Communication Disorders

Question 1

The Importance of Communication

Answer 1

 Human beings communicate through a variety of symbols (e.g., verbal, gestural, visual) Symbolism as fundamental and unique to human evolution and cognition (e.g., Deacon, 1997)

Question 2

Typical Language Development

Answer 2

 Receptive language (i.e. understanding) at approx 9-10 months (Adamson, 1999). Expressive language (i.e. speech) at approx 18 months (end of sensori motor period, Piaget, 1952) Relatively rapid acquisition and progress (e.g., single to multi-word utterances, grammatical tenses, plurals etc)

Question 3

The Importance of Language

Answer 3

 Important social functions (e.g., share attention and communicate with others, develop and maintain relationships) Crucial role in cognitive development (mental processes such as thinking, memory, and self regulation; Vygotsky 1962) Central to the acquisition of academic skills (particularly reading and writing; Catts & Kamhi, 2005) Children with impaired communication skills are disadvantaged in many ways Impact upon educational achievements, friendships, job opportunities etc Associated with behavioural problems due to frustration in being unable to understand others, or to express themselves (e.g., Willinger et al., 2003)

Question 4

What is a Communication Disorder?

Answer 4

A limited or lack of ability to understand or use speech and language to relate to others in societyKey areas: ◦ Receptive & expressive ◦ Articulation ◦ Voice

Question 5

What are Specific Communication Disorders (DSM-IV)?

Answer 5

 Expressive Language Disorder  Mixed Receptive-Expressive Language Disorder Phonological Disorder Stuttering

Question 6

DSM 5 Changes

Answer 6

 DSM-IV Receptive and mixed receptive-expressive language disorder àLanguage Disorder (see Leonard, 2009) Phonological disorder àSpeech-Sound Disorder Stuttering à Child-onset Fluency Disorder Addition of Social (pragmatic) Communication Disorder

Question 7

Language Disorder

Answer 7

 Persistent difficulties in the acquisition and use of language across modalities (i.e., spoken, written, sign language, or other) Due to deficits in comprehension or production  Language abilities that are “substantially and quantifiably” below age expectations

Question 8

Language Disorder: Expressive Components

Answer 8

 Absence of single words by 2 yrs, & two word phrases by 3 yrs (ICD 10) Limited vocabulary Developmentally inappropriate sentence length and / or complexity Difficulty with word recall and substitution

Question 9

Language Disorder: Receptive Components

Answer 9

 Difficulty understanding words, sentences or specific types of words  Difficulty with grammatical structures (e.g., questions, negatives) Lack of understanding of subtle aspects of language (e.g., tone of voice)

Question 10

Speech-Sound Disorder (Phonological Disorder)

Answer 10

 Persistent difficulty with speech sound production that interferes with speech intelligibility or prevents verbal communication of messages Problems in recognising or processing the sound components of language Age-inappropriate use of speech sounds Substitutions and omissions of sounds (e.g. ‘t’ for ‘k’)

Question 11

Child-onset Fluency Disorder (Stuttering)

Answer 11

 Disturbances in the normal fluency and time patterning of speech …and the disturbance causes “anxiety about speaking”  Repetitions of consonant, vowel sounds or whole words Sound prolongations Hesitations Complete verbal blocks (Ramig & Shames, 2002) Anxiety may be situational

Question 12

What is the General Criteria for Communication Disorders

Answer 12

A. Language skills substantially lower than a standardised measure of non-verbal intelligenceB. Significant interference with academic or occupational achievement or with social communication C. Criteria are not met for a Pervasive Developmental DisorderD. . If mental retardation, a speech-motor or sensory deficit, or environmental deprivation is present, the language difficulties are in excess of those usually associated with these problems

Question 13

Social (Pragmatic) Communication Disorder

Answer 13

 Persistent difficulties in the social use of verbal and nonverbal communication Deficits in using communication for social purposes Impairment in the ability to change communication to match context or the needs of the listener Difficulties following rules for conversation and storytelling  Difficulties understanding what is not explicitly stated and with nonliteral or ambiguous meaning of language

Question 14

Is this classification necessary?

Answer 14

 Children who meet the criteria for ASD should not be diagnosed with this communication disorder• ASD does encompass communication problems but it also includes restricted, repetitive patterns of behaviour, interests or activities • Social (pragmatic) communication disorder introduced to ‘catch’ individuals who fell ‘between’ disorders• Aim is to improve diagnosis and care of such individuals

Question 15

However:

Answer 15

 Lack of reliability and validity as a separate diagnosis? (e.g., Ozonoff, 2012; Skuse, 2012) Lack of clinical utility in practice?  Lack of standardised measures to assess pragmatic knowledge Vagueness of age criterion Subject to cultural / interpretation bias

Question 16

Prevalence of Childhood Communication Disorders

Answer 16

 Different incidence rates for specific disorders, but generally higher in boys than girls (e.g., stuttering) Expressive disorders are most prevalent (Carr, 2006) Mixed receptive- expressive disorders are considered to be the most debilitating (Bishop, 2002; Whitehurst & Fischel, 1994) Recovery rates are good, but persistent conditions particularly influence literacy achievements (Bishop & Adams, 1990)

Question 17

Psycho-Social Factors in Communication Disorders

Answer 17

 Likely to play a maintaining rather than causal role (Whitehurst & Fischel, 1994) Language environment (re-visit the nature vs. nurture debate)

Question 18

Parent-Child Interaction

Answer 18

 Verbal interactions between parent and child are bi-directional Overall, little evidence that suggests parents child-directed speech is a primary cause of communication disorders (e.g., Whitehurst et al., 1988) However, parents may modify their speech in response to a child’s limited language skills (e.g., less complex /more intervening) which may have some influence

Question 19

However…

Answer 19

Influence of:◦ Low socio-economic status (e.g., Rescorla, 1984)◦ Large family size ◦ Co-morbidity with conduct disorder (negative and coercive interactions)

Question 20

Assessment of Childhood Communication Disorders

Answer 20

 Multi-disciplinary  Full medical and neurological paediatric assessment Psychometric assessment of receptive and expressive language, and non-verbal intelligence Use of interviewing, observation and behavioural checklists to distinguish from other disorders (Bishop, 2002)

Question 21

Psychological Intervention: Central Goals

Answer 21

(1) Help children to develop and improve their communication skills(2) Develop coping strategies and alternative communication options(3) Practice and use of communication skills and coping strategies in real-world environments

Question 22

Methods of Psychological Intervention

Answer 22

 Individualised speech therapy Behavioural therapy / management  Environmental modification

Question 23

Parent-Child Interaction Therapy (PCIT) for Stuttering (Rustin et al. 1996)

Answer 23

 Flexible and individual approach Open acknowledgement and discussion of communication problems and their impact Emotional awareness and coping strategies Use of praise and child-led play Parents takes the lead role rather than the therapist

Question 24

Evaluation of PCIT

Answer 24

 Matthews et al., (1997) and Millard et al., (2008; 2009) found significant reductions in stuttering using single-case and small group designs Further studies are needed, but small samples also have advantages (e.g., clinical relevance, internal validity) Five phase model for treatment outcome research (Robey, 2004)

Question 25

The Child as an Agent for Change (Weiss, 2004)

Answer 25

 As far as possible, it is important to see the child as an active client Rapport, belief, motivation and responsibility are still relevant for the child-therapist relationship but may need to be approached differently Internalisation of perceived ‘locus of control’ (Rotter, 1966) is crucial for the treatment of communication disorders