Language Disorders: Final Exam

What is **DLD**?

Cases of language disorder with no known differentiating condition. If there is difficulty and there is NOT an identified comorbid condition, it is labeled DLD, regardless of scores on non-verbal IQ tests.

What is **SLI**?

Children whose language development is not following the usual course despite typical development in other areas.

Why was there a switch from **SLI** to **DLD**?

The criteria was being interpreted too strictly. There was a group of individuals who were not receiving services because they did not fit in both criteria (Left a gap). IQ scores were not high enough, but they were not low enough to fit the criteria for other disorders.

Language Characteristics of **DLD**:

**Form deficits** are a hallmark universally.

__Form__: Production errors, comprehension difficulties.

__Content__: Smaller vocabularies, difficultly learning new words.

__Use__: Pragmatic difficulties not as severe as ASD, sound younger/more immature than their chronological age.

Bilingualism does _____ cause SLD or make it worse!

NOT

Define **Intellectual Disability** (ID):

A disability characterized by significant limitations both in __intellectual functioning__ and in __adaptive behavior__, which covers many everyday social and pragmatic skills. This disability originates before the age of 18. Delayed language acquisition is often one of the first signs.

Language Characteristics of **Intellectual Disability:**

__Cognition__: Follows typical developmental sequence but at a slower rate.

__Form__: Follows typical developmental sequence but at a slower rate, once MLU is above 3, tends to use shorter, less complex sentences.

__Content__: Vocabulary size and verbs are strengths.

__Use__: May be slow to develop, gestures are a strength, difficulty with using language forms for different purposes.

__Literacy__: Slower to progress than children without ID.

Define **Down Syndrome**:

Results from an extra (Third) copy of chromosome 21. Includes mild to moderate ID, hypotonia, microgenia, macroglossia, epicanthal folds, etc.

Language Characteristics of **Down Syndrome**:

__Cognition__: Global delays in gross/fine motor, delayed cognitive level, difficulties with executive functioning.

__Form__: Decreased speech intelligibility, inconsistent pronunciations, difficulties acquiring and using syntax, shorter/less complex sentences.

__Content__: Delayed first words, expressive vocab. slower to develop, challenges with semantics/verbs.

__Use__: Joint attention may be delayed.

__Literacy__: Poor phonological awareness, vocabulary knowledge predicts literacy development.

Define **Williams Syndrome:**

A complex neurodevelopmental disorder that results from the deletion of approx. 25 genes on one copy of chromosome 7q11.23. Includes physical aspects include facial dysmorphology, cardiovascular heart disease, and growth deficiency. Behavioral aspects include overfriendliness, social gregariousness, and high anxiety.

Language Characteristics of **Williams Syndrome**:

__Cognition__: Global delays.

__Form__: Grammatical skills are more in line with or sometimes below developmental expectations.

__Content__: Concrete vocab is easier than relational/conceptual vocab.

__Use__: Pronounced pragmatic difficulties, emergence of joint attention is delayed.

__Literacy__: Vocabulary knowledge predicts later reading abilities.

Define **Fragile X Syndrome:**

An inherited, single-gene disorder that is the most common inherited from of ID. Includes high rates of ASD; better language than with DS; difficult to identify boys before the age of 3; elongated face, long/prominent ears, highly arched palate, hypotonia, etc.

Language Characteristics of **Fragile X Syndrome**:

__Cognition__: ID is the prominent cognitive characteristic, rate of intellectual growth is about half that of TD children, core deficit in executive functioning.

__Form__: Intelligibility is reduced in connected speech, slower rates of language growth, less complex noun and verb phrases.

__Content__: Expressive vocabulary is impaired; vocab growth is slower than TD children.

__Use__: Pragmatic impairments more evident in naturalistic tasks; perseverative and repetitive speech, delayed echolalia.

__Literacy__: Reading abilities plateau around age 10.

_____% of children ages 2-17 have ADHD.

11%

_____ out of 3 with ADHD have another comorbid condition (Mental, emotional, behavioral).

2

Diagnostic Criteria for ADHD: **Birth to 16 years old**

6+ symptoms of inattention AND

6+ symptoms of hyperactivity/impulsivity AND

Present for at least 6 months AND

Inappropriate for developmental level.

Diagnostic Criteria for ADHD: **17 and older**

5+ symptoms of inattention AND

5+ symptoms of hyperactivity/impulsivity AND

Present for at least 6 months AND

Inappropriate for developmental level.

Characteristics of **Inattention**:

Fails to give close attention to details, has trouble holding attention, does not seem to listen when spoken to directly, easily distracted, and forgetful in daily activities.

Characteristics of **Hyperactivity/Impulsivity**:

Fidgets with or taps hands/feet, leaves seat in situations when remaining seated is expected, talks excessively, has trouble waiting their turn, and interrupts or intrudes on others.

3 Types of ADHD:

1. **Predominately Inattentive**: Enough symptoms of inattention, but not hyperactive-impulsive present for 6+ months.
2. **Predominantly Hyperactive-Impulsive**: Enough symptoms of hyperactive-impulsive, but not inattention present for 6+ months.
3. **Combined**: Enough symptoms of both criteria present for 6+ months.

**ADHD** Manifestations:

__Language/Literacy__: Strong association with communication disorders (Expressive, pragmatic, and discourse deficits).

__Pragmatics__: Difficulty waiting turns, talking excessively, interrupting others, etc.

__Narrative/Expository Discourse__: Difficulties in higher-order cognitive processes involved in comprehending/monitoring comprehension.

__Reading Comprehension__: Difficulties in organizing and monitoring their story retelling, difficulties in pulling out important aspects.

Core Characteristics of **FASD**:

Birth anomalies associated with excessive alcohol intake during pregnancy, flat midface, flattened philtrum, growth retardation, central nervous system abnormalities, and DLD is nearly universal.

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__Infancy/Early Childhood__: Sleep disturbances, poor sucking response, delays in walking/talking, and failure to thrive.

__School Years__: Hyperactivity, distractibility, poor attention, delayed motor/cognitive/speech development, and interest in social engagement but poor social skills.

__Adolescence__: Reach academic ceiling, depression, social isolation, sexual difficulties, and pragmatic language difficulties.

Maltreated children tend to have _____ language ability.

Lower

Lum et al. (2015) Study: *The relationship between language issues and maltreatment*

Meta-analysis of 26 studies; children ages 2;6-11;0. Results:

Receptive vocabulary **lower** in maltreated children with medium effect size.

Expressive vocabulary trends were **lower** but unclear.

Receptive language **lower** in maltreated children with medium effect size.

Expressive language **lower** in maltreated children with large effect size.

Sexual Abuse of Children with LD:

Children with LD experience **2.5 times** the odds of being sexually assaulted than children without LD (*Increased odds*).

Children with LD experience over **3 times** the amount of digital or oral copulation than children without LD (*More severe*).

**Twice as many females** with LD had sexual abuse allegations than females without LD (*Females more at risk*).

Perpetrators seek victims who are…

Vulnerable, gratifiable (Preferable in appearance, gender, age, etc.), and target antagonistic (Any trait that triggers anger in perpetrators).

Children with LD are abused _____ often and _____ severely than children without LD.

More, more

Can a language disorder exist in one language and not the other?

No

Diagnostic Evaluation of Language Variation (DELV):

Designed to assess language disorders using non-contrastive language structures. Can determine if a child is a dialect speaker and if their language is typical or not.

Children who are culturally-linguistically diverse may be both **under-represented** and **over-represented** on caseloads…

**Under**: Poor language skills while learning language or wait for diagnosis until English is learned (4-7 y.o.).

**Over**: Errors consistent with language learning (Similar to DLD in monolinguals) or perform lower on standardized tests.

Define **Language Difference**:

Reflects a rule-governed language style that deviates in some way from the standard usage of the mainstream culture, but it is not indicative of a limitation in the capacity to learn language.

Define **Language Disorder**:

A significant discrepancy in language skills relative to what would be expected for a client’s age or developmental level.

Define **Simultaneous Bilingualism**:

The acquisition of two languages at the same time, typically with both language introduced prior to the age of 3.

Define **Sequential Bilingualism**:

A second language introduced after the age of 3, at which time some level of proficiency has been established in the primary language, also referred to as successive bilingualism or second language acquisition.

Define **Dual Language Learners**:

Individual learning two languages simultaneously from infancy or who are learning a second language after the first language.

Define **English Language Learners** (ELL):

Language minority students in the United States who are learning English, the majority language, for social integration and educational purposes.

SLP’s should…

Encourage rich, fun, and rewarding communication between parents and children, in whatever language they find most comfortable.

Language Sample Analysis:

**SALT:** Proprietary, free trainings, large databases for comparison, large support network.

**SUGAR**: Completely free, published norms, smaller databases, doesn’t require different programs, not as well established re: support systems.

**CLAN**: Free, powerful (PRAAT integration, connection with audio files, lots of analyses), could improve on user-friendliness.

To calculate MLU:

Divide the number of morphemes by the number of utterances.

Steps of **Dynamic Assessment**:

1. Find skill that was difficult on the standardized testing.
2. Attempt to teach the skill.
3. Record how much you had to help the child.
4. Determine whether this language area needs to be addressed with therapy (If you were able to teach the child quickly, it probably would not be a good goal).

**Vocabulary** Performance on Language Tests:

Bilingual + No DLD: __Distributed vocabulary__ often is equal to or greater than typically developing/monolingual speakers. __Performance is similar to monolingual English speakers with DLD__ (May not be able to distinguish until age 6 or 7).

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Bilingual + DLD: Need to compare with other ELL’s (Cannot compare to typically developing).

**Syntax/Grammar** Performance on Language Tests:

Bilingual + No DLD: May still __behind__ 6.5 years after 1st exposure. __Errors may mimic DLD__.

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Bilingual + DLD: __Do not over regularize irregular verbs__. Limited carryover for language 1 skills to language 2 skills (__Difficulty with generalization__). Length of exposure to English does not predict proficiency in grammar/syntax. __Slow growth and more persistent deficits__.

**Sentence Repetition** Performance on Language Tests:

Bilingual + No DLD: Tend to __add or substitute function words__ (During sentence repetition tasks).

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Bilingual + DLD: Tend to __omit function words and grammatical tense markers__. May overidentify if you do not do error analysis.

**Narratives** Performance on Language Tests:

Bilingual + No DLD: __Do not differ from monolingual peers in narrative macro-structure__. Typically developing ELL’s tend to __demonstrate advantages in macro-structure relative to vocabulary__.

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Bilingual + DLD: __Omit macrostructure elements__ (Examples: Do not include characters or jump from initiating event to the conclusion).

**Literacy** Performance on Language Tests:

Bilingual + No DLD: __No difference in phonological awareness skills__. __Significant difficulties with language and reading comprehension__ (ELL’s). __Worse with low SES__.

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Bilingual + DLD: __Need more research__.

Cognition and DLD:

Working memory is **poorer** in individuals with DLD.

Response time is **longer** for individuals with DLD.

Reduced sustained attention, reduced cognitive flexibility, etc.

RISE+

Repeated opportunities for practice and learning at an adequate intensity, with systematic support and an explicit skill focus.

Define **Massed** Practice:

The teaching episodes are concentrated in a short time.

Define **Distributed** Practice:

The same number of opportunities is spaced over a longer period of time.

The 3 broad categories of intervention approaches along the continuum of **naturalness**:

Child-centered

Hybrid

Clinician-directed

**Child-Centered** Approach:

Daily activities, facilitated play, most natural.

**Self-talk/Parallel talk**: Describing own actions as we engage in parallel play; “play-by-play” of their actions.

**Imitation**

**Expansions**: Take what child has said and add the grammatical markers and semantic details that would make it an acceptable adult utterance.

**Hybrid** Approach:

Milieu therapy, focused stimulation, script therapy, in the middle of naturalness.

**Focused Stimulation**: The clinician carefully arranges the context of interaction so that the child is tempted to produced utterances with obligatory contexts for the forms being targeted.

**Incidental Teaching:** Clinician arranges the setting so that things the client wants or needs to complete are visible but out of reach.

**Clinician-Directed** Approach:

Drill, drill play, CD modeling, least natural.

**Pros**: Specification of linguistic stimuli and clear instructions and criteria for appropriate responses.

**Cons**: Are relatively “unnatural” and targets are not always spontaneously incorporated into everyday language use.

Define the **Universal Design for Learning:**

Aims to provide equal learning opportunities for all students by choosing and modifying strategies to address a wide range of individual differences.

**Main Point:** To get away from the “one size fits all” model of instruction and provide flexible activities and methods to accommodate individual learning styles and needs.

Define **Phonological Processing**:

Child’s ability to perceive, store, retrieve, and manipulate sounds for language.

Define **Phonological Awareness**:

The ability to pay attention to the sound structure of spoken words. Detecting rhymes, syllable, first/last sound. Includes phonemic awareness.

Define **Phonemic Awareness**:

The ability to isolate and manipulate individual sounds or phonemes; segmenting, blending, deleting, adding.

_____ and _____ are key for reading.

Segmenting and blending

Define **Phonological Memory**:

Holding information in your brain but the words do not have meaning. Seen in the ability to repeat nonsense words.

Particularly difficult for kids with DLD.

Define **Phonological Representations**:

The underlying mental portrayal or depiction of the sound system.

Define **Phonics**:

Pairing of the sounds of a language with the letters of the language.

**Development** of phonological awareness (PA):

Begins at age **3-4**; starts with awareness of larger sound units to increasingly smaller sound units.

**4-5** years old: Syllable segmentation

**5** years old: Word initial phoneme ID/matching

**5+** years old: Rhyme oddity tasks

**6+** years old: Phoneme manipulation

Why do we care about PA?

To facilitate the acquisition of reading and writing.

Phonemic awareness can be **taught** and **learned**.

Phonemic awareness is strongly related to **reading** **development**.

Phonemic awareness instruction can help children **learn** to **read**.

Phonemic awareness instruction can help children **learn** to **spell**.

Phonemic awareness treatment is best when children are taught to manipulate phonemes by using **alphabet** letters.

Define **Grammar**:

The whole system and structure of a language. Usually consisting of syntax and morphology, and sometimes also phonology and semantics.

Define **Syntax**:

The architecture of phrases, clauses, and sentences in a language.

Define Syntactic **Form**:

The grammatical category of a word. Includes parts of speech: Noun, pronoun, verb, adjective, adverb, preposition, conjunction, interjection.

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**Verbs**: Words that “signify an action or a state of being”.

**Conjunctions**: Words that connect words with words, phrases with phrases, and clauses with clauses. Facilitate complex syntax. Several types but includes coordinating and subordinating.

Define Syntactic **Function**:

The **role** of a word as it relates to the rest of the elements in a phrase, clause, or sentence. Includes subject, object, predicate, clause, phrase, etc.

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Independent clause **can** be a complete sentence.

Dependent clause **cannot** be a complete sentence.

Define **Phrase**:

One main words with one or more closely associated words grouped around it.

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__Noun Phrase__: “*Jack* ate”

__Verb Phrase__: “The dog *barked*”

__Prepositional Phrase__: “Put the lettuce *in the bag*”

__Infinitive Phrase__: “I want *to eat* dinner soon”

__Gerund Phrase__: “*Running marathons* is my favorite hobby”

Define **Clause**:

A group of words centered around a central meaning; contain a subject and predicate.

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__Independent__: “The boy cried”. “__The dog barked,__ and __it scared the cat__”.

__Dependent__ (Subordinate): “Doug brought me candy, __which I thought was kind__”.

Define **Sentence**:

**Simple**: One independent clause.

**Compound**: Two independent clauses joined by: A coordinating conjunction (FANBOYS), semicolon, or conjunctive adverb (*Nevertheless, although, however*).

**Complex**: One independent clause and one or more dependent clauses.

Define **Implicit** Learning:

The gradual and __unconscious__ acquisition of abstract knowledge about the underlying structure of a complex stimulus, such as spoken language.

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**Passive**; done without overt explanations for why/how rules work; kids with DLD appear to have impaired implicit learning: Both verbal and nonverbal; tasks that require “extraction of statistical regularities”; procedural learning tasks; but cannot say that *causes* DLD or that implicit learning cannot be *improved*.

Define **Explicit** Learning:

A conscious and __intentional__ process that is ideal for learning facts and for acquiring systematic, rule-based information.

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**Active**; involves overt teaching/explaining of the why/how; relies on the medial temporal lobe (Especially hippocampus); also requires: Attention, working memory, logical reasoning; kids with DLD seem to have better explicit memories; kids with DLD are more dependent on explicit, rote strategies, however, they demonstrate less integration with implicit learning as evidenced by less generalization of knowledge and less novel use of newly learned skills.

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*What is the problem?* EL relies heavily on things kids with DLD are not good at: Memory, attention, verbal reasoning.

**Interactions** between Implicit and Explicit Learning:

The COVIS Model (*Competition between Verbal and Implicit Systems*)

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We/our brains have a bias toward explicit learning first.

When input gets too complex, implicit takes over.

Several factors control which system is dominant at any given moment (Learning context, how intact each system is, manipulations that suppress one system).

Factors we manipulate to make our interventions more/less implicit/explicit: **Delivery of the Intervention**

More instructions: More explicit

Fewer instructions: More implicit

Factors we manipulate to make our interventions more/less implicit/explicit: **Elicitation Techniques**

Verbal/written prompts + more active engagement: More explicit

Stimulation and modeling + indirect, naturalistic, less conscious awareness: More implicit

Factors we manipulate to make our interventions more/less implicit/explicit: **Feedback**

Delayed feedback (MTL): Explicit

Immediate feedback (Striatum): Implicit

Demands placed on **cognitive processing**:

**Automatic** Processing (Implicit): Fewer demands on executive functioning and memory.

**Controlled** Processing (Explicit): Verbalization and memorization required.

Define **narrative**:

A spoken or written account of connected events. A story.

Why is narrative proficiency important?

1. **Social** Benefits: Important for peer interactions and classroom involvement.
2. **Cognitive** Benefits: Language is used to express complex thoughts and ideas.
3. **Academic**: Many of the core curricular standards involve skills related to narrative comprehension and composition.

Why do children with DLD have difficulty composing/telling stories?

Poor “pattern finding” skills.

Limited experience listening to and reading stories.

Poor organization of language in long-term memory.

Poor working memory.

Poor attention.

Define **macrostructure**:

Story grammar + causal framework. Includes character(s), setting, initiating event, internal response, plan, attempts, consequence.

Define **microstructure**:

Language used to convey the information in the story.

Narrative intervention should… Leading to…

Improve knowledge of text structure and improve use of explanatory inferences.

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*Leading to…*

Improved memory for information in texts (Spoken or written), improved narrative comprehension/composition, improved language microstructure, improved access to what is already stored in LTM, and better access to learning new information.

Define **narrative proficiency:**

The ability to comprehend and compose in the narrative genre; stories of real or make-believe events.

Define **expository text**:

Not narrative; tells **facts**; least amount of contextual support; heavy use of linguistic processing; extra load on memory and information-integrating systems; requires bottom-up processing.

**Narrative** characteristics:

Largely fictional

1 structure (Story grammar)

May involve familiar scripts/contexts

**Expository** characteristics:

**Facts**!

(At least) 7 structures (Description, list, sequence, cause/effect, problem/solution, persuasion, compare/contrast)

Hard for students… Poorer accuracy on literal and inferential questions; recall fewer ideas (Propositions) from texts when retell or summarize; shorter and simpler retellings; lots of grammatical errors.

How to **assess** **expository**:

Have student read an expository text.

Have them summarize what they remember.

Ask: Factual questions (Literal), inferential questions

Define **expository discourse**:

Non-narrative discourse primarily for **informative purposes**.

Discourse characterized by logical links, hierarchical organization, and generalizing stance.

Expository is largely delivered through writing.

Can use expository for different purposes: Description, enumeration (Lists), explanation, procedures (Steps), comparison, argument or persuasion.

Define **learning strategy**:

Action selected deliberately to achieve particular goal.

**Sketch and Speak** Expository Strategy Intervention

Story planning and recall.

Quick and easy, just enough to remember.

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__Steps__: *Note simply, say fully, & say it again…*

**Pictography**: Write/draw for oral narrative length and quality. Just-enough-to-remember pictography of ideas from expository text.

**Choreography**: Key words. Just-enough-to-remember bulleted notes.

Oral formulation and rehearsal of own full sentences and whole reports.

With interactive and structural scaffolding.

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Active Learning: Reduce, transform, reorganize, retrieve, expand, connect, rehearse with effort and accountability.

Syntactic characteristics of individuals with DLD:

Comprehension difficulties with relative clauses, passive voice, negation.

Rely on word order for comprehension.

**Syntactic production difficulties** for individuals with DLD:

By the time typically developing children’s MLU = 5 (Around age 4-5), 20% of sentences in spontaneous speech contain embedded or conjoined clauses.

Not a lot of overt syntax errors in oral language after age 11: Production error rate decreases from 11 to 3% between ages 8 and 11. Writing errors significant.

Oral language sounds “**simple**” or “**immature**” due to… Fewer complex sentences, less elaboration of noun phrases, simpler verb phrases (Fewer adverbs; quickly, slowly, etc.), fewer combinations of auxiliary verbs (Would have been helping), sentences may be longer because lack of complex structures, lower rates of phase: Subordination, embedding, elaboration.

**Assessment** of Syntax in Individuals with DLD:

1. **Standardized tests** (CELF-5, CASL-2, TILLS, TNL2, TOLD, OWLS-II, Test of Adolescent and Adult Language)
2. **Language samples** (Both oral and written, either conversational or narrative, for children aged 9-12, narrative language samples were better at ID children with DLD than standardized tests).
3. **Specific analyses** (Frequency and type of complex syntax use, use of conjunctions).

**Morphology difficulties** for children with DLD:

Spoken morphological errors usually resolve by age 8 but remain an issue in **writing**.

Define **Clause**:

A series of words that includes a (Stated or implicit) subject (Noun) and a predicate (The verb and other words that come after the verb); the building blocks of sentences – every sentence consists of one or more clauses.

Define **Main Clause**:

The clause containing the primary proposition (Main idea) in a sentence containing more than one clause; could stand alone if all other clauses were removed.

Define **Subordinate Clause:**

A clause that **cannot** stand alone because its structure is dependent on its role relative to the main clause.

Define **Linguistic Landmarks:**

Key words, punctuation, and verb forms that provide clues to identifying important sentence structure concepts such as where clauses begin and end, the type of subordinate clause.

Define **Adverbial Clause:**

A clause that conveys time, place, or manner of information about the main clause. Usually, but not always, starts with an adverbial conjunction. May preceded or follow the main clause in a sentence. When precedes, is set off by a comma.

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Time: “When”, “After”, “As soon as”

Contrast: “While”, “Whereas”