Introduction to Communication Disorders: Childhood Language Disorders (Chapter 4)

Learning Objectives

4.1 Describe language development through the lifespan.
4.2 Characterize language disorders and associated disorders.
4.3 Explain the assessment process in language disorders.
4.4 Describe the overall design of language intervention.

Language Development Across the Lifespan (Key Concepts)

Language development is studied from pre-language through adulthood, with milestones in form, content, and use.
Development is influenced by environment (e.g., SES), language exposure, and social interaction.
Language differences vs. language disorders: differences can reflect dialects or bilingualism; disorders involve impairment affecting comprehension and/or production.
Typical prevalence: about 10\% of children have language disorders severe enough to hinder academics.
Early indicators and risk factors include family SES, maternal education, and exposure to language-rich environments.

Pre-Language (Infancy) – Core Ideas

Early communication is primarily nonverbal and caregiver‑driven; infants engage in triadic interactions with caregivers.
Caregivers use Parentease (exaggerated facial expressions/intonation) to maintain infant attention and simplify linguistic input.
By 3–4 months, infants begin routines and contingencies that establish predictable exchanges.
At 8–9 months, infants develop intentional communication (often gesture-based).
First meaningful word typically occurs around 12\text{ months} and becomes a symbol for a communicative intent.
Perception becomes more native-language–restricted by 8{-}10\text{ months}, guiding later word comprehension and production.
Early symbolic play and cognitive advances support representational abilities.

Toddler Language (12–36 months) – Core Ideas

By ~18 months, toddlers produce about 50 single words and begin combining words.
By a few months later, 3– and 4-word combinations emerge.
Vocabulary growth is rapid; comprehension trails production, and is context-specific.
By around age 2, expressive vocabulary is about 150\text{ words} (typical range varies).
Early word use is context-bound but increasingly combinatorial.

Preschool Language (3–5 years) – Core Ideas

Expressive vocabularies grow to about 2600 words by age 5; receptive vocabularies expand to tens of thousands by later elementary school.
Fast mapping enables rapid vocabulary growth; children infer meanings from minimal exposure.
Pragmatic and semantic skills advance; there is greater awareness of listener needs and conversational structure.
Morphology becomes more complex; bound morphemes (e.g., present progressive -ing, plural -s, possessive -'s, past -ed) are acquired.
By age 5, ~90\% of adult grammar is in place; syntax and complex sentences continue to develop.
Expansion (caregiver input) and metalinguistic awareness support growth.
Important semantic development includes acquisition of locational terms, temporals, quantitatives, qualitatives, familial terms, and conjunctions.

School-Age and Adolescent Language (6–18 years) – Core Ideas

Most daily communication occurs outside the home; reading and writing development rely on metalinguistic skills.
Metalinguistic skills enable abstract thinking about language (judging correctness, manipulating language in thought).
Narrative skills become more complex; conversational turns increase and topic management improves.
Content vocabulary expands dramatically: by grade levels, expressive and receptive vocabularies grow substantially (e.g., about 2600 words by grade school; receptive bases reach tens of thousands).
Figurative language (idioms, metaphors) becomes common and literacy-related; understanding idioms supports reading comprehension.
Morphology and syntax continue to mature, enabling more sophisticated sentence structures and discourse.

Language Disorders: Overview and Major Categories

Language disorders are heterogeneous, including developmental and/or acquired conditions affecting comprehension and/or production.
Distinct from language differences (dialects, bilingualism) when impairment crosses contexts and affects function.
Broad categories include:
- Developmental Language Disorder (DLD; previously SLI) with no obvious cause
- Social Communication Disorder (SCD)
- Autism Spectrum Disorder (ASD)
- Intellectual Developmental Disorder (IDD)
- Learning Disabilities (LD)
- Brain Injury (TBI, etc.)
Prevalence: roughly 7.58\% of children have language disorders with no known origin.
Risk factors for language disorders include being male, lower SES, older maternal age, perinatal factors, and reduced early communication markers.

Specific Disorders (Key Points)

Developmental Language Disorder (DLD)
- No obvious cause; may have low normal nonverbal IQ; late language emergence is a risk factor.
Social Communication Disorder (SCD)
- Pragmatic-language difficulties without restricted, repetitive behaviors; may co-occur with ASD features at times.
Autism Spectrum Disorder (ASD)
- Core features: persistent deficits in social communication/interaction and restricted/repetitive behaviors; incidence ≈ rac{1}{44}; gender differences; level concepts (Level 1–3) describe support needs.
Intellectual Developmental Disorder (IDD)
- Neurodevelopmental with intellectual impairment and adaptive skill deficits; etiologies can be genetic or socioenvironmental; language delays common across domains.
Learning Disabilities (LD)
- Neurodevelopmental, emerges in school years; multiple domains (motor, perception, memory, etc.); often co-occurs with reading disorders; ADHD common comorbidity.
Brain Injury (TBI)
- Can occur via trauma; variable outcomes; language can be impaired even after mild injuries; long-term linguistic and cognitive sequelae.

Assessment: Purpose and Process

Purpose: distinguish disorder vs. difference; describe strengths/weaknesses across language domains.
Components:
- Referral and screening: determine if a problem exists and whether further evaluation is needed.
- Case history/interview: language development, environment, possible etiologies.
- Observation in multiple contexts: variety of partners, topics, and communicative demands.
- Testing: standardized tests for screening; descriptive measures (language samples) for profile; dynamic assessment to inform intervention.
- Language sampling: analyze form, content, and use; MLU (mean length of utterance) and other metrics;
- Sample targets: two or more contexts with different partners; 50 utterances typical for many cases.
- Considerations for ELs and NMAE: differentiate dialect from disorder; use bilingual tests, sampling, and dynamic assessment; DELV as a variation-based measure.

Assessment of English Learners and Nonmainstream Dialectal Speakers (NMAE)

Approximately 10.2% of public school students are English learners; many speak nonmainstream dialects.
Comprehensive assessment reduces misdiagnosis; include tests in both languages when possible; dynamic assessment helps reveal learning potential.
DEpv: Diagnostic Evaluation of Language Variation (DELV) supports NMAE norms; dialectal scoring accounts for variation.

Intervention: Principles and Practices

Goals: language development beyond the immediate target; integrate multiple domains (syntax, semantics, pragmatics) in meaningful contexts.
Target selection and sequencing:
- Use assessment results; tailor targets to child’s abilities; training in meaningful contexts.
- Include family, school staff, and peers in intervention to support generalization.
Evidence-based practice principles:
- Do not focus solely on one deficit; address interrelated language domains and functional communication.
- Where direct evidence is limited, use principled, holistic approaches with monitoring.
Intervention procedures (3-part model): Teach-Model-Coach-Review (TMCR) and similar frameworks.
Teaching behaviors: model the target, cue the child, provide reinforcement/corrective feedback, plan for generalization.
Generalization: ensure learned features transfer to daily environments (home, school, peers).
Culturally and linguistically diverse considerations: honor cultural values; support heritage language; bilingual intervention when feasible.

Intervention Across the Lifespan

Early intervention (IDD, ASD) is highly beneficial; focus on presymbolic communication, cognitive support, and AAC if needed.
Preschool: practice language form in conversation and narratives; build vocabulary and early semantic categories.
School-age: emphasize pragmatics, semantics, and academic language; support literacy and metalinguistic skills.
Adolescents: maintain supports to address pragmatic and academic language needs; goals aimed at social participation and education.
Adults with severe ASD/IDD may require ongoing intervention; LD may require continued supports in postsecondary settings.

Targeted Considerations for Assessment and Intervention

Target selection: prioritize functional communication goals within daily contexts.
Sequence: align with child’s current abilities and naturalistic learning opportunities.
Use of multiple models: individual, group, classroom-based, and school-wide supports; train teachers, aides, and peers to reinforce skills.
Outcome measures: track generalization, functional communication, and academic performance.

Levels of Autism Spectrum Disorder (ASD) – Functional Levels

Level 1: Requiring Support
- Difficult initiating social interactions; challenges with organization and planning.
Level 2: Requiring Substantial Support
- Social interactions limited; restricted/repetitive behaviors present; greater support needs.
Level 3: Requiring Very Substantial Support
- Severe deficits in verbal and nonverbal social communication; extreme distress with change; substantial support required.

Key Takeaways for Last-Minute Review

Language development is a staged, mostly predictable process, but disorders introduce variability in how language forms, uses, and is learned.
Assessment is comprehensive and multi-method, combining observation, sampling, standardized tests, and dynamic methods; consider ELs and dialect differences carefully.
Intervention is holistic, context-driven, and involves modeling, cueing, feedback, and strategies to generalize to real life; collaborate with families and educators.
Understanding the distinctions among DLD, SCD, ASD, IDD, LD, and brain injury helps tailor assessment and intervention.
Evidence-based practice emphasizes functional outcomes, flexibility in methods, and culturally responsive approaches.

Reflection Prompts

At what ages can children participate in simple conversations, and what supports facilitate those abilities?
How do cause-and-effect differences between DLD and LD influence intervention targets?
Why is pragmatics frequently affected across disorders, and how does it differ from syntax/semantics?
Why isn’t testing alone sufficient for assessing language disorders, and how can dynamic and language sampling complement formal tests?