Early Childhood Language Disorders Flashcards
What standardized measures can you use to assess language in early childhood?
- Rossetti Infant-Toddler Scale
- Developmental Assessment of Young Children
- Clinical Evaluation of Language Fundamentals Preschool
Rossetti Infant-Toddler Scale
Birth-3;0 years
Subtests: interaction attachment, pragmatics, gestures, play, language comprehension, language expression
Behaviors can be directly elicited from the child, directly observed, or reported by parent or caregiver to credit the child’s performance.
Developmental Assessment of Young Children, 2nd Edition (DAYC-2)
Birth-5;0 years
Obtains information about a child’s abilities through observation, interview of caregivers, and direct assessment
Communication: evaluates receptive/expressive language skills (vocabulary, grammar, following directions)
Receptive language:
- Turns head toward voice when someone speaks to him/her
- Briefly stops activity when told “no”
- Responds to “where” questions
- Points to 15 or more pictures of common objects when they are named
Expressive language:
- Produces 3 or more single vowel sounds
- Spontaneously says familiar greetings and farewells
- Uses 10-15 words spontaneously
- Uses five or more regular plurals
Clinical Evaluation of Language Fundamentals Preschool-3 (CELFP-3)
3;0-6;11 years
Assesses language development across multiple areas
Subtests: sentence comprehension, word structure, expressive vocabulary, following directions, recalling sentences, basic concepts, word classes, phonological awareness, descriptive pragmatics profile, preliteracy rating scale
Subtests assess a multitude of skills, including but not limited to:
- Comprehension of various word structures (adjectives, prepositional phrase, verb condition, infinitive, relative clause)
- Ability to follow multi-step directions
- Auditory memory
- Concepts such as sequencing, attributes, same/different
- Phonological awareness (blending, segmentation)
What standardized measures can you use to assess vocabulary and phonological awareness in early childhood?
Vocabulary:
- PPVT (2;5+)
- EVT (2;6+)
Phonological Awareness
- PAT (2;5-9;11)
- Subtests: rhyming, segmentation, isolation, deletion, substitution, blending
What informal measures can you use to supplement an early childhood evaluation?
Observation: assess how child interacts w/their environment (gestures, eye contact, etc.)
Parent questionnaire: CSBS DP or MC-CDIs
Language sample: SLAM cards, conversational speech, SALT/SUGAR
Communication and Symbolic Behavior Scales (CSBS)
6 months-2;0 years
Parent interview and direct observation of natural play to collect information on communication development
Evaluates:
- Emotion and eye gaze
- Communication
- Gestures
- Sounds
- Understanding
- Object use
MacArthur Bates Communication Development Inventory
Parent report instrument used to screen children, develop prognoses, plan intervention, and monitor progress
Words and gestures form (8-18 months): child’s understanding of vocabulary items, words understood/produced, communicative gestures used
Words and sentences form (16-30 months): child’s production of words, use of early forms of grammar, written examples of utterances
CDI-III (30-37 months): measures expressive vocabulary and grammar
What CLD considerations should an SLP make during an evaluation?
Culturally appropriate testing choices (BESA, DELV-NR)
Dynamic assessment: evaluates child’s learning potential
Bilingual English Spanish Assessment
4;0-6;0 years
Components:
- 3 subtests: morphosyntax, semantics, phonology
- 2 questionnaires: Bilingual Input-Output Survey & Inventory to Assess Language Knowledge (ITALK)
Fetal Alcohol Spectrum Disorder (FASD)
Caused by alcohol consumption during prenatal development
FASD - criteria for diagnosis & facial dysmorphology
3 criteria:
- Growth <10th percentile
- CNS involvement
- Facial dysmorphology
Facial dysmorphology
- Small head, low nasal bridge, underdeveloped jaw, thin upper lip
FASD - CNS involvement
- Poor sucking reflex
- Fine and gross motor delays
- Language acquisition delays
- Delayed developmental milestones
FASD - cognitive & language characteristics
Cognitive:
- Attention/inhibition difficulties
- Decreased short-term memory
- Hyperactivity, distractibility, poor attention
Language:
- Discourse/pragmatic level deficits (e.g., perspective, narratives, reading emotional cues)
- Passive conversationalists
Treatment targets for FASD
- Executive functioning
- Language processing
- Social communication skills
FASD protective factors
- Diagnosis before 6 years old
- Loving, stable, home
- Absence of violence
- Involvement in special education
Neonatal Abstinence Syndrome (NAS)
Baby is born addicted to drugs (opioids, heroin, antidepressants, Benzes)
Signs of symptoms of NAS
Occur within 72 hrs of birth (last 1 week-6 months)
- Tremors, seizures, overactive reflexes, tight muscle tone
- Excessive crying
- Poor feeding/slow weight gain
- Breathing problems
- Fever, blotchy skin
- Trouble sleeping
Complications & outcomes of NAS
Complications:
- Low birthweight
- Jaundice
- NICU stay
- Medical treatment
Outcomes:
- Risk for lower developmental scores
Intelectual disability
Significant limitation in intellectual functioning and adapted behaviors (e.g., personal care, money management, job responsibilities, empathy, making friendships)
Difficulty processing across academic (reading, writing, math) and cognitive (language, reasoning, memory) domains
Language acquisition:
- Pragmatic deficits
- Integrating verbal and nonverbal information
Down Syndrome
Abnormality of chromosome 21
What are the 3 main features of Down Syndrome?
- Short stature
- Decreased cognitive capacities
- Physical changes (macroglossia, almond shaped eyes, microgenia)
How does Down Syndrome impact vision & hearing?
Vision: general oculomotor dysfunction
Hearing: frequent, persistent otitis media, leads to hearing impairment
What are the speech and language acquisition characteristics of Down Syndrome?
Speech:
- Low intelligibility
- Rapid speaking rate
- Mild dysphonia
Language:
- Late to talk
- Slow vocabulary growth
- Difficulty w/syntax
Strong social intelligence –> socially engaged, empathetic
Fragile X
X linked condition (most common cause of intellectual disability in males
Physical characteristics of Fragile X
- Connective tissue problems
- Hyperextension of joints
- High palate
- Large, nautical ears
- Long face/jaw
Social/emotional behaviors & cognitive characteristics of Fragile X
Social-emotional:
- Anxiety/social isolation
- Hyperactive
- Self-injurous
- Compulsive
- Difficulty in busy places
- Problematic transitions
- Reduced eye contact
Cognitive:
- Intellectual disability (deficits in exec functioning, sequential processing, planning, inhibitory control
- Strengths –> simulatenous processing & long term memory
Speech and language characteristics of Fragile X
Speech:
- Apraxic like errors
- Fast rate of speech
- Cluttering
- Impacted connected speech
Language:
- Impaired expressive vocabulary
- Tangential
- Perseverative, repetitive
- Delayed echolalia
- Difficulty w/word retrieval
22q11.2 Deletion (DiGeorge)
Rare genetic condition; missing copy of genetic material
Symptoms of 22q11.2 Deletion
Growth delays, feeding problems, congenital heart disease, cleft/craniofacial issues, breathing concerns
Infancy: nasal vomiting & regurgitation, GERD, chronic constipation, failure to thrive
22q11.2 Deletion effects on speech & language
- Severe hypernasality & VPI
- Severe articulation impairment
- Language disorder
- Dyspraxia
- High pitched voice
- Hoarseness
22q11.2 Deletion developmental concerns
- Autistic-like characteristics
- Behavior differences (ADHD, OCD, anxiety)
- Difficulty w/complex & abstract reasoning, perspective talking
Strengths –> reading, rote memorization of facts
William’s Syndrome
Developmental disorder characterized by mild-moderate ID, distinctive facial features, and cardiovascular problems
Strengths –> verbal abilities, social personality, affinity for music
Physical characteristics of William’s Syndrome
- Joint looseness
- Short stature
- Microcephaly
- Blue eyes
- Small and widely spaced teeth
- Prominent lower lip
Cognitive & behavioral characteristics of William’s Syndrome
- Overactive
- Limited attention span
- Distractable
- Difficulty w/change
- Higher anxiety
Language characteristics of William’s Syndrome
- Excessively social
- Good verbal ability
- Echolalia
- Superficial language with long complex syntactic structures
- Use of complex vocabulary
- Word finding difficulties
- Poor receptive vocabulary
Prader-Willi Syndrome
Autosomal disorder (deletion of chromosome 15)
Physical characteristics of Prader-Willi Syndrome
Fair skin, light hair, small hands/feed, narrow forehead, short, almond shaped eyes
Behavior & common characteristics of Prader-Willi Syndrome
- Delayed puberty, infertile, feeding problems (early infancy)
- CAS
- Insatiable apetite (obesity, type 2 diabetes)
- Saliva issue
Behavior: temper, compulsive behaviors, sleeping problems, stubbornness
Language characteristics of Prader-Willi Syndrome
- Difficulty w/pragmatics
- Shortner utterances
- Close talker (no eye contact but stand very close)
Autism Spectrum Disorder
Neurodevelopmental disorder characterized by…
4 criteria for diagnosis:
- Deficits in social interaction/communication
- Restrictive/repetitive behaviors or interests
- Symptoms in early childhood
- Limits/impairs everyday functioning
Provide examples of social interaction difficulties
- Joint attention
- Social reciprocity
- Language/cognitive skills (acquisition of words, vocal development, symbolic play)
Compare and contrast typical characteristics of children w/ASD vs children w/o ASD
Children w/ASD: interested in things, no preference for faces, don’t visually track people
Children w/o ASD: interested in people, visual preference for faces
Provide examples of restrictive/repetitive behaviors
- Simple motor movements
- Use of objects
- Adherence to routines
- Resistance to change
- Rituals
Clinical onset of ASD
- Development regression around 2-3 years old
- Onset of behavior characteristics
- Lack of response to name, little/no babbling, decrease gaze behavior, little responsiveness to social ames
Language development and everyday functioning of children w/ASD
Language development:
- Early: absent nonverbal intentional communication, limited vocabulary, difficulty w/pretend play, lack of reciprocity, echolalia
- Late: literal language, difficulty w/theory of mind, lack “intuitiveness” in new situations
Everyday functioning:
- Difficulty sleeping, inappropriate emotional responses, anciety
Risk factors of DLD
- Presence of pre/peri/postnatal medical complication
- Prematurity, low birth weight
- Medically fragile
- Stressors in family makeup (finances, conflict, etc.)
What are the 4 most predictive factors of DLD?
- Maternal education level
- 5-minute APGAR
- Birth order
- Biological sex
Biological & environmental risk factors
Biological:
- Poor nutrition
- Lack of preventative health care
- Exposure to toxins
- Chronic health problems
- In utero infections
Environmental:
- Inattentive parental care
- Foster care
- Low maternal education
- Single-parent home
Language-based & language-adjacent red flags
Language-based:
- Small vocabulary, few verbs, more general verbs, 5-month comprehension delay, restricted syllable structure, few spontaneous imitations, few gestures
Language-adjacent:
- Reduced symbolic play, reduced rate of conversation, limited imitation, lack of social smile
What are treatment approaches for early childhood?
- Child centered approach (parallel talk, expansions, extensions)
- Enhanced milieu technique
- Hanen program
- Focused stimulation
- Prelinguistic milieu
- Toy talk
What is the “Child Centered Approach”?
Facilitative play/language facilitation
The SLP gives the child an opportunity to provide target responses in a play setting. The child is not required to respond; there is no correct/incorrect response
Implements parallel talk, expansions, and extensions
Define parallel talk, expansions & extensions
Parallel talk: describe the action the child is doing
- E.g., “you put pig in”
- Can be used before child is speaking
Expansions: comments that add semantic and syntactic details to incomplete phrases
- E.g., cow house –> the cow is in the house
Extensions: adding more information to the child’s utterances
- E.g., baby cry –> yes, the baby is sad
Expansions/extensions incease likelihood of spontaneous imitation
What is Enhanced Milieu Technique? Describe the treatment propulation & goals
A naturalistic approach, SLP sets up the environment to facilitate verbal communication
Treatment population:
- Cognitive delay, language disorder, ASD, Down Syndrome, severe disabilities
Goals:
- Increase freq. of communication
- Enhance diversity of utterances
- Strengthen complexity of speech
- Improve generalized use
What are the 6 steps of Enhanced Milieu Treatment?
Environmental arrangement:
- Increase engagement by using toys of interest
- Arrange them in a way that encourages communication (e.g., give playdoh w/no tools)
Response interaction:
- Respond to every form of communication
Modeling:
- Adult models language at target MLU and slightly above
Expansions:
- Adult repeats utterances & adds word/phrase
Time delays:
- Used when child hasn’t inititated any communication
- Prompts child to produce more complex response
Milieu prompting:
- Functionally reinforce communicative attempts by providing access to requested objects, continued adult interactions, feedback
What are the Hanen Programs?
SLP and parent work together to formulate goals and identify how to target them in naturalistic contexts
Strategies –> focused stimulation, expansion, child-led, anticipatory waiting, recasting utterances (highlight key concepts)
**Indirect, child-led, family-centered
List the 5 different Hanen Programs
- It Takes Two to Talk
- Target Word
- I’m Ready
- More than Words
- TalkAbility
Hanen Programs: It Takes Two to Talk
Builds language skills in children 2-6 years old at one single word stage of development
Hanen Programs: Target Word
Develops vocabulary and expressive language in children under 30 months
Hanen Programs: I’m Ready
Targets literacy skills in children 3-5 years old
Hanen Programs: More than Words
- (15-24 mos) who meet ASD criteria OR (24-48 mos) who have ASD diagnosis
- Practical strategies to address child’s needs & routine based activities
Hanen Programs: TalkAbility
- 4-8 year olds communicating at the sentence level
- Targets extended conversation, understanding nonverbal messages, taking others’ perspetives, developing play skills
What is Focused Stimulation? Treatment population?
- Child is provided w/concentrated repetitions of words/phrases within naturalistic communicative contexts
- Facilitates comprehension and possible language production
E.g., while playing with Mr. Potato head, target “on” and “off” (I put on the nose, I took off the ears)
Treatment population:
- Delayed expressive language, SLI, developmental disabilities, cognitive delays, ASD
- Children at single word level
What is Prelinguistic Milieu
- Tx approach that encourages child’s communication attempts (vocalizations, gestures, facial expressions, etc.)
- Aims to increase social communication skills (joint attention, turn-taking, reciprocity)
- Based on theory of social interactionsim
Strategies:
- Imitate vocalizations & add words
- Respond to pointing by labeling an object
- Use exaggerated facial expressions & sound effects
- Incorporate into daily routines
**Effectively improves communication/language skills in kids with ASD, Down Syndrome, cerebral palsy, etc.
What is Toy Talk? Target population?
A language modeling strategy that shifts conversation toward descriptive comments about the object itself; designed to promote nouns as sentence subjects
Target pop: 0-5 years pold
How do you implement Toy Talk? What are the benefits of this strategy?
Implementation:
- Talk about what the toy is doing
- Use name of toy (instead of a pronoun)
- Use descriptive sentences rather than questions
Benefits:
- Supporrts grammatical development
- Increases identification of subject position
- Increase academic success
Assessing language production in LLE
- Quantity of words produced
- Quality of words produced
- Frequency of words produced
- Type (category) of words produced
LLE risk factors
- Low birth weight
- Family history of speech, language, reading, learning problems
- Male
- Differences in neuron development
- Prolonged, untreated otitis media
- Parental factors (education levels, neglect)
Positive prognostic indicators
- Receptive vocabulary
- Spontaneous imitation
- Use of a lot of specific verbs
Describe the importance of the diversity of verbs
Verb diversity is more important than verb quantity
- General all purpose verb (do, get, go, have, look, play, put, see, want)
- Mental state verbs (think, know, believe remember)
- Action words specific to activities
Gestures are a predictor of…
Later language abilities (intentional communication)
- Commplement: word and gestures refer to same meaning
- Supplement: gesture adds additional meaning
What is syntactic bootstrapping?
Child gains meaning of words from other words around it (i.e., knows how to use the word but might not know the definition)
Provide examples of early pragmatic skills
- Eye contact
- Expressing emotion
- Responding to name
- Joint attention
- Social smile
- Greets
- Protests
- Shows/gives object
Characteristics of later talkers
- Less than 50 words/no 2-word combinations by 2 years old
- Expressive language affected
- Toddler years: atypical babbling, decreased vocabulary, behavior problems, delayed comprehension and use of symbollic gestures
Morphosyntax treatment approaches
- Syntax stories: stories loaded with syntactic frame
- Toy talk: increases use of 3rd person within noun phrases
Discourse language therapy
- Story champs/story cubes: label story macrostructure elements, child retells story
Stage 1: pragmatics
6-8 months: babbling, joint attention
6-9 months: gestures
12 months: comp 50 words, speak 1st word
Stage 2: early vocabulary
12-18 months: exp. 50 words (nouns, personal-social)
Stage 3: early word combinations
18-30 months: “word spurt” (agent-action, action-object)
Stage 4: morphosyntax
30+ months: simple sentence structures, add morphological markers (-s, ing, ed, on/off)
Stage 5: discourse
4+ years: refine conversational/ narrative skills, understand jokes & humor
