Special Populations

co-occuring conditions for assessing/treating phono SSDs

• considerations

Autism:

• 25% of autistic children are minimally speaking

• some research says delay is due to primarily pragmatic defs

• other research suggests motor speech diffs

• motor diffs include: unusual posture, clumsiness, motor planning probs

• motor abnormalities (esp organization)

• imitation diffs

motor difficulties in autism:

• motor diffs include:

  • unusual posture

  • clumsiness

  • motor planning probs

• motor abnormalities (esp organization)

• imitation diffs

SSD in autism:

• unusual patterns of phono devel

• restricted use of phono contrasts necessary to signal meaning differences

• idiosyncratic phono processes

  • ICD, backing, glottal replacement

  • unusual cluster reduction, stops replacing glides

• prosodic differences

  • stress, intonation, loudness, pitch level, juncture, speaking rate, vowel reduction, contrastive stress, lexical stress

What is a big phono difference we see in autistic children?

• prosodic differences

  • stress, intonation, loudness, pitch level, juncture, speaking rate, vowel reduction, contrastive stress, lexical stress

what is cerebral palsy?

• CP is a group of neurological disorders that appear in infancy/early childhood that permanently affect body movement and muscle coordination

• caused by damage/abnormalities in developing brain that disrupts the brain’s ability to control movement and maintain posture/balance

• NOT A PROGRESSIVE DISORDER

• issues w movement, posture, balance

cerebral palsy is a progressive disorder. T/F

• F

Common signs of CP:

• first signs appear early

• could be delayed until 2 yrs

• frequently have devel delay

• slow to reach devel milestone such as rolling over, sitting, crawling, walking

• hypotonia (floppy)

• hypertonia (rigid)

• infants/children can have unusual postures, favour one side of body more when crawl/reach

Three types of CP:

• spastic CP

  • most common

  • stiff muscles, awkward movements

• dyskinetic CP

  • slow/uncontrollable jerking or writhering movements of hands/feet/arms/legs

  • hard to sit straight/walk

  • troubles with hearing, controlling breathing, coord muscle movements needed for speaking

• ataxic CP

  • poor coord

  • walk unsteadily with wide based gait

  • diff w precise movements (buttoning shirt, tying shoes)

Spastic CP

• spastic CP

  • most common

  • stiff muscles, awkward movements

Dyskinetic CP

• dyskinetic CP

  • slow/uncontrollable jerking or writhering movements of hands/feet/arms/legs

  • hard to sit straight/walk

  • troubles with hearing, controlling breathing, coord muscle movements needed for speaking

Ataxic CP

• ataxic CP

  • poor coord

  • walk unsteadily with wide based gait

  • diff w precise movements (buttoning shirt, tying shoes)

Speech diffs with CP across all three types:

• problems with phonation

• problems with respiration

• problems with resonation

• problems with articulation

• ALSO MOTOR CONTROL

Problems with phonation:

• breathy/harsh voice

• pitch/intensity variations

• diff coordinating voicing and articulation

Problems with respiration:

• difficulty with initiating and sustaining phonation

• variations in loudness, may affect stress

• loss of expiratory support at end of utterance

Problems with resonation:

• inconsistency or hypernasality

• lack of intelligibility

Problems with articulation:

• sound distortions

• disorganized phono systems

• difficulty with literacy

Craniofacial syndromes:

• failure of parts to fuse/merge early in prenatal development

• cleft lip (most frequent)

• cleft palate (most frequent)

• most of these orofacial deficits result from interaction of genetic and environmental factors

Orofacial clefts are at risk for:

• speech/lang delay and probs related to VPI

• disordered lingual artic (even if VP func is ok)

• expressive lang delays

• babbling diffs and delays

• deviant phonetic patterns in older children

• middle ear disease and otitis media (prob no inc risk if only cleft lip, with cleft palate germs will get up into ear)

Cleft lip/Cleft palate

• orofacial defs

• cleft lip, lip not fused, uni or bilateral

• cleft palate, palate not fused, uni or bilateral

orofacial clefts; at high risk for:

• speech/lang delay and problems related to VPI

• disordered lingual artic

• expressive lang delay

• babbling diffs and delays

• deviant phonetic patterns in older children

• middle ear disease and otitis media (more so cleft palate)

fetal alcohol syndrome:

• mom drank alcohol while baby in womb, alcohol goes into baby’s blood and causes damage to brain/causing body

FAS characs facial abnormalities:

• small width of eyes opening

• long, flattened philtrum

• thin upper lip

• pre/postnatal growth delay

• functional/structural central nervous system abnormalities

FAS communication characs:

• common disorders of speech:

  • fluency

  • poor intonation

  • voice dysfunction

  • slurred speech

  • poor articulation

• lang acquisition and comprehension influenced by hearing and cognitive funcs

  • cog disabilities and behaviour more apparent in school aged children and goes into adulthood

• involuntarily imitating words/phrases of others

• verbal learning and memory defs

• expressive lang defs (86%)

Crouzon syndrome:

• underdevelopment or atrophy of midface, shallow eye sockets, congenital absence of auditory meatus of the ear (ear canal missing, diff degree of HL)

• comm difficulties:

  • degree of palatal involvement

  • severity of oral cavity alignment

  • type and degree of HL

Treacher Collins Syndrome:

• writhering (atrophy) of face

• microtia (congenitally abnormally small auricle)

• conductive HL

• cleft palate

• abnormal dentition (malocclusion), VPI, bilateral conductive HL

• small ears

Down Syndrome:

• most common genetic cause of intellectual disability

• extra chromosome 21 usually

• can be caused by something else

  • translocation - part of chromos 21 attaches to another

  • mosaicism - some cells include extra copy of chromos 21

• older you get = more likely to have child with DS

DS hearing:

• 2/3 children have conductive HL, sensorineural HL, or both

• can be unilateral or bilateral

• ranges from mild to profound

• more susceptible to otitis media (maybe due to narrow auditory canals, craniofacial differences)

• otitis media found in 96% of young children w DS

• 83% require tympanotomy tubes

DS motor skills - speech production can be related to:

• small oral cavity, large tongue, narrow high palate

• missing/additional muscles characterize facial structures

• diff in nerve innervation

• dysarthric factors

  • reduced speed, range of motion, coord of articulators

• boys w DS show differences in

  • structure of lips, tongue, velopharynx

  • less skilled at speech motor functions and coord speech movement of lips, tongue, velopharynx and larynx

DS cognitive skills:

• 80% have ID (IQ range 40-55)

• 20% severe ID to low avg

• visual long term memory impairments

• verbal short term memory deficits unrelated to HL or speech diffs

• impaired phono memory skills

DS language impairments:

• expressive/receptive lang impairments in areas of:

  • vocab, syntax, pragmatics, phonology

• less complex sentences

• FW delayed

• vocab growth is slower

• expressive defs more impaired than receptive

DS phonology:

• preschool/young children show phonological errors

• apraxia of speech, dysarthria, voice quality may contribute to poor intelligibility of people w DS

phono processes seen in DS:

• consonant cluster reduction

• FCD

• unstressed syllable deletion

• stopping of fricatives

• devoicing word final voiced consonants

SSD DS intervention:

• minimal pair contrasts

• cycles

• core vocab

• phonemic awareness

things that will help with DS intervention:

• emphasize visual supports

• provide varied repetition and practice in different environments to promote generalization

• slowing rate of speech

• focus on functional/meaningful goals

• adopt lifelong learning approach

• train conversational partners

fragile x and tuberous sclerosis:

• both different but similar

• fragile X is caused by mutations in the FMR1 gene

• tuberous sclerosis caused by mutations in TSC1 or TSC2 genes

fragile x and tuberous sclerosis are the primary genetic conditions that result in autism. T/F

• T

Characs of fragile X:

• 85% intellectual disability

• sensory and tactile defensiveness

• gross and fine motor impairments

• speech and language deficits

• some exhibit social avoidance and other pragmatic diffs

• females less impaired than males

motor skill defs and motor speech diffs in Fragile X:

• motor skill deficits:

  • delays in gross motor planning and coordination

  • generalized hypotonia

  • joint hyperextendibility

• motor speech difficulties:

  • extreme variability in artic rate that consists of bursts of speech and unpredictable shifts from rapid to slower rates

  • dysfluencies- rapid repetition of sounds and syllables

Males with FXS have more difficulties with diadochokinetic tasks, reps of reduplicated and non reduplicated syllables, and more oral groping behaviours. T/F

T

Males with FXS have strengths in articulation of single words, phonemic repertoires and use of phonological processes no different than TD children. T/F

T

What are some things to remember when working with people with intellectual disabilities?

• establish JA

• elicit imiation

• phonemic awareness

• early literacy/artic/phonology interventions

• language intervention throughout

• use a mirror