Language Disorders 3 Midterm

The stages of communication development, per Paul, Norbury, & Gosse are

prelinguistic (preintentional & intentional)

emerging language

and developing language

The stages of communication development, per Hanen are

discoverer

communicator

first word user

combiner

List established risk factors in CA

genetic disorders

congenital anomalies

maternal substance abuse

teratogens (infection & toxins)

prematurity

low birth weight

Define "established risk"

a diagnosed medical condition with high probability of developmental delay

In CA, are kids born with an established risk factor automatically qualified for EI services?

Yes! (just has to be known etiology & likely to cause language delay)

What are some factors that put kids at risk for speech/language delay?

- parental risk (not sure exactly what this is though)

- health care access (issues)

- exposure to environmental toxins

- poverty

- low social-emotional exposure/nurturing

- family history

Are kids who are considered "at risk" automatically enrolled in EI services in CA?

No, but they can be found eligible if they're assessed

What are some populations with established risk?

Chromosomal anomalies/genetic disorders

neurological disorders

congenital malformations

metabolic syndromes

sensory disorders

atypical developmental disorders

toxic exposure

chronic medical illnesses

severe infectious diseases

What are some common congenital malformations?

cleft palate or lip, club foot, heart murmur

Congenital malformations are also known as __________ and generally occur when in development?

also known as birth defects

generally occur during the first trimester in utero

Describe the syndrome: Williams syndrome

- impacts multiple organ systems

- causes higher risk of heart disease and feeding problems

- caused by a missing piece of chromosome 7

- causes distinctive facial features (elfin-like face) and short stature

- mild-mod ID

- very trusting of strangers

Name the syndrome:

- impacts multiple organ systems

- causes higher risk of heart disease and feeding problems

- caused by a missing piece of chromosome 7

- causes distinctive facial features (elfin-like face) and short stature

- mild-mod ID

- very trusting of strangers

Williams syndrome

Describe the syndrome: Down Syndrome

- causes ID of varying levels & developmental delays

- increased risk of heart defects

- caused by an extra copy of chromosome 21

Name the syndrome:

- causes ID of varying levels & developmental delays

- increased risk of heart defects

- caused by an extra copy of chromosome 21

Down Syndrome

Name the syndrome:

- caused by deletion or mutation on SHANK3 gene on chromosome 22

- causes developmental, neurological, and behavioral issues

- may be mostly nonverbal

- may have seizure disorders, low muscle tone, GI issues, sleep disturbances, sensory sensitivities

Phelan-McDermid

Describe the Syndrome: Phelan-McDermid

- caused by deletion or mutation on SHANK3 gene on chromosome 22

- causes developmental, neurological, and behavioral issues

- may be mostly nonverbal

- may have seizure disorders, low muscle tone, GI issues, sleep disturbances, sensory sensitivities

Describe the Syndrome: Rett syndrome

- rare neurodevelopmental disorder impacting mostly girls

- caused by mutation in MECP 2 gene on x chromosome

- period of normal development then a language regression around 1-4 years old

- increased risk of seizures

Name the syndrome:

- rare neurodevelopmental disorder impacting mostly girls

- caused by mutation in MECP 2 gene on x chromosome

- period of normal development then a language regression around 1-4 years old

- increased risk of seizures

Rett syndrome

Name the syndrome:

- missing piece of genetic material on chromosome 22

- can impact organ development

- can cause heart problems, feeding problems

- cleft palate, thin enamel/missing teeth, teeth coming in late

- hearing problems

- bx or mental health challenges

DiGeorge Syndrome

Describe the Syndrome: DiGeorge Syndrome

- missing piece of genetic material on chromosome 22

- can impact organ development

- can cause heart problems, feeding problems

- cleft palate, thin enamel/missing teeth, teeth coming in late

- hearing problems- bx or mental health challenges

Name the syndrome:

- part of chromosome 5 is missing

- small head size, low birthweight, small jaw, widely set eyes, low-set ears

- many skills delayed

- webbed fingers/toes, heart defects

- cat-like cry

Cri du Chat Syndrome

Describe the Syndrome: Cri du Chat Syndrome

- part of chromosome 5 is missing

- small head size, low birthweight, small jaw, widely set eyes, low-set ears

- many skills delayed

- webbed fingers/toys, heart defects

- cat-like cry

Describe the Syndrome: Kabuki Syndrome

- mutations in KMT2D or KDM6A genes

- long eyelid openings

- arched & broad eyebrows

- possible flattened or broad nasal tip, short stature

- heart defects, vision problems, hearing loss, feeding problems, poor immune system, bx issues

- mild-mod ID

Name the Syndrome:

- mutations in KMT2D or KDM6A genes

- long eyelid openings

- arched & broad eyebrows

- possible flattened or broad nasal tip, short stature

- heart defects, vision problems, hearing loss, feeding problems, poor immune system, bx issues

- mild-mod ID

Kabuki Syndrome

Name the Syndrome:

- change in FMR1 gene on X chromosome

- affects males & females

- delayed talking

- anxiety

- hyperactive bx

- large ears, elongted face, prominent jaw/forehead, flat feet

Fragile X

Describe the Syndrome: Fragile X

- change in FMR1 gene on X chromosome

- affects males & females

- delayed talking

- anxiety

- hyperactive bx

- large ears, elongted face, prominent jaw/forehead, flat feet

Describe the Syndrome: Turner Syndrome

- female born with only one X chromosome

- learning disabilities, heart defects, short stature, delayed puberty, potential infertility

Name the Syndrome:

- female born with only one X chromosome

- learning disabilities, heart defects, short stature, delayed puberty, potential infertility

Turner Syndrome

Describe the Syndrome: Klinefelter Syndrome

- male born with extra X chromosome

- low testosterone levels

- learning, language, behavioral challenges

Name the Syndrome:

- male born with extra X chromosome

- low testosterone levels

- learning, language, behavioral challenges

Klinefelter Syndrome

What is Rubella?

- when is it most dangerous

- what can it cause?

- viral infection aka German measles

- very dangerous especially in the 1st trimester

- can cause congenital Rubella Syndrome

What is toxoplasmosis?

- what is it caused by?

- what can it cause?

- infection with a parasite that can be passed through the placenta

- may be caused by poorly cooked food or exposure to cat feces

- causes neurological issues, eye damage, organ damage, still births, miscarriages

What is cytamegalovirus (CMV)?

- how does it spread?

- what can it cause?

- common herpes virus found in tears, saliva, and blood

- spread through prolonged contact

- causes hearing loss, vision loss, developmental delays, neurological impairments, and can lead to premature delivery

What are examples of environmental toxins?

- what can they cause?

- chemicals, heavy metals (mercury, lead, etc), pollutants (tobacco smoke, pesticides, etc)

- can cause low birth weight, developmental delays, increased risk of some cancers

What is Fetal Alcohol Syndrome caused by, and what does it cause in the baby?

- caused by mother's alcohol consumption which crosses the placenta and enter's the baby's bloodstream

- causes developmental delays, failure to thrive, learning disabilities, low birth weight, short stature & slow growth, behavior concerns

What is the most common umbilical cord complication?

Nuchal cord, which is the cord wrapped around the neck in pregnancy or labor (becomes dangerous if its wrapped tightly or for a long time)

20-30% of all births include a nuchal cord

What are two possible complications of a nuchal cord?

Hypoxic Ischemia Encephalopathy (HIE)

Cerebral Palsy (if prolonged)

Premature birth is when a baby is born at or below

36 weeks

What is the risk of developmental delay for a baby born prematurely?

30-50%

Low birth weight is less than (what weight)?

2500 g

Very low birth weight is less than (what weight)

1500 g

What are some known causes of prematurity?

- amniotic fluid/membrane infection

- drug/alcoholo abuse

- fetal distress

- maternal age (adolescent or advanced maternal age)

- maternal chronic illness

- maternal kindey infection/problems

- multiple gestation

- placental bleeding

- premature rupture of membranes

- pre-eclampsia

- uterine abnormalities

What is pre-eclampsia?

high blood pressure, which typically develops after 20 weeks of pregnancy

What is respiratory distress syndrome?

- and what are the treatments?

- a potential complication of prematurity

- this is the greatest cause of death in premature/low birth weight babies

- immaturity of the lungs makes them prone to collapse

- continuous positive airway pressure (CPAP), intubation/mechanical ventilation, and synthetic surfactant

What is synthetic surfactant?

- surfactant reduces surface tension in the lungs

- so giving baby synthetic surfactant helps the lungs expand more easily

What is bronchopulmonary dysplasia (BPD)?

- and what is a risk factor for it

- and what are potential complications

- thickening of lung wall

- babies are at risk for this if on oxygen for more than 28 days

- may need long-term tracheostomy, and may affect growth

What is Patent Ductus Arteriosus (PDA)?

- connects pulmonary artery & aorta, and can cause blood flow to the lungs

- can lead to heart failure

- may require surgical intervention

What is an apnea?

baby stops breathing for 20 seconds or more

What is bradycardia?

decreased heart rate

What is intracranial/intraventricular hemorrhage (IVH) and how is it rated?

- bleeding in the ventricles of the brain

- can lead to ID, spastic quadriplegia, hydrocephalus

- rated grade I - grade IV

What is necrotizing enterocolitis?

- tissue death in the intenstines

- baby must be fed via NG tube

Premature babies are ready to attempt oral feeding at what gestational age?

35-37 weeks

What are the factors that indicate readiness for oral feeding in a premature baby?

- 35-37 weeks gestational age

- respiratory/cardio stability

- motoric stability (tone, posture, quality of movements)

- coordination of suck/swallow/breathe

- alertness

- demonstrates hunger

Suckling is

reflexive/primitive act of using the tongue to draw milk

Sucking is

more broad description of non-nutritive & nutritive sucking

What is rooting?

reflex that helps the baby to find the nipple to feed

What is the phasic bite reflex?

the baby demonstrates a rhythmic bite/release pattern of opening & closing the jaw when the teeth or gums are stimulated

What are non-oral feeding options?

nasogastric tube (called NG tube or gavage)

orogastric tube (OG tube)

nasojejunal tube (N-J tube)

gastrostomy tube (G-tube)

How is a nasojejunal tube different from a G tube?

N-J tube inserts into the nose and goes directly to the intestines (it bypasses the stomach)

How might an SLP advise parents/nurses on how to support a baby during non-oral feeding

- encouraging non-nutritive sucking during tube feeding by introducing a pacifier

- if parents are present, encouraging skin-to-skin contact during feeidng

- positioning advice - elevated side-lying is usually a good idea

- counsel parents on communicative interactions during feeding

- provide baby oral stimulation during feeding

Typically developing infants are usually introduced to solids at (what age)

5-8 months

What are some specialized feeding assessments that could be used with an infant?

Video fluoroscopic swallow function studies

ultrasound studies

endoscopy

_________ & motor skills tend to develop together, while ________ & motor skills tend to be competing systems (meaning that skills in these two areas don't develop simultaneously, they take turns)

feeding & motor skills tend to develop together, while communication & motor skills tend ot be competing systems (meaning that skills in these two areas don't develop simultaneously, they take turns)

Babies tend to learn to sit up around the same age as what feeding skill?

starting purees/other real foods

Babies tend to learn to crawl around the same time as what feeding skill?

lateralizing the tongue (and therefore being able to eat soft solids)

Babies tend to learn to walk around the same time as what feeding skill?

Being able to now eat everything!

Babies are able to "munch" at what age?

4-6 months (on soft foods like banana and avocado)

Babies are able to lateralize their tongue movements at what age?

9-12 months

Babies are able to rotary chew at what age?

18-24 months (can handle most textures at this point)

Canonical babbling is

syllables containing at least 1 vowel approximation and 1 consonant approximation

Lack of canonical babbling at ____ months is correlated to delayed verbal development.

10 months

By age _______ months, there should be more consonants than vowels in a baby's speech sounds

16 months

Generally describe the levels of neonatal care

Level I - well newborn nursery

Level II - special care nursery, baby is expected to recover quickly

Level III - NICU - gives life support for babies born very small or pre-32 weeks

Level IV - Regional NICU - lots of pediatric subspecialties, can facilitate transfers & surgeries

APGAR is performed at what times after birth?

1 minute & 5 minutes

What is assessed as part of an APGAR score?

breathing effort, heart rate, muscle tone, reflexes, skin color

A total score of less than ___ indicates a baby who may need more medical attention

7

At 26 weeks gestation, what is a baby doing/developing?

- growing eyelashes

- just finished developing fingernails

- practicing swallowing amniotic fluid

- starting to hear noises from in the womb

At 32 weeks gestation, what is baby doing/what are they like?

- organs fully formed except for the lungs

- practicing using lungs by inhaling amniotic fluid

- skin is now opaque instead of translucent

At 40 weeks gestation, what is baby doing/what are they like?

- fully grown & ready to be born

- brain continues to develop even though body growth slows

- skin may start getting dry spots as it has shed the waxy coating it used to have

Name 3 pieces of NICU equipment & what they measure

cardiorespiratory monitor (heart rate & breathing)

pulse oximeter (O2 levels in the blood)

supplemental oxygen (provides babies oxygen)

Why are orogastric tubes (tube into the mouth) not often chosen for NICU babies?

- more gagging/potential for bradycardia when it's placed

- easy for baby to displace by thrusting the tongue

- difficult to provide oral feeding trials

What are the steps for completing an SLP evaluation in the NICU? (broken into 10 steps)

1. obtain orders from neonatologist

2. Thorough chart review

3. Call RN to find out feeding times for the day.

4. Go to NICU & wash hands and arms for minimum 2 minutes

5. Gather supplies

6. Ask Rn for updates & concerns

7. Change & weigh diaper, get temp, swaddle baby

8. Document when you started feeding (feed for 30 minutes max)

9. Start feeding as you typically would and then adjust based on baby's response

10. Review recommendations with RN & post information at crib-side

A typically developing child says their first word by ____(what age)______-

1 year / 12 months

When working with child who has a language delay & is in the emerging language stage, they are likely in what age range?

18-36 months

By the END of age 2 (right before their 3rd birthday) a child should be able to say how many words

200 words!

List some pros and cons of norm referenced tests

Pros: consistency across administrations, provide percentile ranks/standard scores, useful for eligibility decisions

Cons: may not be reflective of communication in natural environments, young kids may not do well in structured test situation, may be biased against kids who don't match the normative sample, compliance based, not as useful for tx planning

What is another milestone babies should be reaching by the 2 year mark?

Combining two words together (will need at least ~50 words expressively to do this)

What are some pros and cons of criterion referenced tests?

Pros: flexible, more naturalistic, more culturally responsive, useful for tracking progress over time & tx planning

Cons: no standardized scores for eligibility info, may be subjective, may take more time than standardized tests

What kind of test should I do for...

- eligibility decisions

- treatment planning

- progress monitoring

- culturally and linguistically diverse children

(options are norm-referenced, criterion-referenced, and dynamic assessment)

- eligibility decisions = norm-referenced

- treatment planning = criterion-referenced

- progress monitoring = criterion-referenced

- culturally and linguistically diverse children = criterion-referenced & possibly dynamic assessment

Example of a criterion-referenced assessment

Rosetti Infant & Toddler Language Scales

Examples of a norm-referenced assessments

PLS-5 and CSBS

CA regulations for EI =

delay of 25% or more between current and expected level of development in 1+ area: cognitive, physical, communication, social/emotional, adaptive

OR

established risk factor

The first mandate for EI was in 1986 by public law #_________

public law #99-457

Describe multidisciplinary assessment

parallel, discipline specific, maximizes strengths of professionals

can lead to fragmented services & no inter-disciplinary collaboration

Describe interdisciplinary assessment

coordinated diagnosis and recommendation process between disciplines, and roles are sometimes shared based on who the child has best rapport with

Transdisciplinary assessment

traditional/arena assesment with a holistic/family-centered approach

Describe the following "patterns of change":

- normal-abnormal

- abnormal-abnormal

-catch up

- varying developmental change

- normal-abnormal = normal development pattern, just delayed (slower)

- abnormal-abnormal = delay increases over time, and development is occurring in an atypical pattern

-catch up = period of accelerated development (think: child who gets hearing aids, or tubes placed after chronic ear infections)

- varying developmental change = fluctuations in developmental gaps over time (think: medically complex child who progresses when well and plateaus when unwell)

Frequency of communication for 18 vs. 24 month olds - how many communicative acts per minute?

18 month olds complete 2 communicative acts per minute

24 month olds complete 5-7 communicative acts per minute

Deictic gesture examples

pointing, reaching, showing, giving

Symbolic gesture examples

play schemes, displaying the functions of objects