exam #3 language disorders (8,9, WLD)

what is a hearing impairment? how can it be described?

a deficit in hearing sensitivity that can affect both loudness and clarity

• considered to be one of the most common health concerns for children in the US

• can be described in a number of ways:

  • permanent or fluctuating

  • etiology or sight of lesion

  • degree of loss

what is the prevalence of hearing loss?

4 of every 1000 babies born with hearing loss per year

• increases with age

  • 20% US population 12yr old + with hearing difficulties severe enough to impact communication

what is conductive hearing loss?

• damage to outer or middle ear that affects how sound waves are transmitted to cochlea

• caused by impacted wax or infection (OM) usually

• decrease in loudness of sound but not clarity

• intervention usually effective and child should be able to use oral language to communicate

what is sensorineural hearing loss?

• caused by damaged to inner ear, specifically hair cells of cochlea, auditory nerve, or auditory neurological pathways to brain

• severity of hearing loss depends on extent of damage to hair cells

• results in loss of intensity and clarity of sound

• amplification helps with intensity but not clarity

• recruitment is a common problem

what is unilateral hearing loss? include the prevalence, common cause, and risks.

• prevalence of 3-13/1000

• due to mumps experienced in early childhood mostly

• usually unaware of problem until it begins to affects specialized communication requirements, interpersonal communication, or academic achievement

• children are at risk for academic difficulties (esp w/out intervention

what is congenital hearing loss and acquired hearing loss? what are their causes?

• congenital = occurs at birth or in immediate post-natal period, caused by genetic factors, meningitis, prematurity, and maternal rubella

• acquired = after birth when child has had some exposure to oral language, caused by genetic factors, meningitis, viral infections (influenza, mumps, cytomegalovirus), trauma, OM

what is otitis media, its prevalence, and its impact on hearing loss? how is it usually treated?

• infection in middle ear often with fluid in middle ear cavity

• ~70% children have one episode of OM < 3 yro, many will be reoccurring

• 50% mild hearing loss during infection, 5-10% moderate hearing loss

• usually treated with meds/surgery

• hearing loss due to OM —> basis for later language disorders = controversial

how is mild hearing loss classified? what does intervention look like for this?

• 15-30 dB

• less likely to be identified in early screenings and inattentive behavior not associated with poor hearing

• adolescents with mild loss tend not to wear hearing aids

• intervention: hearing aids, encouraging used of visual and auditory cues, and preferential seating

• early intervention —> no language delay

how is moderate hearing loss classified?

• 30-60 dB

• benefit from hearing aids bc conversational speech isn’t completely audible + rely on visual support

• may have delayed language and speech problems, specifically with consonants

• intervention —> speech and language can develop to normal or near normal levels

how is severe hearing loss classified?

• 61-90 dB

• most severe impairment: respond only to sounds that are high intensity and at close range, even with amplification

• even with amplification, frequently a delay in language development

• speech is delayed; consonant, vowel, and diphthong errors

• may show abnormal voice quality

• outcome depends on how early HL was detected and when intervention began

how is profound hearing loss classified?

• 91-120 dB

• least likely to benefit from auditory input

• reliance on tactile and visual cues

• significant impacts on speech, language, communication development

• hearing aids provide environmental/suprasegmental features of sounds but not speech discrimination

• development of adequate oral language is difficult; no cochlear implants

how is total hearing loss classified?

• 121+ dB

• children do not hear even with hearing aids, feel rather than hear

• vision is primary modality to acquire language

• lang development affected even with CI or ASL from early age

• cochlear implants can produce results for some individuals with total hearing loss equivalent to those achieved with less severe losses but there is substantial variability

describe the speech banana.

• most sounds occur within the 15-65 dB level

• most sounds occur within the 125-5000 Hz level

• those with mild hearing loss would have difficulty understanding things like f, s, th

factors contributing to HL outcomes: early identification and audiological management means…

• early identification and intervention is key to child development within first year; can achieve language levels of their peers

• early identification of HL in infants can alleviate serious lifelong delays in speech, communication, cognition, and social-emotional development

• children with HL who have the best outcome odds:

  • No other risk factors

  • diagnosed by birth, amplified by 3 mo, enrolled in intervention by

  • CI by 18 months if needed

what is neuroplasticity? how does it relate to audition?

• the ability to achieve language levels consistent with hearing peers due to a plastic auditory system

• despite damage or disease, the auditory system can develop appropriately with early stimulation

• without stimulation, human central auditory system remains maximally plastic for only 3.5 years

  • aka the sensitive period of auditory development

factors contributing to HL outcomes: choice of communication modality means…

• one of the most controversial aspects of working with children with hearing impairment

  • Deaf culture vs professionals who believe that all children with HL can learn to talk and listen

• 95% of children with HL born to parents who can hear

  • philosophy of the deaf community or using spoken language in the household

factors contributing to HL outcomes: family involvement in remediation means…

• when a child is born with HL, parents must learn to maximize early childhood experiences

  • must be taught to use scaffolding, imitation, closed-ended questions during first year of life

  • facilitative language techniques that reflect child’s zone of proximal development

  • engage in frequent storybook reading

what are some oral language and speech characteristics of HL: syntax and morphology?

• delay related to degree of HL

• use of simple sentence structure, difficulty with past tense and 3rd person

• omission of auxillary verbs and function words

• telegraphic characteristics to connected speech

• likely to interpret sentences based on word order

what are some oral language and speech characteristics of HL: semantics?

• reduced word used

• difficulty comprehending word meanings and with abstract expressions

• concrete and literal expressive vocabulary with delayed concept development

• rely on being taught new vocab

• gap between vocab widens with age

what are some oral language and speech characteristics of HL: pragmatics?

• preschoolers give inappropriate and ambiguous responses to utterances of greater linguistic complexity

• common intentions:

  • commenting, requesting, acknowledging, calling attention to action/object

what are some oral language and speech characteristics of HL: speech?

• consonant errors more frequent than vowels

• voiced sounds often substituted for voiceless

• greater production of nasal consonants

• vowel production more neutralized to schwa

• voice lacks rhythm, breathy, nasal quality

• little control over pitch and loudness

what are some characteristics of HL: reading and writing?

• 30% HL 16 year olds are illiterate, 60% reading below 6th grade level

• reading gap widens with age: 9 years (1/5 grade level blow), 14 years (5+ years below)

• less difficulty with punctuation and spelling, more difficulty with writing

  • syntactic complexity

  • lexical cohesion

  • organizing ideas to include sufficient details

what is central auditory processing disorder (CAPD)? define the symptoms based on ASHA.

• children with no evidence of HL but have language and academic difficulties that come purport are due to poor auditory processing

• ASHA: difficulties in the perceptual processing of auditory information in the CNS as demonstrated by poor performance in one or more of the following skills

  • sound localization/lateralization, auditory discrimination and pattern recognition, temporal aspects, auditory performance in competing acoustic signals

what are the difficulties with CAPD definition? what are some suggestions for CAPD management?

• controversial to conceptualize, measure, diagnose, and best EBP for intervention

• professionals need to be suspicious about nature of CAPD in children with language disorder

• suggestions for management include:

  • environmental modifications

  • compensatory strategies

  • direct intervention

  • language intervention for those with language deficits

what is the ultimate goal of hearing?

comprehension of linguistic and non-linuistic sounds

what are the levels of auditory skills?

• not acquired in a sequential fashion

  • detection level

  • discrimination level

  • identification level

  • comprehension level

what is detection level?

• most basic level of sound awareness

• baby’s ability to detect the presence of absence of sound in an environment

• clear cut if the infant has normal hearing

• if hearing impaired, varied frequencies can be heard better than others

what is discrimination level? what do children master first and then second?

• second level of hearing difficulty

• children first master discrimination of the suprasegmental aspects of language: pitch, prosody, rhythm, stress, and inflection

• later master the segmental aspects of language: phonemes, morphemes, and syllables

what is identification level?

• third level of hearing difficulty

• child able to identify (point) or label an item

• auditory memory and recall, attention to understand the content and meaning of what’s being said

• auditory closure = the ability to fill in a missing or misspoken part of a word or message

what is comprehension level?

• the comprehension of speech and environmental sounds in all settings

• ultimate goal of the hearing maturation process

• critical for learning

what are the affects of background noise?

• affected by the level of noise in a room, acoustics, and distance between talker and listener

• classrooms with high levels of background noise —> difficulties for hearing impaired children

• signal to noise ration used to describe the relationship of the signal that a child needs to hear to the level of background noise that is present

what sound:noise ration is suitable for normal hearing vs hearing-impaired children?

• 20+ dB for normal

• 30+ dB for hearing impaired or deaf

what are the 2 main communication modalities?

• spoken communication (talking and listening)

  • sign language

what is the Listening and Spoken Language Philosophy?

• founded on the belief that strong auditory skills are critical for language development

• in order for children to obtain sufficient auditory experience, parents must:

  • maximize auditory input through high quality and on going audio services

  • implement all available tech (like hearing aids)

  • provide intensive aud/lang experiences in age appropriate and natural contexts

• proponents believe HL kids can do the above and be chill; listening is the foundation for pre speech and language skills

what is one reason for successful outcomes of Listening and Spoken Language Philosophy? list the stats and benefits?

• cochlear implant

• leads to faster rates of language learning and higher overall language achievement levels

• basis for improvement at early ages relates to sensitive periods and neural plasticity

describe the use of Sign Language. what is the family and educational issues surrounding it?

• children who are deaf use because visual learners

• children with HL born to deaf parents immersed in deaf culture using a bilingual/cultural approach

• approximately 21% of deaf children use ASL as primary means of communication

• ASL can parallel early spoken language in rate and pattern ONLY if parents are proficient in ASL; leads to deficits otherwise

• SLPs must support family in understanding implications of using ASL

what is total communication?

• more common manual communication approach

• may incorporate a variety of different forms of sign, signed exact english, and Pidgin Signed English (ASL + ENGLISH)

how are assistive listening devices used for children with HL?

• used in public environments

• help hear listeners with a better S:N ration

• FM systems are most common

  • radio transmitter and microphone close to mouth

  • signal directed to ear through earphone

what are the four stages of developmental continuum of literacy?

• oral language (receptive and expressive)

• emergent literacy

• early literacy (decoding and spelling)

• later literacy (reading fluency and comprehension)

what is the connection between early language impairment and reading achievement?

• higher risk; 60% of children with those impairments —> later reading difficulties

• language processing issues in kindergarten —> 73% poor readers in 2nd grade

what is the Simple View of Reading?

• Believes that reading consists of two components:

  • Decoding = word recognition processes that transform print into words

  • Linguistic comprehension = process by which words, sentences, and discourse are interpreted

what are the core skills of reading?

• phonological awareness

• decoding

• sight word recognition

• vocabulary

• fluency

• comprehension

when is and what is the emergent literacy period?

• birth to beginning of formal education

• accumulations of letters, words, books

• depends on how much exposure to literary artifacts, events, and interest in reading

name some emergent literacy skills.

• oral language

• concepts about print

• knowledge of environmental print

• alphabet, phonological awareness knowledge

• pretend reading and writing (emergent)

why is phonemic awareness important to the growth of word-reading ability?

• helps children understand the alphabetic principle and develop alphabetic knowledge

• helps children notice the regular ways that letters represent sounds in words

• helps children become flexible decoders to decode even irregular words

• makes it possible to generate possibilities for words in context that are only partially “sounded out.”

what are the three stages in the development of word recognition skills?

• Logographic Stage: construct associations between unanalyzed spoken words and one or more salient features of the printed word or its surrounded context

• Alphabetic Stage: reading words by processing sound-letter correspondences

• Orthographic Stage and automatic sight word recognition: use of letter sequences and spelling patterns to recognize words by sight without phonological decoding

describe how children begin to develop word recognition skills for reading.

• begins with phonemic decoding to identify words never seen before

• then process letters in larger spelling patterns

  • like learning affixes and prefix/suffixes

• learning patterns make it easier to decode words

• skilled readers become orthographic, processing words by sight and its visual representation integrated with its structure and meaning

how do children develop reading comprehension skills?

• use stored knowledge about language, text structures, and genres

• ability to understand spoken language is the foundation for reading comprehension

  • ex: vocab, implicit knowledge of syntactic forms, background knowledge, inferencing and metacognitive abilities

describe the “Reading Rope”.

• language comprehension (background info, vocab, reasoning, literacy knowledge)

• PLUS

• word recognition (phonological awareness, decoding, sight recognition)

• EQUALS

• Skilled reading = fluent execution and coordination of word recognition and text comprehension

what does reading comprehension require?

• recognition or decoding words

• understanding difficult words (abstract, technical, complexities)

• parsing complex sentences

• reasoning beyond what’s explicitly stated

what are the knowledge blocks for spelling?

• phonology

• orthography

• morphology

• semantics

• allows people to develop mental graphemic representations of new words

what are the spelling benchmarks?

• Precommunicative Spellers

• Semiphonetic Spellers

• Phonetic Spellers

• Transition Spellers

• Conventional Spellers

describe the square depiction of reading disabilities based on the simple view of reading.

what is the IDA definition of developmental dyslexia?

• A specific learning disability that is neurobiological in origin

  • difficulties with accurate and/or fluent word recognition, poor spelling and decoding abilities. T

  • deficit in the phonological component of language

  • problems in reading comprehension and reduced reading experience, slow vocab and background knowledge

what is the prevalence of dyslexia?

• 5-10% of population

• one of the most common language-based learning disabilities

• 70-80% of those with reading and spelling difficulties have dyslexia (8 million American students)

• occurs in all language but confusing why in english

what is the spoken language profile of someone with developmental dyslexia?

• hard to remember precise oral pronunciations of words

• frequent history of articulation therapy

• low to above average oral language skills

• listening comprehension better than reading

what are some reading and writing characteristics in persons with developmental dyslexia?

• Deficits in phonological and orthographic coding

• Depressed reading fluency

• Poor spelling

• Omission of punctuation, inflection, function words

• Capitalization, Punctuation

• Often poor handwriting, sometimes letter reversals

what is mixed reading disability?

• garden variety poor readers

• difficulties in word recognition and listening comprehension

• significant problems in language comprehension associated with more global cognitive deficits (verbal and nonverbal processing)

what is the spoken language profile of individuals with mixed reading disability?

• depressed oral language skills in one or more domains

• deficits in phonological processing are often mild/or do not occur

• history of early language impairment

• deficits in production of oral language narratives

• deficits in use of morphological and syntactic forms

what is the reading and writing profiles of individuals with mixed reading disaiblity?

• can exhibit relatively good word recognition, reading fluency, and spelling

• depressed reading comprehension

• depressed writing composition

what does it mean to have a specific comprehension deficit?

• Problems with listening comprehension, but with normal or above normal word recognition

• Good phonological decoding

• sometimes been referred to as hyperlexia

  • perform poorly on tests of semantic and syntactic processing

  • associated with one or more developmental disabilities such as ID, autism and schizophrenia

  • can co-occur with other “splinter skills” such as exceptional music talent or memory for names and dates

what percentage of school aged population has specific reading disaiblity? what is there core issue and marked weakness?

• 5-10%

• core deficit in phonological awareness

• difficulty spelling novel and nonsense words, marked weakness in morpho-syntactic structures

causes of reading disabilities: matthew effects

• extrinsic factor

• simply just considering children to be RD —> negative consequences that influence reading development

• low expectations in remedial or low ability groups —> further reading problems

• not reading a lot —> language problems due to low new vocab and advanced grammar/discourse

causes of reading disabilities: genetic basis

• intrinsic cause

• siblings have 40% change of having RD if other one does

• parent of RD kid has 30-40% changes of having RD history

• familial risk for RD is continuous, not discrete

• in 68% of identical twins, both had RD

  • show that many other factors must contribute to reading development

causes of reading disabilities: brain anatomy/functioning

• intrinsic factor

• only broca’s area is functioning for a dyslexic

• in normal person:

  • broca’s = articulation/word analysis

  • parieto temporal = word analysis

  • occipito temporal = word form

causes of reading disabilities: attention based deficit

• intrinsic factor

• ADHD not primary cause of RD but may co-occur (about 36%)

• overlap greater for inattention not hyperactivity

• distinct developmental disorders with own causal factors

causes of reading disabilities: language-based deficits

• intrinsic factor

• closely associated with RD

• often precedes and causally linked to reading problems; develop reading problems upon starting school

• language problems also a consequence of reading problems

describe reading and spelling programs as an intervention for reading disability.

• Structured literacy teaching is the most effective approach for students who experience difficulty reading and spelling

  • Synonymous with multisensory structured language approach

  • Content of instruction is analysis and production of language at all levels

    • Phoneme awareness

    • Sound-symbol (phoneme-grapheme) correspondences

    • Patterns and conventions of print (orthography)

    • Morphology o Syntax o Semantics

what are the principles and methods of structured literacy?

• Explicit (directly and clearly, applies each new concept to reading and writing)

• Systematic and cumulative (planned sequence of skills that progresses)

• Hands on, engaging and multimodal

  • Moving tiles/building words with tiles, using hand gestures to support memory for associations

  • Listening, speaking, reading and writing paired

  • Diagnostic and Responsive

  • Student responses guiding pacing, presentation and amount of practice given within the lesson

what is cultural diversity?

• referred to as multiculturalism

• regional, ethnic, social, racial, linguistic, and cultural variations in any society

• ethnicity, socioeconomic status, race, language, and culture are separare concepts

what is linguistic diversity?

• all the behaviors by which individuals communicate with one another

• focuses on differences in form (phonology and grammar), lexicon, and pragmatics that distinguish languages and varieties

what is dialect?

• variations of a language, varying in grammar, vocab, and or phonology

• societal, historical, economic and educational factors can combine in favor of a particular dialect and make it standard

• rule governed and used by a community

• functional and effective

how do you distinguish a dialect from a language? (2)

• distinguished from a language in two main ways:

  • share a common core of grammatical and other characteristics with all other dialects of the language

  • speakers of different dialects should be able to understand one another even if it requires some effort

how is a bilingual characterized?

• not two monolinguals combined into one

• fluent with both written and spoken forms of native language with less proficiency in second language

• equivalent but different areas of competence in two language; prefer to use in different contexts

in the usa, how many residents speak a foreign language at home? school? how many english language learners in school?

• 1/5 residents and 1/5 school

• estimated 4.6 million ELLs in schools

what are the four main ethnic groups in the usa?

• hispanic american

• african american

• API

• native american

how are ELLs impacted by communication disorders?

• usually at a greater risk for negative educational outcomes

• 10% of all the members of all racial minority groups have disorders in S, L, or hearing

a language disorder likely exists if language skill…

• is considered defective by the individual’s cultural community

• operates outside the norms of acceptability for that community

• calls attention to itself or interferes with communication within that community

• results in difficulties in adjustment for the client

over-diagnosis of language and literacy problems are common in what population and why?

• culturally and linguistically different children

• incidence is about the same as English only populations = 10%

• over-reliance on standardized tests: CLDs are unfamiliar with the situation or lack of experience with concepts being tested

how do we determine if a CLD child has a true language impairment?

• a differential diagnosis from language disorder

• language difference: using a dialect, inexperience with english

• language disorder: true developmental issue in both native language and english

what cultural competencies does an SLP need to know to make a differential diagnosis?

• knowledge about particular dialect as a rule-governed linguistic system

• knowledge of the phonological and grammatical features of the dialect

• knowledge of non-discriminatory testing procedures

how is language dominance identified and why is it important?

• needed to do the least biased assessment

• establish through observation and or structured questionnaires

• IDEA requires an environment in which the child is most likely to yield accurate information; doesn’t need to be standardized

how do you test english dominant children vs non english dominant children?

• english

  • testing in english

  • sensitive to pragmatic, experiential, and dialectal differences that must be assessed before deciding whether a disorder is present

• non english

  • test in english and dominant language

  • compare both performances to see progression

what are the assessment methods for testing CLD children?

• standard tests with normative data from CLD children

• process-dependent tasks (requires minimal knowledge, like working memory and non word tasks)

• dynamic assessment

  • test, teach, assessment

  • helps to differentiate stronger and weaker language learners

how do you diagnose a CLD child with a language impairment?

• must be diagnosed with language impairment in their native language for it to count

• if only showing difficulty in second language, it’s a language difference

  • language therapy by SLP not recommended for them

  • ESOL is recommended

what language should be used for CLD treatment?

• not english

• should be native language which facilitates second language learning

if a monolingual SLP is providing services to a CLD child, what are some examples of what they can do and how they should seek help?

• can provide:

  • in-service training, consultation, diagnostic services, paraprofessional training, screenings/interviews, research, advocacy

• seek help:

  • hiring bilingual SLP consults, interdisciplinary teams, train personnel

if a language disorder has been ruled out of a child with CLD, what does an SLP do?

• nothing. it’s just a difference

is a monolingual SLP has a CLD with a LD but theres no other professionals in the community who speak their native language, what do they do?

• recruit peers from native language to provide peer mediation

• deliver intervention in english using indirect language stimulation and activities

describe what development synchrony is.

the idea that brain development is reliant on reciprocal networks

• neural networks during early years of life cultivate langyage, literacy, executive functioning, etc.

• if auditory skills are mastered as close as possible to the expected biological clock, then the entire neural network experiences developmental synchrony

what is audism?

the systemic oppression of the deaf and hard of hearing community; associated with medical model and failure to provide patients with all management options