CMSD 4170; Language Disorders- Exam 2 Study Guide

What is cultural competence?

An ongoing process that involves self-awareness and humility and recognizing that one does not know about the languages and cultures of the patients we serve.

Dimensions of cultural variability

Cultural Value Orientation (time orientation)

Verbal Communication

Nonverbal Communication

Relational Communication Norms (appropriate expectations)

What Cultural Competence is NOT

A discrete endpoint

A list of characteristics

An isolated set of skills and knowledge

Process of Cultural Competence

Developing Cultural self-awareness --> Gaining Cultural Knowledge --> Undressing and Redressing Power Imbalances --> Holding Systems Accountable

Developing cultural competence

asking yourself "What is my culture, and how does it influence the ways I view and interact with others?"

Gaining cultural knowledge

what are other cultures like? what strengths do they have?

Undressing and redressing power imbalances

asking ourselves "How can I use my understanding of my own and other's culture to identify and work to disrupt inequitable systems?"

Holding systems accountable

How can I work on an institutional level to ensure that the system I'm part of moves toward greater inclusion and equity? -- using the system to keep ourselves and our work accountable

What are attributes of a "culturally competent" clinician? (4)

1. Appreciate cultural patterns and individual variations

2. Engage in cultural self-scrutiny and improve self-awareness

3. Use evidence-based practice

4. Understand the communication contexts and needs of clients

What is a Dialect?

A rule-governed linguistic variation attributable to different cultural group

What is Dialect Shifting? What are other names for it?

Using different linguistic styles for different situations

Code Switching

Translanguaging

What is a language disorder?

Refers to an impaired comprehension and/or use (production) in written, spoken, and/or other symbol systems.

What does language disorder impact?

Form

- Syntax, morphology, phonology

Content

- Semantics

Use

- Pragmatics

Additional considerations to language disorder

Social, Psychological, and Educational Impact

- How much of this is needed? How much will this influence a person?

Language Disorder Versus Language Difference

- Language Difference is the ability to speak another language different from the one used in instruction.

The Meaning of Significant

- Was it serious enough to be considered a disorder?

research terminology -- specific learning disability is described by the DSM-5 to be a child...

having substantial and persistent problems with learning

research terminology -- developmental language disorder (DLD) is described as a communication disorder that

interferes with learning, understanding, and using language

Insurance

F80.1 Expressive Language Disorder

F80.2 Mixed Language Disorder

Educational Terminology

Developmental Delay

Speech or Language Impairment

Specific Learning Disability

Current Terms for Language Disorders

Late Talkers

Language Disorders

Language Disabilities

Language Impairments

Specific Learning Disorder

Terms that are no longer used

Childhood Aphasia

Language Deviance

Language Delay

Common Signs for lang disorders

Preschool

Shorter sentence length

Omission of grammatical signs

Slow development of errors with pronouns

Problems forming questions with inverted auxiliaries

Difficulty conversing with more than 1 child

Immature requests

Difficulty with complex narratives/directions

Difficulty with oral resolution of conflicts

Longer reliance on gestures

Common Signs

Elementary

Word-finding accompanied by pauses

Naming errors

Slower processing speed in language comprehension

Difficulty with indirect requests

Difficulty in maintaining topics

Problems with figurative/non-lit language

Problems with abstract language concepts

Problems providing details

Poor narrative construction and cohesion

Common Signs

Adolescence

Difficulty expressing ideas about language

Inappropriate responses

Poor social language

Problems providing sufficient information

Redundancy

Inadequate sense of limits or boundaries

Difficulty expressing needs and ideas

Word-finding difficulties

Prevalence refers to....

Refers to the # of people who are living with the condition in a given time period.

Incidence refers to....

Refers to the # of new cases identified in a specific time period.

Late Language Emergence (aka Late Talker) (When typically diagnosed/noticed?)

Children who show delays in the earliest stages of language development

50% catch up with their peers by 3 or 4 years of age. The other half have "language delays"

How are language disorders classified?

3 things

Etiology

Manifestation

Severity

Etiology

Refers to the cause or set of causes

Primary Disorder

Occurs in the absence of any other significant disability

Secondary Disorder

Occurs as a result of another disability

Developmental Disorder (in terms of manifestation)

Present from birth

Acquired Disorder

Acquired sometime after birth, typically as a result or injury

Manifestation

Is the disorder comprehension, expression, mixed?

- comprehension - problems with comprehension but normal expression (language comprehension disorder)

- problems only with expression (specific expressive lang disorder)

Manifestation in Form, Content, Use can mean _______ vs ______

FOCAL VS DIFFUSE

Focal manifestation of a disorder

A disorder affecting only 1 domain

Diffuse manifestation of a disorder

A disorder affecting multiple domains

Reading and Writing

(Manifestation) -- poor decoding and poor language comprehension skills

decoding and comprehension disorder (mixed reading disorder -- dyslexia and developmental language disorder)

Reading and Writing

(Manifestation) -- good decoding and poor comprehension skills

comprehension problems (reading comprehension disorder -- DLD)

Reading and Writing

(Manifestation) -- poor decoding and good comprehension skills

decoding problems (dyslexia)

when we say "severity" of a language disorder, we mean...

the determined extent to which a disorder hinders a child's ability to use a lang for a functional purpose -- disturbing a child's social/educational functioning

What are the prevalent types of language disorders?

Specific Language Impairment (SLI)/(DLD)

Autism Spectrum Disorder (ASD)

Intellectual Disability

Brain Injury

Specific Language Impairment (or DLD)

Defining Characteristics

Inconsistent skills across different domains

History of slow vocabulary development

A tendency toward word-finding problems

Specific Language Impairment (or DLD)

Causes and Risk Factors

No known cause for SLI

Considerable difficulty with grammatical production and comprehension that begins during toddlerhood and continues through school age.

Autism Spectrum Disorder (ASD)

Defining Characteristics

Deficits in social communication

Impairments in restricted and repetitive patterns of behavior (RRBs)

what are the four main characteristics of autism?

1. have to be present from birth

2. have to affect everyday functioning

3. must have restrictions in social communication/interaction

4. must have repetitive and restrictive behaviors

Autism Spectrum Disorder (ASD)

Causes and Risk Factors

Neurodevelopmental disability/ neurobiological

Present at birth but signs and symptoms unfold over first few years of life

Intellectual Disability

Defining Characteristics -- has significant limitations in

Significant limitations in both...

(1) Intellectual functioning

(2)Adaptive behavior

Intellectual functioning in terms of intellectual disability's defining characteristics (what do we mean by "intellectual functioning")

Learning, reasoning, word-problems

Adaptive behavior in terms of intellectual disability's defining characteristics (what do we mean by "adaptive behavior")

Everyday practical and social skills

Intellectual Disability

Causes and Risk Factors

prenatal damage, biomedical/psychosocial factors

Characterized by impairment of skills manifested during the developmental period

Brain Injury

Defining Characteristics

Influenced by severity, site and child characteristics

Mild to severe

Brain Injury

Causes and Risk Factors

Damage or injury to an individual's brain tissue after birth

5 Main Areas of Development

Cognitive development

Communication development

Physical development, including vision and hearing

Social or emotional development

Adaptive development

(CCPSA)

How are language disorders identified? Possible team members

speech-language pathologists, special and general educators, audiologists, pediatricians, psychologists, and parents

The Assessment Process (in order) for DLD

Childhood Language Intervention

Referral

Screening

Comprehensive Language Evaluation

Diagnosis

what is a screening?

A task or test to see if further evaluation is needed

Comprehensive Language Evaluation determines

Determine whether a diagnosis is present

A diagnosis tells us what three things?

Type of impairment, severity, affiliated domains

options for Type of Impairment

Primary/Secondary

Affiliated Domains

Form, Content, Use

comprehension/production

Within treatment, what is a "Treatment Target"

Elements of language that are addressed during intervention

Within treatment, what is a "Treatment Strategy"

Ways in which treatment targets are addressed

Within treatment, what is a "Treatment Context?"

Settings in which treatment takes place

Broad Treatment Approaches

Behavioral

Cognitive-linguistic

Social-interactive

Family-centered

Behavioral Treatment Approach

Emphasizes the importance of the environment in shaping behavior.

Positive/Negative Reinforcement

Positive/Negative Punishment

Cognitive-Linguistic Treatment Approach

Emphasize the developmental sequences and underlying rule-governed organization of communicative behavior

Social-Interactionist Treatment Approach

Based on theories of developmental psychology that emphasize the importance of social interactions

Family-Centered Treatment Approach

Treatment goals emphasize an individual's participation within and access to family activities and contexts

what does IDEA stand for?

Individuals with Disabilities Education Act

IDEA Part C is designed specifically for what/who?

Designed to support the family to meet the developmental needs of its infant or toddler (birth to 36 months)

PART C of IDEA deals specifically with which ages?

Birth to 36 months (3 years-old)

PART B of IDEA deals specifically with which ages?

3 years-old to 21 years-old

PART B SECTION 619 of IDEA specifically deals with what?

Preschool services (2-5 years-old)

Guding principles for EI

4

1. Family centered and culturally and linguistically responsive services

2. Developmentally supportive and promote children's participation in their natural environments

3. Comprehensive, coordinated, and team based

4. Based on the highest quality evidence available

Functions of the SLP in EI (early intervention_

Prevention

Assessment

Planning and Intervention

Consultation and Collaboration

Service Coordination

What are parts of the natural environment?

1. Settings/place

2. Activities/routines

3. Materials

4. People

Embedded intervention, and why is it important?

Strategies that address specific learning goals within the context of everyday activities, routines, and transitions at home, at school or in the community.

Helps children learn skills in everyday routines and activities as they interact with familiar people and things

What is ASD (Autism Spectrum Disorder)?

A developmental disability caused by differences in the brain.

What does the DSM 5 say about ASD?

Impairment in social communication and restricted repetitive behaviors, interests, and activities (RRBs)

Impairment in Social Communication

DSM 5

1. Impairment in social-emotional reciprocity

2. Impairment in the social use of nonverbal behavior (gestures, facial expression,gaze)

3. Difficulty developing relationships

Restricted and Repetitive Behaviors

DSM 5

1. Repetitive movements or speech

2. Inflexible adherence to routines

3. Highly restricted or fixated interests

4. Unusual sensory interests or responses

For a diagnosis, how many of the social communications and RRBs need to be detected?

Impairment in social communication- ALL 3

Impairment in RRBs- 2 out of the 4

Identity-First language for ASD

"autistic person"

"autistic child"

The disorder is inseparable than the person and is an important part of the person's identity

generally more preferred by autistic adults*

Person-First language for ASD

"person with autism"

"child with ASD"

places the person first, disorder doesn't identify the person

generally more preferred by family members and professionals

_____ in _____ children have Autism

1 in 44 children

ASD is present across all

racial, ethnic, and socioeconomic groups

ASD is 4x more common in

boys than girls

ASD symptoms presentation changes

throughout life

Variability in ASD in which three categories?

Levels of Support

Continum of verbal skills

Range of intellectual abilities

Early intervention (ASD) -- when can it be detected? when can it be reliably diagnosed?

Can be detected in toddlers (around 18 months) and can be reliably diagnosed by age 2

what is the average age of diagnosis of ASD?

The average age of diagnosis of ASD is 4-6 years old.

what does better screening for ASD at younger ages lead to?

leads to earlier identification and therefore earlier enrollment in intervention

Echolalia

Act of repeating or echoing words or sentences that others have said

Delayed Echolalia

Repetition of verbal messages that were previously heard at some other point

Immediate Echolalia

The exact repetition of a word or words directly after they are spoken

Mitigated Echolalia

Immediate or delayed echolalia with some change in the original form/wording

Generative language

Generating a spontaneous production based on what I am thinking

Diagnostic Assessment for ASD

Autism Diagnostic Observation Schedule (ADOS)

Differences in Level of Understanding in ASD

May repeat words and phrases that are beyond level of comprehension.

Some language is understood at a very high level when related to an intense interest.

Difficult to understand the true ability of those who are nonverbal

ASD interventions that are NOT recommended

Auditory integration

TherapyFacilitated Communication

Rapid Prompting Method (RPM)