SLHS Final
I. ASSESSMENT
What does assessment mean?
Assessment is the process of gathering information to describe a child communication and determine if a language disorder exists
What is the difference between screening and diagnosing?
Screening is a brief check to see if a child might have a problem while a diagnostic evaluation is a comprehensive process to determine if a disorder is present and its nature.
What is the difference in the interpretations of outcomes from a screening versus a diagnostic evaluation?
Outcomes from screening indicate if a child needs more testing while diagnostic outcomes determine eligibility for services and identify specific areas of impairment.
What is the difference between sensitivity and specificity?
Sensitivity: the proportion of people who have a language disorder and are correctly identified by the test (true positives)
Specificity: the proportion of people who do not have a language disorder and are correctly identified by the test (true negatives)
What is a cut-off score on an assessment and how is it used?
A score on an assessment used to differentiate children with a disorder from those with typical development.
What is a standardized, norm-referenced assessment?
Tests designed to compare a child performance to a normative sample of peers.
On a standardized, norm-referenced assessment of language, what is an average standard score?
Most standardized language assessments the average standard score is 100 (with standard deviation of 15)
What is the minimal level of acceptable (aka: fair) diagnostic accuracy for sensitivity and specificity based on the guidelines provided by Plante and Vance (1994)?
> 90%: Good
80%-89%: Fair (Acceptable)
< 80%: Unacceptable.
How is language sampling used as a method of assessment? What types of questions are most appropriate, open-ended or closed-ended questions directed at the child and why?
Language sampling method is a collection of a child's spontaneous utterances used to evaluate expressive language skills in naturalistic contexts
Open ended questions are more appropriate because they maintain interest and elicit longer, more complex responses than classes- indeed questions.
What is the minimum number of fully intelligible utterances that we want from a child in order to conduct an analysis, such as MLU, of their expressive language skills?
A minimum of 50-100 fully intelligible utterances is wanted for a valid analysis like MLU
Why do speech language pathologists count morphemes instead of words when determining the length of children’s utterances?
SLPs count morphemes because they provide a more sensitive measure of a child's grammatical development (e.g. “running” shows more morphosyntactic complexity than “run”).
What is MLU (mean length of utterance) and how is it calculated?
MLU is the average number of morphemes per utterance calculated by dividing the total number of morphemes by the total number of utterances.
What are Brown’s 14 early grammatical morphemes? (be able to recognize their use or lack of use in obligatory contexts)
Be able to complete a mini language sample and language sample analysis when given a transcript of a child’s productions and the rules for counting morphemes. It will involve calculating an MLU.
Differentiate static assessment from dynamic assessment. When might we rely on dynamic assessment?
Statscript assessment is what a child can do independently (standardized tests) while dynamic assessment uses a “test-teach-retest” model to see how much support a child needs to learn a skill. We rely on dynamic assessment when distinguishing a language difference from a disorder.
II. INTELLECTUAL DISABILITIES (to include Down Syndrome)
What are the three criteria a child needs to meet to be labeled as having an intellectual disability (essentially the definition of intellectual disability?
1. Significant limitations in intellectual functioning (IQ below 70)
2. Significant limitations in adaptive behavior (conceptual, social, and life skills)
3. originates before 18.
What does intellectual functioning refer to? What does adaptive functioning refer to?
Intellectual functioning refers to general mental capacity (IQ) while adaptive functioning is the ability to act as independently and responsibly as others of the same age in everyday life.
How does the rate of learning, including learning language, differ for children with an intellectual disability versus children who are typically developing?
Rate of Learning: Children with ID acquire skills, including language, at a slower rate than children who are typically developing.
Severity Factor: The specific learning rate and the extent of the deficits are a function of the severity of their cognitive deficits/ID.
Consistency: They do not necessarily learn language at a constant rate (e.g., specific profiles seen in Down Syndrome or Prader-Willi Syndrome).
Be able to differentiate among prenatal and postnatal causes of intellectual disability.
Prenatal (Before Birth):
Chromosomal: (e.g., Down Syndrome, Fragile X Syndrome, Williams Syndrome, Prader-Willi Syndrome).
Maternal Diet: (e.g., Iodine deficiency).
Environmental: (e.g., Fetal Alcohol Syndrome, prenatal exposure to toxins).
Postnatal (After Birth):
Traumatic Brain Injury (TBI).
Infections: (e.g., Meningitis, Encephalitis).
Toxins: (e.g., Exposure to lead or mercury).
Environmental Deprivation: Severe lack of stimulation or nutrition.
Autistic children are at higher risk than their allistic peers for what type of disorder, which in males, is much more likely to meet the criteria of intellectual disability than with females (as females tend to be less severely affected)?
Autistic children are at higher risk than their allistic peers for Fragile X Syndrome.
Gender Difference: In males, Fragile X is much more likely to meet the criteria for intellectual disability, whereas females tend to be less severely affected.
Can some children with intellectual disability learn how to read?
Yes, some children with ID are able to read and decode at a level commensurate with their language skills and IQ, though they may learn at a slower pace.
What causes Down syndrome?
Trisomy of chromosome 21
What are the major risk factors for Down Syndrome?
Advanced maternal age
What is the relationship between Down Syndrome and Autism? Down Syndrome and Alzheimer’s Disease?
Autism: 10% of children with down syndrome also meet criteria for Autism.
Alzheimer's: There is a high risk for early-onset Alzheimer's in individuals with down syndrome.
What are some key morphosyntax characteristics in Down Syndrome? What about semantic characteristics? What is the relative strength in language?
Morphosyntax (grammar) semantics (vocab) and pragmatics (social use)
How does AAC support language development in children with Down Syndrome?
Provides a visual bridge and reduces motor pressure for speech.
What is Enhanced Mileu Teaching including the key components?
A hybrid intervention that uses environmental arrangement, responsive interaction and naturally occurring “incidental teaching" that promote communication.
What is meant by an ecological approach to intervention?
Considers the "whole picture" (family, social, and job needs).
What is Functional Communication Training (FCT)?
A behavioral intervention used to replace maladaptive or “problem” behaviors with functional communication (e.g. using a sign to request a break instead of hitting)
What are visual supports and why are they useful?
Tools like visual schedules or picture cards that help make abstract language more concrete and predictable for children with ID
Why is structured and repetitive practice effective?
Vital because ID requires "lots and lots" of repetition to move info to long-term memory.
Why might traditional literacy goals not be appropriate for children with intellectual disabilities and how might functional literacy goals be more appropriate?
Focusing on reading skills needed for daily living (e.g. reading a menu or signs)
III. AUTISM
What is the difference between Autism and Social Communication Disorder?
Autism involves restricted and repetitive patterns of behavior interests whereas scd involves social communication deficits without those restricted repetitive patterns.
What domain of language (using the Bloom and Lahey model) is always a challenge for Autistic children?
Pragmatics (use)
What is the difference between Autistic and Allistic children?
Autism refers to individuals on the spectrum while allistic references to non autistic individuals,
Most autistic children have sensory differences, such as hypersensitive or hyposensitive sensory functioning relative to allistic children. What is the difference between hypersensitivity and hyposensitivity?
Hypersensitivity is an over response to sensory stimuli with hyper sensitivity is un der response or seeking stimuli.
How does sensory sensitivity relate to the concept of dysregulation? Is a dysregulated Autistic child ready for language intervention? Why or why not?
If an autistic child is dysregulated they are not ready for language intervention because they are not in a state where they can focus or learn new skills.
What is the difference between the medical model of disability and the social model of disability?
The medical model views disability as a mismatch between the person and the environment.
What is meant by using a strengths-based approach when providing intervention to Autistic children?
What is masking/camouflaging in relation to describing the behaviors of autistic individuals? Why is masking/camouflaging a problem? What increases the likelihood that an autistic individual would engage in masking/camouflaging?
The act of hiding autistic traits to appear more “typical” it is a problem because it leads to mental exhaustion and burnout.
Be able to recognize examples of therapy that promotes conformity (making the child more typical) vs. therapy that promotes identity.
Conformity tries to make the child act "typical" (stopping stims); Identity respects neurodiversity and promotes autonomy
Why is there no one-size-fits-all approach to treatment?
ASD is inconsistent and variable; every child's sensory/communication needs differ.
Be able to differentiate autonomy vs. dependency? Which one is better to focus on in in treatment?
Autonomy is better to focus on as the goal is to empower the child tto communicate their own needs and thoughts rather than making them dependent on specific prompts or clinicians.
Are all behaviors (e.g., hitting, avoidance) communication?/Be able to recognize when “problem behaviors” are responded to in a neurodiversity-affirming way.
A neurodiversity affirming approach focuses on changing the environment (reducing sensory triggers, educating peers) rather than focusing the autistic person to change their identity.
What role do peers play in the communication success of Autistic children?
Peers are communication partners; we must educate peers to be affirming rather than just "fixing" the Autistic child.
What is a strengths-based approach?
Focuses on interests and abilities instead of just deficits
What does it mean to change the environment, not the person?
Modify the world (lighting, schedules) to fit the person.
What are Social Stories? How might they be useful in intervention or Autistic children? Explain social situations to make the world predictable.
IV. AUGMENTATIVE AND ALTERNATIVE COMMUNICATION (AAC)
What is the ASHA definition of AAC?
AAC includes all forms of communication (other than oral speech) used to express thoughts, needs, wants and ideas.
How is AAC different from assistive technology?
AAC is specifically for communication, while Assistive Technology is any item used to improve functional abilities broadly (e.g., a reacher tool).
When is it needed? Is it always permanent?
Needed when speech doesn't meet all needs. It can be temporary or permanent.
What populations commonly use AAC?
ASD, ID, Down Syndrome, CP, ALS, TBI, Stroke.
What is the difference between aided and unaided communication? What are some examples of aided AAC? What are some examples of unaided AAC?
Unaided: Uses only the body (signs, gestures, facial expressions).
Aided: Requires external tools (picture boards, speech-generating devices)
What is the difference between direct selection and scanning?
Direct Selection: The user points directly to the desired item (by hand, eye gaze, or tool).
Scanning: The device highlights items one by one, and the user activates a switch when the correct item is reached.
What is the difference between core vocabulary and fringe vocabulary? How does this relate to individualizing AAC content?
Core: High-frequency words like "I," "want," "go," and "more".
Fringe: Specific words related to the individual's personal interests (e.g., names of games or specific hobbies).
What is total communication? What is multimodal communication?
Total Communication: A philosophy that encourages the use of every available means to communicate. This includes using a combination of signs, oral speech, high-tech AAC, and gestures together to ensure a message is understood.
Multimodal Communication: The idea that all people (not just those with disabilities) use multiple modes to communicate. For example, using facial expressions, body language, and vocalizations at the same time to convey a message.
What are the four communication purposes? Which is most likely targeted and why is it a problem?
Communication of Needs and Wants: To regulate the behavior of another person to get something (e.g., "I want juice").
Information Transfer: To share information (e.g., "I went to the park yesterday").
Social Closeness: To establish or maintain a social relationship (e.g., "I love you" or joking with a friend).
Social Etiquette: To follow social conventions (e.g., "Please" or "Thank you").
Which is most likely targeted? Needs and Wants.
Why is it a problem? It is a problem because it overlooks the human need for Social Closeness. If we only teach a child to ask for things, we are not teaching them how to build relationships, share their feelings, or connect with others.
V. INTERVENTION/TREATMENT
Differentiate the main purposes of intervention (prevention, remediation, compensation)
Prevention: For children at risk to avoid later problems.
Remediation: To correct current deficits.
Compensation: Teaching strategies to manage signs of the disorder when it cannot be fully eliminated.
What is the relationship between risk and prevention?
We provide intervention to children who are "at risk" to prevent a language disorder from occurring or to minimize its impact before it starts.
At-Risk Factors: Biological (e.g., premature birth, genetic syndromes) or Environmental (e.g., poverty, lack of stimulation).
The Goal: By intervening early with at-risk populations, the goal is to shift the child's developmental trajectory toward a more typical path, effectively "preventing" the need for more intensive remediation later.
What is the relationship between progressive neurological diseases and maintenance?
The Relationship: For individuals with progressive diseases (like ALS, Parkinson’s, or Alzheimer’s), the purpose of intervention is Maintenance.
The Goal: In these cases, the disease is expected to worsen, so the SLP is not trying to "cure" or "remediate" the language. Instead, the goal is to preserve and maintain current levels of functional communication for as long as possible.
Maintenance in Practice: This often involves setting up AAC systems early while the person still has motor control, so they can maintain their ability to express needs and social closeness as the disease progresses.
Explain the differences between facilitation, induction, and maintenance
Facilitation: Accelerating the rate of learning a skill the child would have eventually learned.
Induction: The intervention is responsible for the child learning the skill.
Maintenance: Preserving a skill that would otherwise be lost (often used in progressive diseases).
What is the zone of proximal development and why is it important to consider for language intervention?
The distance between what a child can do alone and what they can do with assistance. It is important because targeting skills within the ZPD ensures therapy is neither too easy nor too difficult.
Differentiate among child-centered, clinician-directed, and hybrid approaches to intervention.
Child-Centered: Clinician follows the child's lead in natural play (e.g., parallel talk).
Clinician-Directed: Clinician chooses materials and targets (e.g., drill).
Hybrid: Combines both, focusing on specific goals within naturalistic activities (e.g., Milieu Teaching or Script Therapy).
Why do we care about generalization of language skills learned in intervention? What are ways to promote generalization (discussed in your reading)
The ability of a child to use a skill learned in therapy across different settings and partners. It is promoted by using naturalistic contexts and involving families in treatment