M1-M3 Language Disorders Birth to Age 5 Exam

models of child language disorders

theories explaining how children acquire language and specific strategies to support language development

cognitive model

links language acquisition to broader cognitive development

mismatch model

language develops when a child encounters new info that doesn’t quite fit existing language knowledge but thinking about how it’s not necessarily because of the child, but the result of environment that child is in (doesn’t quite fit needs of the child).

categorical model

identifies language impairments into discrete types based on observed difficulties

identifies the best grouping to apply to a child who is not using language as expected for his age

specific disabilities model

looks at identifying language deficits without a known cause

individuals with language disorders differ in abilities relative to others, focuses on strengths and weaknesses

descriptive-developmental or communication-language approach

most commonly used model of child language as it relates to language disorders

focuses on practical social functions of language and how it develops in context

form, content, use

etiological model

underlying causes of a language disorder such as potentially resulting in neurological conditions or brain damage

categorizes children according to syndrome, condition, disorder (etiology)

cognitive model focuse

This model emphasizes the relationship between cognitive development and language acquisition

cognitive model key idea

Children's ability to think, remember, and understand concepts influences their language learning.

• For instance, better memory skills can help a child form stronger links between words and their meanings.

language disorders result from deficits in non-linguistic cognitive ability

cognitive model examples

A child who has developed the cognitive ability to understand object permanence (that an object still exists even when out of sight) may also be better able to learn and use words for that object

therapy may target a child’s working memory to improve their ability to process and recall spoken language

mismatch model focus

How environmental challenges impact an individual’s language

mismatch model key idea

Language learning is likely driven by environmental stimuli that aligns with the individual’s need

mismatch model example

A child with minimal exposure to print is less likely to recognize the significance of letters, potentially resulting

lack of structured routines can create a mismatch that negatively impacts language learning and development

categorical model focuse

• Classifying language difficulties into distinct types

syndrome or syndrome of behavior it accompanies

categorical model key idea

Language disorders can be categorized based on the specific area of language affected, allowing for more targeted interventions

categorical model examples

• Receptive Language Disorder – Difficulty understanding words, sentences, and directions.

• Expressive Language Disorder – Difficulty using words, sentences, and proper grammar.

• Pragmatic Disorder – Difficulty using language appropriately in social situations

specific disabilities model focus

•Identifying language impairments that are not attributed to other conditions; distinguishing traits or characteristics; a child’s specific strengths and weaknesses and abilities believed toi nfluence language development

individuals with language disorders differ in some abilities relative to other or how they show within child variation

specific disabilities model key idea

LD, Specific Language Impairment (SLI), describes a primary language disorder that is not a result of hearing loss, intellectual disability, or other neurological conditions.

distinguishing traits or characteristics; a child’s specific strengths and weaknesses and abilities believed toi nfluence language development

specific disabilities model example

child may struggle to learn and use language effectively without any known medical reason, impacting their speaking, listening, reading, and writing skills

descriptive-developmental or communication-language approach focus

Understanding language development in the context of the child's broader communication skills and social interactions

detailed description of child’s strengths and weaknesses across all domain areas of language

descriptive-developmental or communication-language approach key idea

This approach views language as a social tool and examines how children learn to use it effectively in various situations to achieve their communication goals.

child with a language disorder follow same developmental path as typical children just slower or at a significantly different rate

descriptive-developmental or communication-language approach example

Analyzing how a child's language use, including their gestures, tone of voice, and interaction patterns, supports their ability to make requests, ask questions, and connect with others.

etiological model focus

Identifying the underlying causes of language disorders

etiological model key idea

this model seeks to understand the biological, neurological, or environmental factors that lead to language difficulties

etiological model example

Identifying the genetic predisposition, brain injury, or medical condition (like a stroke) that might be causing a child to experience difficulties with speech or language.

samuel t. orton (1937)

a neurologist, credited with bringing awareness to developmental language disorder

language disorders are multifactorial

mcginnis (1956)

developed “Associative method” teaches children with learning disabilities

morley (1957)

instrumental in applying information on normal language development to the problem of treating children with language disorder

language disorders

persistent or persistent difficulties in acquisition and use of language across various domains

• A difficulty in understanding and using spoken or written language

• Potentially affects a person’s ability to communicate effectively

• Research has shown early identification/intervention can:

• Improve language skills

• Reduce the risk of academic and social difficulties

• Complex

• Involve a combination of factors, such as., genetic, neurological, and/or

environmental factors

• SLPs diagnose and treat

• Support academic, social, and professional success

key aspects of language disorders

Bloom and Lahey (1978) and Lahey (1988) framework for exploring language competencies.

• Form: syntax, morphology, and phonology

• Content: semantic

• Use: pragmatics

causes of language disorders

Co-occurring Conditions – Language disorders can co-occur with otherconditions

• Can make the language disorders more complex to diagnose and treat

• Ex. Attention-deficit/hyperactivity disorder (ADHD), Autism Spectrum Disorder (ASD), or Intellectual Disability

• Genetic factors – genetic component

• Researchers have identified specific genes that may be involved in language development

• May not be fully understood

• Neurological factors – neurological conditions; disrupts the brain’s ability to process and produce language

• Ex. Developmental brain abnormalities, Traumatic brain injury, Stroke, or degenerative diseases

• Environmental factors – Poverty, neglect, abuse can impact language development

• Ex. A child who experiences chronic stress or sleep deprivation

• Developmental factors – may experience a delay in language development that may or may not be related to other developmental delays

• can be temporary

comorbidity

language orders rarely occur in isolation→ comorbidity refers to a situation where a child may experience 2 or more disorders simultaneously→ independent causal origins or causally related

diagnosing a language disorder

1. Observations - observe the child’s language use and social communication skills in a variety of settings

2. Comprehensive Evaluation (Additional Assessments)– SLP may recommend additional assessments to rule out other conditions that

can impact language development

3. Diagnosis – Based on the results of the evaluation, the SLP will determine whether the child meets the criteria for a diagnosis of language disorder

4. Treatment Plan/Planning - If a diagnosis of language disorder is made, the SLP will develop a treatment plan tailored to the child’s specific needs and strengths

5. Intervention – appropriate teaching techniques, dynamic

assessment, evidence-based practice,

6. Follow up assessments/Progress Monitoring

developmental language disorder (DLD)

A language disorder not associated with a known etiology

when language challenges significantly interfere with social interaction, academic achievement, and or daily functioning

form linguistic characteristics of DLD

syntax, morphology

most consistently omit morphosyntactic markers of grammatical tense in spontaneous speech

• Errors in grammatical forms in older children are an indicator of a language disorder

content linguistic characteristics of DLD

Limited or poor vocabularies throughout development

• As children get older the problem becomes what they know about words

• (e.g., words with multiple meanings

use linguistic characteristics of DLD

pragmatics

• Can be seen as immature

• difficulty understanding and applying pragmatic rules

• Ex. Social conventions

diagnosis of DLD

development- a problem that arises in childhood → communication milestones

language- receptive and/or expressive → think of what is used to communicate (eg spoken or written)

disorder- a significant deviation from the typical developmental patterns→ both neutralist (test scores) and normative (functional assessment) criteria

consider control, culturally and linguistically diverse individuals

diagnostic issues in DLD

eligibility criteria- Consider a child’s language development relative to chronological age

•the child’s overall level or cognitive ability or “mental age”

•Individuals with Disabilities Education Act (IDEA Amendments of 1997, public law 105-17) stipulates that services be determined on an individual basis

subtypes- lack of agreement

range in severity or classification are often subjective

diagnostic cutoffs- •cutoff scores for eligibility are mandated by school districts

•Arbitrary

•Inconsistent profiles of language skills and deficits

diagnostic issues funcitonal impact

Functional impact

• ___________ position stresses that language

disorders must involve a significant deficit

relative to environmental expectations

(Tomblin, 2008)

• WHO International Classification of Disease—

10 (2004) stresses the importance of

evaluating the impact of disorder on everyday

well-being

brain structure and function

• Magnetic Resonance Imaging (MRI) – common method used to examine brain structure and function

• Functional Magnetic Resonance Imaging (fMRI) – used to identify regions of the brain that become active while performing language tasks

• Electrophysiological Measures (EEGs) – measure language processing in real time

• Researchers have reported subtle differences in the size of different brain regions

• i.e., the inferior frontal gyrus and the superior temporal gyrus

expressive language disorders

Difficulty with expressing oneself through speech or writing

May struggle with using appropriate grammar, vocabulary, or sentence structure

mixed receptive-expressive language disorder

• A combination of expressive and receptive language difficulties

• Difficulty with both understanding and using language effectively

• Difficulty with grammar, vocabulary, sentence structure, and cosmprehension

common language disorders in practice

1. Children with Developmental Language Disorders

1. Language impairments are the most salient

2. Children identified as having as having language-learning disorders

1. Co-existing literacy difficulties

3. Children with language disorders that are associated with or secondary to some other developmental disorder such as ASD or intellectual disorder (ID)

appraisal (assessment)

Collection of data from a variety of sources to describe the client’s condition

process of collecting information

reviewing case histories, conducting interviews, administering standardized tests, observing play and interaction and gathering input from various stakeholders, caregivers, and other professionals

diagnosis (assessment)

the assignment and labeling of the clinical condition by means of the interpretation of standardized tests, case history information, observation, and medical examination, often with some inference about its underlying cause

process of analyzing that info that we gathered to determine whether a language disorder is present

young children- interpreting results and identifying whether delays are within typical limits or indicative of a disarray- identify contributing factors (ex. hearing loss, medical conditionm, and role of medical condition)

assessment

• Decide whether the child has a significant impairment in language form, content, or use to describe the deficit in some detail relative to the normal developmental sequence of language acquisition, and to determine how this deficit will affect the child’s daily activities

broader ongoing process that includes both appraisal and diagnosis

involves data to establish a child’s baseline, setting, intervention goals, and monitoring change over time and devolves as the child develops

dynamic, not just one time

goals of assessment

to decide whether the child has a significant impairment in language form, content, and/or use

to describe that deficit in some detail relative to the normal developmental sequence of language acquisition

to determine how this deficit will affect the child’s daily activities (school, family, and social well-being)

to understand and convey how a child functions within the environment, given the individual profile of communicative strengths and weaknesses

screening for potential delays,

establishing baseline functions

identifying intervention goals

monitoring progres over time

key principles of assessments for young children

developmentally appropriate- match child’s age and stage

family-centered, involving caregivers as essential info

multiple sources of info for unstandardized tools, observations

behavioral and formal caregiver reports and play-based assessments to get a complete picture

culturally and linguistically responsive, avoid bias, and misinterpretation

general assesment principles

assessing communicative functioning

special ed programs focus on functional assessments

International Classification of Functioning Disability and Health (WHO)- provides a framework for describing individual’s health in relation to what they can do in a standard environment and in their actual environment

considers family priorities, cultural and linguistic diversity, and developmental appropriateness

goal- understand child’s communicative strengths and contexts

collaboration

helps you see the whole child with the full picture

referral, case review, and observation

collect referral info

case history

language or communication sample

low structure observations

helps form hypothesis about the child’s needs and determine which tools to select

mapping out the assessment plan

select tools based on child’s age or client’s age, developmental level, and referral question: so why are they being referred? are there speech concerns or language concerns?

integrate info from range of sources→ history, interview, hearing tests, vision assessment, neuromotor assessment, general developmental level

evaluate eligibility for services, including standardized testing

mapping out assessment plan pt 2

determine presenting problem, but consider related issues

construct series of assessment to suit client needs

order of administrations, what do first to build your board, how to incorporate caregiver input, and when to use structured versus a more naturalistic method to get as much info as possible

decide which tools and methods best match the child’s developmental level- ex standardized tests, play-based observation, or caregiver interviews

planned out activities to build rapport and maintain attention, be ready to adjust if child is fatigued

okay to change work to meet needs of client and where they need support

outline adjustments or modifications to meet the needs and ensure assessments are in function family centers- considering age range

why are we assessing?

screening identifies children at risk for DLD- does not characterize the nature and extent of difficulties (be aware of culturally and linguistically different backgrounds)

screening instrument properties

establishing baseline function

identifying goals for intervention

measuring change in intervention

collateral areas

areas and components/domains of language

form- syntax, morphology phonology

content- knowledge of basic concepts underlying language, semantic relations among words and clauses, understanding ambiguity and multiple meanings, understanding figurative language use

use- appearance of appropriate rang of communicative functions, discourse management, flexibility of language for different listeners and social situations, clarity, cohesion, and coherence in discourse

standardized tests (how are we assessing)

norm-referenced tests- developed by devising a series of items that are given to large groups of children with normal language development and then computing acceptable range of variation in scores for age range covered by test

compare a child’s performance to age

helpful for eligibility decisions

s

standardized test limits

can miss subtle or functional difficulties, especially in natural settings

fairness

being narrow item sampling

elicitation or nets that may not reflect spontaneous communication patterns (not natural)

standardizes tests (how are we assesing) pt 2

validity, reliability, diagnostic accuracy, standardization, measures of central tendency and variability, standard error of measurement

validity (standardized tests)

whether a test measures what it claims to measure

ex. does a receptive vocab test truly reflect a child’s comprehension of words? or is it confounded by attention or cultural factors?

ensure results are meaningful

reliability (standardized tests)

across readers or between different forms of the same test

give stable scores when the child’s abilities haven’t changed, consistent stable and repeatable results under similar conditions

diagnostic accuracy (standardized tests)

measures like sensitivity identifying true deposits so that the child does indeed have a language disorder

specificity- identifying true negative so identify that the child does not have a language disorder

high diagnostic accuracy- helps us correctly identify children who do and do not have language or have a languge disorder

specificity and sensitivity

standardization (standardized tests)

test was administered and scored the same away across a large representative group of children

establishes the norms we compare our clients to so whether it’s based off of same age, or same grade level

measures of central tendency and variability (standardized tests)

mean, media, and mode that shows center of data

standard deviation shows spread out scores and

in the normal way, these help us interpret where a child falls relative to peers

standard error of measurement (standardized tests)

no test score is exact

how much a score might vary due to measurement error

helps us interpret confidence intervals around a child’s score, avoiding over interpretation of small number differences

adding to credibility that’s obtained

uses (standardized tests)

to demonstrate a client is significant different from others

to establish eligibility for services

other methods of assessment

interviews, questionnaires, and developmental scales

can give valuable context but often lack standard scores to they’re not always used for eligibility

developmental scales- sample behaviors from a period of development, provide age-equivalent; not appropriate for eligibility

creiterion-referenced procedures (how are we assessing)

examine particular communication behaviors without comparison to other children; no eligibility determination

used when eligibility has already been established to- establish baseline function, identify goals for intervention

examine specific communication skills without comparing to norms

ideal- whole setting and progress monitoring ex language probes, elicited productions and structured analysis

eliminate specific error patterns and functional deficits in natural contexts that you wouldn’t otherwise pick up in standardized assessments

language comprehension and criterion refernced procedures

avoid overinterpretation

specify appropriate responses

elicited imitation

elicited production

structured analysis

integrated approaches

behavioral observations (how are we assessing)

used to sample a particular behavior- appearance, frequency, context/antecedents

use standard or clinician-created checklists or rating forms

development of reliable rating format

allows us to see communication in real time as it happens

ex. play, turn-taking, interaction styles, often uncovers needs not yet visible in formal testing settings

dynamic assessment (how are we assessing)

level of support needed for client to achieve goal is identified

test-teach-test- provide varying levels of support for communicative behavior; assess level needed for success

identifies error patterns and self-monitoring abilities

degree of modifiability of client behavior (stimulability)

preferred intervention style

works best for addressing some challenging skills a student may be having

curriculum-based assessment (how we are assessing)

examine how language supports or limits their access to the curriculum

bridge assessments to functional educational planning

formative assesment (curriculum-based assessment)

include informal ways to stimulate learning (ongoing)s

summative assessments (curriculum-based assessment)

includes structured and standardized assessment of school achievement (end of learning)

recommendations (integrating and interpreting assessment data)

is speech/language intervention warranted

statement for goals for intervention, based on assessment data

suggestions for methods to approach activities and reinforcers based on observations during assessment

reports (integrating and interpreting assessment data)

identify key info

examination of findings

behavioral observations

severity/progress

summary/concluding statementsda

data integration

combining scores, observations, caregiver input, and functional performance to create a coherent picture of the child’s communication