Child language disorders test

Speech vs language

Speech= verbal expression of sounds, words, and utterances (articulation, voicing, fluency)

Language= arbitrary combo of sounds and structure to communicate for expression and understanding using different forms like AAC speech ASL (form- phonology morphology syntax content- semantics use- pragmatics)

When language goes “wrong”

Late Language Emergence/ Language Delay= delay in language onset with no other diagnosed disabilities
or developmental delays, expressive and/or receptive delays and will catch up with peers later

Language Difference= Dialect, bilingualism, etc meaning no disorder

Language Disorder= categorically- diagnosed using criteria from a known condition assuming similarities in all those diagnosed. Descriptive/developmental- describing based on skills in form/content/use and compares to other kid’s development milestone. occurs in 5 language domains, impact reading/writing/listening, can occur with disorders or be causes by it (secondary) or in isolation

SLI vs DLD

SLI- children who have limited language ability but a lack of language learning problems seen, used in research, too specific and excludes some conditions like ADHD etc and promotes the idea of a gap of nonverbal IQ and language use

DLD- a subset of language disorders and consensus for children with language deficits, broader and allows for co-occurring conditions (adhd), lets symptoms of delay change over lifespan and is better to use in language disorders in isolation. Word finding phonemes morphology memory all technical language difficulties. DLD is a subset of
Language disorders

-Labels matter because of public awareness, funding needed for support programs, research and people getting help for it to have the best results and insurance gets the best coverage though potential of treatment is something insurance loses quickly (don’t do developmental if it’s something life-long, they think over time it will be get better naturally)

Labels, Laws, & Eligibility for Services

-Health care system uses international statistical classification of diseases and related health problems (ICD 10 shifting to ICD 11) which classifies disease

-Educational system uses individual with disabilities education act (IDEA) federal law defines disability and those eligible for free public special education with some IEP (individualized education plans)

SLP roles

Education
• Prevention
• Screening & Assessment
• Intervention
• Support & Counselling

-Prevention

Primary Prevention- Elimination or inhibition to lessen susceptibility
Secondary Prevention- Early detection preventing further complications,  risk factors are systemic like poverty and includes birth defects

-Identify disorders early, Reduce impact, identify at-risk populations and education (teachers, parents, general public, admin)

Primary Prevention trying to get it at its source, Secondary Prevention if not then early intervention and treatment, Tertiary Prevention if not then giving better functioning/”rehabilitation”

Assessment

multi-step process for observing

Screening- brief no formal diagnosis formal instrument or checklist

Assessment- diagnose & develop intervention goals well-constructed, reliable, & valid. medical status (education, socioeconomic, cultural, and linguistic backgrounds, info from teachers+service providers), auditory, visual, motor, and cognitive status, intervention strategies. Cultural and linguistic Competency, refer to other professionals

Intervention & Support

data and evidence-based practice (EBP), culturally appropriate, counsel collab and advocacy, family-centered intervention. child be understood + 1 word plus utterance, multi-step directions, verb tense

DLD defining

subset of Language disorders, # of people with disorder, vary across individuals.

Form- fewer grammatical
morphemes, Simplified grammatical
structures, weak phonemes

Content- delay first words, less vocabulary, poor use figurative language, Difficulty word finding

Use- bad long convo, coherent narrative, understanding abstract language

Developmental, brain based, genetic

DLD understudied

complex with multiple brain pathways with language areas as deep structures, neuroimaging tech hard with kids, brain diffs cause of language difficulties, or result of difficulties

DLD brain differents

brain asymmetries, white matter pathways (superior longitudinal fasciculus)
important to language less robust, Abnormalities in the basal ganglia, particularly the caudate nucleus

50-70% genetic but does not follow a Mendelian
(recessive/dominant)

info from- twin studies with shared genes and environmental influences, KE family & FOXP2 mutation in a single autosomal-dominant gene for word process, speech intelligibility mouth movement complex sentence structure

FOXP2- not a “gene for language”, help them transform into RNA with relevance to speech and language phenotypes, “Risk factor” alleles with different genes

DLD across lifespan- early childhood

CATALISE not recommend diagnosis of DLD until age 5, language delay catches up, though fear that toddlers will not receive services without a Dx label, differentiate typical variations in language development from language delay or language disorder, language milestones though normal variations

Infancy lang development

Pre-intentional- birth to 7 months, developing cognition skills with no meaning to actions with adults reaction like they do matter, vocalizes recognizes laughs

Pre-linguistic- ~7 months-first word (12-14 months) intentional communicators with gestures, responds to name babbles points reaches waves

Emerging language- gesture/intent using words/lexicon and combos, 13-24 months (objects people body parts 2 words, pronouns, possessives, when/where) 25-36 months (past tense, plural, conjunction, why/how, request and protest focus and comments). less than 10 cause for concern

18-24- requests and comment

Risk factors in infancy

Fragile X syndrome, craniofacial differences, maternal alcohol/drugs poverty abuse, In-utero infections (illness and low birth weight), frequent middle ear infections, toxin and malnutrition

Observe communication differences to look for disorder/delay, responsiveness, respond to activities and narrative activities

-hearing screenings for newborns might not get follow-up, look for otitis media

Late Language Emergence (LLE)

late talkers with no diagnosis, less than 24 months 50 words or less no word combos. 50%–70% catch up to peers, can evolve into other conditions or language/literacy issues

Preschool years – Developing Language

50 words + vocab, form sentences, articles prepositions, “why” questions

Individuals with Disabilities Education Act

broad categories of disability, primary disability, for IEPs. Speech or Language Impairment for voice, fluency, or
speech sound disorders, DLD reading, writing, mathematics and/or
language

School-aged children issues

issues in past possessives be and do, hard to use complex syntax, higher demands plus writing, MLU not accurate, negation relative clauses passive, less complex less elaborate less propositional “cat in the hat”, subject and verb components, relative clause (where when why), smaller vocabularies, word finding, convo and narratives with poor decontext (talking about things not in room) and non-explicit (rules)

Reading

language-based, Decoding words (sounding words out), Reading comprehension

Standardized tests not enough

to fill in gaps, may only have one or two items per target, validity, reliability, sensitivity/specificity

Validity- Face validity (valid first glance) Construct validity (construct measured by this, language or attention) Concurrent validity
(similar measures) Predictive validity (predict later performance)

Reliability-
Test-retest Reliability (fluctuate score short periods) Inter-rater/inter-examiner Reliability - (person administering/scoring)

Sensitivity- language impairment identification

Specificity- doesn’t get people without the impairment

Language
Language Sample Analysis

naturalistic communication contexts, , MLU, PGU, Type-token ratio, use of subordinate clauses. Fill in gaps, gloss (repeat child’s narrative back to them to encourage more narration. 50 utterances, turnabouts “That sounds scary. I wonder what happened next”

activities, play and pictures

Deficits in School-aged children with DLD:
Discourse & Narrative language

Conversation: Children with DLD can have difficulty maintaining conversations.
• Can be prone to false starts, mazes
• May give inaccurate or incomplete information
• May have problems repairing conversation breakdowns

Narrative Discourse: Recalling & telling stories is often a problem for children with DLD.
• Problems following a coherent overall structure (e.g., telling events in logical order)
• Poor understanding of temporal & causal relations
• Difficulty inferring feelings or events that are not directly stated

Communication Intent

Requests for objects & actions
• Rejections & Protests

Joint attention

Focusing attempts (any attempt to direct a caregiver’s attention to an object or event)
• Comments

Types of Standardized tests and psychometrics

norm referenced (from other children) criterion referenced (from determined score)

Validity: Does the test measure the skills that it’s designed to measure?

Reliability: Can you repeat the test and get the same score?

Sensitivity: How accurate is the test when identifying children with language impairments?

Specificity: How accurate is the test when identifying children with typical language skills?

Non-standardized assessments: Language Sample Analysis (LSA)

Language sampling techniques are used to elicit spontaneous language in various naturalistic communication contexts.

Purposes of Intervention

• Client age
• Etiology
• Assessment & Intervention history

Eliminate the underlying problem – also known as complete remediation. The client becomes a ‘typical’ language user needing minimal additional maintenance.
2. Change the Disorder - Improve existing language skills through specified intervention (ex: expanding the number of grammatical morphemes correctly used in sentences)
3. Teach compensatory strategies – Does not attempt to remediate individual skills. Instead, teaches strategies, tricks or cues to “get around” the problem.
4. Change the environment – alter the communicative context to improve communication function

• Areas of deficit & Current client abilities (information from
assessment)
• Communicative function
• Teachability of the skill

Not all assessment results
can be directly translated to goals

Functional Goals: the ICF (international classification of functioning disability and health)

Functioning and Disability
• Body Functions & Structures describes actual anatomy and physiology/psychology of the human body.
• Activity & Participation describes the person's functional status, including communication, mobility, interpersonal interactions, self-care, learning
Contextual Factors
• Environmental Factors are factors that are not within the person's control, such as family, work, government agencies, laws, etc.
• Personal Factors include race, gender, age, educational level, coping styles, etc.

Consider Zone of Personal Development and teachability

These are the skills that the child is ready to learn.
• Intervention should be aimed at skills within a child’s ZPD.

teachability should be a secondary consideration when choosing goals. Developmental and functional factors come first.

General Intervention Principles

Family-centered care: a collaborative approach to the planning, delivery, & evaluation of clinical services. The emphasis is on working with the family and client & including their perspectives in all aspects of treatment planning

Types of Interventions (a range of naturalness)

Clinician-Directed Approaches- decrease
irrelevant stimuli and maximize opportunities
to practice

Drill (or Drill practice)- Repeated structured trials with reinforcement, highest rate of stimulus presentations & trials (very efficient)
Drill play -Repeated trials with more reinforcing events in games
Modeling- Client listens to multiple trials of the
target structure, after hearing several model
examples, the client attempts the target

Child Centered Approach(es)- client directs the session activity

Self talk/parallel talk- Clinician describes their own (or the child’s) actions while engaging in parallel play with the child, Response from the child is not necessary

Expansions and Extensions- Expansions add grammatical pieces to the child’s utterance
• Extensions add semantic information to the child’s utterance

Hybrid Approaches- Clinician maintains some control of activities – consciously attempts to elicit language

Focused Stimulation- Child is given of models of the target, Activities are carefully arranged to ‘tempt’ the child to produce the target form
Script therapy- Uses “scripts” or scenarios
that the child knows (sometimes these scripts are established within the therapy setting), Stimulates language production by violating the script

Evidence-Based Practice (EBP

Clinical expertise/expert opinion- The knowledge, judgment, and critical
reasoning acquired through your training
and professional experiences
Evidence (external and internal)- from the scientific literature (external evidence) and from data and observations collected on your individual client (internal evidence)
Client/patient/caregiver perspectives- family values, priorities from client and
their caregivers

Intellectual Disability

intellectual functioning issues (e.g.,
learning, reasoning, and problem solving), starts before age 22, limitations in adaptive behavior (social, life skills). not diagnosed by SLP by communication assessment (modified for client needs) can support diagnosis

Strengths-based intervention

optimal level of communicative potential, goals and strengths. form collaborative teams, consider client variability, improve quality of life and functioning (compensatory strats)

Down Syndrome

Mild-moderate intellectual disability most common chromosomal difference, extra full or partial copy of chromosome 21, Receptive language is typically stronger than expressive language. 2/3 have hearing loss, good visual spatial memory impaired phonological memory

Language Characteristics of children with Down Syndrome

Form- Relatively poor intelligibility, Difficulty acquiring & using syntax, Shorter, less complex sentences (lower MLU), fewer question & negation forms

Content- Significantly delayed 1st
words

Use- Delayed early joint attention /communication behaviors, Fewer requests, Decreased elaboration in conversational turns, Fewer requests for clarification

Good pragmatic skills

Fragile X syndrome

x chromosome repetition, most common form of inherited moderate-severe male 1/3 mild in women intellectual and developmental disability

Language
Characteristics of
Children with Fragile
X syndrome

Working memory (both auditory and visual-
spatial)
• Attention, especially sustained attn. and
inhibitory control
• Sequential processing (carrying out/thinking
about tasks in a specific order

Good long term memory

Form:
• Delayed production & comprehension of grammar/
morphosyntax, Less complex phrases (Shorter
MLU)
Content
• Mixed research results (some showing reduced receptive vocabulary, some showing no difference from typical), Vocabulary skills may be influenced by ASD status & gender

Use: High comorbidity with social
anxiety & ASD, Language may be tangential, May be perseverative/repetitive, Difficulty maintaining coherent, semantically rich
discourse in conversation, Narratives may be a relative strength in adolescents & young adults with Fragile X

Executive functioning

cognitive process for task planning+execution

Attention: includes orientation, and sustained or selective attention
• Working memory: holding information in your mind and manipulating it as new information comes in
• Inhibition Control: Ignoring thoughts or details that are not important to the task at hand. Stopping yourself from doing something
that doesn’t fit the situation.
• Shifting/flexibility: Switching tasks or shifting your thought process.

Attention

A concept in cognitive psychology that refers to how we actively process specific information present in our environment
• Attention is not a monolithic system. It has multiple aspects:
• Orientation: aligning attention with a source of sensory input
• Sustained attention: the ability to direct and focus cognitive activity on specific stimuli over a period of time. sustained attention task
• Selective attention: selecting task-relevant information and minimizing interference from irrelevant information.

Working Memory

A limited capacity part of the memory
system that combines the temporary
storage & manipulation of information in the service of cognition
(Baddeley)
• Working memory ≠ Long term
Memory
• Temporary storage system
• Information is not stable
• Working memory ≠ “Short term”
Memory
• Implies more than simple storage of
information
• Information is “worked on” somehow while it
is held in storage

Inhibition Control

The ability to “steer” or manage thoughts, emotions
and actions.
• Without it, we’d be unable to control our impulses and thoughts
• There are two main ways that inhibition control works:
• Behavioral control: The ability to keep yourself from doing things that you think you shouldn’t do.
• Interference control. The ability to manage your thoughts. This includes focusing on something that needs your attention and ignoring whatever doesn’t.

Cognitive Flexibility

• How well your brain can appropriately shift, or adjust your behavior according to a changing environment.
• Also known as “fluid” or “flexible” thinking
• Cognitive flexibility lets you react to your environment
by:
• disengaging from your current task
• configuring an appropriate new response
• implementing this new response to the task at hand
• The more flexible your thinking, the better you can adapt to whatever is happening around you. This also helps you react
to unexpected changes in your situation

Executive Dysfunction

A breakdown of any EF skill at any
level. Such a breakdown can impact an
individual’s ability to complete functional
tasks, such as:
• following a sleep schedule
• completing assignments
• meeting deadlines
• planning for activities
• navigating social situations
• managing medications

significant impact on the well-being and
academic progress (especially in children)

SLPs treat EF

SLPs play a central role in the screening, assessment, and treatment, function goals, Children with DLD tend to perform lower on EF tasks

Teaching relevant knowledge & skills (e.g.
vocabulary) to build automaticity
• Teaching morphosyntax skills to help break down directions & tasks (especially in children with co-occurring DLD)
• Teaching memory-assisting techniques such as rehearsal and visualization
• Emphasizing the meaning & relevance of curricular content

compensatory strategies and changing
the environment to accommodate

Attention Deficit-Hyperactivity
Disorder (ADHD)

before age 12, at least 6 months, in 2+ settings. treat with counseling therapy meds behavior management

Predominantly inattentive
presents with:
• problems staying on task
• difficulty paying attention
• difficulty staying organized

Predominantly hyperactive-
impulsive presents with:
• extreme restlessness/ constant
moving, including in situations when
it may not be appropriate
• acting without thinking
• having difficulty with self-control

and mixed for both

Emotional dysregulation
• Rejection Sensitive
Dysphoria
• Hyperfocus
• Sleep Disturbance
• Time Blindness
• Anxiety
• Fatigue