Disorders of Child Language Exam 1

The acronym DLD refers to which of the following:

• Delay or Language Difference

• Developmental Language Delay

• Developmental Language Disorder

• Either “Developmental Language Disorder” OR “Developmental Language Delay,” depending on whether you are using IDEA or ICD-11 terminology

Developmental Language Disorder

Which of the following statements is NOT TRUE about language?

• Language is a rule-based, shared system

• Language involves both expression and understanding

• AAC, speech, and writing are all considered to be ways of expressing language

• All of the above statements are true about language

All of the above statements are true about language

According to a strictly categorical perspective of child language disorders, what are the most important observations to make as an SLP?

• What adaptations to the classroom or home might help the child function optimally

• How the child’s behaviors can be described in terms of form, content, and use

• How the child’s behaviors fit into a particular disorder category

• How the child’s environment might be contributing to their behaviors

How the child’s behaviors fit into a particular disorder category

True or false: According to ASHA’s definition, language disorders are specific to children and rarely affect individuals later in their lives

False

True or false: According to CATALISE, the term “developmental language disorders” includes children with lower nonverbal reasoning/IQ, but does not include children whose language problems are secondary to other conditions

True

A child whose language does not resemble the national “average” for his age, but does conform to the expectations of his specific speech community, has a:

• Specific Language Impairment

• Language delay

• Language difference

• Language disorder

Language difference

Which of the following indicates a problem with the syntactic component of language?

• A toddler does not differentiate between the /s/ and /z/ sounds when speaking

• A child cannot interpret sentences in the passive voice when listening to a story

• A teenager has problems interpreting audience perspective and points of view when reading

• A preschooler leaves out plural and past tense endings when speaking

A child cannot interpret sentences in the passive voice when listening to a story.

• differentiating sounds is phonology

• interpreting audience perspective is pragmatics

• plural and past tense endings are morphology (-s, -es)

Which of the following sets of guidelines would determine the wording of a student’s Individualized Education Plan (IEP)?

• Medicaid coding guidelines

• ICD-11 guidelines

• IDEA guidelines

• CATALISE Consortium guidelines

IDEA guidelines

Which of the following terms is considered an out-of-date way to label a language disorder?

• dysphagia

• infantile aphasia

• developmental aphasia

• all of the above are considered out-of-date labels for language disorders

all of the above are considered out-of-date labels for language disorders

True or false: The term Specific Language Impairment includes children who have significant limitations in their language abilities, but excludes children who have additional diagnoses like ASD or ADHD

True

According to a study by McGregor in 2020, the number of people living with DLD in the United States can be estimated at:

• 750 thousand

• Over 5 million

• Nearly 1 million

• 10 million

Over 5 million

True or false: The symptoms of DLD vary across cases; it is unusual to find two cases that sound exactly alike

True

Match the symptom of DLD below with the domain of language that it effects.

Symptoms:

a) The use domain of language: pragmatics

b) The form domains of language: morphology, syntax, phonology

c) The content domain of language: semantics

Domains:

1) Simplified sentence structure and potential errors in complex grammar

2) Delayed acquisition of first words

3) Difficulty telling an organized narrative

a and 3

b and 1

c and 2

True or false: SLI/DLD has been found to run in families following a Mendelian (dominant/recessive) pattern of inheritance

False

Which of the following best characterizes the results of “twin studies” of SLI?

• Monozygotic twins are more likely to both have SLI than pairs of dizygotic twins. This shows a stronger contribution of environment than genetic inheritance in the disorder

• Monozygotic and dizygotic twin pairs are equally likely to both have SLI characteristics, meaning that genetics have little effect on the transmission of the disorder

• Dizygotic twins are more likely to both have SLI than pairs of monozygotic twins. This shows a strong genetic component to the disorder

• Monozygotic twins are more likely to both have SLI than pairs of dizygotic twins. This indicates a strong genetic component to the disorder

Monozygotic twins are more likely to both have SLI than pairs of dizygotic twins. This indicates a strong genetic component to the disorder

Which of the following statements is true about the FOXP2 genes?

• It is an autosomal-recessive gene

• It encodes for a transcription factor, aiding the process of encoding DNA into RNA

• It explains the majority of cases of SLI

• All of the above are true

It encodes for a transcription factor, aiding the process of encoding DNA into RNA

True or false: Symptoms of DLD/SLI can change over time; the same client can experience different difficulties at different ages

True

Which of the following is not one of the brain differences observed in clients with DLD/SLI?

• Differences in the asymmetry of language function

• Differences in white matter tracts important to language function

• Differences in the basal ganglia area that support language function

• All of the above are differences that have been observed in the brains of clients with SLI/DLD

All of the above are differences that have been observed in the brains of clients with SLI/DLD

Which of the following is not true about the pre-intentional stage of communication?

• Infants in this stage are developing the cognitive skills needed to mentally represent ideas

• Infants in this stage do not intend to create a particular outcome with their behavior

• This stage lasts from approximately 7 months until the infant begins to use words

• All of the above are true of the pre-intentional stage

This stage lasts from approximately 7 months until the infant begins to use words

Match the communication behavior with the appropriate stage

Behaviors:

a) Emerging language

b) Pre-intentional/perlocutionary

c) Developing language

d) Prelinguistic/illocutionary

Stage:

1) Vocalizes during play or feeding by cooing

2) Begins to make requests via gestures

3) Combines words into two-word utterances

4) Comprehends spatial prepositions like “under”

a and 3

b and 1

c and 4

d and 2

Select all that apply: Which of the following may be factors that help differentiate a child with late language emergence (LLE) from one with a language disorder?

• An expressive vocabulary of less than 50 words at age 24 months

• Difficulty comprehending syntax at 28 months

• No two-word combinations used at 30 months

• No grammatical embedding at 30 months

• Difficulty comprehending syntax at 28 months

• No two-word combinations used at 30 months

Select all that apply: Emma is nine months old. Which of the following behaviors might indicate a communication problem, considering Emma’s stage of development?

• Emma does not combine words

• Emma does not coo, babble, or vocalize

• Emma does not respond when her caregivers try to talk or play with her

• Emma does not show joint attention

• Emma does not coo, babble, or vocalize

• Emma does not respond when her caregivers try to talk or play with her

• Emma does not show joint attention

True or false: According to the IDEA, a “Speech or Language Impairment” includes children who have difficulties with reading, writing, or mathematics

False

Select all that apply: Which of the following grammatical morphemes can be particularly difficult for students with DLD/SLI

• plural -s

• past tense -ed verb endings

• progressive -ing verb endings

• third person singular verb -s

• past tense -ed verb endings (walked, liked)

• third person singular verb -s (he goes, she works)

True or false: A student with DLD may not have many overt syntax errors in their speech, but those errors may appear more often in their writing

True

Which of the following sentences contains a relative clause?

• She put the book on the table.

• She did not read the book.

• She read the book.

• She read the book that her sister recommended.

She read the book that her sister recommended.

• “that her sister recommended” is the relative clause

• “that” is the relative pronoun

True or false: Semantic deficits in DLD may take the form of restricted vocabulary and/or over-reliance on non-specific terms like “things” and “stuff”

True

When we say that classroom discourse is often “decontextualized,” what do we mean?

• It often discusses subjects that are not in the immediate environment

• Is it often explicitly discussed or explained by the teacher

• It contains more complex syntax and multi-step directions than conversation

• None of the above

It often discusses subjects that are not in the immediate environment

Select all that apply: Which of the following skills makes up the “Simple View” of reading?

• Confrontation naming

• Language comprehension

• Decoding/word recognition skills

• Self-regulation

• Language comprehension

• Decoding/word recognition skills

In what specific way(s) might DLD affect reading skills?

• Reduced vocabulary might make it difficult to recognize words and associate them with their meanings

• Problems with morphosyntax might reduce comprehension of complex sentences

• Phonological issues might inhibit learning of letter-sound correspondences

• All of the above

All of the above

Communication

the active process of exchanging information and ideas

Speech

verbal expression of sounds, words, and utterances; encompasses:

• articulation

• fluency

• voice

Language

a system of patterns and symbols used to communicate (regardless of modality)

• phonology

• morphology

• syntax

• semantic

• pragmatics

Language Triangle

Categorical Perspective of Language Disorder

medical mode, focuses on diagnostic categories and labels

Descriptive/developmental Perspective of Language Disorder

describes and doesn’t classify; focuses on detailed description of a child’s language skills

Disadvantages of using the term “Specific Language Impairment” (SLI)

• arguments of how truly “specific” it is

• children with ADHD do not fit into this definition

• useful for research into isolated language problems

  • excluded common clinical cases

Advantages of using the term “Developmental Language Disorder” (DLD)

• broader, inclusive of children with lower nonverbal IQs and commonly co-occurring conditions (ADD, dyslexia, dysgraphia)

• more descriptive without implying anything about causes

• “developmental” indicates the changing nature of symptoms over the lifespan of a child

Four reasons why labels matter:

• public awareness

• funding

• research and EBP

• service eligibility

Individual with Disabilities Education Act (IDEA)

• federal law that tells states how to define disabilities, and who is eligible for a free appropriate public education under special education law

• this will be a label on a child’s IEP

Primary Prevention

elimination or inhibition of the onset and development of a disorder by:

• altering susceptibility

• reducing exposure

Secondary Prevention

early detection and treatment of disorders which may lead to:

• elimination of the disorder

• reducing or slowing the disorder’s progress, preventing further complications

Screening

• brief

• doesn’t result in a formal diagnosis

• indicates need for full assessment

• can be a checklist/screening instrument

• well-constructed, reliable, valid

Assessment

• in-depth and multi-step

• indicates areas of strength and needs

• can be used to diagnose and develop intervention goals

• well-constructed, reliable, valid

Steps of a Comprehensive Assessment:

1) Case history (includes medical status, education, background, information from teachers/service providers)

2) Patient/client/student and family interview

3) Review of auditory, visual, motor, and cognitive status

4) Observations and work sample analysis: Standardized and/or non-standardized measures of specific aspects of speech, spoken and non-spoken language, cognitive-communication, and swallowing function

5) Identification of potential for effective intervention strategies and compensations

*6) Follow-up services to monitor status

Signs and symptoms of DLD vary across individuals, depending on:

• the language domain(s) affected

• the severity and level of disruption to communication

• the age of the individual

• the stage of linguistic development

  • clients can experience different symptoms at different times

Prelinguistic (illocutionary) stage

• 7 months to 12-14 months

• children are not yet using words to communicate (may use gestures, eye contact, babbling, etc)

• it is intentional

Developing language

• children are entering preschool years (age 3-4)

• have expressive vocabularies greater than 50 words

• and have begun to combine words into full sentences

Preintentional (perlocutionary) stage

• newborn to 7 months

• unintentional communication

• but adults tend to act as if infants intend a particular outcome by their behavior

Supporting infant communication

• respond to the infant - look at them when they make noise, imitate, laugh when they do)

• narrate daily activities

• establish communication routines (sing/play/read every day)

Toddlerhood: Emerging langauge

• children are using words to communicate

• starting to use word combinations

• increasing their vocabulary and types of words, their “first lexicon”

Emerging communication intent (toddlers)

• request for objects/actions

• rejections/protests

• focusing attempts

• comments

Common grammatical morphology errors in school-aged children with DLD:

morphology: the rules of word structure

• past tense inflection (talk vs talked)

• omission of possessive ‘s

• omission of -s in 3rd person singular

• omission or incorrect forms of ‘be’ and ‘do’

Common syntax errors in school-aged children with DLD:

syntax: sentence structure rules, involving how words are arranged in a sentence

• trouble understanding passive sentences, negation, sentences with relative clauses

• fewer complex sentences and prepositional phrases

Common semantic errors in school-aged children with DLD:

semantic: meaning behind each word in a sentence

• problems with words that have multiple meanings

• smaller vocabularies

• shorter words

• over-reliance on non-specific terms (thing, stuff)

Decontextualized - classroom discourse

discusses subjects that are removed from the immediate physical environment

Not explicit - classroom discourse

rules and structure is seldom discussed (turn-taking, when to speak, what to speak of)

Conversation discourse

• false starts, mazing

• inaccurate/incomplete information

• problems repairing conversation breakdowns

Narrative discourse

• problems following a coherent story structure

• poor understanding of temporal and causal relations

• difficulty inferring feelings or events that are not directly stated