Chapter 4: Special Considerations for Special Populations Flashcards
What services does an SLP provide in general?
Identifying communicative strengths and weaknesses
What services does an SLP provide in articulation?
Articulation
What services does an SLP provide in language?
Receptive, expressive related to academic
What services does an SLP provide in literacy?
Decoding, comprehension
In what areas do SLPs provide assessment and intervention?
7
Pragmatics
Semantics
Syntax
Phonology
Morphology
Cognition
Perception
Why do we need to understand clinical and educational reports?
They affect our assessment and intervention
Intellectual Disability is disability characterized by significant limitations both in _______ and ______ which covers many every day social and practical skills. This disability originates before age ______.
Intellectual functioning
Adaptive behavior
18
What are the Cognitive characteristics of Nonspecific ID?
2
IQ scores (70-75 limited >2 SD below mean)
Slower developmental trajectory compared to typical
How does ID affect our intervention of language Form?
Use shorter and simple utterances
How does ID affect our intervention of language Content?
Simplified syntax
How does ID affect our intervention of language Use?
4
Delayed development of intentional communication
Less clarification and request for clarification
Poor narrative cohesion
Poor humor comprehension
How does ID affect Literacy?
Children don’t initiate reading activities = read less
How does ID affect our implications for clinical practice?
Address developmental goals
How often does Down Syndrome occur?
Why does it occur?
1 in 700 live births
Extra Chromosome 21
What are they symptoms of Down Syndrom?
8
Mild to moderate ID
Hypotonia (low tone)
Small chin
Round face
Oversized tongue
Health concerns (heart defects, GERD
Otitis media
Thyroid dysfunction
What are the Cognitive Characteristics of Down Syndrome?
2
Developmental fine and gross motor delays
IQ 40-70
What are the general Language Characteristics of Down Syndrome?
(5)
Poor working memory
Visuospatial working memory
Learning rules
Poor attention
Poor problem solving
How does Down Syndrome affect Language Form?
5
Poor intelligibility
Vowel distortions
Apraxia
Poor syntax
Shorter utterances
How does Down Syndrome affect Language Content?
2
Delayed 1st words
Poor phonological Short term memory
How does Down Syndrome affect Language Use?
2
Strengths with narratives with picture supports
Poor responses
How does Down Syndrome affect Literacy?
Dependent on phonological skills and comprehension
What are the implications for clinical practice for clients with Down Syndrome?
(6)
Monitor hearing
Monitor articulation
Use gestures and pictures
Target early language development
Focus on tasks
Possible AAC (picture symbols, Voice output)
How common is William Syndrome?
How is it caused?
1 in 7,500
Deletion of 25 genes on 1chromosome 7q11.23
What are the common symptoms in William Syndrome?
3
Physical facial dysmorphology
Heart disease
Growth deficiency
What Cognitive Characteristics are seen with William Syndrome?
(4)
Global developmental delays
Mild to moderate ID
Visuospatial deficits
Poor motor development
What is seen in Language Form in William Syndrome?
3
Canonical babbling delayed
May have articulation problems
Poor grammatical understanding/comprehension (related to verbal working memory)
What is seen in Language Content in William Syndrome?
2
Good concrete vocabulary
Difficulty with temporal, spatial, dimensional concepts
What is seen in Language Use in William Syndrome?
1+3
Pragmatic deficits
- Poor nonverbal facial expression perception
- Poor provision of appropriate responses
- Few cognitive inferences
What is seen in Language Literacy in William Syndrome?
2
Variable reading/decoding
Lower comprehension
What are the Implications for clinical practice for clients with William Syndrome?
(3)
Work with family to increase language
Systematic phonetics
Improve reading comprehension
What is Fragile X Syndrome?
2
X Chromosome has duplications
Affects protein production needed for brain development, inherited
What Cognitive Characteristics are seen in Fragile X Syndrome?
(6)
½ have borderline IQ
Executive function deficit – sequential processing
Working memory
Selective attention
Fine and gross motor delays
Can have comorbid ASD, ADHD
What is seen in Language Form in Fragile X Syndrome?
4
Poor intelligibility
Phonological processing (awareness)
Shorter MLU
Simpler utterances
What is seen in Language Content in Fragile X Syndrome?
3
Mixed receptive vocabulary
Fewer different words
Slow rate of growth
What is seen in Language Use in Fragile X Syndrome?
5
Pragmatic limitations similar to ASD
Tangential language
Perseveration
Stereotypical phrases
Poor working memory
What is seen in Literacy in Fragile X Syndrome?
2
Nonword reading difficulties
Limited research
What are Implications for clinical practice for clients with Fragile X Syndrome?
(3)
Socially meaningful activities to increase communication
Early intervention
Differential diagnosis ASD
What are some strategies to assist clients with Visual Impairment?
(4)
May need Braille
Large pictures
Large print
Text to speech programs
(There is a range of visual impairment. Contact visual specialist in area, optometrist, ophthalmologist)
What may be seen in Language Form in clients with Visual Impairment?
(2)
May have delayed speech
May have appropriate MLU
What may be seen in Language Content in clients with Visual Impairment?
May develop age appropriate vocabulary depending on experiences
What may be seen in Language Use in clients with Visual Impairment?
(3)
May use few gestures
Need help with use of questions, initiation
Need structured language activities
What may be seen in Literacy in clients with Visual Impairment?
(2)
Dependent on vision
Focus of education
What are the Implications for clinical practice for clients with Visual Impairment?
(3)
Facilitate early social communicative exchanges between child and parents
Provide labels and descriptions, model pretend play
Model reading
What is Profound Hearing Loss?
91+ dB SPL
What are the three types of hearing loss?
Conductive (treatable, otitis media)
Sensorineural (loss due to damage of inner ear, cochlear implants may be used)
Mixed (both conductive and sensorineural)
What are Cognitive Characteristics seen with Hearing Impairment?
(2)
Depends on cause of loss
May have comorbid deficits
What is seen in Language Form seen with Hearing Impairment?
6
Delayed babbling
Intelligibility may be negatively impacted (hyponasal voicing errors, initial syllable deletion)
May need sign language (parents may need training)
Lower MLU
Morphological errors (-s, -ed)
Spelling may be impaired
What is seen in Language Content seen with Hearing Impairment?
(2)
Vocabulary may be delayed
More repetition of new words/sign
What is seen in Language Use seen with Hearing Impairment?
4
Depends on culture
Family beliefs
Aided hearing
Conversational structures
What is seen in Literacy seen with Hearing Impairment?
2
Depends on exposure to print
Phonological pairing/or signed vocabulary
What are the Implications for clinical practice seen in clients with Hearing Impairment?
(2)
Work closely with Audiologist
Language used or aides used need to be considered (look at development and needs/wants of parents)
What is seen in Language Form in children with Otitis Media?
2
May be impacted dependent on length of conductive loss
May lead to speech sound disorder/delays
What is seen in Language Content in children with Otitis Media?
May not be impacted, or may impact morphology (-s, ed) may impact spelling
What is seen in Language Use in children with Otitis Media?
May impact interactions with others
What are the Implications for clinical practice with children with Otitis Media?
(1+5)
Note differences in
- Attention
- Repetition of sounds
- Phonological awareness
- Decoding
- Answering questions
Do SLPS diagnose Auditory Processing Disorders?
Refer to Audiologist who can do nonspeech assessment to determine if the Auditory nerve is functioning
What is often comorbid with Auditory Processing Disorders?
2
ADHD
DLD
What are the Clinical Implications for clients with Auditory Processing Disorders?
(5)
No clear plan for Assessment or Treatment
Look at perceptual attention, following directions, level of prompting and/or cueing needed
Look at Language Assessment results!
Work with Audiologist!
Determine if an FM system would work or not, classroom accommodations
What historically causes Deaf-Blindness?
2
Rubella (German Measles)
Usher’s syndrome
What sort of assessment and intervention needs to be performed with students who are deaf-blind?
Early dynamic
Who do you need to consult with for students who are deaf-blind?
(3)
Audiologist
Vision Specialist (Ophthalmologist)
Talk with parents about goals, needs, concerns
What kind of interventions can be used with students who are deaf-blind?
(4)
Object-based AAC
Loud toys (depends on hearing)
Light up toys
Tactile prompting (hand over hand) during activities
What are the two types of TBI?
2
Focused
Diffuse
What can impact the severity of a TBI?
2
Age
Severity of initial injury and areas impacted will impact development
What are some Cognitive Characteristics of TBI?
3
Dependent on location of injury and pre-injury cognitive status
48% have IQ
What is seen in Language Form in children with TBI?
2
May have short utterances or long utterances
Dependent on areas injured
What is seen in Language Content in children with TBI?
2
Dependent on areas injured
Potential hearing difficulty
What is seen in Language Use in children with TBI?
Output may be limited or excessive (tangential)
What is seen in Literacy in children with TBI?
Dependent on pre-injury skills and focus of therapy
What are some Implications for clinical practice in children with TBI?
(2)
Assessment and Intervention need to focus on areas of deficit and client and parent goals!
Look at school records, academic status pre-injury
How do we assess Pediatric Test of Brain Injury?
3
10 subtests that assess neurocognitive, language, and literacy abilities that are relevant to school curriculum.
Use for dynamic assessment through different phases of recovery
Results should be compared to pre-injury function and used to determine Plan of Care.
How do we design intervention for students with TBI?
4
Dependent on severity of injury and course of recovery
Retrain or develop cognitive skills
Teach compensatory strategies
Use structured tasks, address attention, impulsivity, language comprehension, problem solving, and Self-monitoring
What are Focal Brain Lesions?
3
Caused by CVA (stroke)
Premature birth
Pediatric heart conditions
What is seen in language development in children with Focal Brain Lesions?
(2)
Early delays in word comprehension and word processing (LCVA), gestures (RCVA)
Shorter narratives, simple sentence structure, fewer different words, no mention of character’s mental states
What are Implications for clinical practice for children with Focal Brain Lesions?
Need to refer to assessment error analysis to determine areas of weakness
What is Landau Kleffner Syndrome?
4
Acquired epileptic aphasia
Onset 3-6 yr of age
Loss of already acquired language skills
May have auditory comprehension deficits, expressive deficits - dependent on location of seizure damage
What improves Prognosis for Landau Kleffner Syndrome?
Better if onset is after 6 yrs, language is already learned.
What are Implications for clinical practice for children with Landau Kleffner Syndrome?
(2)
Language skills are dependent on pre-seizure language and speech abilities.
May need to investigate voice output devices to replace verbal language, use sign language, depends on client and parents.
What is often seen in Autism Spectrum Disorders?
3
Poor eye contact
Limited expressive language
Poor joint attention
What Cognitive Characteristics are often seen in Autism Spectrum Disorders?
(2)
50-70% nonverbal IQ is
What is often seen in Language Form in Autism Spectrum Disorders?
(7)
Apraxia
Phonological errors (memory)
Nonsense word repetition deficits
Rhyme awareness
Poor prosody, grammar, morphosyntax
Simple sentence structure
Short utterances
What is often seen in Language Content in Autism Spectrum Disorders?
(2)
Vocabulary deficits
Don’t use semantic information to facilitate encoding and recall
What is often seen in Language Use in Autism Spectrum Disorders?
(4)
Conversational deficits
Lack of initiation or over initiation
Poor topic maintenance
Poor referencing in narratives, difficulty with figurative language (idioms, sarcasm)
What is often seen in Literacy in Autism Spectrum Disorders?
(2)
Hyperlexia with poor comprehension
Not much research
What are Implications for clinical practice for children with ASD?
(4)
Dependent on the child’s level of functioning and parent’s goals.
May be behavioral problems, lack of structure/too much structure
Sensory processing deficits (textures, smells, lights, hearing
Referral to OT, PT, Nutrition when needed)
Focus on each child and their needs with broad goals
What is Pragmatic Language Impairment?
2
language deficits affect communication, social interaction and use of language in context.
No repetitive behaviors
Term can be used to describe children with DLD and ASD
What is a Nonverbal Learning Disability?
6
Opposite of DLD
Children with average Verbal IQ but below aveage Nonverbal IQ
Difficulty with visual-spatial and visual-motor, and fluid reasoning compared to other DLD
Poor mechanical math skills, poor novel problem solving, concept formation, repetitive speech, poor social perception and judgment.
Strength in single word reading and fluent speech
May be more likely to be diagnosed with ASD.
Lack of research!
What are symptoms of ADHD?
2
Inattentiveness – poor attention and concentration, poor organization, difficulty completing tasks without supervision.
Hyperactivity/Impulsiveness – fidgety, always moving, interrupting and talking incessantly, and acting without thinking.
What Cognitive Characteristics are often seen in ADHD?
2
Nonverbal IQ in normal range
Poor working memory, planning, inhibition, and motivation
What is often seen in Language Form in ADHD?
2
Difficulty with processing speed
Some grammatical errors
What is often seen in Language Content in ADHD?
6
Poor mapping semantic features
Word recall deficits
Poor inferences
Figurative language
Metaphors, and humor
Good receptive vocabulary
What is often seen in Language Use in ADHD?
4
Inappropriate initiation
Interrupting
Poor topic maintenance
Too much or too little detail.
What is often seen in Literacy in ADHD?
2
25-40% comorbid reading Disorder and ADHD
Poor decoding and comprehension
What are Implications for clinical practice for students with ADHD?
(4)
Provide structured activities and teaching models
Focus on important information (main idea, details) and provide strategies
Give breaks between activities
Work with family, teachers, and client toward a common goal
What is Selective Mutism?
2
Child does not speak in certain situation where there is an expectation of speaking, especially school.
Must persist for more than 1 month (ELL for 6 months)
In what populations is Selective Mutism more common?
2
More common in girls 2:1
Social anxiety disorder – 60-75% also have DLD
What do we need to do when assessing children with Selective Mutism?
(2)
Detailed case history from parents and teachers
Observation of the child in class, playground, etc. is recommended.
What do we need to remember when designing interventions in children with Selective Mutism?
(3)
Behavioral interventions and medical treatment may be considered
Positive reinforcement for speaking, desensitization to stressful situations, self modeling techniques, and family counseling.
Rote tasks – days of the week, months of the year, holidays
What parental behaviors can cause Environmental Disadvantage?
(5)
Substance abuse
Neglect
Low socioeconomic status
Abuse (emotional, physical, sexual)
Neglect (abandonment, poor supervision, poor nutrition/clothing)
How can Environmental Disadvantage impact language?
3
Decreased motivation to speak
Decreased language developmental models
Decreased opportunities to have normal social interactions and language learning
How common is Abuse/Neglect?
40 million children
Are children with developmental disorders and language impairments more likely to be abused than typically developing children?
Yes
How can Abuse/Neglect affect language?
5
Reduced vocabulary growth
Shorter MLUs (deficits persist into adulthood)
Difficulties using language to discuss feeling and needs, convey abstract concepts
Poor reading/literacy
Poor pragmatic skills
What is Fetal Alcohol Spectrum Disorder?
3
Substance abuse during prenatal development
Alcohol interferes with cell chemical processes
Cocaine and related drugs increase risk of premature delivery
What Caregivers Environmental Factors can occur with Fetal Alcohol Spectrum Disorder?
(2)
Poor child care and supervision
Decreased positive communication exchanges and teaching opportunities
What are common Characteristics in Fetal Alcohol Spectrum Disorder?
(6)
Flat upper lip
Flattened philtrum
Flat midface
Low birth weight
Small stature
Slow weight gain
How does Fetal Alcohol Spectrum Disorder affect the Central Nervous System?
(4)
Smaller cranium at birth
Structural brain abnormalities
Developmental delays in feeding and speech and language
Sleep disturbances
What are the Clinical Implications for children with Fetal Alcohol Spectrum Disorder?
(4)
Legal duty to report maltreatment!
Increased risk of Otitis Media, ADHD, and behavioral challenges
Deficits in Executive Function, language processing, and social skills (pragmatics)
May have sensory deficits (need a multidisciplinary team)
What are Assessment Goals for Nonspeaking Children?
3
Determine the children level of comprehension
Determine if any intentional communication is occurring and for what purposes
Consideration of testing to be used
How can Alternative and Augmentative be used for Nonspeaking Children?
A bridge between current communication level and verbal communication
What disorders create
Severe Speech-Motor Disorders?
(4)
Cerebral palsy
Cleft palate
Apraxia
Dysarthria
What do we want to look for in Severe Speech-Motor Disorders?
Physical impairments (consult OT and PT)
What should we be concerned about in Severe Speech and Physically Impairment (SSPI)?
(3)
Limited sensorimotor interactions with people and objects because of physical limitations
Limited access to communication systems due to limited knowledge of parents/case managers/SLPs
Limited provision of AAC products and devices due to cost (Not all SLPs are comfortable with AAC)
What is Low Tech AAC?
Picture symbols and object schedules
What do you need to create Low Tech AAC?
2
Need computer, color printer, laminator
Possibly Boardmaker program
What are the different types of Voice Output Communication Systems?
(4)
One message (Single switch)
Multiple messages (Go Talk 20, Cheap talk 4/8, Tech plus 32)
Dynamic display (Tobii Dynavox, Prentke Romich, Saltillo)
Ipad applications
What do you need when starting AAC use?
7
Assessment and intervention plan
Look at speech and language skills including Articulation (apraxia, dysarthria)
Look at receptive and expressive language skills
Look at motor skills (fine motor, gross motor)
Look at visual skill (eye gaze needed)
Look at cognitive and motor abilities (Do you need mount?)
Family support and training needs
What is the only prerequisite for AAC?
Consciousness
What is Childhood Apraxia of Speech?
A neurological childhood speech disorder in which precision and consistency of movement underlying speech are impaired in the absence of neuromuscular deficits….results in speech sound errors and prosody.
How does Childhood Apraxia of Speech differ from SSPI?
There is no underlying neurological weakness or impairment
How do we assess Childhood Apraxia of Speech?
2
Look at volitional speech motor movements – Oral Peripheral Exam
Mouth, lips, tongue, sequencing (diadochokinetic)
How do we differentiate the 2 types of CAS?
2
Inconsistent production of stress – naming 2 syllable words
Variation in the timing of speech – prosody
How do we plan intervention in CAS?
3
MOTOR Approaches – masses practice, drilling
PROSODIC Approaches – analyze words into syllables, blending and timing with stress
Consider AAC – low to high tech to support language and speech development
What goals should we set for Nonverbal Children with ASD?
Establish intentional and functional communication
What can be comorbid in Nonverbal Children with ASD?
3
Apraxia of speech
ADHD
Other conditions
How should we design intervention for Nonverbal Children with ASD?
(5)
Start with gestures : signs with verbalizations
Picture boards (Need to be meaningful)
Choose core words that are powerful
Talk with parents to see what is important to them!
Work with parents, teachers concerning supporting AAC use
How should we design Intervention for children with ASD?
5
Direct therapy is recommended!
Multidisciplinary therapy is recommended
OT – address sensory issues, support language development, and help with fine motor skills needed if use AAC
PT - address positioning issues, gross motor, and support language development.
Parent training is vital!
