Child Language Disorders
Unit 1 Beginning Research and SLI
Research: Evidence Based Practice
Research
- Started in the medical community
- Based on scientific evidence
- Must be meaningful, purposeful, and relevant
- What does the literature and date tell is best practice?
- Helps us to make informed decisions
- Must evaluate the quality of the research
Client Preferences
- What is relevant to the client and family in terms of goals
Clinician Expertise
- Your knowledge applied to the individual case
Evidence Based Practice
Randomized Controlled Trial (RCT)
- Large studies across multiple data sites with large numbers of participants
- Investigates a particular protocol or treatment
- Results can be generalized to the population
- Drawback
- Ethically responsible research
- Heretrogeneity of the disordered population
- Language is a complex area and coordination of research would be difficult
- High cost
- Started with swallowing for SLP
- Ron Gillam (Utah State University)
- Research in language
- Narrative language
Basic and Applied Research
- Basic Research: Theory Driven Research
- Answers the WHY?
- Builds Theories
- Example → Nativism: Noam Chomsky
- Applied Research: clinical relevance
- Answers a more specific question
- Solutions to Real World Problems
- Example: DAVE, S., MASTERGEORGE, A. M., & OLSWANG, L. B. (2018).
Motherese, affect, and vocabulary development: dyadic communicative interactions
in infants and toddlers. Journal of Child Language, 45(4), 917–938.
doi:10.1017/S0305000917000551
Descriptive and Experimental Research
- Students want Applied and Experimental research → compare groups to generalize to the population
ASHA Journals (Peer Reviewed)
- American Journal of Speech-Language Pathology (AJSLP) *ideal for reaction paper
- Applied articles, some basic
- Applied research
- American Journal of Audiology (AJA)
- Same as AJSLP, but for Audiologists
- Applies articles, some basic
- Language, speech and hearing services in the schools (LSHSS)
- Applied articles, no basic or theoretical research
- Journal of Speech, language, and hearing research (JSLHR)
- Basic or theoretical articles, some applied articles
- Most powerful journal
- The ASHA Leader
- Topical reviews of current trends in speech-language pathology/audiology
- Not a very scientific publication, however it is peer reviewed
- Perspectives
- Special Interest Groups (19) in different topic areas
- Reaction Paper Assignment: Due October 16th 11:59pm 20pts
- Pick and read ONE experimental (data) journal article on any topic related to childhood language disorders (assessment and/or intervention) from our ASHA Journals (American Journal of Speech Pathology, Language, Speech-Hearing Services in the Schools, American Journal of Audiology, Journal of Speech-Language Hearing Research) (See ASHAwire).
- The article should be published between 2019-2026
- Your reaction paper cannot be over any journal article I have on my course reserves.
- This is an independent project! Do not share journal articles among class members regarding this assignment. After you read the article, summarize the article in your OWN words.
- At the end of your paper, you should then reflect on the article (what you liked about the article, what you did not like about the article, how will the article help your clinical assessment when you become an SLP or Aud). Always include an APA citation at the top of your paper with doi number (I will explain).
- Applied Article
- Language Speech and Hearing Services in the Schools
- American Journal of Speech-Language Pathology/Audiology
- Basic Article
- Journal of Speech, Language, and Hearing Research
- Experimental study with group comparisons and/or pre and post testing
APA References
Wagner, B. T., & Henry, M. H. (2019). Investigating the impact of linear order on the reconstruction of multiple symbol utterances. American Journal of Speech-Language Pathology, 41(4), 124-136. doi: 723456-97
Summarize the article
Then, provide a reaction to the article (likes, dislikes, implications for clinical practice)
Language: Domains
- 5 Domains
- Pragmatics (need definitions)
- Morphology
- Syntax
- Phonology
- Semantics
- Morphosynaptic development
- Bloom & Lahey
- Form (phonology, morphology, & syntax
- Content (semantics)
- Function/use (pragmatics)
- All of the domains are interconnected in some way, so a primary area of deficit can impact other domains in language
- A language disorder is evident if a child falls -1.5 standard deviations below the mean in one or more of the above areas. (-1.25 SD, there is a possibility of a language disorder)
- More than 1 assessment tool (standardized test, criterion test), typically ⅗
- During assessment you determine the strengths and weaknesses in all 5 domains
- Certain populations will have deficits in certain areas (e.g., autism will have problems in pragmatics & semantics)
- When a language disorder is exhibited the same developmental trajectory is followed, but the acquisition progresses at a much slower rate (Big Point!)
Language Disorders
- “Disorder”
- Impairment
- Delay
- Late talkers
- Communicatively impaired
- There is no agreement on these terms, no uniform descriptors
- Disorder Vs. Delay
- A disorder is more severe than a delay
- You can grow out of a delay
- Delay is often used for young children
- Wait and see can result in a lack of necessary intervention, leading to a more significant problem
- Late-Talkers
- Language acquisition is slow
- Are susceptible to language disorders
Specific Language Impairment (SLI)
- New term - Developmental Language Disorder (DLD)
- No consensus in terminology → you may see both terms in research
- Definition: A language disorder that occurs across the lifespan. Limitations in receptive and/or expressive language. Normal in every way, except in the area of language, normal IQ, normal hearing, no CNS anomalies
- Children that know what they want to say but cannot come up with the words
- SLI/DLD occurs across the lifespan but could be diagnosed in adolescence or adulthood.
- Typically, a disorder of preschool age children
- Residual SLI
- Persists across the lifespan
- Heterogeneous population
- Neurobiological in nature
- Some problem in the neurological development anatomical/physiological
- Main problem is in morphosyntactic development
- Grammatical morphemes
DLD/SLI
- IQ
- Normal IQ: 100
- New Numbers from NIH
- Normal is as low as the 70 range (low normal)
- IQ and Language are typically congruent
- We want to see individuals with a gap in their IQ and Language performance
- There is an increase in the number of individuals eligible for services
- Medical History
- No Evidence of a seizure disorder
- No otitis media
- No oral anomalies
- Oral motor function is within normal limits
- Range rate coordination of tongue is normal
- No impairment in reciprocal social interactions
- Some subtle motor problems
- Genetically linked
- 30% of DLD children have parents or siblings with a similar disorder
SLI/DLD
-Prevalence
- 7.2% of the population
- 70-80% of DLD/SLI will have reading and writing problems later in life
- Most children will never make a total recovery
- Typically diagnosed in the preschool years
- Shorter utterances with omissions, many missing grammatical morphemes (especially bound)
→ Verbs are more difficult than nouns, as they are more abstract
- Problems with articles, regular past tense, -ed, -ing
- Many Children with DLD will be passive communicators
- Difficulty initiating communication
- Not assertive, preventing more communicative interactions
DLD/SLI: Semantic Characteristics
- Specific Characteristics for DLD
- Semantics
- Don’t produce first words until 23 months of age
- At 24 months only 17 words are produced, compared to 200 words by TD children
- Reduced vocabulary (receptive and expressive)
- Difficulty with Fast Mapping, they will require repeated exposure to novel words to \
learn them
- Combining words is difficult (semantic relations)
- Acquisition of new words is slow and diversity of words is poor (low TTR)
- Less knowledge of word meaning
- Mazes - false starts, hesitations, dysfluencies and repetitions
- Poor processing, trying to get more time to figure out what to say
- TTR is obtained through a language sample, a criterion - referenced procedure
- Phonology
- Typically have a sound acquisition problem (80%)
- The phonological system may be completely intact
- Problems with patterns of sounds
- Phonological awareness
- Explicit awareness of the sound structure of our language
- Metalinguistic ability (thinking about language)
- Rhyming, blending, segmenting (syllables)
- Related to future problems with reading and writing difficulties
- Receptive and expressive
- Looks at the word and syllable level
- Sound/syllable/word segmentation is correlated with reading
- Phonological awareness is at the words level (syllable) phonemic awareness looks at the smaller sound this is better for language
- Phonemic awareness assesses only sounds in words
- Highly correlated to reading development
- Developmentally more difficult than phonological awareness
- Receptive: Phonological awareness
- Expressive: Acquisition of the sound system
- Hallmark characteristic is that children have difficulty with morphology and syntax : test question
DLD
- Specific Characteristics for DLD
- Morphology and syntax (Morphosynatactic Dev.) most common Language disorder
- Shorter and less complex
- Leave off articles, plural –s
- Problems with pronouns
- Difficulty with verbs, copula
- Prepositions
- Irregular past tense
- The parts of speech that are not stressed
- Grammatical morphemes are short in duration, have a reduced intensity level, and have
a lower pitch
- Is it easier or harder for children to count the syllables or recognize the sounds (harder)
- If you see a child with phonological problem and language problems → work on language problems first
Pragmatics
- DLD is typically not a pragmatic disorder
- Lack of initiating (less frequent opportunities for initiation)
- Fewer acknowledgments of others that are speaking
- Try to gain attention at inappropriate times
- Switch topics suddenly
- Timing and turn-taking in conversation
- May interrupt frequently
- Problems with narratives/retelling a story; may omit parts, don’t use cohesion devices (and, then, etc.)
- Less responsive to a peer’s attempt to initiate conversations
- No blunt social/pragmatic deficit with children who have DLD
Causes of Language Disorders
- Noam Chomsky
- Theory of language Acquisition
- Language is innate
- Modular system
- If children have language problems, it is because of a problem with the module
- Linguistic Rules
- Deep structure (embedded in the brain)
- Surface Structure (what you hear)
- Problems with language acquisition may be related to the deep structures of language
Causes of Language Disorders - Theories
- Information Processing Theory
- Most popular contemporary view
- Limited capacity system that processes, stores, and retrieves information
- Working memory
- Short term memory
- Long term memory
- Episodic memory
- Working Memory
- Popular in the literature in relation to language
Overview Of Working Memory
- Working Memory is a limited capacity system that holds information for a short amount of time
- It is an active system that processes and manipulates information
- Foundational for cognitive functions such a reading or holding a conversation
- Contains three subsystems controlled by the central executive
- phonological loop
- Visuospatial sketchpad
- Episodic buffer
Working Memory
- *Working memory
- Process, store, and manipulate information as it is received auditorily and/or visually
- Alan Baddeley (University of York)
- Expert in the area
- Information is held in the memory system while it is manipulated
- Ex. Recall the last word in the sentence and tell me if it is true or false
- Related to academic success, vocabulary development, language development, reading development, spelling, writing
- Short - term Memory
- Processing and storing without any computation
- Ex. “Say these numbers after me..”
- Long - term Memory
- Responsible for storing information for longer periods of time
- Episodic Memory
- Autobiographical information
- Personal experiences
- Supported by long-term memory
- Components
- Central Executive
- Phonological loop
- The Articulatory Rehearsal Mechanism
- Phonological Store
- Episodic Buffer
- Visuo-Spatial Sketchpad
- Recycles visual and spatial information
- A visual and spatial information store
- Some can take visual information and recycle into the phonological loop
Assessment - Criteria for Diagnosis
- Possibility of a language disorder at or below -1.25 SD of the mean
- At or below -1.5 SD of the mean there is a known language disorder
- NIH recommends ⅗ failed standardized (norm-referenced) tests and/or criterion referenced measures (at or below the 10th percentile)
-Standardized Tests
- Based on the performance of age-matched peers
- Administered in a standardized manner, following the exact protocols prescribed by the authors
of the test
- Developed and normed based on a large population of typically developing people (100 or more
people age group)
- May include normative data for atypical (disordered) populations
Informal Criteria for Diagnosis
- Criterion-Referenced Measures (Informal)
- Assess very specific language and
communicative abilities
- You have to achieve a certain level of proficiency
- Included a predetermined level of proficiency
- There should be specific protocols you follow
- Language sampling
- TTR: Type Token Ratio (language diversity)
- ASHA does not support informal assessment
Type Token Ratio (know how to do this)
- Vocabulary diversity
- ~46% of words should be different
- # of different words divided by # of total words
- Ball, house, my, home, ball, no, yes, house, ball, table
- # of different words: 7
- Total # of words: 10
- TTR: 0.70
Ex. I pet dogs. I want to playing. I playing dog. I want to play
# Different words: 8
Total words: 14
TTR: 57%
A language sample was obtained by johnny the language sample was 1 to 3 words the clinician calculated the TTR. Johnny had 57% and was in a normal range.
TTR does measure semantic development (vocab)
Mean Length of Utterance (MLU) (know how to do this)
Assess morphostatic development morphemes and syntax
The child is 3 years and 6 months (42 months)
- I eat spinach, My pizza tonight, Go home, I don’t like you, Goodbye
- Free Morphemes: 13
- Bound Morphemes: 1
- Total Morphemes: 14
- # of Utterances: 5
- MLU: 2.8 (Brown’s Stage 3) (normal)
Ex. My new cats. I like pizza. We will play tonight. Sing a pretty song. Will you go to the store
(child 36 months)
- Free Morphemes: 20
- Bound Morphemes: 1
- Total Morphemes: 21
- # of Utterances: 5
- MLU: 4.2 (Brown’s Stage 3) (normal)
Ex.
- The larger the language sample, the more accurate the representation of the client’s ability
Language Sampling
- Most common/popular tool
- Systematic Analysis of Language Transcripts (SALT) - Jon Miller (University of Wisconsin - Madison)
- Software that analyzes language samples
- Mean Length of Utterance (MLU)
- Total number of morphemes divided by the total number of utterances
- Free Morpheme - a word that can stand alone, a root word (ex. Bike, house, gym)
- Bound Morpheme - a prefix or suffix that can’t stand alone (ex. -ed, -s, -ing)
DLD: Assessment
- Assessment of DLD
- Standardized Tests
- Most agencies require standardized assessments for making a diagnosis
- Must be at or below -1.5 SD or the 10th Percentile
- Structured Photographic Expressive Language Test - 3rd edition (SPELT -3)
- Ages 4:0 through 9:11 years
- Assesses morphology and syntax
- Barry’s Favorite know this
- The Test of Nonverbal Intelligence - 4th edition (TONI-4)
- Ages 6:0 - 89:11
- Assesses cognitive ability without being language
based
- Measures nonverbal (fluid) intelligence, specifically
abstract reasoning and problem-solving ability without relying on language
Have to have normal intelligence
-We can’t give an test IQ
- Comprehensive Test of Nonverbal Intelligence - 2nd edition (CTONI-2)
- Ages 6 - 89:11
- Assesses cognitive ability without being language based
- The Test of Language Development - Primary 5th edition (TOLD-P5)
- Ages 4 - 8:11
- Picture Vocabulary, Oral Vocabulary, Relational Vocabulary, Sentence Imitation,
Syntactic Understanding, Morphological Completion, Word Discrimination, Word Articulation, Word Analysis
Many SLPs use this test looks are so many areas.
- The Test of Auditory Comprehension of Language - 4th edition (TACL-4)
- Receptive language test
- 3 subtests
- Single vocabulary words
- Receptive grammatical morphology
- Compound complex sentences
- Ages 3 - 12:11
- The Peabody Picture Vocabulary Test - 5th edition (PPVT-5)
- Receptive one word vocabulary (English nouns and verbs)
- 2:6 - 90+
- The Expressive Vocabulary Test - 3rd edition
- Expressive one word vocabulary
- 2:6 - 90+
- The Receptive One Word Picture Vocabulary Test - 4th edition (ROWPVT-4)
- One word receptive vocabulary
- Ages 2 - 70+
- The Expressive One Word Picture Vocabulary Test - 4th edition (EOWPVT-4)
- One-word expressive Vocabulary
- Ages 2-70+
- The Comprehensive Test of Phonological Processing - 2nd edition (CTOPP-2)
- Ages 4-24:11
- Measures phonological processing and memory
- Blending words
- Phoneme isolation
- Blending nonwords
- Memory
- Rapid digit naming (word fluency)
- Rapid letter naming
- Nonword repetition: helps to diagnose children with language
Disorders
- Children with a language disorder they will do well with 1 or 2 syllables but 3-6
syllables they will struggle
- The Goldman - Fristoe Test of Articulation - 3rd edition (GFTA-3)
- Ages 2-21; 11
- Target: bubbles
- The Khan-Lewis Phonological Analysis - 3rd edition
- Companion to the GFTA-3
- Ages 2-21; 11
- Cluster reduction,
- Phonological processes
- 80% of children with
- The Clinical Assessment of Articulation and Phonology - 2nd edition
(CAAP-2)
- Ages 2:6 - 11;11
- Criterion Referenced Assessment/Measurement
- Tests that have not been normed for comparisons
- You predetermine the level of performance/criteria (ex. 70% accuracy with all English
consonants)
- Not all criterion referenced instruments are published (ex. In a 15 minute period, Jay
will present me with a toy 7 times.)
- The Rosetti Infant Toddler Scale
- A published criterion referenced instrument
- Checklists for pragmatics, attachment, play, communication
- May ask the mother “how the child plays”
DLD: Goal Types
- Goal Writing
- 2 types of goals
- Vertical
- One goal at a time targeted until mastery
- After mastery, you move on
- For clients who can’t handle multiple goal areas simultaneously (more sever
cognitive impairments)
"The client will correctly name common household objects given a semantic cue (e.g., 'You use this to sweep the floor') with 80% accuracy across three consecutive sessions."
- Horizontal
- Multiple goals are targeted simultaneously
- For individuals with normal cognition (IQ)
- Ideal or children with DLD
- Ex. During a 45-minute play-based session, the activities shift to address each goal:Activity 1 (Past Tense): The child plays with a toy car and describes what happened ("The car crashed!").Activity 2 (Third-Person Singular): The child describes what a doll is doing ("She walks to the house.").Activity 3 (Possessives): The child identifies who owns the toys ("This is Ben's hat.").
- Behavioral Objectives
- Long-term or semester goal
- The terminal performance the client should achieve by the end of the semester
- The client will be able to communicate a story with settings, initiating events,
attempts and consequences, when provided a book with pictorial illustrations
with 90% accuracy.
- Agent, requirement, performance level
- Instructional Goals (short-term goals)
- Lead up to the behavioral goal
- The client will produce the setting of a story when provided a book and a verbal
model of using setting statements by the clinician with 90% accuracy.
DLD: Probes
- Measurement
- Probes
- Untrained target words used to measure the clients progress
- You have not used the probe in therapy
- Shows whether or not treatment has generalized
DLD: Language Intervention
- Language Intervention
- The main goal is to provide auditory models/stimulus
- Typical children do not require as much repetition, but impaired children require repeated
stimulus
- Models increase the child’s spontaneous productions of targeted words/morphemes/sounds
- Nonmeaningful repetitions of stimulus do like to improve productions
- Children learn language through natural consequences of interacting and talking with others,
they recognize the benefits of communicating with others
- Models are essential for both expressive and receptive language learning
- The therapy we provide should promote generalization of language and communication
DLD: Intervention Activities
- Intervention Activities
- Songs with pictures
- Stories
- Using objects works well with young children
- Daily activities
- Dress up
- Pinicis
- Beginning, Middle, and End is necessary
- Puppets
DLD: Auditory Input Models
- Intervention is not designed for production, instead you should provide auditory input with various types of models
- Conversational Recast
- Take an aspect of the child’s original utterance and repeat the utterance with the addition of
grammatical and syntactic information (similar to motherese)
- When you are working with a child, Recast what they say “I like juice” “great johnny I like juice too.”
DLD: Enhanced Conversational Recast
- Enhanced Conversational Recast
- saying the child’s name, touching the child’s hand, arm, or shoulder, or getting in the child’s visual before doing the recast
- Always talk in complete utterances and repeat
- Providing intentional cues, making sure the child attends to the auditory input you are providing
- Establishing eye contact, often by saying the child’s name
- Expand on utterances, use frequent redundancy
- Utterances should be provided with participation within the environment
- the child should enjoy the interaction
- Provide the child time to respond, allows the child to process
- Change intonation, rhythm, intensity, & emphatic stress (prosodics)
- Makes the utterance more salient
DLD: Parallel and self talk
- Parallel Talk
- Providing auditory input when the clinician describes what they are the child are doing
- Parallel talk you describe that the client is doing “you are rolling the dice”
- Self-Talk
- Only describing what you are doing
- Self-talk you describe that you as the clinician is doing “I’m scooping Ice cream and putting it
in the bowl”
- Good for children with limited language
- Don’t use telegraphic speech, use grammatically and syntactically correct sentence (Linguistically correct models)
- Just above the child’s level
- Stay away from questions, they don’t help children with language disorders provide models instead!
- Neutral Activities
- Don’t use emotionally charged toys
- Relatively simple vocabulary
- Words that are simple phonologically
DLD: Focused Stimulation
- Focused Stimulation (Marc Fey)
- Providing a constant frequent model of a particular grammatical morpheme (in the context of play and interaction between the clinician and the client)
- Morphosyntactic development
- Auditory input and models
- Don’t use spontaneous play with no direction
- Planned play with a clear beginning, middle and end
- Therapy needs to be planned, motivated, intentional and focused
Ex. Focused Stimulation Activity
When doing MLU the child is missing -ing
Activity: Picnic, zoo, popcorn. Ex. Tea party
We are having a tea party:
I enjoy drinking tea.
I have friends that drink tea.
My mom is drinking tea
My brother likes drinking teas
My sister likes drinking tea
My dog likes drinking tea.
I’m getting a tea cup.
I am getting plates.
I’m getting a tea pot.
I’m getting sugar.
Are you getting a tea pot?