Introduction to Communicative Disorders - Exam #2

Alphabet

• Stems from the Greek letters “alpha” and “beta”

• Becomes different for children as they are learning to read and recognize letters

  • Most likely because sometimes the same sound is spelled many different ways

IPA

• Stands for International Phonetic Alphabet

• Specialist developed this alphabet, which is a different set of phonetic systems that can adequately represent most sounds

Vowels

• Are voiced

• Need complete, proper vocal fold contact and vibration to be produced

• The way we produce vowels occurs as the shape of how the oral cavity changes

• Mouth is more open with vowel productions; sounds change due to the shape of mouth/oral cavity; sound produced by the VF/larynx passes through the oral cavity

• Different shapes of the oral cavity modify the laryngeal tone for different vowel productions

• Classified according to tongue positions: front, central, back, high, mid, and low positions

Diphthong

When two vowels are combined

Consonants

Produced by constricting the oral cavity

Manner

Type of constriction or airflow

Stops

Stopping air, quick bursts of air; pressure is built up and released as in plosives or stop plosives /p, b, t, d, k, g/

Fricatives

Constricted airflow or forcing air through oral cavity /f,v,th/ both voiced and voiceless /th/ also /sh, zh, s, z, h/

Affricates

Combo of stop and fricatives /ch, j/

Glides

When we gradually change the shape of the mouth/articulators to produce sound /w, y/

Liquids

Have the least restriction of sound production; considered a semi-vowel because it’s like they’re in between a vowel and a consonant for production /l,r/

Nasals

Include /m, n, ng/; produced with the velopharyngeal port “open” so air can travel up from the larynx and vocal folds out through the nose; all other sounds are produced with the velopharyngeal port closed

Place

Place or location of production; how we shape the sound to say it

Bilabials

Use of lips only /b, p, m/

Labiodental

Produced by lips and teeth /f, v/

Dental sounds/linguadentals

Produced by tongue and teeth; voiced and voiceless /th/

Alveolars/lingua-alveolars

When the tongue tip reaches and touches behind the alveolar ridge; /t, d, s, z, n, l/

Palatals/lingua-palatals

When tongue comes into contact with hard palate; /sh, zh, ch, j, r, y/

Velars

Produced when back of tongue raises to soft palate; /k, g, ng/

Glottals

Vocal folds open and air passes through; /h/

Distinctive features

Unique characteristics of a phoneme that distinguishes one phoneme from the other

By what age should babies be cooing?

3 months

By what age should babies be babbling consistently?

6-7 months

By what age should a child be able to produce vowels?

3 years

Speech sound disorder

If a child is diagnosed with an articulation disorder, it may also be referred to as a speech sound disorder

Idiopathic disorder

No known cause of the disorder; no organic difficulty noted to anatomy

Substitutions

Saying one sound for another

Distortions

• A “slushy” type production of a sound; air typically escaping laterally when it’s not supposed to

• Commonly seen on /s, z, sh, j, ch/, however can be present on /l/ as well by adding an /l/ to the end of the word such as “hisl”

Additions

Occurs when a sound that does not belong in a word is added (ex: cuppa for cup, salow for slow)

Final consonant deletion

Final consonants are omitted: “bo” for boat, “bee” for beep, “hi” for hide, “hau” for house, “bu” for book

Initial consonant deletion

Initial consonants are omitted: “ot” for pot, “us” for bus, “eep” for deep, “ink” for sink

Cluster reduction

One or more consonants of a cluster are omitted: “kate” for skate, “bu” for blue, “tong” for strong, “teep” for steep

Fronting

Sounds produced in the back of the mouth are substituted for those produced at the front of the mouth; alveolars are used in place of palatal and velar sounds: “tey” for key,

Backing

Sounds produced in the front of the mouth are substituted for those produced at the back of the mouth; ex: “gog” for dog

Reduplication

A syllable of a target word is repeated: “baba” for bottle, “dada” for dog, “tata” for television

Epenthesis

An unstressed vowel, typically the schwa /ə/, is inserted inappropriately: “sapoon” for spoon, “looka” for look, “cuppa” for cup

Steps of assessment

1) Case history interview of the client, family, and disorder

2) Hearing screening

3) Oral motor examination

4) Speech-language sample collection and screening

5) Formal assessment

What does a case history interview entail?

Reviewing all past medical history, parent concerns, gestational information, milestones, past illnesses, ear infections, family history of speech-language issues; other diagnoses

Stimulability

Child’s ability to imitate correctly modeled sound productions

Major elements of speech sound disorder treatment programs:

• Selecting target responses

  • Final goal is correct production of misarticulated phonemes in conversational speech in all situations

  • Therapist may specify a criterion of 90% accuracy in the target phonemes in conversational speech produce at home and other nonclinical situations

• Developing stimulus materials

  • Could involve pictures, objects, correct modeling of target sound productions, instructions on how to produce them, and manual guidance to help the articulators make appropriate movements

• Determine starting point

  • Auditory discrimination/production, sound, syllable, or word, single/multiple sound targets, and sequence of treatment

• Implementing treatment procedures

  • Involves feedback as well as positive/corrective reinforcement

• Assessing productions/maintenance

Nativist theory

• The belief that children are automatically born with the innate ability to learn speech and language

• Language is present at birth; language is not “learned” but the child is born with a LAD (language acquisition device) — Chomsky

Behaviorist theory

• Belief that language and speech verbalization is learned; children develops language and speech based on their environment and what they are exposed to

• Belief that social reinforcement can increase babbling, cooing, sounds, words, phrases, sentences, and conversation

• Motherese - special way of talking that allows caregivers to communicate w/ infants and children

  • Using simple words, greater pitch variations, higher pitched, short and simpler sentences, slower rate of speech production, and clearer enunciation/articulation of speech

Preverbal behaviors

Precede words and phrases; crying, cooing, babbling, laughing; around 3-4 months; if we imitate these sounds/respond to the child, they will typically react and respond back

First word occurs:

Around 12 months

At 18 months, children will be:

• Putting 2 words together

• Morphemes also start forming here including plurals, “ing”, past tenses, articles, and mean length of utterance continues to build

  • Free and bound morphemes

• Syntax is building

0-1 month

Startle response to sound

2-3 months

Cooing, production of some vowel sounds; response to speech; babbling

4-6 months

Babbling strings of syllables; imitation of sounds; variations in pitch and loudness

7-9 months

Comprehension of some words and simple requests; increased imitation of speech sounds; may say or imitate mama or dada

10-12 months

Understanding of “no”; response to requests; response to own name; production of one or more words

16-22 months

• Following simple directions; production of two-word phrases; production of 20 or more words

• Response to two-step directions; production of 50 single words; production of I and mine

2-2.6 years

Response to some yes-no questions; naming of everyday objects; production of phrases and incomplete sentences; production of the present progressive, prepositions, regular plural, and negation no or not

3-3.6 years

Production of 3 to 4 word sentences; production of the possessive morpheme, several forms of questions, negatives can’t and don’t; comprehension of why, who, whose, and how many; and initial productions of most grammatical morphemes

Language learning differences between younger and older children

• Younger children:

  • Language learning process is relatively fast

  • Vocabulary consists of essential words, simple sentence forms, and simple grammatical morphemes

  • Communication styles are often limited or mimic family speech patterns

• Older children:

  • Language learning process is more gradual

  • More advanced vocabulary, begin learning multiple meanings of words, increased syntactic and morphologic growth, spoken sentences become more complex/longer, writing will become more mature and longer

  • Exhibit more advanced language skills including complex and compound sentences, using abstract language forms like idioms, proverbs, and verbal reasoning/problem solving

  • Communication styles influenced by peers (slang, code-switching)

  • Longer conversations, more relevant comments on the topic under discussion, change topics w/ smooth transition, and consider others’ thoughts and feelings

  • Narration is beginning to be noted; cohesive description, engaging conversational partners

Limited language skills

Also referred to as language delay, language disorder, language impairment, or language problem; vary in severity and are more severe in some kids than others

Specific language impairment or developmental language disorder

• Language disorders in children who are developing normally in all other areas (physical areas)

• Children free from gross organic or neurological impairments

Language learning disability

School-age child who has limited language skills

Characteristics of problems typically seen in children with language disorders

• Limited skills in understanding spoken language

• Poor listening skills

• Limited understanding of word meanings and meanings in general

• Limited expressive language skills

• Limited or absent production of morphologic elements of language

• Limited production of sentence structures and syntactic perfromance

• Inappropriate language productions

• Limited conversational skills

• Limited skills in narrating experiences

Semantic language disorders involve:

• Acquiring words and their meanings rather slowly

• Showing slow growth of vocabulary

• Tending to learn only simple, frequently used, and concrete words only

• Difficulty understanding the meanings of spoken words

Morphological language disorders involve:

• Children with this form of language disorder tend to speak without many morphological features (plurals /s/ or past tense /ed/)

• Plurals are missing (“give me two block”)

• Auxiliary “is” is missing (Daddy coming home)

• Article “the” is missing (Book on table)

• Past tense “ed” is missing (I walk home yesterday)

• Possessive inflection /’s/ is missing (Mommy hat)

• Inappropriate use of regular past tense “ed” replaces the irregular verb went (He goed)

• Inappropriate pronoun is missing (Me going)

Syntax/Syntactical language disorders involve:

• Difficulties in sentence construction

• These children speak in short or incomplete sentences

• They make mistakes in word order

• They also may not understand syntactically complex sentences

Pragmatic language disorders involve:

• May acquire some language structure but can’t use them appropriately in social situations

• Poor discourse skills, lack of turn-taking, lack of topic maintenance, interrupt w/ irrelevant utterances, and poor narrative skills (conversational interaction)

Genetic factors of language disorders

• May run in multiple family members

• May see disorders occurring in twins

• May be passed down from parents

Clinical conditions that may cause language disorders:

• Hearing loss

• Autism spectrum disorder

• Cerebral palsy

• Traumatic brain injury

• CVA/stroke

• Environmental factors such as social isolation, abuse, neglect, or being socially deprived

Assessment of language disorders

• Screen may be performed first to determine if a full assessment/evaluation is needed

• Case history review/chart review

• Parent/caretaker interview

• Oral motor examination

• Hearing screening - if fails, recheck; if fails a 2nd time, refer to audiology

• Conversational speech and language sample - once recorded, analyze for all areas of language including semantics, pragmatics, morphology, syntax, and phonology including any speech sound errors

• Formal language testing using a standardized assessment of choice

• Write up a formal report following all evaluation materials performed and establish long-term and short-term goals based on the findings

Treatment of language disorders

• Based on all testing results noted above

• Compare to age normative data to determine how far behind the patient is function

• Choose several areas to target in therapy

• Provide activities of interest, excitement, and encouragement to the child; provide appropriate models, correct and provide cues when needed, provide training and education to the family and caretakers, homework and encourage carryover into their daily environments, encourage self-monitoring, and proper stimuli for an added effect

Special considerations:

• Children with intellectual disabilities may need the services of a psychologist

• Children with autism spectrum disorder may need the services of an interdisciplinary team (psychologist/psychiatrist, nurse, social worker, special educators, etc.)

• Children with hearing loss may need the services of an audiologist or a hearing amplification device

• Children with physical disabilities may need the services of medical specialists, physical therapists, and occupational therapists