Lecture 13 - Language Impairment Flashcards
several conditions are related to difficulties in spoken language acquisition:
- hearing impairment
- intellectual impairments
- autism/PDD
- specific language impairment
hearing impairment
spoken language learning issues because they’re not getting language input
not an intellectual impairment!
- 1 million kids in US, 90% to hearing parents
- Most prelingually deaf (occasionally they’ll get an infection that causes them to lose hearing but mostly born deaf)
- Trouble developing oral language (no auditory model to serve as a teaching signal: no representation of adult models)
• This cascades into difficulty in language
comprehension, reading
• Difficulty is usually related to how profound the hearing loss is
intellectual impairments
down syndrome, William’s syndrome
specific language impairment
not terribly well defined: diagnosis of exclusion:
can’t find anything other intellectually wrong with a child except they have a lot of trouble with language
a note of skepticism
things to keep in mind
particularly with respect to autism, symptoms could be made better but not curable
parents are very motivated to seek solutions, and there are plenty of people to take advantage of them for lots of money - insist on higher standards of evidence
evidence-based practice
if it really works, it should stand up to a simple t-test
should be scientifically tested with an experiment that shows a statistical significance at the end
wide range of autism treatments have not gone through this process
hearing impairment
can we just fix it?
some solutions
- Not exactly.
- sometimes hearing aids can be used
- Cochlear implants (surgical) show some efficacy*
- Just lip-read? Is not as easy as it sounds.
Cochlear implants
– take a bunch of electrodes and stick it into the cochlea and the electrodes directly stimulate different places along the auditory nerve: MAJOR surgery: work well with adults, because they’re already learned speech (can fairly readily start understanding things), but with kids it’s trickier (babies can’t communicate comprehension or what they’re struggling with)
– Stimulate auditory nerve directly, past site of problem – Still not the same as actual speech input
– See improvements in language skills, esp. if implanted young, but not like real hearing
• Still need lots of educational support
– controversial: insult or threat to signed language/signed culture
why not lip reading as a solution for hearing impairment?
- Kids with residual hearing can have more success. The lips alone do not provide sufficient info to tell you what someone is saying (“olive juice” = “I love you”) = massive overlap of sounds that are different but look alike
- Some sounds not visible (Ex.: /l/, /g/, /k/): can’t see what is going on
- Some sounds look alike (/m/, /b/, /p/): what you see in places of articulation and duration
hearing impairment
phonology
– Not very intelligible, even with training
– CI: more intelligible, but still not great articulation
hearing impairment
language development, lexicon
– Reading skills, vocab max out @ 4th grade level
hearing impairment
grammar
– Poor grasp of English syntax (e.g. passives, etc.
that are hard for younger non-deaf children)
– Better to teach use of [written] language to
communicate effectively
Hearing impairment
• Educational philosophies
1) oral/aural
2) total communication
3) bilingual/bicultural
oral/aural
(verbal-auditory therapy)
trying to get kids to communicate in the spoken word modality
really didn’t work before cochlear implants
– Can be effective if cochlear implant, residual
hearing; resurgence due to implants
– Cued speech: handshapes to supplement lips (when lips aren’t producing visible differences)
Total communication
in response to poor outcomes from oral/aural
made up a sign system (NOT a langauge) that was yoked to English
Make up sign systems yoked to English (SEE - signed exact english)
problem: can’t do prosody, content words are more important in spoken english but function words (a, the, ing) get equal weight in SEE
Bilingual/bicultural (bi-bi)
– Learn ASL first, then transition English as second language = medium to teach English as spoken or written
– Good in principle, limited by teachers’ expertise (if you don’t live in a metropolitan area, don’t have access to a good ASL teacher)
– in a perfect world this is the best solution
intellectual disabilities (ID)
• Down syndrome (poor language)
• Williams syndrome (don’t have preserved language)
- extremely rare
- Fragile X syndrome: deletion of one of the X chromosomes: if you’re female it’s not so bad, but if you’re male you’re fucked.
- Range of cognitive difficulties (obviously not language specific)
- Sometimes, physical difficulties: e.g. heart problems in William’s syndrome
- Poorer categorization, generalization (can’t transfer knowledge to different settings and new situations)
- much much better outcomes if there is Early intervention!!
Down syndrome
- caused by an extra copy of the 21st chromosome: Trisomy 21 (trisomy of any other chromosome it’s fatal)
- level of achievement related to working memory skills
- Look like younger TD (typically developing) children, mostly
– Behind by 20 months at age 3, 24 months at age 4 – Big trouble with English morphosyntax (word order, function morphemes) – Later, pretty good narrative, pragmatic skills
• 10%+ diagnosed with autism
Williams Syndrome
- Genetic, pretty rare
- Characteristic appearance, health issues (heart problems)
• Old claim: bad cognition, seems pretty verbally fluent, good language (reverse of Down Syndrome)
– do they have a preserved language module? and damaged cognition module?
• New claim (see Karmiloff-Smith’s work):
language abilities in keeping with overall
cognitive abilities; still behind for chronological age
Down Syndrom (DS) vs. Williams syndrome
- DS: holistic (looking at the overall form)
- WS: analytic split (look at individual pieces) w/DS
some relation to cognitive function but not language specific
Fragile X
• Problem with X chromosome (mostly boys
affected; biggest source of intellectual disability w/known source in boys)
- Delayed language onset
- Poor oral-motor skills, articulation
- A little better than DS for language skills
- Perseveration in language
- As many as 25% diagnosed with autism
how do we deal with these intellectual disabilities?
Language instruction (DS especially):
- Catch it early
- Teach real-life language skills (grocery list instead of Hamlet)
- Teach so as to generalize skills (transfer skills learned in one situation to a new situation)
- Train learning/rehearsal of new info (chunking strategies, working memory strategies)
- If severe, try augmentative or alternative communication (AAC)
– Symbols/pictures – Signed system (complex but can mold a handshape better than a speech sound!!)
• For DS, keep teaching throughout adolescence (because they’re still developing)
Autism is part of a “spectrum” of disorders, including…
– Rett syndrome
– Autism [spectrum]
(no longer Aspergers)
Categories change from time to time
Is Asperger different from hi-functioning
autism?
DSM-V: says they’re the same thing
Are all cases of autism from same source[s]?
we don’t know
there is no gene
no blood test
nominal fallacy
error in logical thinking where we assume: we have name for it, so we must understand it and know what it is
just because we’re calling a bunch of things “autism” doesn’t mean we understand what it is
we’ve named this cluster of behavioral symptoms but it might a different disorders with different symptoms, etc…
Diagnostic Criteria for Autism
- Highly delayed onset/absence of language
- Impaired conversation starting, responding
- Use language skills in stereotyped, repetitive way (e.g. imitative speech)
• Lack of age-appropriate pretend-play or
socially-imitative play
age of discovery of autism
around 2 years old (much later than down syndrome)
but it’s really hard to diagnose early: how do you know whether it’s individual variation or not
signs of autism before 2 years
– Aberrant eye gaze (don’t do joint attention)
– Lack of responsiveness to name
– Hand flapping, toe walking
– Pierce et al. 2011
Pierce et al. 2011:
autism
visual preference for geometric patterns over people (which is super strange cause little typically developing kids love looking at people, faces, bodies)
regression in autism
1/3 are reported to show regression
seem like they’re doing ok and then they seem to recede into more autism-like behavior patterns
is that really what’s going on or it was there all along and just noticed at this time?
seeming increase in autism cases over time
– MMR vaccine? NOOOOO—original article discredited and yet the myth lives on because people want a scapegoat
– Corresponding decrease in other kids of ID (intellectual disabilities) diagnoses
likely genetic basis for autism
– Siblings at risk
– Families tend to have some of the behaviors even if they don’t have a clinical diagnosis
– Heritability likely, a little hard to tell b/c autistic people don’t have
kids as often
many brain differences for autism
– Accelerated growth of the brain during time when symptoms first identified: may be that if the brain is growing at at time when it’s not supposed to be that indicates problems
Autism: Social &
communicative problems
1) poor joint attention
2) symbol use is difficult
3) theory of mind is underdeveloped
poor joint attention
– On 1st birthday, lack of pointing/showing
– Didn’t look @ faces, respond to name
symbol use is difficult
– Conventionalized gestures (waving, pointing)
– difficulty with pretend play: Banana phone
theory of mind is underdeveloped
– difficulty understanding others’ intents, perspectives
alternative to theory of mind
ability to control your own attention vs. you need some kind of planning function to maintain continuity
impaired executive function or weak central coherence
autism and language
language outcome strongly linked to:
- age of diagnosis
- initial cognitive profile
- initial language profile
- amount of speech language intervention
language and autism
- Receptive, expressive correlated, both related to IQ
- poor pragmatics
- Phonological skills better than others (tend to have pretty good pronunciation)
- Problems with intonation and stress (unusual prosody)
- Confuse you and I (theory of mind issues)
- Difficulty imitating (but echolalia - where they say something over and over again)
- Hard to tell how very early behavior predicts b/c diagnoses late
- demotivated to learn/pay attention to language: Not catalyzed by desire to socially interact
