Language Impairment Flashcards
Language impairment
Heterogeneous group
Developmental and/or Acquired Disorders
and/or Delays
Affects spoken and/or written language in comprehension and/or production
Involves one or more aspects of language
NOT a language difference
ASHA defines language disorder as
ASHA defines language disorder as the impairment or deviant development of comprehension &/or use of a spoken, written, and other symbol system
May involve language form, content or use
Can have deficits in receptive &/or expressive
language skills
Can range from mild to severe
Communication disorder diagnose in childhood
Expressive language disorder
Mixed receptive and expressive language
disorder
Phonological disorder
Stuttering
Communication disorder not otherwise specified
Expressive disorder
Limited vocabulary
Shorter and less complex sentences Production of Grammatical errors
Difficulty with word recall
Mixed receptive and expressive
Same as expressive in addition to
Difficulty understanding or comprehending
Difficulty responding to simple directions
Decreased ability to identify pictures or objects
Decreased response to name
Decreased ability to comprehend spatial relations, temporal concepts
Expressive and mixed disorders can co-occur with mental retardation, sensory deficits, or environmental deprivation.
Delayed early communication skills
Rate of intentional communication may be lower in pre-linguistic period, leading to poorer language outcomes
Limited vocalizations and fewer gestures
Less joint action and lower social interaction
Slow acquisition of first words
May demonstrate delays in comprehending simple words or phrases
Slow onset of word combinations
Limited phonetic inventory
Between ages 2-5 should begin to acquire more complex sentence structure marked by increase of usage of inflectional morphemes
Red flags in development disorders
Limited or no babbling by 12 months
No gesturing by 12 months
No single words by 16 months
No two-word spontaneous phrases by 24 months
Any loss of any language or social skills at any age
Signs of disorders shown in kindergarten
Difficulty with all elements of language including pragmatics
Verb phrase elaboration
Past tense verb forms
Early problems learning to read
Poor social interaction and academic success
Biological factors
Genetic/ chromosomal disorders- Down Syndrome
Sensory Impairments- hearing loss, visual impairment
Neurological Disorders- Seizure Disorder, Cerebral Palsy
Congenital Malformations- Cleft Palate
Developmental Disorders- Autism, Mental Retardation
Environmental factors
Age an health of mother Nutrition
Drug use/ alcohol
Exposure to infection
Failure to thrive
Prematurity/low birth weight
Child Abuse and Neglect
Associated disorders and related causes
Mental Retardation/intellectual disability Learning Disabilities
Specific Language Impairment
Autism Spectrum Disorder
Brain Injury
Neglect and Abuse
Fetal Alcohol Syndrome
Mental retardation/ intellectual disability
Now called Intellectual Disability
Characterized by:
*Substantial limitations in intellectual functioning
*Significant limitations in adaptive behavior
*Originates before age 18
Severity based on IQ, ranges from mild to profound
Effects of mental retardation/ ID
Cause can be biological or socioenvironmental.
Organization of information is challenging
Memory and retrieval of information is poor.
The more severe the MR, the more difficulty the person will have in discriminating.
Children with MR/ID vary greatly in their communication abilities.
Language characteristics of MR/ ID
Language abilities can be below cognitive abilities
Slower rate of development
Later, begin to deviate from typical
developmental patterns
Use shorter, more immature forms
All areas of language can exhibit deficits.
Learning disabilities
Heterogeneous
*Difficulties in acquisition and use of listening, speaking, reading, writing, reasoning, or mathematics.
*3% of all individuals have LD, but severity varies widely
Language-learning disability-Primarily difficulty learning and using symbols.
Affects males more than females
As many as 80% of those with LD have some form of reading problems.
Organization is inefficient, so memory is less accurate and retrieval is slow.
6 Categories of learning disabilities
Six categories of characteristic
*Motor, attention, perception, symbol, memory,
emotion
Attention Deficit Hyperactive Disorder (ADHD)
Attention Deficit Hyperactive Disorder (ADHD)
*Underlying neurological impairment in executive
functioning that regulates behavior.
Dyslexia
Dyslexia
*Difficulty comprehending or producing written
symbols
Lifespan issues with LD
Little interest in language or books in preschool
Slow oral language development
May require special education services
Can be successful with accommodations in the classroom
Some receive special services while be included in regular classroom
Some children with LD seem to outgrow aspects of their disability
Some require lifelong adaptations.
Specific language disability (sld)
Significant limitations in language, with no known neurological, sensory, behavioral or cognitive deficits
Occurs more often in boys
Strong family history of SLI
Limited vocabularies, late onset of first words, shorter utterances and sentence length, word finding deficits and omissions grammatical morphemes
Exhibit some information processing and memory problems
Expressive language delay is greater than receptive
Problems with reading once they begin school
Language characteristics of sli
Difficulty with:
*Extracting regularities from language
*Registering different contexts for language
* Constructing word-referent associations for lexical growth
Inappropriate use of language forms cause pragmatic problems
Difficulty in grammatical markers
May speak slowly with disruptions
Less efficient use of syntax
Difficulty using context for vocabulary development
Late bloomers
Late bloomers are children who appear to be delayed in the first few years of life, but “catch up” to their typically developing peers by age 4
◦ Though they appear delayed initially, in early years, comprehension tends to be better than “Late Talkers” and LB tend to use more gestures to communicate
Late talkers
Late talkers appear delayed early on, and the delay continues past age 4
◦ Typically identified as having a language impairment by this age
Genetic chromosomal disorders
Fragile x
Sex linked genetic disorder
Most common inherited cause of mental retardation
Down syndrome
Most common chromosome anomaly Trisomy 21
Down syndrome
Usually demonstrate difficulties with all aspects of communication and language acquisition
Delayed acquisition of linguistic symbols
Rely primarily on concrete word meanings
Shorter less complex sentences
Phonological processes
Poor attention and organization
Poor memory skills
Primary sensory deficits
Visual impairment
Visual difficulties may create a greater delay in early gestural communication development
Usher syndrome which may affect both the visual and auditory systems. Most common cause of deafness/ blindness. Born with hearing loss and progressive loss of vision
CHARGE association present at birth C=coloboma
H=heart, A=atresia choanae, R=retarded growth and development, G=genital, E=ear
Usher syndrome
Usher syndrome which may affect both the visual and auditory systems. Most common cause of deafness/ blindness. Born with hearing loss and progressive loss of vision
Charge syndrome
CHARGE association present at birth C=coloboma
H=heart, A=atresia choanae, R=retarded growth and development, G=genital, E=ear
Facial Asymmetry
Smaller Lower Jaw
Facial Paresis
Cleft lip and/or palate Feeding Disorders
Intervention with change syndrome
Providing compensatory strategies such as hearing aids or cochlear implants
Glasses or eye surgery
Remediation strategies to train functional
skills
Speech and language therapy.
Augmentative communication systems for individuals who are deaf and blind
Neurological disorders
Cerebral Palsy (static encephalopathy)
• Results from brain injury or anomaly that occurs early in development
• Occurs in 2-5 children per thousand births
• Can occur during pregnancy (genetic
condition)
• Can occur at birth (asphyxia) or after birth due to head trauma
• Prematurity
Cerebral palsy
Children with CP are at risk for
Seizures
Feeding difficulties
Speech and language delays Learning disabilities
Mental retardation
SpinaBifida
SpinaBifida
• Incomplete closure of the neural tube
• Vitamin supplements with folic acid have shown to significantly reduce the occurrence
• 80 percent of cases results in decreased absorption of cerebro spinal fluids which causes hydrocephalus and learning disabilities . Spina Bifida itself does not cause DLD
Children exposed to drugs and alcohol
Low birth weight, microencephaly, heart problems, developmental delay
Experience irritability/overstiumulated
Failure to thrive
Disruptive sleep cycles
Difficulty sucking
General developmental delays
Hyperactivity/distractibility
Autism
Considered to be a neurological disorder, but specificity not identified
Dominant in boys
Three components for a diagnosis
Qualitative impairment in social interaction
Qualitative impairment in communication
Restricted repetitive/ stereotyped behaviors
Rett’s Disorder,Childhood disintegrative disorder, Asperger’s, PDD-NOS
Autism cont
Some children never develop speech or functional language
Others develop functional, but idiosyncratic use
Because of limited communication skills, you see
an increase in behaviors
About 50% have MR
Significant deficits in the area of semantic language skills; pronoun usage
Perseveration on topic
Echolalia
Limited capacity for joint attention
Limited capacity for symbol usage- e.g. play skills
Correlation with Autism
PERVASIVE DEVELOPMENTAL DELAY (PDD) HYPERLEXIA
SEMANTIC-PRAGMATIC DISORDER
ASPERGERS SYNDROME (AS)
Asperger’s syndrome
Language is not a problem
Score average or above average on
intelligence tests
Have same social problems or limited interests as children with autistic disorders
Pervasive developmental disorder include
Autism
Rett’s disorder
Childhood disintegrative disorder
Asperger’s
PDD/NOS most common form of autism
Characteristics of PDD
Difficulty with verbal communication, including problems using and understanding language.
Difficulty with non-verbal communication, such as gestures and facial expressions.
Difficulty with social interaction, including relating to people and to his or her surroundings.
Unusual ways of playing with toys and other objects.
Difficulty adjusting to changes in routine or familiar surroundings.
Repetitive body movements or patterns of behavior, such as hand flapping, spinning and, head banging.
Changing response to sound. (The child may be very sensitive to some noises. Also, seem to not hear others when their name is called.
Temper tantrums
Difficulty sleeping
Walk on tip-toes
Lining up toys in a row
Lack of eye contact or fleeting eye contact
Retts syndrome
Girls only
Most common cause of mental retardation in
females
Normal development form 6-18 months with a period of stagnation and then by a rapid regression in motor and language skills
Screaming fits and inconsolable crying are common
Childhood disintegrative disorder
Average age of onset is between 3 and 4 years of age
Communication and social skills are normal up until this age
Loss of vocabulary is extremely dramatic
Seizures
Low IQ
Communication difficulties
Decreased expression of intentions
Failure to develop joint attention to objects Echolalia (immediate and delayed)
Poor eye contact
Delayed symbolic and pretend play skills
Identification of developmental language delay
AUTISM-guidelines for immediate further evaluation for possible autism or PDD
No babbling by 12 months
No gesturing by 12 months (bye-bye)
So single word by 16 months
No eye contact
No response to name or commands
Any loss of language or social skills at any age
Brain injury
Includes traumatic brain injury (TBI, stroke, congenital malformation, convulsive disorders, and encephalopathy
TBI
Diffuse brain damage due to external force
1 million children and adolescents in US
Site and extent of the lesion, age of onset, and age of injury impacts recovery/post accident function
Range of cognitive, physical, behavioral, academic, and linguistic deficits
Social disinhibition may occur
Lifespan issues with TBI
Immediately after accident
*Possible unconsciousness and amnesia
*Disoriented
*Physical and personality changes
Recovery may take years
*Spontaneous recovery in the first months
Neural recovery is unpredictable and irregular
Young children often recover quickly
*Need to recover language AND continue to learn language
Often subtle cognitive and social deficits persist
Language characteristics of TBI
Evident even after mild injuries
Some deficits remain long after injury
(pragmatics)
Language Comprehension and higher level language are often affected, but not form
Word retrieval, naming, object description are difficult
Narration is often difficult
Neglect and abuse
1 Million children per year in the US
Child-mother attachment more significant in
language development and maltreatment
Lifespan Issues
*Possible recurring physical, psychological and emotional problems
LANGUAGE CHARACTERISTIC
Pragmatics is most affect language area
*Less talkative with fewer conversational skills
*Less likely to volunteer information
Shorter and less complex utterances
Other language impairment
Nonspecific Language Impairments Late Talkers
Childhood Schizophrenia
Selective Mutism
Otitis Media
Children who receive cochlear implants.
Assessment
Testing
Standardized Tests
Dynamic Assessment
Sampling
*Select variety of discourse types and contexts
*Record for later transcription
*Analysis
Quantitative and qualitative measures
Code Switching
Intervention
Goal is effective use of language in everyday situations.
Goal of intervention is to improve functioning in the identified deficit area.
Child’s abilities determine methods selected.
Training should be within meaningful
contexts when possible.
EVIDENCED-BASED PRINCIPLE
Targets should not focus on one deficit area
Intervation cont
Basic tenets of good teaching behavior
*Model desired behavior
*Cue client to respond
*Respond with reinforcement or corrective feedback.
*Plan for generalization.
Success occurs when there is generalization to the everyday language environment.
Early Intervation
Family is the center of services.
Facilitate family’s ability to support their
child’s development.
Provided in a variety of settings, home- based, school or center-based, preschools
Provide intervention in the child’s natural environment
Provide within the context of the child’s daily routines.
CPSE
After or close to age three
Paid for by the Board of Education
Center-based or home-based
Inclusion Classes where kids who are typically developing are mixed with children who are delayed in development
