Intro to Communication Disorders- Chapter 4:Typical Language Development
Communication:
Begins at birth
Is integral to a child’s social- emotional, cognitive, and adaptive development
Important to remember there is WIDE variability in ages of acquisition for language development.
Path of Language Development:
Early language development = rapid attainment of milestones in all major areas – phonology, morphology, syntax, semantics, and pragmatics.
There seems to be a “critical window” of language growth between birth and age 5 for optimum language development
Later language development = gradual and subtle improvements primarily in syntax, semantics, and pragmatics.
DEVELOPMENTAL SPEECH-LANGUAGE MILESTONES:
Birth-3 Months:
Startles at loud sounds
Seems to recognize mother’s voice and quiets if crying
Cries differently for different needs
Smiles when sees you
4-6 Months:
Tracks with eyes in direction of sound
Responds to changes in tone of your voice
Babbling sounds more speech-like with many different sounds
Chuckles and laughs
Vocalizes excitement and displeasure
7 Months - 1 Year:
Enjoys games like peek-a-boo and pat-a-cake
Listens when spoken to
Recognizes words for common items
Begins to respond to requests
Babbling varies more and includes long and short groups of sounds
Uses gestures to communicate
Imitates different speech sounds/familiar words
One - Two Years:
Emergence of first true words around one year, consistent vocal pattern with predictable meaning
Points to a few body parts
Follows simple commands and understands simple questions
Listens to simple stories, songs, rhymes
Points to pictures in a book when named
Says more words every month One - Two Years
Emergence of first true words around one year, consistent vocal pattern with predictable meaning
Points to a few body parts
Follows simple commands and understands simple questions
Listens to simple stories, songs, rhymes
Points to pictures in a book when named
Says more words every month
Uses some one- or two- word questions (“Go bye-bye?”)
Puts two words together (“more drink”), follow predictable combination patterns
Uses many different consonant sounds at the beginning of words
At 18 months, vocabulary could range from 5-20 words; by 2 years, vocabulary could vary from 100- 300 words
Children with larger vocabularies use a greater range of grammatical
structures.
Two - Three Years:
Understands differences in meaning (go/stop, up/down)
Follows two requests (“Get your shoes and bring them to me.”)
Listens to and enjoys hearing stories for longer periods of time
Has a word for almost everything in their environment
Lexicon: personal dictionary
Uses two- or three- words to talk about and ask for things (“Mommy eat cookie”)
Uses k, g, f, t, d, and n sounds with some consistency
Speech is understood by familiar listeners most of the time
Often asks for or directs attention to objects by naming them
Interactions between infant/caregiver:
Pre-language
Caregivers talk to infants as if they understand
Reciprocal relationship begins early, eye gaze
MOTHERESE: A term used in the study of CHILD LANGUAGE ACQUISITION for the way mothers talk to their young children. Its
features include simplified grammar, exaggerated speech melody, diminutive forms of words such as doggie, and a highly repetitive style. Occurs across languages and cultures.
Late Talker or Language Disorder?
Approximately 10% of toddlers are considered late talkers (i.e., 18 to 24-
month-olds who do not speak at all or two-year-olds with fewer than 50
words).
The stages of speech and language development are very consistent, but the exact age when a child hits these milestones varies significantly.
3. A child’s inborn ability to learn language, the amount and kind of language
the child hears, and how people respond to their communication
attempts -all can accelerate or slow down the speed of development.
A child who is a late talker but who exhibits a high level of understanding
and is able to communicate in other ways (i.e., gesturing, sign language) is probably on his own, normal timetable.
Reasons why a child may be a late talker:
Preemies—Babies born early may take a little longer to meet their milestones. Gauge a preemie’s progress from her due date, not her birth date.
Ear Infections—A child with recurrent ear infections could have compromised hearing, and thus delayed speech.
Different Timetable— Children may work to perfect one type of skill (i.e., walking) at the expense of talking.
It is important to remember that MOST TRUE LATE TALKERS CATCH UP BEFORE AGE 3.
Significant Early Speech/Language Milestones:
4-6 months- vocal play
Babbling (reduplicated and variegated) - around 6 months
10 months and older - jargon
First true words- around 1 year
Two word combinations- around 18-24 months
Three - Four Years:
Caregivers provide feedback and models such as repeating the child’ utterance in mature form or reformulating it. Model-repeat-restate.
At age 3, could have a vocabulary of 900-1000 words
Verbs begin to predominate uses some plurals and past tenses
Answers simple “who,” “what,” “where,” and “why” questions
Talks about activities at school or at friends’ homes, can recount the past and remember short stories because of increased memory
People outside of the family usually understand child’s speech
Uses a lot of sentences that have 4 or more words
Usually talks easily without repeating syllables or words
Produces early consonants /p, b, m, w, h, d, k/
Babbling:
Babbling behavior may predict later language ability as determined by:
Quantity of babbling
How MUCH a child babbles seems to matter (Positive correlation between # of babbling events during a specific time period & later language)
Diversity of babbling
How MANY different kinds of consonants & vowels they use seems to matter
Preschool Years- There appears to be a critical window for language
development during ages 3 to 5/6:
Use
Children introduce topics and maintain them for 2-3 turns with
caregivers
Begin to consider the needs of the listener
4-year-olds can tell simple sequential stories
Content/Vocabulary
2 yrs: 300 words
3 yrs: 900 words
4 yrs: 1,500 words
Form
About 90% of adult syntax is acquired by age 5
Mean length of utterance (MLU)
Articles, adjectives, auxiliary verbs, prepositions, pronouns, and adverbs are added
By the end of preschool, children form compound and complex sentences
DEVELOPMENTAL SPEECH- LANGUAGE MILESTONES—By age 5, a child should be able to:
Use many descriptive words spontaneously, adjectives and adverbs,
vocabulary of about 2000 words
Understand common opposites: big-little, hard-soft, heavy-light
Count to ten
Use completely intelligible speech, in spite of articulation problems, produces /f, v, y/l
Repeat sentences as long as nine words
Define common objects in terms of use (hat, shoe, chair)
Follow three step commands
Understand simple time concepts: morning, afternoon, night, day,
later, after, while.
Uses future, present and past tense appropriately
WHEN IS A SOUND ERROR A CONCERN?
Intelligibility Guidelines for SLP’s:
2 year olds (25-50%)
3 year olds (70-80%)
4 year olds (nearly 100%)
SCHOOL AGE:
5 years & up:
Intelligible speech with:
Some misarticulating
Words that are different from adult form
Strong correlation between phonological development and later reading success
Speech skills should be considered a significant variable that influences reading and spelling acquisition.
DEVELOPMENTAL SPEECH- LANGUAGE MILESTONES—By age 6, a child should be able to:
Use speech that is completely intelligible and socially useful
Tell one a rather connected story about a picture, seeing relationships between objects and happenings
Vocabulary of 1500- 2100 words
By age 7, a child should be able to:
Handle opposite analogies easily: girl- boy, man-woman, flies- swims, etc.
Understand such terms as: alike, different, beginning, end, etc.
Tell time to quarter hour
Do simple reading activities and write or print many words
DEVELOPMENTAL SPEECH- LANGUAGE MILESTONES— By age 8, a child should be able to:
Use: complex and compound sentences
Have: few lapses in grammatical constrictions-tense, pronouns, plurals
Have: well established speech sounds, including consonant blends
Read: with considerable ease and write simple compositions
Use: appropriate social niceties in his speech in appropriate situations
Carry on: conversation at adult level
Follow: fairly complex directions with little repetition
Have: well developed time and number concepts
SCHOOL AGED
Use
Conversational skills develop
Make relevant comments and adapt roles and moods
Teens demonstrate more affect and discuss topics infrequently mentioned at home
Number of turns on topic increases
Interrupting increases but function is to move the topic along
Narratives gain additional elements
Content
First graders
Expressive vocabulary of about 2,600 but may understand 8,000 roots and 14,000 with derivations
Receptive vocabulary grows to 30,000 by 6th grade and 60,000 words in high school
Definitions become more dictionary-like
Multiple word meanings
Figurative language
Form
Gradual slowing of language form development
Sentences expand with conjunctions
Comparatives (-er) and superlatives (-est)
Variations of compound and complex sentences
Morphological development focuses on adding prefixes and suffixes to change word meaning (-er, un-, dis-, -ment, -tion).
SECONDARY SCHOOL YEARS
Listen effectively to a speaker’s intent and critically evaluate, distinguish and determine the following:
Facts from opinion
Main ideas
Nature of message (informative, propaganda, humor, persuasive) in relationship to its source
Appropriately use words, pronunciation, voice, grammar and gestures for the following purposes:
Express ideas and feelings clearly and concisely
Express, describe, and defend with evidence various points of view, including the student’s own
Ask questions effectively
Give concise and accurate directions
LANGUAGE IMPAIRMENT (LI/SLI)
Disorder primarily characterized by issues with language, 4-7% of all preschool children
Can impact any or all language areas (form, content, use), many have processing difficulties, word retrieval problems and limited vocabulary
Language problems NOT due to deficits in hearing, oral structure/function, general intelligence- not due to any obvious causes!
Risk factors for LI: male, ongoing hearing problems, Genetic factors
Sustained attention deficits in children with LI, issues with working memory, executive function
Late talkers at 24-31 months still have weaknesses in language in late adolescence
Children with LI have poorer outcomes in literacy, mental health, and employment
SOCIAL COMMUNICATION DISORDER (SCD)
Relatively new term/disorder in the field (DSM-V, 2013)
Similar to ASD but do not have repetitive movements or fixated interests.
Persistent difficulty in the social use of verbal and nonverbal communication
Characteristics may include difficulty: adjusting communication style to varied partners or situations, understanding and regulating emotions, understanding perspective of others (Theory of Mind), literal interpretations, understanding and adhering to conversational rules, understanding nonverbal and vocal tone.
ASSOCIATED DISORDERS AND RELATED CAUSES
Intellectual disability
Learning disabilities
Autism spectrum disorder
Brain injury
Neglect and abuse
Hearing loss
Fetal alcohol syndrome and drug-exposed children
Other language impairments
INTELLECTUAL DISABILITY
Substantial limitations in intellectual functioning
Significant limitations in adaptive behavior
Originates before age 18
Severity can be based on IQ and ranges from mild to profound
Newer severity ratings are based on the amount of assistance needed for daily tasks
Causes can be biological or socioenvironmental
Various processing deficits
Lifespan Issues
Infants may be identified early (at birth)
Early intervention is best
Severity determines placement in educational programs
Only children with the most profound ID accompanied by other disabilities are placed institutions
In adulthood, living and working arrangements vary widely
Language Characteristics:
Children with Down syndrome and Fragile X have moderate to severe language delays
Language comprehension and/or production can be below the level of cognition
Children with ID produce shorter, more immature forms
LEARNING DISABILITIES
Heterogeneous group of disorders manifested by significant difficulties in the development and use of listening, speaking, reading, writing, reasoning, or mathematical abilities
>75% have difficulty learning and using symbols
3% of all individuals have LD
Possible biological and neurological factors
Many Learning Disabilities are language based
Lifespan Issues:
As preschoolers, may exhibit little interest in language or books
Linguistic demands of the classroom are well above oral language abilities
Many require special education
Can be successful in the regular education classroom with adaptations
Some seem to outgrow aspects of their disability although some require lifelong adaptations
Other adults continue to have difficulty
AUTISM SPECTRUM DISORDERS
Motor patterns – rocking, fascination with spinning objects
Certain routines, objects, foods, clothing
Adverse reactions to some sounds or textures
Incidence is 1 in 88 children
Boys are 5 times more likely to exhibit ASD characteristics
Most have IQs above 70
25% also exhibit ID
Primary causes are biological
Eye and face detection processing may be delayed
Overall processing is gestalt
NDE Rule 51- Must demonstrate deficits in each of these areas:
Atypical development of social competence
Atypical development of communication
Atypical range of interests and patterns of behavior
School-aged children may be included in regular education classes or be in special education classes depending on severity
People who are mildly involved live on their own and hold competitive employment
Language Characteristics of ASD:
Communication problems are one of the first indicators
25-60% remain nonspeaking
Often lack typical intonation
Immediate or delayed echolalia
Deficits in pragmatics persist
Those who have good language might still misinterpret the subtleties of conversation
BRAIN INJURY
Can result from TBI, stroke, congenital malformation, convulsive disorders, or encephalopathy
Among children, the most common form is TBI
TBI: Diffuse brain damage as a result of external force
Approximately 1 million children and adolescents in the US have experienced TBI
Variables include site and extent of lesion, age at onset, and age of the injury
Exhibit a range of cognitive, physical, behavioral, academic, and linguistic deficits
Social disinhibition
Lifespan Issues
May be unconscious after the accident
Disorientation and memory loss
Physical disability and personality changes
Neural recovery can be unpredictable and irregular
Young children can recover quickly but experience difficulties learning new information and may exhibit severe, long- lasting problems
Older children have more to recover but less new information to learn
May be subtle cognitive/social impairments
Language Characteristics:
Language problems are evident even after mild injuries
Some deficits (pragmatics) remain long after the injury
Language comprehension and higher functions such as figurative language and dual meanings are also often impaired
Language form is relatively unaffected
Word retrieval, naming, object descriptions, and narration may be difficult
FETAL ALCOHOL SYNDROME AND DRUG EXPOSED CHILDREN
One in every 500-600 live births is a child with FAS or other fetal drug exposure
Low birth weight and CNS problems
Hyperactivity, motor problems, attention deficits, and cognitive disabilities
Mean IQ is borderline ID
Effects of drugs on the fetus vary with drug, manner of ingestion, and the age of the fetus
Those exposed to crack have low birth weight, small head size, and are jittery and irritable
LIFESPAN ISSUES:
Caregiver-infant bonding may be disrupted
Can result in poor academic achievement and antisocial behavior
Language Characteristics:
FAS: Delayed development of language, echolalia, and comprehension problems
Drug exposure leads to few vocalizations, inappropriate gestures, and language deficits
As preschoolers, they exhibit word-retrieval problems, short sentences, and inappropriate turn taking and topic maintenance
Problems with abstract meanings, multiple meanings, and temporal and spatial terms
They are behind their peers in reading and other academic tasks
LANGUAGE & PHYSICAL DEVELOPMENT
Physical development effects Communication success:
Adolescents with obvious physical disability or delay in development or acceleration in development have a disadvantage in peer acceptance and peer popularity.
Effect
Preoccupation with bodily changes
Feel uncomfortable grouped with peers who have already begun those changes
Desire conformity
Intolerant of noticeable developmental differences
These factor greatly affect how adolescents perceive themselves and communicate with others.
EDUCATIONAL IMPLICATIONS
Communication disorders carry the potential to isolate individuals from their social and educational surroundings.
When children have muscular disorders, hearing problems or developmental delays, their acquisition of speech, language and related skills is often affected.
EARLY INTERVENTION MAY BE THE KEY TO FUTURE ACADEMIC SUCCESS
ASSESSMENTS FOR LANGUAGE DISORDERS
Purpose: distinguish between clients who have a language disorder vs. those who do not (dialectical differences, English language learners)
Should help determine need for services, type of services, goals to be worked on, interventions to be implemented
Comprehensive examination of language skills should look at all five elements of language.
Language is one of the most difficult domains of human behavior to assess
Factors:
definition of what language is/includes
sequence and timing of language development
multiple domains to assess
nature of disorder can vary greatly
cultural influences
LANGUAGE TESTING
Language evaluation should include a comprehensive standardized language assessment first (CELF-5, CASL, PLS-5) to determine weaknesses in any specific language domain.
Then more evaluation may be needed in weak areas (i.e. syntax, semantics, pragmatics) with other formal and informal measures.
Dynamic assessment includes probing to explore a client’s ability to modify behavior, test-teach-test paradigm.
STANDARDIZED LANGUAGE TASKS OFTEN INCLUDE:
Vocabulary- receptive and expressive, definition tasks, synonyms/antonyms
Syntax/Morphology- sentence imitation or completion, elicit specific forms with picture/story cues
Comprehension- following multi- step directions, answering nquestions at various levels of difficulty
Figurative language- multiple meaning words, idioms
Verbal expression- narrative/story telling, tell steps to a task, describe similarities/differences
Pragmatics- set up social situations with verbal and picture cues
LANGUAGE ASSESSMENT COULD INCLUDE:
Referral source
Screening
Case history and interview (Figure 4.2, p. 96 in text)
Observation (Figue 4.3, p. 97 intext)
Formal standardized testing (Figure 4.4, p. 98 in text)
Language sample/elicitation tasks (Figure 4.5, p. 99 in text)
Narrative/conversation tasks
Observational checklists
OBJECTIVES OF INTERVENTION
Client should show improvement not just in clinical setting; progress should generalize to real-world environments.
Client should not have to think about what was learned; in large part their response should be automatic.
Client must be able to self- monitor their skills; listen to/observe themselves and make corrections as needed.
Client should make optimum progress in the minimum amount of time.
Intervention should be sensitive to the personal and cultural characteristics of the client.
VARIOUS TYPES OF INTERVENTION
Direct: individual, small group
Consultative- teach skills to teacher, care giver
In natural environments (home, classroom, vocational sight, etc)
Counseling
Tele-practice
GENERAL PRINCIPLES OF TEACHING BEHAVIOR
Break down desired behavior into sequenced and manageable goals/steps
Model desired behavior for client.
Cue the client to respond.
Respond to the client in the form of reinforcement and/or corrective feedback.
Plan for generalization of the learned behavior to everyday environmental use.
TARGET/GOAL SELECTION
Consider developmental sequence
Consider client’s personal needs/preferences
Break down desired behavior into sequenced and manageable goals/steps (task analysis)
CRITERION FOR BEHAVIORAL OBJECTIVES
A. Actor: Who is expected to do the behavior?
B. Behavior: What is the observable and measurable behavior?
C. Condition: What is the context or condition of the behavior?
D. Degree: What is the targeted degree of success?
Johnny will correctly spontaneously produce the initial /k/ sound when naming pictures of noun/verbs with 90% accuracy.
Communication & Development Overview
Begins at birth; integral to social-emotional, cognitive, and adaptive development.
Wide variability in acquisition ages.
Critical window for language growth: Birth to age 5.
Early development: Rapid milestone attainment in phonology, morphology, syntax, semantics, and pragmatics.
Later development: Gradual improvements in syntax, semantics, and pragmatics.
Developmental Speech-Language Milestones
Birth–3 Months: Startles to loud sounds; recognizes mother's voice; different cries for different needs; smiles.
4–6 Months: Tracks sounds; responds to vocal tone; babbling (vocal play) becomes speech-like; chuckles/laughs.
7 Months–1 Year: Enjoys peek-a-boo/pat-a-cake; recognizes common word names; gestures; imitates speech sounds; variegated babbling.
1–2 Years:
First true words emerge around 1 year.
18 months: 5–20 words; 2 years: 100–300 words.
Puts 2 words together ("more drink"); points to body parts/pictures; follows simple commands.
2–3 Years:
Uses 2–3 word combinations; understands differences (go/stop, up/down).
Follows 2-step requests; speech understood by familiar listeners most of the time.
3–4 Years:
Vocabulary of 900–1,000 words; uses 4+ word sentences.
Answers simple who/what/where/why questions; understood by outside listeners.
Produces consonants: /p, b, m, w, h, d, k/.
By Age 5:
Vocabulary of ~2,000 words; counts to 10; uses present, past, and future tenses.
Follows 3-step commands; repeats sentences up to 9 words; completely intelligible (/f, v, y, l/).
By Age 6: Vocab of 1,500–2,100 words; completely intelligible; tells connected stories about pictures.
By Age 7: Handles opposite analogies; tells time to quarter hour; reads/writes simple words.
By Age 8: Uses complex/compound sentences; carries adult-level conversation; consonant blends established.
School-Age & Secondary Years
School-Age: Receptive vocabulary expands to ~30,000 words by 6th grade and ~60,000 by high school; morphological focus on prefixes/suffixes (-er, un-, dis-, -tion).
Secondary: Critical evaluation of speakers (fact vs. opinion); defends viewpoints with evidence.
Key Concepts & Early Markers
Motherese: Simplified grammar, exaggerated melody, repetitive style, diminutives (e.g., "doggie"); universal across cultures.
Babbling: Quantity and consonant/vowel diversity predict later language ability.
Speech Intelligibility Guidelines:
2 years: 25–50%
3 years: 70–80%
4 years: Nearly 100%
Late Talkers vs. Language Impairment
Late Talkers: ~10% of toddlers (18–24 mos with no words, or 2-year-olds with <50 words). Most catch up before age 3.
Reasons: Prematurity (gauge by due date), recurrent ear infections, focus on motor skills.
Language Impairment (LI/SLI): Affects 4–7% of preschoolers. Deficits not due to hearing, oral structure, or IQ deficits. Risk factors: male, hearing problems, genetics.
Social Communication Disorder (SCD): Persistent difficulty with social/pragmatic use of communication without repetitive behaviors or fixated interests (DSM-V).
Associated Disorders
Intellectual Disability (ID): Limitations in intellectual and adaptive functioning originating before 18; language production/comprehension often below cognitive level.
Learning Disabilities (LD): >75% have symbol learning difficulties; language-based.
Autism Spectrum Disorder (ASD): Deficits in social competence, communication, and restricted interests. Pragmatic deficits, echolalia, atypical intonation.
Brain Injury (TBI): Pragmatics and word retrieval impaired; syntax/form relatively preserved.
Fetal Alcohol Syndrome (FAS) / Drug Exposure: Delayed language, short sentences, word retrieval issues, CNS/attention deficits.
Assessment & Intervention
Assessment Steps: Case history, screening, observation, formal standardized testing (CELF-5, CASL, PLS-5), language sample, dynamic assessment (test-teach-test).
Intervention Goals: Generalization to real world, automaticity, self-monitoring, efficiency, cultural sensitivity.
Behavioral Objective Criteria (ABCD):
Actor: Who does the behavior.
Behavior: Observable/measurable action.
Condition: Context/situation.
Degree: Targeted success rate (e.g., 90% accuracy).