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1. Child and Adolescent Psychiatry > Communication Disorders > Flashcards

Communication Disorders Flashcards

1
Q

list the communication disorders

A

language disorder

speech sound disorder

childhood onset fluency disorder (stuttering)

social (pragmatic) communication disorder

unspecified communication disorder

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2
Q

how many criteria are there for language disorder

A

4 (A, B, C, D)

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3
Q

what is criterion A for language disorder

A

persistent difficulties in the acquisition and use of language across modalities (spoken, written, sign, other) due to deficits in comprehension or production that include the following:

  1. reduced vocabulary (word knowledge and use)
  2. limited sentence structure (ability to put words and word endings together to form sentences based on the rules of grammar and morphology )
  3. impairments in discourse (ability to use vocabulary and connect sentences to explain or describe a topic or series of events or have a conversation)
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4
Q

what is criterion B for language disorder

A

language abilities are substantially and quantifiably below those expected for age, resulting in functional limitations in effective communication, social participation, academic achievement or occupational performance, individually or in any combination

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5
Q

what is criterion C for language disorder

A

onset of symptoms in the early developmental period

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6
Q

what is criterion D for language disorder

A

difficulties not attributable to hearing or other sensory impairment, motor dysfunction, or another medical or neurological condition and are not better explained by intellectual disability or global developmental delay

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7
Q

what is expressive language ability

A

the production of vocal, gestural or verbal signals

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8
Q

what is receptive language ability

A

process of receiving and comprehending language messages

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9
Q

why do both expressive and receptive language modalities need to be assessed

A

may differ in severity

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10
Q

what aspects of speech does language disorder usually impair

A

vocabulary and grammar–> which then limits the capacity for discourse

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11
Q

how does language disorder usually present

A

childs first words or phrases are likely to be delayed in onset

vocabulary size is smaller and less varied than expected

sentences are shorter and less complex with grammatical errors, especially in the PAST TENSE

there may be word finding problems, impoverished verbal definitions, or poor understanding or synonyms, multiple meanings or word play appropriate for age and culture

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12
Q

are language deficits usually over or underestimated

A

usually underestimated, as kids are good as using context to infer meaning

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13
Q

in language disorder, how are difficulties with discourse often demonstrated

A

shown by a reduced ability to provide adequate information about the ket events and to narrate a coherent story

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14
Q

in language disorder, how are problems with remembering new words often demonstrated

A

difficulties following instructions of increasing length, difficulties rehearsing strings of verbal info (i.e phone number, shopping list), difficulties remembering novel sound sequences

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15
Q

how is a diagnosis of language disorder made

A

based on the:

synthesis of the individuals history

direct clinical observation in different contexts

and scores from standardized tests of language ability which can guide estimates of severity

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16
Q

what is the relationship between family history and language disorder

A

a positive family history of language disorders is often present in those presenting with language disorder

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17
Q

what social indicators may prompt referral for a full language assessment (r/o language disorder)

A

being shy or reticent to talk

preference to communicate only with family members or other familiar individuals

*not diagnostic but if notable and persistent, want to rule out language disorder

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18
Q

when does the adult level of language competency appear

A

adolescence

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19
Q

by what age are individual differences/variations in language acquisition more stable (with better measurement accuracy i.e in assessing language disorder)

A

by age 4 years

differences by this age are easier to measure and more predictive of later outcomes

language disorder diagnosed from age 4 years is likely to be stable over time and typically persists into adulthood

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20
Q

what are some prognostic factors in the assessment of language disorder

A

children with RECEPTIVE language impairments have a POORER prognosis than those with predominantely expressive impairments

(they are more resistant to treatment, and difficulties with reading comprehension are frequently seen)

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21
Q

list the general ddx for language disorder

A

normal variations in language

hearing or other sensory impairment

intellectual disability

neurological disorder

language regression

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22
Q

what is often the presenting feature of intellectual disability

A

language delay

*the definitive diagnosis of language disorder vs intellectual disability may not be able to be made until the child is able to complete standardizes assessments; separate diagnosis not given unless language deficits are clearly in excess of intellectual limitations

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23
Q

what should you consider if you see language regression in a child younger than 3 years old

A

may be a sign of ASD (along with developmental regression) or specific neurological condition (i.e landau-kleffner syndrome)

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24
Q

what should you consider if you see language regression in a child older than 3 years

A

may be symptom of seizures (must assess for epilepsy)

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25
Q

how many criteria are there for speech sound disorder

A

4

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26
Q

what is criterion A for speech sound disorder

A

persistent difficulty with speech sound production that interferes with speech intelligibility or prevents verbal communication of messages

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27
Q

what is criterion B for speech sound disorder

A

disturbance causes limitations in effective communication that interferes with social participation, academic achievement or occupational performance (individually or in combination)

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28
Q

what is criterion C for speech sound disorder

A

onset of symptoms in early developmental period

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29
Q

what is criterion D for speech sound disorder

A

difficulties not attributable to congenital or acquired conditions, such as cerebral palsy, cleft palate, deafness or hearing loss, TBI or other med or neuro condition

30
Q

what elements are required for speech sound production

A

both the phonological knowledge of speech sounds

and

the ability to coordinate the movements of the articulators (jaw, tongue, lips) with breathing and vocalization for speech

31
Q

what are the two aspects of speech sound disorder

A

phonological disorders (knowledge of the sounds)

and/or

articulation disorder (the ability to make the sounds)

32
Q

what % of speech should be intelligible at age 2 years? at age 4 years?

A

2 years–> 50% intelligible

4 years–> overall speech should be intelligible

*children with speech sound disorder continue to use immature phonological simplification processes past the age when most children can produce words clearly

33
Q

by what age should most speech sounds be produced clearly, and most words pronounced accurately according to age and community norms?

A

age 7

34
Q

what are the “late 8” speech sounds?

A

L

R

S

Z

Th

Ch

Dzh

Zh

*these are the most frequently misarticulated sounds and thus they also tend to be learned later
*misarticulation of any of these sounds by itself could be considered within normal limits up to age 8

35
Q

what speech sound disorder is particularly common

A

lisping (misarticulating sibilants)

may be associated with an abnormal tongue-thrust swallowing pattern

36
Q

how does treatment impact speech sound disorder

A

most respond well to treatment, and speech difficulties improve over time and thus the disorder may not be lifelong

37
Q

what is a poor prognostic factor in speech sound disorder

A

co occurring language disorder

*may also be associated with learning disorders in this case

38
Q

ddx of speech sound disorder

A

normal variations in speech

hearing/sensory impairment

structural deficits (i.e cleft palate)

dysarthria (i.e in cerebral palsy, worster-drought syndrome)

selective mutism

39
Q

what is another name for child onset fluency disorder

A

stuttering

40
Q

how many diagnostic criteria are there for child onset fluency disorder

A

4

41
Q

what is criterion A for child onset fluency disorder

A

disturbances in the normal fluency and time patterning of speech that are inappropriate for the individuals age and language skills, persist over time, and are characterized by frequent and marked occurrences or one (or more) of the following:

sound a syllable repetitions

sound prolongations of consonants as well as vowels

broken words (i.e pauses within a word)

audible or silent blocking (filled or unfilled pauses in speech)

circumlocutions (word substitutions to avoid problematic words)

words produced with an excess of physical tension

monosyllabic whole word repetitions (i.e I-I-I-I-I see him)

42
Q

what is criterion B for child onset fluency disorder

A

the disturbance causes ANXIETY about speaking or LIMITATIONS in effective communication, social participation, or academic and occupational performance, individually or in any combination

43
Q

what is criterion C for child onset fluency disorder

A

onset of symptoms in the early developmental period (later onset cases are diagnosed as adult onset fluency disorder)

44
Q

what is criterion D for child onset fluency disorder

A

not attributable to speech-motor or sensory deficit, a dysfluency associated with neurological insult, or another medical conditions and is not better explained by another disorder

45
Q

what is the essential feature of child onset fluency disorder

A

disturbance in the normal fluency and time patterning of speech that is inappropriate for the individuals age

46
Q

how does the extent of the speech disturbance in child onset fluency disorder vary

A

extent of the disturbance varies from situation to situation and often is more severe when there is social pressure to communicate

dysfluency often absent during oral reading, singing or talking to inanimate objects or pets

47
Q

what is the relationship between child onset fluency disorder and language abilities

A

unclear–> kids with this disorder show a range of language abilities

48
Q

what other signs or symptoms may accompany child onset fluency disorder

A

motor movements i.e eye blinks, tics, tremors or lips or face etc

49
Q

by what age do most children show symptoms of child onset fluency disorder

A

occurs by age 6 for 80-90% of those affected

age at onset from 2-7 years old

50
Q

how does child onset fluency disorder usually start

A

onset can be insidious or more sudden, but typically they start gradually

typically starts with repetition of initial consonants, first words of a phrase, or long words

child may not be aware of dysfluencies

51
Q

what % of kids recover from the dysfluencies that characterize child onset fluency disorder

what is an indicator or likelihood of recovery

A

65-85%

severity of the fluency disorder at age 8 predicts recovery or persistence into adolescence and beyond

52
Q

is there a genetic risk for child onset fluency disorder

A

yes

risk of stuttering among first degree relatives of those with child onset fluency disorder is more than 3x risk in the general population

53
Q

what can exacerbate dysfluency

A

stress and anxiety

54
Q

that is the ddx for child onset fluency disorder

A

sensory deficits

normal speech dysfluencies

medication side effects

adult onset dysfluencies (if during or after adolescence)

tourettes disorder

55
Q

how many criteria are there for social communication disorder

A

4

56
Q

what is criterion A for social communication disorder

A

persistent difficulties in the social use of verbal and nonverbal communication as manifested by ALL of the following:

  1. deficits in using communication for social purposes, such as greeting and sharing information, in a manner that is appropriate for social context
  2. impairment of the ability to change communication to match context or the needs of the listener such as speaking differently in a classroom than on a playground
  3. difficulties following rules for conversation and storytelling, such as taking turns in conversation, rephrasing when misunderstood
  4. difficulties understanding what is not explicitly stated, and nonliteral or ambiguous meanings of language
57
Q

what is criterion B for social communication disorder

A

the deficits result in functional limitations in effective communication, social participation, social relationships, academic achievement, or occupational performance (individually or in combination)

58
Q

what is criterion C for social communication disorder

A

onset of symptoms in early developmental period (but deficits may not become fully manifest until social communication demands exceed limited capacities)

59
Q

what is criterion D for social communication disorder

A

not attributable to other med or neuro condition or to low abilities in the domains of word structure or grammar, and are not better explained by ASD, intellectual disability, global developmental delay or another mental disorder

60
Q

what is the most common associated feature of social communication disorder

A

language impairment–characterized by history of delay in reaching language milestones, and historical, if not current, language structure problems

individuals with social communication disorder may avoid social interactions

61
Q

other than language impairment, what other disorders commonly co-occur with social communication disorder

A

ADHD
behavioural problems
specific learning disorders

62
Q

what is the youngest age you could reasonably start to ID social communication disorder

A

age 4 or 5

younger than this, kids havent yet developed enough speech and language to be able to fully assess their social/pragmatic functioning

milder forms of this disorder may not be apparent until early adolescence

63
Q

what is the natural course of social communication disorder

A

variable

some kids improve substantially over time and others continue to have difficulties persisting into adulthood

even among those who improve, early deficits in pragmatics may cause lasting impairments in social relationships and behaviour, and also in acquisition of other skills like written expression

64
Q

list risk factors for social communication disorder

A

family hx ASD, communication disorders or specific learning disorders

65
Q

ddx for social communication disorder

A

ASD–this is the primary consideration for those presenting with social communication deficits

ADHD

social anxiety disorder

intellectual disability and global developmental delay

66
Q

how do you differentiate between social anxiety and social communication disorder

A

differ in the timing of onset of symptoms

in social communication disorder, individual has NEVER has effective social communication

in social anxiety, social communication skills developed appropriately but are not utilized because of anxiety/fear/distress about social situations

67
Q

how do you differentiate between ASD and social communication disorder

A

in ASD, there is the presence of restricted/repetitive patterns of behaviour, interests or activities–> this is absent in social communication disorder

*note that those with ASD may only display this restricted/repetitive pattern in early developmental period so need to do careful history because may not have it at time of presentation

68
Q

what is unspecified communication disorder

A

applies to presentations in which symptoms characteristic of communication disorder that cause clinically significant distress/impairment predominate but do not meet full criteria for communication disorder or for any of the disorders in the neurodevelopmental disorders class

use when clinician chooses NOT to specify reason criteria are not met and includes situations in which you dont have enough info to make a diagnosis

69
Q

treatment for social communication disorder (psychDB)

A

behavioural interventions/techniques

speech therapy on social interactions

educational accommodations

70
Q

treatment for language disorder (psych DB)

A

Speech and language therapy = main treatment

assistive technology may be helpful

71
Q

treatment for speech sound disorder

A

speech therapy

72
Q

treatment for child onset fluency disorder

A

speech therapy

CBT–> used to identify thought processes that worsen stuttering and ID coping strategies related to stress from stuttering

electronic delayed auditory feedback tools can also be used to help individuals slow down their speech

1. Child and Adolescent Psychiatry (32 decks)

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