DLD

• how many children have language disorders

  • 7-8%

• how many continue to have difficulties with lang into adulthood

  • 70% of those diagnosed at age 5

Factors that result in behavioral features

• genetic factors

• neurobiological factors - anatomy/structures and functions of the brain

  • language in the brain

  • brain structure and function

  • electrophysiological measures

• environmental factors

• cognitive factors

  • auditory processing

  • limited processing capacity

  • procedural deficits

• comorbidity

Descriptive Developmental Approach/model

• tenets of the model

  1. we don’t always know the etiology

  2. most important info is lang status in form, content, and use

  3. look at normal

Purposes of Intervention (NOT to “cure” child)

1. change or eliminate underlying problem

2. change nature of disorder

3. teach compensatory strategies

4. change the child’s environment

Zone of Proximal Development

1. learner can do unaided

2. what they can do with help

3. what they cannot do

• The goal is step 2: What they can do with help

• ex: don’t target a phoneme that they child should not have already developed

continuum of naturalness

• if you want to encourage generalization, do you want a more natural or less natural setting? MORE NATURAL

• most natural - child-centered

• least natural - clinician directed

• child centered: facilitated play

• hybrid:

  • prelinguistic milieu teaching

  • responsivity education

  • cycles approach

  • focused stimulation

  • script therapy

  • structured play

  • combining hybrid activities with explicit instruction

  • using conversation

  • using narratives

• clinician directed: Drill, drill play

EBP

• external evidence, internal evidence, client/family preferences

• research, clinical experience, patient preferences

• steps

  • ask a question

  • search for evidence

  • critically appraise evidence

  • make a decision - integrate the evidence

  • evaluate performance after acting

Treatment

• communication temptation/prompting

  • eliciting language from the child

  • ex: putting an empty cup in front of child so they ask for water

• balanced turn taking

  • allow response time

  • child leads production, clinician responds

  • more effective than asking questions

• 2 things we always work on during treatment

  • pragmatics

  • meta skills

    • phonological awareness

    • editing

    • organization

    • self regulation

    • executive functioning

Working with Parents

• help parents model interaction behaviors

  • turn taking

  • imitation

  • establishing joint attention

  • developing anticipatory sets - ex: “ready, set, ….”

• help parents be aware of infant communication patterns

  • respect - tell them we know it’s hard

  • enjoy their children

• help parents develop monitoring skills

  • be sensitive

Language Facilitation Techniques

• self talk - describe your own actions

  • “I’m pushing the train on the track!”

• parallel talk - describe the child’s actions

  • “Oh no, you made the train crash”

• imitations - imitate what the child says

• expansions - add semantic and grammatical info to be acceptable adult production

  • C: “Dolly drink” E: “Yes, the dolly is drinking”

• extensions - add semantic information

  • C: “dolly drink” E: “The dolly is drinking juice”

• build ups and breakdowns - expand child’s utterance and then break it down into phrases

• recast - expand child’s utterances into a different type or more elaborated sentence

  • C: “puppy play” E: “Is the puppy playing?”

Intervention based on age

• early intervention: 0-3 infant

  • What would be appropriate for a child who cannot talk?

    • prelinguistic milieu teaching

    • communication temptations

• Younger school aged children, preschool, early elementary

  • language modeling

  • drill play

  • language facilitation

• Older child, adolescent

  • compensatory strategies

  • meta skills

  • narratives

continuum of discorse - oral to literate

• conversation

• narratives

• expository

Intervention - PLAY

• drill play (clinician directed)

  • ex: letting child make a move in connect 4 every time they hit a target

• structured play (hybrid) - structure to an activity

  • ex: playing kitchen with specific food toys

• facilitated play (child centered) - letting child take lead and clinician facilitates communication

  • ex: playing with play dough

prelinguistic milieu teaching (PMT)

• goal - establish and increase nonlinguistic acts

• prompts/communication temptations

• teaching child intentionality

Script therapy

• reduces cognitive load using familiar context

• model script and violate the script and see what child does

• predictable for children

• culturally responsive approach

• can carry over to the home

Service delivery models

• clinician model - therapy in the clinic room

• classroom based - therapy happens in classroom

• collaborative - SLP and classroom teacher work together (SLP and teacher co-teach classroom)

• consult - teacher consults with SLP on what the child might need

• Response to Intervention (RTI) - tiers (kids in RTI doesn’t have IEP)

  • tier 1: child receives normal classroom instruction

  • tier 2: child receives instruction in small groups

  • tier 3: child receives more intense instruction from SLP

Culture

• uncertainty avoidance - how does a culture react to unknowns

• individualism vs collectivism

• power distance - how does the culture treat authority figures

• cultural humility

• cultural responsiveness

• continuum

  • destructiveness

  • incapacity

  • blindness

  • pre-competence

  • advanced cultural competence