Intellectual Disability, Learning Disability, Late Talkers, Brain Injury, and Other Language Impairments

Question 1

Intellectual Disability

Answer 1

Intellectual Disability, according to American Association on
Intellectual & Developmental Disabilities (AAIDD)
○ “Substantial limitations in intellectual functioning”
○ “Significantly limitations in adaptive behavior consisting of
conceptual, social, and practical skills”
○ “Originating before age 18 (AAIDD, 2008)
■ IQ: 2 SD below mean (i.e. 68); 1-3% of U.S. population
■ Adaptive areas: language, academic learning, self-help
■ Developmental: as developing into adults
◉ American Association on Intellectual and Developmental Disabilities
(AAIDD)-founded in 1876
○ Focus on policies, research, evidence-based practice etc.
2

Question 2

Intellectual Disability: Severities

Answer 2

IQ: 2 SD below mean (i.e. 68 or below); 1-3% of U.S. population
◉ Severities from mild to profound intellectual disability
○ Mild IQ 52-68*- most common, with fewer other conditions
(89% if ID population–2014)
○ Moderate: IQ 38-51
○ Severe: IQ 20-35
○ Profound: IQ <20
3

Question 3

Intellectual Disability: Overall Characteristics

Answer 3

Severity: largely varied, associated with IQ
◉ 90% ID: mildly delayed (Owens, 2014)
◉ Varied assistance, support, living environment, mode of
communication, education affects the individual in different ways
◉ Individual learning styles; important accommodations may be needed
◉ Language disorders–varied, by different causes/severities
◉ Biological/genetic factors most likely cause ID
○ Prenatal: Down syndrome (DS), Fragile X Syndrome
○ Perinatal: birth asphyxia, placental dysfunction
○ Postnatal: Bacterial meningitis, severe/prolonged malnutrition,
TBI
4

Question 4

Intellectual Disability: Overall Causes

Answer 4

Causes can be unknown, or many causal factors
◉ Biological factors: biology/severity–strong correlation
◉ Social-environmental factors:
○ Poor diet, housing, medical care…
○ Psychological disadvantage
◉ Informational Processing:
○ Attentional capacity: children with ID/TD can have similar
attention skills; ID difficulty with scanning/selection of stimuli
5

Question 5

Intellectual Disability: Language Characteristics

Answer 5

Single most important characteristic of disorder”** (Owens, 2014, 24)
◉ Tremendous variety in language skill level
○ Factors: prelinguistic communication, cognitive skill level,
vocabulary comprehension and chronological age (CA)
○ Cognition-language connection is not consistent in ID!
◉ Sequence of language development similar in TD children, but ID
slower overall
○ Development rate slower: intentions, role taking, sentence forms,
morphology, phonological processes
○ Development rate slower: development of presupposition:
–”speaker’s assumption of the listener’s perspective, what she or
he knows and needs to know” (Owens, 2014, 25)
◉ Immature language forms overall 6

Question 6

Intellectual Disability: Some Language Characteristics
Semantics, morphology, syntax and phonology

Answer 6

Semantics: more concrete word meanings, slower vocabulary growth,
limited use of variety of semantic units
○ Learn word meanings from exposure in content (DS)
◉ Syntax/morphology:
○ Similar sequence of development as TD children
○ Similar length/complexity of sentences as TD children
○ Similar morphology development as TD
○ Shorter, less complex, more immature forms
◉ Phonology:
○ Similar to development of TD, but reliance on less mature;
(capable of more advanced forms)
7

Question 7

Intellectual Disability: Some Language Characteristics
(Owens, 2014)
◉ Comprehension
Pragmatics:

Answer 7

Comprehension:
○ Poorer sentence recall than mental-age (MA) TD matched
children
○ Poorer receptive language than MA TD children (DS children
poorer receptive language)
○ Reliance on context for meaning
◉ Pragmatics:
○ Less dominant conversational role
○ Can infer communication intent from gestures
○ **Gestural patterns similar to TD children
■ Notable use of gestural patterns (Lima, Delgado, & Cavalcante,
2017) 8

Question 8

Intellectual Disability: Down Syndrome (DS)

Answer 8

Fewer word tokens, fewer word types
◉ Shorter utterances overall
◉ Greater perseveration verbally than MA children (less than children
with Fragile X Syndrome)
○ Perseveration: repetition/excessive talking that is not necessary
on a given topic
◉ Less mature syntactic output–capable of more
◉ Less likely to request clarification during communication
breakdowns–capable of more
◉ Phonological differences than expected from delayed development

Question 9

Intellectual Disability: Down Syndrome (DS)
(Owens, 2014)
Narratives:

Answer 9

Narratives:
◉ Oral/written shorter, but can include similar narrative structure,
linguistic complexity, spelling/punctuation skills
◉ Poorer cohesive ties than TD children
◉ Narrative abilities differ with vocabulary comprehension skills
10

Question 10

Intellectual Disability: Fragile X Syndrome

Answer 10

FXS, Martin-Bell Syndrome: genetic condition→intellectual disability
◉ Moderate to severe delays in language communication
◉ More perseverative than children with DS
○ More jargon: meaningless and unintelligible speech than DS
○ More echolalia: repetition of partner’s speech
◉ More differences in phonology than TD
◉ Fragile X with/without ASD
◉ Production: longer/complex sentences than children with DS
11

Question 11

Intellectual Disability: Processing & Techniques
Informational Processing:
Attentional capacity

Answer 11

Attentional capacity: children with ID/TD can have similar attention skills; ID
difficulty with scanning/selection of stimuli
◉ Using visual/auditory stimulus cues to highlight information
◉ Gestures to highlight auditory information
◉ Cues gradually decreased with learning
◉ Assist child in learning to scan for relevant cues
12

Question 12

Intellectual Disability: Processing & Techniques (Owens, 2014)
Informational Processing:
Discrimination:

Answer 12

Discrimination: difficulty–ability and speed related to ID severity
■ Less accurate discrimination leads to difficulty identifying
relevant cues
■ Therapy can assist with discrimination:
similarities/differences to aid child
■ ‘Meaningful sorting’–real objects: *functional
characteristics (i.e. size/function)
○
13

Question 13

Intellectual Disability: Processing & Techniques (Owens, 2014)
Informational Processing:
Organization:

Answer 13

Easier to pre-organize information for ID individual
◉ Use visual/spatial cues to help organize information
◉ Repetition of information to help with short term memory tasks
◉ Using associative strategies–what items are associated together
and why
14

Question 14

Intellectual Disability: Processing & Techniques (Owens, 2014)
Informational Processing:
Memory

Answer 14

:
◉ Visual memory –not just auditory memory. Use visuals!
◉ Overlearning, lots of examples
◉ Physical imitation to symbolic rehearsal tasks
◉ Signal recall of events (smell, taste etc.)–easier to recall and can be
reduced over time
○ Generalize from signal recall to symbolic recall of events
◉ Explicitly highlight important information—selective attending
◉ Associations for new words–connect to old words (visual cueing)
○ Sentential/narrative associations to help with memory recall
15

Question 15

Intellectual Disability: Processing & Techniques (Owens, 2014)
Informational Processing:
Transfer

Answer 15

Transfer: Training should be same/very similar to actual situation
◉ Using real items in initial training
◉ Address similarities from one situation to another
○ Child should recognize connections across situations
◉ Training to include people from child’s everyday life
◉ Address previous tasks & connection when having new problems
16

Question 16

Learning Disability (NJCLD, Adopted 1990; Updated 2016)
◉ National Joint Committee on Learning Disabilities Definition of Learning Disabilities

Answer 16

Learning disabilities is a general term that refers to a heterogeneous group of disorders
manifested by significant difficulties in the acquisition and use of listening, speaking,
reading, writing, reasoning, or mathematical abilities. These disorders are intrinsic to the
individual, presumed to be due to central nervous system dysfunction, and may occur
across the lifespan. Problems in self-regulatory behaviors, social perception, and social
interaction may exist with learning disabilities but do not by themselves constitute a learning
disability. Although learning disabilities may occur concomitantly with other disabilities (for
example, sensory impairment, intellectual disabilities, emotional disturbance), or with
extrinsic influences (such as cultural or linguistic differences, insufficient or inappropriate
instruction), they are not the result of those conditions or influences”
◉ 17

Question 17

Learning Disability

Answer 17

Complex; varied
◉ *Heterogeneous
◉ Easy to describe various characteristics; difficult to explain underlying processes
◉ Central nervous system dysfunction–possible cause
◉ Children with LD: normal/near-normal intelligence
◉ Difficulties can be in one/many areas: motor, attention, memory, perception,
symbol(ic), emotion
◉ Motor difficulties:
○ Hyperactivity: condition of overactivity– always in motion (ADHD)
◉ Attention difficulties:
○ Short attention span, inattentiveness
○ LD: easily distracted, easily overstimulated
◉ Memory difficulties:
○ Difficulty with short/long term memory, retrieval–remembering directions,
names, sequences. Many have word retrieval (finding) difficulties

Question 18

Learning Disability–Perceptual Disability

Answer 18

Learning Disability–Perceptual Disability: perceiving sounds, words,
printed letters
○ Difficulty: interpretation after stimuli are seen, heard etc.
○ Figure-ground perception: ability to isolate a specific stimulus
from a background of competing stimuli
○ Listening to the teacher in background noise
○ Sensory integration: making sense of auditory/visual stimuli
occurring at the same time–integrating the whole message
○ Taking auditory message + facial expressions, gestures, intonation
to convey language→all together
19

Question 19

Learning Disability (Owens, 2014)
◉ Emotional problems

Answer 19

Emotional problems may be present
○ Impulsive, withdrawn, exercise poor judgement etc.
◉ 4 Modalities of Language may be affected to various degrees
◉ Language development delays overall
○ Exhibiting: language of younger children
■ May have mature structures, used less often
○ Difficulties with content/form of language
○ Delays in syntactic complexity
○ Difficulties with morphological learning–i.e. bound morphemes
20

Question 20

Learning Disability (Owens, 2014)
◉ Pragmatics
◉ Phonology
◉ Semantics

Answer 20

Pragmatics
○ Difficulty initiating, responding, asking, answering
○ No real difficulties turn-taking etc.
◉ Semantics
○ Word retrieval difficulties
○ Difficulties with relational terms (comparatives/superlatives,
spatial, temporal etc.)
○ Difficulties with coordinating conjunctions
○ Difficulties with figurative language, multiple meaning words
◉ Phonology
○ Production-inconsistent; more complexities→difficulties
21

Question 21

Learning Disability (Owens, 2014)
◉ Syntax/Morphology
◉ Comprehension

Answer 21

Syntax/Morphology
○ Difficulties with possessives
○ Difficulties with pronouns, verb tense
○ Difficulties with negatives/contractions
○ Difficulties learning new sentence forms; can repeat reduced
form
○ Difficulties with articles (a, an, the)
◉ Comprehension
○ Reading comprehension; difficulties with retrieving meaning from
printed word–poor strategies
○ Difficulties with varied wh-questions
○ *Some students with LD don’t demonstrate comprehension
difficulties 22

Question 22

Learning Disability: Dyslexia

Answer 22

Dyslexic children and adults struggle to read fluently, spell words correctly and
learn a second language, among other challenges. But these difficulties have no
connection to their overall intelligence. In fact, dyslexia is an unexpected
difficulty in reading in an individual who has the intelligence to be a
much better reader. While people with dyslexia are slow readers, they often,
paradoxically, are very fast and creative thinkers with strong reasoning abilities.
Sally Shaywitz, Overcoming Dyslexia, 2nd edition, pp.143- 24.
23

Question 23

○Learning Disability: Dyslexia Extremely

Answer 23

Learning Disability: Dyslexia Extremely common 20% population
◉ 80– 90 percent of LD→dyslexia
◉ Neurological basis: Differences in brain connectivity
◉ Life–no cure
○ Supports can greatly increase child/adult’s success
◉ The Yale Center for Dyslexia and Creativity:
○ Signs of dyslexia at different ages

Question 24

Fetal Alcohol Syndrome Disorder

Answer 24

Alcohol exposure in utero–affecting central nervous system (CNS) in
fetus
○ Low birth weight, short length, CNS dysfunction
○ Small head, hyperactive, cognitive disabilities
○ Deficits in attention, poor memory, EF, behavior, mental health
○ Delayed development, echolalia
○ Language production exceeds comprehension–deficits in
concept formulation, response inhibition
○ Infants: irritable, difficulty sucking
◉ Owens: similarities in FASD and LD–behavior/language
○ Many children FASD—also diagnosed LD, ADHD
25

Question 25

Fetal Alcohol Syndrome Disorder (Owens, 2014)
◉ Children in school
Intervention Strategies:

Answer 25

Children in school:
○ Difference in social communication
○ Longer/greater number of inattention, passive behavior–smaller
and shorter than TLD peers
◉ Intervention Strategies:
○ *Picture cues to augment verbal information
○ *Preferential seating, remove distractions
○ Novel objects, topics etc. to ‘hook’ child
○ Significant description, modeling
○ Careful explanation; ask child to repeat directives/information
○ Eye contact/call child’s name prior to directives
○ Provide patient ‘buddy’ to help child with social interaction 26

Question 26

Traumatic Brain Injury

Answer 26

Traumatic Brain Injury (Owens, 2014)
◉ Brain injury: age of onset, site of lesion, extent of lesion
◉ Deficits: cognitive, physical, behavioral, linguistic, academic
◉ Prognosis: chance of recovery
○ Varies, based on damage area, size, lesion, site
○ Range: full recovery to vegetative state
◉ TBI due to blow to head (i.e. car accident)
◉ Severity;
○ Mild concussion-loss of consciousness <30 seconds
○ Moderate TBI-30 min-24 hours, with/without skull fracture
○ Severe TBI-coma 6 hours+
◉ Variables affecting recovery–extremely varied
◉ Shorter loss of consciousness/amnesia & better posttraumatic
abilities=better recovery

Question 27

Traumatic Brain Injury (Owens, 2014)
◉ Language

Answer 27

Language
○ Affected, even after minor injuries
○ Difficulties with executive function (EF) and pragmatics
■ Difficulty regulating language, too lengthy, inappropriate
■ Narratives significantly affected
■ Topic maintenance affected
■ Difficulties with figurative language, dual meanings
○ Not affected: language form and content
■ Surface structure
■ Semantics, content vocabulary (although may be some
difficulties with object description, word retrieval etc.
◉ **Deficits can remain even when overall improvement occurs–subtle
deficits in pragmatics may remain 28

Question 28

Traumatic Brain Injury (cont.) (Owens, 2014)
◉ Difficulties

Answer 28

Difficulties with Executive Function (EF)
○ Inattentive, easily distractible
○ Organization: categorization, sequencing, abstracting,
generalizing affected
○ Difficulty making inferences, solving problems
◉ Memory Deficits
○ Storage/retrieval deficits (long term intact–usually not affected)
◉ Table 2.11 (p.56) for more TBI language characteristics

Question 29

Cerebrovascular Accident (CVA)

Answer 29

Rupture/blockage blood vessel: Portion of brain denied oxygen
○ Damage usually localized
◉ Children: congenital heart problems, blood vessel malformations
◉ Language difficulties
○ Language returns, but difficulties noted when demands increase
○ Word retrieval deficits: speed/accuracy
○ Language comprehension difficulties
○ Higher level academic/reading difficulties may continue
○ Pragmatics difficulties common (may be subtle)
31

Question 30

Late Talkers
Expressive language

Answer 30

Expressive Language
○ Not achieved 50-word (minimum) milestone / two-word combinations at
24 months– ‘late talkers’ (LT)
○ **Expressive vocabulary percentile
◉ Receptive Language
○ Receptive language/comprehension skills intact (Hawa & Spanoudis,
2013); some studies expressive/receptive delays
◉ Phonological Profile
○ Vocalization: less than peers (Rescorla & Ratner, 1996)
○ Limited phonetic inventories (Rescorla et al., 1996; Paul & Jennings, 1992)
○ LT use fewer consonants overall (Carson, Klee, Carson & Hime, 2003;
Paul et al., 1992) & more open syllable/word shapes (Carson et al., 2003)
32

Question 31

Late Talkers
◉ Vocabulary
Pragmatics

Answer 31

Vocabulary
○ Atypical, not simply delayed (MacRoy-Higgins, Shafer, Fahey & Kaden,
2016)
◉ Pragmatics
○ LT presented less pragmatic language behaviors, inhibiting their
language learning (MacRoy-Higgins & Kaufman, 2012)
○
33

Question 32

Late Talkers
◉ Attention
social/Emotional Development-Temperament

Answer 32

Attention
○ Reduced attention to task during word learning, possibly affecting lexical
delay (MacRoy-Higgins, & Montemarano, 2015)
◉ Social/Emotional Development-Temperament
○ Depressed, serious, more withdrawn, less alert/interest in play, higher
anxiety, less likely to request assistance (Hawa & Spanoudis, 2013; Irwin,
Carter & Briggs-Gowan, 2002; Carson, Klee, Perry, Muskina & Donaghy,
1998; Paul & Kellogg, 1997)
○ Poor social-emotional competence (Horwitz et al., 2003)
○ 34

Question 33

Late Talkers
◉ Assessment: intervention services?

Answer 33

Assessment: intervention services?
◉ Catch up’: Late talkers to age-matched peers (Rescorla, Roberts, Dahlsgaard,
1997)
○ Standardized testing targeting non-verbal language, auditory
comprehension, expressive vocabulary/language
○ Longitudinal studies through school-age to adolescence
◉ Some notable areas of weakness
○ Syntax & morphology (Rescorla et al., 1997)
○ Narrative tasks (Girolametto et al., 2001)
○ Verbal memory/reading (Rescorla, 2009)