SLP521 - Quest 1

consistent 2-word phrases

2 years old

most challenging language domain for people with DLD

use

what is language?

a code whereby ideas about the world are expressed through a conventional system of arbitrary signals for communication

what are we assessing in young children?

language form, content, and use

language domains

form, content, use

form

syntax, morphology, phonology

content

semantics

use

pragmatics

secondary language impairment

comes from something else identifiable (intellectual disability, acquires illness, sensory loss, etc.)

prevalence

all the people that have it

incidence

how often it happens

ASHA definition of a language disorder

impairment in comprehension and/or use of a spoken, written and/or other symbol system

Tomblin's definition of a language disorder

when the child's level of language achievement results in an unacceptable level of risk for undesirable outcomes

"ideal" definition of language disorder would...

specify size/nature of the impairment, detail the comparison group, and detail how the impairment is measured

"a 30% delay" is an example of what?

age-equivalent score

comparison group

relative to environment, academic setting, and developmental level

CA

chronological age

MA

mental age

why don't we use MA?

cognitive level "limits" language level

drawbacks of discrepancy models

assumes cognition and language can be cleanly separated, assumes cognition is easily measured, lang discrepancies vary over time, diff combinations of tests would yield diff results

discrepancy or no discrepancy?

most contemporary definitions do NOT include an MA discrepancy; use functional needs approach for eligibility

what are the benefits/drawbacks of choosing a narrower band for typical expectations? (90-110 instead of 85-115)

the outer ends would have access to services that they didn't before, but an increased caseload isn't always possible

what are the benefits/drawbacks of choosing a wider band for typical expectations? (75-125 instead of 85-115)

there's a smaller caseload but people who might need treatment aren't getting it

etiology of language disorders

don't know a single cause for DLD (could be a combination of genetics, brain structure/function, environmental factors)

genotype

an individual's variant of a gene

endophenotype

genetically-influenced behavioral trait

phenotype

observable trait

heritability

percentage of variation in a trait that can be attributed to genetic influence

can you use brain scans to diagnosis language disorders?

no

cognitive models

auditory processing, limited processing capacity, procedural benefits

auditory processing

deficits in sound perceptions = difficulty in language learning BUT is not predictive of later language

limited processing capacity

underlying deficits affect higher level skills BUT isn't always casual (ex: improving working memory does not directly improve language)

procedural deficits

rule-based learning is impaired so grammar is impaired (more evidence for this model but still isn't perfect)

only ______ directly results in better language

treating language rather than focusing on lower level skills

why do we assess young children?

screening -> establish baseline functioning -> establish treatment goals -> monitor progress

screening

identify children who may be at risk for DLD, does not diagnose, examines broad range of lang/comm functions

outcome of a screening

no concern, re-screen, or refer for a full evaluation

establishing baseline function

all areas of comm, establish strengths/weaknesses, comprehensive lang assessment, determine diagnosis

establish goals for intervention

compare to typical development, consider where the child is most behind, what skills would be easiest for their current needs, and developmental sequence

measuring progress

moving to the next target and/or changing intervention approach

how do we assess young children?

case history, caregiver interview, hearing screening, oral mech exam, IQ, comprehensive lang and speech testing (look for converging evidence)

caregiver/teacher interview

open-ended questions to get social history and current situation; child's wants/needs, when and with whom they're communicating

observation

child interacting with their environment, ability to answer questions and follow directions, motor skills and activity levels, social-communication, etc.

non-language

hearing, speech, and oral-motor/voice

standardized assessment

clear administration and scoring so it's always given the same way

basals

start point below assumed level (correct -> continue; incorrect -> go lower)

ceilings

ceiling-out when too many questions are wrong, don't continue the test

validity

measures what it is supposed to measure (face, content, construct, concurrent, and predictive validity)

reliable

inter-rater and test re-test reliability

sensitivity

probability that a child with the disorder will test positive (screeners)

specificity

probability that a child without the disorder will test negative (baselines) (looking for DLD)

norming sample

big enough, includes individuals similar to the child being tested, maybe includes individuals with language disorder

confidence band for true score

observed score +/- SEM

SEM

standard error of measurement (natural variation)

benefits of caregiver checklists

most common person for that child, sees the child in a variety of settings, child exhibits comfortable behavior with them

drawbacks of caregiver checklists

bias, very lengthy, might be invalid

PLS-5

slightly more sensitive

CELF

recommended 1.5 SD because both sensitivity and specificity are high

criterion-referenced measures

hierarchy of skills that can be used to measure what the child can/cannot do; no standard scores; can be individualized

communication/language sampling

scripted interactions that provide communication opportunities

communication/language sampling pros

highly correlated to natural contexts and can examine lots of different communicative behaviors

communication/language sampling cons (scripted and unscripted)

difficult to test receptive language and hard to ensure all areas of language are assessed

dynamic assessment

determining how support can impact performance (test, teach, retest or increased modeling/prompting); can but part of standardized assessment but cannot provide a standard score

global language assessments

PLS-5, CELF-P3, CASL-2

global language assessments strengths

overall picture, measures expressive and receptive, can allow for qualification of services

global language assessments weaknesses

unnatural, doesn't assess pragmatics very well

measures of language content (standardized assessments)

vocabulary (breadth and depth), basic concepts (quantity, size, color, shape, etc.)

breadth

how many types of words does the child know? (ex: # of nouns)

depth

how much does the child know about words? (definitions, relationships to other words)

measures of language content (language sample)

lexical diversity (NDW and TTR), retrieval

NDW

number of different words (in a language sample)

TTR

type/token ratio (# diff words / # total words)

measures of language form (standardized assessments)

identify the described phrase, produce the cued form

measures of language form (language sample)

Brown's stages; MLU; tense & agreement errors; uses of questions, negation, and complex sentences

measures of language use (standardized assessments)

ADOS-2 is gold standard for social communication (CASL-2 and TOPL-2 also have)

measures of language use (language sample)

observation of communicative intents (frequency, types, developmental sequence)

what are the 3 purposes for language intervention that PNG identifies?

change/modify the disorder by teaching new language behaviors or increasing frequency of language behaviors, teach compensation strategies/tools, and change the child's environment

how to intervene

consider the research, the client (and family), and your own experience

clinician directed

specific targets, clinician initiates, high target rate, responses are reinforced as behaviors

hybrid

specific targets, interactive, moderate target rate, responses are "communication in planned ways"

child centered

no specific targets, child initiates, no target rate, responses are communication

clinician directed approaches

drill, drill play, and modeling

drill

antecedent + behavior + reinforcement

drill play

motivation + antecedent + behavior + reinforcement + motivation

modeling

multiple models provided by clinician, then child is asked to use a form with similar cues (technically sometimes clinician directed)

what might you teach with clinician directed approaches?

types of skills and level of client's knowledge

to whom might you teach with clinician directed approaches?

someone compliant (older kid or adult)

how do you teach with a clinician directed approach?

clinician initiates, child responds, clinician reinforces

benefits of clinician directed approaches

repetition, know you're targeting a specific skill, child has already struggled with the "natural way"

drawbacks of clinician directed approaches

unnatural environment, makes generalization even harder

clinician directed approaches methods

indirect language stimulation (matching language to actions)

why does the technique of indirect language stimulation work?

joint attention, language mapping = increased understanding

indirect language stimulation

self-talk, parallel talk, imitations, expansions, extensions, build-ups/breakdowns, recast

parallel talk

saying out loud what the child is doing

self talk

saying out loud what you're doing

imitation

repeating what the child says (not the best because of wrong grammar)

expansion

making it grammatically correct (not adding information)

sequence

expansion gets longer each time

buildup/breakdown

chop up the components and make them into other short/simple but grammatically correct phrases

recast

changing statement into a question