurrent OM

• 50% will have mild HL during infection

• 5-10% will have mod HL

• treatment: medication and/or PE tube surgery

• role of HL due to transient OM as the basis for later language disorders remains controversial

HL factors affecting language development

• age when HL occurs

• age when HL is identified and treated

• child's auditory and language experience

• level of parental involvement

according to recent studies, what are more than 90% of families choosing as the primary modality of communication for their child w/ HL?

• spoken language, 4% chose ASL

• in 1995 60% ASL & 40% spoken

speech sound production in children w/ HL

- diff managing breath support, moving articulator smoothly

- consonant errors more frequent than vowels

- may speak too loudly or softly

pragmatics in children w/ HL

- diff due to inexperience & limited conversational partners

- inappropriate/ambiguous responses

semantics in children w/ HL

- vocab develops slowly; no incidental learning

- less variety in vocabulary

- concrete words learned easier than abstract

morphosyntax in children w/ HL

- diff w/ plurals, possessives, and verb tense markers

- produces and understands shorter utterances

- unsophisticated grammatical forms

reading/writing in children w/ HL

- diff w/ phonological awareness, phonics, word reading, spelling, writing

- mild-moderate HL: 1-4 grade levels behind hearing peers

- severe-profound HL: achieve skills no higher than 3rd-4th grade

factors influencing outcomes in children w/ HL

- early detection and intervention; children who are identified/treated within the first year of life can achieve language levels equivalent to their hearing peers

- choice of communication modality

- family involvement and remediation (maximie early lang experiences)

neuroplasticity & HL

• despite damage or disease, the auditory system can develop appropriately w/ early stimulation w/in a certain time period

• recent studies reported optimal lang development may occur if auditory access begins before 9 months

• hearing performance &
  language acquisition comparable to typical hearing peers up
  to 10 years after cochlear implantation

developmental synchrony

• the creation of the neural networks during the first few years of life cultivates lang abilities, literacy, executive function, social-emotional skills, etc.

• if auditory skills are mastered as close as possible to the expected biological clock, the entire neural system experiences developmental synchrony

auditory processing disorder (APD)

• difficulties in the perceptual processing of auditory info in the CNS = poor performance in one or more of the following skills:

  • sound localization and lateralization

  • auditory discrimination

  • auditory pattern recognition

  • temporal aspects of audition

  • auditory performance in competing acoustic signals

what difficulties are children w/ APD commonly referred for?

- hearing in noisy situations

- remembering spoken information

- maintaining focus on an activity

- reading and/or spelling

- processing nonverbal information

development of auditory skills

• goal: understand lingustic & nonlingustic skills

• language exposure is natural and non-sequential

auditory skill level

• detection - awarness of sound

• discrimination - differenciating sounds

• identification - recognizing & labeling sounds

• comprehension - understanding

assessment tools for HL

- MacArthur Bates Communication Development Inventories: parent-completed report assists in screening young children's emerging lang & communication skills

- Cottage Acquisition Scales for Listening, Language, and Speech: includes developmental checklist

communication modalities

- spoken language: Listening and Spoken Language (LSL) intervention focuses on development of listening skills

- sign language: requires intensive immersion, consider requirements to support comm skills over time, greater community, academic system

- total communication: may incorporate a variety of diff forms of sign lang (ASL, SEE, Pidgin Signed English)-

audism

- systemic oppression of the DHH community

- associated w/ medical model viewpoint that DHH is an impairment that must be "fixed"

- failure to provide a patient with all management options w/o acknowledging the Deaf community is an act of audism

Paradigm Shift in Pediatric Hearing Care

• by providing appropriately selected & fitted hearing tech + caregiver coaching = probable age-appropriate listening & spoken lang development

cultural diversity

- commonly referred to as multiculturalism

- includes regional, ethnic, social, racial, linguistic, & cultural variations in any society

linguistic diversity

context multiculturalism — differences in form (phonology & syntax), lexicon, & pragmatics that distinguish one language from another & one variety/dialect of the same language (e.g. American English or New Zealand English)

what is the most common spoken language besides English in the U.S.?

Spanish (61%)

T/F: 8.3% of certified ASHA members identify as multilingual

True

What % of elemetary & secondary students w/ lang disorders also identifid as ELL

12%

T/F: It is estimated that 10 percent of the members of all racial/ethnic minority groups have disorders in speech, language, or hearing.

true

dialect

- variations of a language in grammar, vocab and/or phonology; includes accent (pronunciation)

- are rule-governed; not a disordered form of speech/lang

how is a dialect distinguished from a language?

• a smaller branch of a language, sharing a common core grammatica’ characteristics with all other dialects of that language

• speakers of diff dialects = understand

• speaker of diff languages not understand each other

bilingualism characteristics

- fluent w/ both written & spoken forms of their first (native) lang & have less proficiency in second lang

- have equivalent but different areas of competence in two languages & prefer to use one over the other in particular circumstances

simultaneous bilingualism

begin to acquire second lang (L2) before 3 years of age

sequential bilingualism

begin to acquire second lang (L2) after 3 years of age

multilingual learners

includes students who are fluent in English & learning another lang

dual language learners

individual learning two lang simultaneously from infancy or learning a L2 after L1 in early childhood

English language learners

• children & adults who are learning English as an additional lang

• a significant # of ELL students also have a concomitant disability & are at greater risk for negative educational outcomes

emergent bilingual

a child who acquires another language through school and who is still able to function in their heritage language

heritage language

language(s) that are different from the dominant language in a given social context

T/F: Limted English Proficient is preferred over ELL

False; ELL is prefered

subtractive bilingualism

as some individuals learn a L2 they lose

skills in their native (heritage) language if it is not reinforced & maintained in the individual's environment

what does influence of transfer mean?

the structures of L1 directly influence utterances of L2

what is the silent period?

- may occur during the initial phase of L2 acquisition while the individual focuses on listening/comprehending the new language = the learner understanding more than they can say

code switching

• changing dialects or language within/across utterances based on the linguistic context/communication environment

• does NOT occur randomly— grammatically & socially constrained

• may be a cognitive strategy for multilingual people to easily access all the language they know in order to provide alternate ways to convey meaning

translanguaging

- proposes that multilingual speakers have a unified linguistic repertoire consisting of all of the linguistic features that a speaker uses based on different contexts w/o focusing on a single language

- SLPs can adopt a translanguaging approach to assessment practices that allow multilingual individuals to express themselves using their full linguistic repertoires

levels of language proficiency

- Basic Interpersonal Communication Skills: social language; context-embedded, everyday lang that occurs b/t conversational partners; typically requires 2 years under ideal conditions to acquire

- Cognitive-Academic Language Proficiency: academic language; context-reduced; typically requires 5-7 years under ideal conditions to acquire

T/F: Any clinician can engage in multilingual service delivery.

true; they can use their langs in service delivery as a language-matched multilingual service provider or collab w/ a trained interpreter to provide cross-linguistic services

SLP roles/responsibilities regarding CLD

- engage in culturally responsive & critically reflective practices

- support students, patients, clients + their families: advocate for patients/families, collab w/ client/family in treatment planning, advocate for the benefits of multilingualism, support the dev/maintenance of heritage language comprehension & use

- collab w/ other professionals: develop effective relationships w/ interpreters & translators

CLD & the language domains

- phonology: may include diff phonological patterns as the result of transfer/influence from another language

- morphology: grammatical structures are not constant across languages; pronouns, verb conjugation, verb inflection, & tense may not exist in each language

- syntax: underlying syntactic deficits will manifest diff across languages; cross-lingustic influence from dom lang into hertiage lang may occur; children w/ spoken lang disorders demonstrate signifcant deficts for mophemes w/ limted perceptial saliency

- semantics: may learn specific words and/or categories of words in their heritage language and other words in the language used in different environments

- pragmatics: will vary depending on culture; some ignore personal space while others avoid eye contact

language difference

- ELL is using a dialect or has not had enough experience with English to use it proficiently

- lang therapy by SLP is NOT recommended

- ESOL instruction is recommended

language disorder

ELL has a true language disorder that affects the development of both their native language & second language

A language disorder likely exists in an ELL if language...

- is considered defective by individual's cultural community

- operates outside the norms of acceptability for community

- calls attention to itself or interferes with communication within that community

- results in difficulties in adjustment for the client

T/F: Signs of a communication disorder are seen across all the languages that a multilingual person uses, but the symptoms usually differ across languages.

true

T/F: a differential diagnosis must be made when determining if a CLD child has a true lang impairment

true

why is there an overdiagnosis of language & literacy problems in CLD children?

- part of reason for over-identification is over-reliance on standardized tests

- children from CLD backgrounds often score lower on standardized tests bc they are unfamiliar with test-taking situations or lack of experience with the concepts & knowledge contained in these tests

Incidence of comm disorders in CLD should be no higher than English-only pops %

around 10%

in order to do the least biased assessment, SLPs must identify the child's _______.

dominant language

T/F: IDEA requires that testing be provided in the language or other mode of communication in which a child is most proficient.

true; does not have to be standardized, but must take place in the form most likely to yield accurate information

assessment in language dominance

• English-dominant children: testing can be done in English; must be sensitive to pragmatic/experiential/dialectical differences that must be evaluated before deciding whether

  a disorder is present

• Non-English dominant children: test in English AND dominant language; comparing performance in both languages gives the clinician an idea of whether the child is progressing adequately for age in the home language & where gaps in English are found

assessment methods for CLD children

- thorough case history, interview, and questionnaires

- standardized tests w/ normative data from CLD children

- process-dependent tasks that require minimal use of prior knowledge/experience (ex: digit span, working memory, nonword repetition)

- dynamic assessment: test, teach, retest; shown to differentiate stronger & weaker lang learners in Puerto Rican, African-American, & Native American pre-k/kg children

T/F: You can use interpreters every at each step of the assessment methods for CLD children

true

what do studies/research say regarding CLD treatment considerations?

- no study supports the English only approach

- researchers emphasize that children's language learning

can be maximized when treatment is in the child's native language & L1 is used as an organizational language framework to facilitate L2 learning

factors that inform language intervention for multilinguals

- language history & relative experience w/ each language

- frequency of use for each language

- proficiency in each language, including how well the individual understands and produces language

- environment, including where and with whom the client uses each language

- family considerations and goals

bilingual approach

- SLP treats constructs common to both languages or error patterns exhibited with relatively equal frequency in both languages first

- goal: to determine initial treatment, not to determine language of intervention

cross-linguistic approach

focuses on the linguistic skills unique to each language & addresses areas of need noted in a specific language

T/F: Early stages of intervention for CLD children with language disorders should be given in the native language whenever possible, with gradual transition to intervention and instruction in English.

true

what services can a monolingual SLP provide?

- in-service training

- consultation

- diagnostic service

- paraprofessional training

Why should providers be open and flexible in selecting, administering, and interpreting diagnostic or treatment regimens?

To best address the unique, individual characteristics and cultural background of clients and their families.

parts of the brain used for reading

• Broca's area

• Wernicke’s

• Angular Gyrus

• Visual Word Form Area

Broca’s Area Function

• Phonological Awarness

• Primarily responsible for processing speech sounds to produce spoken & written lang

• Frontal lobe!

Wernicke’s Area Reading Function

• Comprehension

• Stores word meanings, context, & connotations of what we read

• Meaning processor

• Temporal Lobe

Angular Gyrus Reading Function

• Phonics Chip

• Allows reader to attach sound (phonological) to correct symbol (letter)

• Where we connect spoken word to written word

• Parietal lobe

Visual Word Form Area Reading Function

• Letter box

• Rapid, effortless recognition of letters, syllables, & whole words

• Orthographic processor develops when learning to read to develop sight word vocab

• Occipital Lobe

Differences btw spoken & written lang across CONTENT Vocab

• Spoken: redunant & LESS specific vocab, more pronouns

• Written: Varied & specific vocab, more adj,adverbs, & cognitive verbs

Differences btw spoken & written lang across FORM Phonology & Orthography

• Spoken: Speech fleeting signal, word boundaries by pauses, & prosodic cues

• Written: Permanent, clear word boundaries (layout & punctuation)

Differences btw spoken & written lang across FORM Morphosyntax

• Spoken: focus on inflectional morphemes (e.g -s, -'s, -ed, -en, -ing, -er, -est)

• Written: cohesion w/ complex syntax, & elaborated noun & verb phrases

Differences btw spoken & written lang across USE PRAGMATICS

• Spoken: Contextualized, real-time message sharing, aided by nonverbal cues (nods, eye contact, facial exp)

• Written: Decontextualized, messaged fixed by writer (asynchronously)

Differences btw spoken & written lang across MANNER OF LEARNING

• Spoken: Learned IMPLICITLY in social interactions, & requires knowledge of lang (speaker unaware)

• Written: Learned EXPLICITLY though instruction, awarness of lang supports literacy

How do the components of Scarborough’s Reading Rope contribute to skilled reading?

• Word Comprehension becomes increasingly automatic, allowing readers to quickly & effortlessly recognize words though:

  • Phonological awarness, decoding, sight recogntion

• Language Comprehension becomes increasingly strategic, enabling understanding through text:

  • Background knowledge

  • Vocab

  • Lang structures

  • Verbal reasoning (metaphors)

  • Literacy knowledge

What is skilled reading?

Fluent execution & coordination of word recognition & text comprehension

developmental continuum of literacy

1. oral language; receptive & expressive

2. emergent literacy; concepts about print, phonological awareness, alphabet knowledge

3. early literacy; decoding & encoding

4. later literacy; reading fluency & comprehension

Emergent reading & writing skills:

• oral lang

• concepts about print

• knowledge of enviro print

• ABC knowledge

• phonological awarness

• pretend reading & writing

Simple View of reading equation:

Word recogniton x lang comprehension = Reading comphrension

reading fluency

ablility to read connected text rapidly, smoothly, effortlessly & automatically w/ little conscious attention to the mechanics of reading (decoding)

what are the core skills of reading?

- phonological awareness

- decoding

- sight word recognition

- vocabulary

- fluency

- comprehension

steps to reading

1. accurately decoding letters

2. identifying target word

3. retrieving definition of word

4. combining syntactic and semantic information

5. combining the representations of individual sentences to comprehend a passage

stages of word recognition

• logographic stage: children construct associations between unanalyzed spoken words and 1+ salient features of the printed word/context (ex: recognize McDonald's sign by shapes and colors)

• alphabetic stage: reading words by processing sound-letter associations

• orthographic stage: use letter sequences and spelling patterns to recognize words by sight without decoding

direct word recognition

• sight word reading; visual, orthographic representations (mental representation of words)

• “you see it, you say it”