Language Disorders 3 Midterm

Paul, Norbury, & Gosse Stages of Communication development

• prelinguistic

  • preintentional

  • intentional

• Emerging Language

• Developing Language

Hanen Stages of Communication Development

• Discoverer

• Communicator

• First Word User

• Combiner

Established Risk definition

diagnosed medical condition with high probability of developmental delay

Established Risk factors for communication disorders in infants

• genetic disorders

• congenital anomalies

• maternal substance abuse

• teratogens (infections and toxins)

• prematurity

• low birth weight

At Risk definition

Situation where child is possibly vulnerable to delays

At Risk factors for communication disorders in infants

• parental

• health care access

• exposure to environmental toxins

• poverty

• low socio-emotional exposure/nurturing

• Family history

Populations with established risk

• chromosomal anomalies/ genetic disorders

• neurological disorders

• congenital malformations

• metabolic syndromes

• sensory disorders

• atypical development disorders

• toxic disorders

• chronic mental illnesses

• severe infectious diseases

Pre-natal congenital malformation

Birth defects

• occurs at the cellular level during the first trimester

• may be treated in utero

• pre-delivery diagnosis is ideal

Chromosomal genetic disorders include:

• Williams syndrome

• Down syndrome

• Phelan-McDermid

• Rett syndrome

• DiGeorge Syndrome

• Cri Du Chat Syndrome

• Kabuki Syndrome

Williams Syndrome characteristics

A rare genetic disorder that affects multiple organ systems

Symptoms:

• cardiovascular issues

• elfin like appearance

• developmental delays

• highly socialable personality

• low muscle tone

• sensitive hearing

• feeding difficulties in infancy

Down Syndrome characteristics

A genetic condition where individuals have an extra copy of chromosome 21

Symptoms:

• flat face

• low muscle tone

• cognitive impairments

• developmental delays

• higher risk of hearing loss

Phelan-McDermid Syndrome characteristics

A rare genetic disorder caused by deletion or mutation in the SHANK3 gene on chromosome 22

Symptoms:

• delayed or absent speech

• neonatal hypotonia

• large head

• droopy eyelids

• often co-occurs with autism

Rett Syndrome characteristics

A rare genetic neurodevelopmental disorder that mostly impacts girls

Symptoms:

• rapid hand movements

• slowed head growth

• breathing irregularities

• rapid regression of previously acquired skills

• rigid muscle tone

DiGeorge syndrome characteristics

A genetic disorder caused by a missing piece of genetic material on chromosome 22

Symptoms:

• cleft palate

• developmental delays

• learning disabilities

• small chin and low set ears

• feeding difficulties

• heart defects

• hearing loss

Cri du Chat Syndrome characteristics

A rare genetic disorder caused when part of chromosome 5 is missing

Symptoms:

• low birth weight

• small head

• slow growth

• widely spaced eyes

• distinctive shrill cry

• small jaw

• hypotonia

• hyperaction or agression

• feeding difficulties

Kabuki Syndrome characteristics

A rare genetic disorder caused by mutations in the KMT2D or KDM6A genes

Symptoms:

• arched eyebrows

• long eyelid slits

• postnatal growth deficiency

• hypotonia

• feeding difficulties

• recurring ear infections

• conductive hearing loss

Sex chromosome genetic disorders

• Fragile X

• Turner syndrome

• Klinefelter syndrome

Fragile X characteristics

A change in the FMR1 gene located on the X chromosome; effects males and females

Symptoms:

• large ears

• long face

• flexible joints

• ADHD and Autism like symptoms for pragmatic attention and eye contact

• frequent ear infections

Turner Syndrome characteristics

Female born with only one X chromosome

Symptoms:

• webbed neck

• delayed puberty

• recurring middle ear infections

• structural heart issues

Klinefelter Syndrome characteristics

Male born with extra X chromosome

Symptoms:

• slow in development of motor skills (speech, talking)

• cognitive language learning disabilities

Rubella in Utero exposure

Very dangerous in 1st trimester and can lead to Congenital Rubella Syndrome; causes birth defects like hearing and vision loss, developmental delays, heart defects, and can lead to miscarriage

Toxoplasmosis in utero

Infection with a parasite, can be caused by poorly cooked food or exposure to infected cat feces. Can be passed from mom to baby in the placenta. May cause neurological issues, eye damage, spleen/liver/organ damage, still birth, miscairrage.

Cytomegalovirus in utero exposure

Common herpevirus that is found in bodily fluids such as saliva, tears, and blood. Spread through prolonged contact. May cause hearing and vision loss, developmental delay, neurological impairments, and premature delivery.

Environmental toxins in utero exposure

Chemicals, heavy metals, pollutants may cause low birth weight, developmental delays, and increased risk of some cancers

Fetal Alcohol Syndrome in-utero exposure

Mother’s alcohol consumption which can cross the placenta and enter the infant’s blood stream. May cause developmental delays, learning disabilities, failure to thrive, lower birth weight, shorter stature, behavior concerns like agression and hyperactivity.

Characteristics of umbilical cord complications

• most common is nuchal cord

• umbilical cord is wrapped around babies neck in utero or during birth

• can cause hypoxic ischemia encephalopathy (HIE)

• can result from baby turning or timing of decent

• Effects 30-40% of all births

• Prolonged exposure may lead to developmental diagnosis

Implications of infant mortality

• low birth weight/medically fragile infants

  • include factors like education and rare

• Medical interventions

  • global decline, us not good

• Population trends

  • drugs, young moms, access to healthcare are all barriers

Percentage of low birth weight in US in 2011

8.1%; ranked 30 of 34

What is normal gestation timeline

40 weeks

What classifies a premature infants gestational age

at or below 36 weeks with low birth weight

Premature infants have what percent risk of developmental delays?

30-50% risk

What classifies as low birth weight?

<2500g (5 ½ pounds)

What classifies very low birth weight?

<1500g (3 ½ pounds)

What percent of teen pregnancies account for premature births?

about 20%

List of known causes of premature birth

• amniotic fluid/membrane infection

• drug/alcohol abuse

• fetal distress

• maternal age (adolescent or advanced maternal age)

• maternal chronic illness

• maternal kidney infections/problems

• multiple gestation

• placental bleeding

• poor prenatal care

• premature rupture of membranes

• pre-eclampsia

• uterine abnormalities or incompetent cervix

• smoking 3.8% of all births

• hypertension 3.2 % of all births

• Diabetes 1.2%

• unhealthy weight 34.7%

Complications of prematurity

• Respiratory distress syndrome

• Bronchopulmonary Dysplasia

• Patent Ductus Arteriosis

• Apnea

• Bradycardia

• SIDS

• Intercranial/Intrventricular Hemorrhage

• Nectrotizing Entercolitis

Respiratory Distress Syndrome

• greatest cause of death in LBW/premature infants

• immaturity of lungs

• prone to collapse

• Treat with continuous positive airway pressures, intubation or medical ventilation, or synthetic surfactant (substance produced in lungs to help with expanding and contracting)

Bronchopulmonary Dysplasia (BPD)

• thickening of lung way

• underdeveloped lungs

• there is a risk if the baby is on O2 for more than 28 days

• may need long term tracheostomy

• may affect growth

Patent Ductus Arteriosus (PDA)

• connects pulmonary artery and aorta

• may lead to heart failure

• may require surgical intervention

• can cause blood flow to lungs

Apnea

stop breathing

Bradycardia

decreased heart rate which means decreased blood flow to organs and brain

SIDS

Sudden Infant Death Syndrome

• no known cause of death up to one year of birth

Intercranial/Intraventricular Hemorrhage (IVH)

Bleeding in the ventricles of the brain, hydrocephalis, intellectual disability, spastic quadropalgia

Necrotizing Enterocolitis

Tissue death and inflamation of the intenstines

mortality rate as hugh as 50%

need NG tube right away

Criteria for infants being ready for oral (po) feeding

• 35-37 weeks gestational age

• respiratory/cardio stability

• motoric stability

• coordination of such, swallow, breathe

• alertness

• demonstrates hunger

Suckling Definition

More of a reflexive or primitive act of baby using the tongue to draw in milk

Sucking Definition

Use more Broadly, eating or non-nutritive sucks also apply

Rooting Definition

This reflex helps the baby find the nipple to feed and is generally present from birth to 3 or 4 months

Phasic Bite Reflux Definition

Teeth or gums are stimulated and the baby exhibits a rhythmic bite and release pattern

• this can be seen until 9-12 months

Non-Oral Feeding options

• Nasogastric tube (NG tube or Gavage)

• Orogastric tube (OG tube)

• Nasojejunal tube (N-J tube)

• Gastrostomy tube (G-Tube)

What are the disadvantages of Non-oral feeding tubes?

• reduced sucking and oral motor development

• may develop an aversion to food or oral hypersensitivity

• rare risk of laryngeal damage

How can an SLP support with non-oral feeding?

• encourage non-nutritive sucking during tube feed (or passifier use)

• skin-to-skin contact during feeding

• Positioning (elevated sideline position for feed, hold upright to burp after)

• Counsel communicative interactions during feeding (eye contact)

• provide oral stimulation during feeding

What is a cue that a NICU baby is done feeding?

• hand up or hands up

• uncomfortable squirming movements

• gagging

• arching of the back

How do you calculate the adjusted age of a premature infant?

Chronological age - the number of weeks or months baby arrived before the due date

Pre-intentional feeding age range

birth - 8 months

Components of pre-intentional feeding assessment for solid foods

• oral-motor skills observation (indicated through bottle and breast feeding success)

• Specialized assessments include:

  • Video Fluoroscopic swallow function studies

  • ultrasound studies

  • endoscopy

When is a typically developing infant introduced to solids?

between 5-8 months

when able to sit upwards and move tongue back

1. Sucking age range

birth to 4 months

• liquids

2. Munching age range

4 to 6 months

• purees

• soft solids

• up + down jaw movement

• in sitting position

3. Lateral tongue movements age range

9 to 12 months

• lumpy textures

• nothing to hard

• crawling

4. Rotary chew age range

8 to 24 months

• most textures are good to eat

• jaw movement up and down plus grinding motion

• walking and good oral control

5. Mature Chew age range

24 months on

• mastered chewing

• can eat anything

Vocalization babbling assessment

Canonical babbling are syllables that contain at least one vowel and one consonant

• a lack of these at 10 months is correlated to delayed verbal development

• note rate of babbling and lack of increase

• note that by 16 months there should be more consonants than vowels

Core components of Prelinguistic Milieu Teaching (PMT)

• environmental arrangement (low impact toys, less stimuli)

• modeling gestures and vocalizations

• prompting (time delays, physical prompts)

What are the primary goals of PMT?

• increase gesture use

• develop coordinated eye gaze

• create intentional communication

Characteristics of vocalization focused interventions

• encourage babbling, consonant production, and sound meaning mapping

• use vocal play and imitation

• sound modeling in play (bang, bang, pow)

• reinforcing intentional vocalizations

• using parentese

Level I Neonatal care

Well newborn nursery, not set up for extreme measures or emergency procedures

Level II Neonatal care

Special Care Nursery, seriously ill but expected to recover quickly

Level III Neonative care

Neonatal intensive care unit (NICU)

• provide life sustaining support

• full range respiratory support

• support for low birth weight

• but no large or specialized surgeries

Level IV Neonatal care

Regional neonatal intensive care until (Regional NICU)

• located within institutions that have NICU and surgery

• full range of pediatric subspecialties

• facilitate transfers

• where the surgical team supports the baby

List of reasons for NICU stays

• prematurity

• respiratory distress syndrome

• sepsis or infection

• hypoglycemia

• perinatal depression (from a traumatic delivery)

• Neonatal abstinence syndrome (withdraw from drugs)

• any baby who needs extra support, a specific environment, help self-regulating, generally babies cant go home until 37-40 weeks or about full term

What is APGAR

Appearance

Pulse

Grimace

Activity

Respiration

When do you test APGAR

1 min and 5 mins after birth

APGAR bad score

total score under 7 may be a sign that baby needs more medical attention

Most common reasons for low APGAR

• difficult birth

• c-section

• fluid in infants airway

Prematurity: 26 weeks characteristics

• eyelashes are growing

• fingernails just finished developing

• baby is beginning to practice swallowing amniotic fluid

• starting to hear noises in the womb

Prematurity: 32 weeks characteristics

• organs are fully formed, except for lungs

• practicing using lungs by inhaling amniotic fluid

• skin is now opaque instead of translucent

• start with PO feedings at this stage

Full term: 40 weeks characteristics

• skin starts to have ry spots from shedding coating from the womb

• brain continues to develop and growth of the body slows

• fully grown

Job of the NICU heart or cardiorespiratory monitor

tracks babys heart rate and respiration with leads on chest and abdomen

Bradycardia number on monitor

<100bpm

heart rate at 130bpm stop and regulate baby before continuing to feed

What is a baby’s normal pulse ox

blood oxygen level

90-100%

Characteristics of Orogastric feeding tube

• more gagging or potential for bradycardia when being placed

• easy for baby to displace

• difficult to provide oral feeding trials

• large tube can be placed

Characteristic of Nasogastric (Gavage) feeding tube

• more comfortable

• possible increase in airway assistance

• periodic apneas

• more for short term

Characteristics of G-Tube

long-term feeding solution that goes right into the stomach

SLP NICU eval components

• obtain orders from neonatalogist

• do a thorough chart review

• call RN to determine feeding times

• gather supplies (slow flow nipples, wash cloth, formula, breast milk, gown)

• change diaper and get temp

• complet oral mech

• document when you start feeding

• check vitals through whole process

• start feeding normally

• go over recommendations with RN and post sign a cribside

What is the ultimate goal of SLP in NICU

• provide comfortable feeding for the baby to avoid aversion to feeding or food

What is the definition of emerging language?

the child has said their first words. The child is lingustic

Steps for EI language assessment

• history

  • case history

  • parent interview

  • oral mech/hearing screening

• Assessments

  • screenings, informal and standardized tests

  • play

  • analysis or error types, form consistency, and contextual differences

Language assessment best practices

• observe

  • spontaneous behaviors

  • elicit behaviors

  • interpret behaviors

Norm Referenced Tests

• compared a childs performance to a normative sample

• how skills compare to others

• PLS-5

• CELF

• PPVT-5

Pros of Norm referenced tests

• ensures consistency

• provides percentile ranks, standard scores, age-equivalents

• useful for eligibility

Cons of norm-referenced assessments

• may not accurately reflect functional communication skills

• can be biased

• must be structured

• may not be valid below 36 months

• compliance based

• narrowly defined acceptable behaviors

Criterion referenced tasks

• measured a child’s skill against a predefined set of criteria vs. comparing to peers

• goal is to determine if a child has mastered a specific language skill

• Rosetti

• MacArther Bates Communicative Development Inventories (CDI)

• language sample analysis

Pros of Criterion referenced

• flexible administration

• more culturally responsive

• useful for tracking progress

• useful for intervention planning

Cons for criterion references

• does not provide standardized scores for eligibility

• can be more subjective and based on clinical judgement

• may take more time to administer

CA regulations for EI eligibility

• birth - 36 months

• developmental delay (significant difference on 25% or more between current level of functioning and expected level of functioning)

• established risk

• high risk for developmental disability

How to calculate score they must receive below for services

adjusted age times 25%= that value. Then take that value and subtract it from 25. That will give you the cutoff age for the child to qualify

IFSP about

• birth- 3 mandate in 1986 (PL 99-457 Part H)

• IDEA reauthorized in 2004

• strength based plan of care

• for family and child

• comprehensive plan to promote development of the child

Elements of IFSP

• present level of functioning

• family’s resources, priorities, and concerns

• expected outcomes, including criteria, procedures, timelines

• modifications

• services to meet outcomes

• transition plans

Multidisciplinary team

• parallel without lots of collaboration

• discipline specific

• individual professions conduct their own assessments

• strength: very specific for each profession

• cons: fragmented services, limited collaboration, information not shared between professionals