Lecture #8 - child language disorders 2 Flashcards
what does DSM-V language disorder stand for ?
Diagnostic and Statistical Manual of Mental Disorders
what are the 3 definitions of DSM-V language disorder ?
1) persistent difficulties in the acquisition and use of language across modalities (i.e., spoken, written, sign language, or other) due to deficits in comprehensoin or production
2) language abilities 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
3) onset of symptoms in early developmental period
4) dificulties not attributable to hearing or other sensory impairment, motor dysfunction, or another medical or neurological condition and not better explained by intellectual disability or global devlopmental delay
what are some examples of deficits in comprehension or production in regards to DSM-V language disorder ?
- reduce vocabulary (word knowledge and use)
- limited sentence structure (ability to put words and word endings together to form sentences based on rules of grammar and morphology)
- impairments in discourse (ability to use vocabulary and connect sentences to explain or describe topic or series of events or have conversation)
what does impairement in discourse mean?
having trouble with the flow of conversation or storytelling (it can make it hard for someone to organize their thoughts, stay on topic, or explain things in a clear, logical way)
what are the two types of perspectives in language disorders ?
normative & naturalist perspectives
what is a “normative perspective” ?
- impact on overall development and ability to function in everyday situations
- child is recognized by those in their environemnt as having a problem
how do “normative perspectives” defines language disorder ?
defines language impairment related ont only to child’s abilities, but also society’s view on these abilities and on the linguistic, social, psychological and educational consequences of these abilities
how do “naturalist perspectives” defines language disorder ?
defines language impaiment solely based on the child’s level of functioning
what is a “naturalist perspective” ?
- child scores significantly below expectations on norm-referenced or standardized tests
- impaurment identified based on notion of significant deviation from norm
what term is defined as :
This view focuses on whether there is a clear difference from what’s typical based on standardized measures. If someone’s language abilities are significantly below the average or expected level for their age, then it’s considered a disorder. In short, it’s all about measuring how different someone’s skills are from what’s “normal” or typical.
naturalist perspective
what term is defined as :
This view looks at how a language difficulty affects a person’s life. Here, a disorder is only diagnosed if the language issue causes noticeable problems in everyday life—like trouble communicating with others, issues in school, or difficulty in social settings. It’s about whether the person’s language skills actually get in the way of living a normal life.
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in a naturalist perspective anything below the _______ is viwed as having a language disorder
mean
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in a nromal distribution, anything from where and onwards is considered normal and typical
16th
what is a language disorder ?
overarching term describing language problems that have functional imacts and are likely to persist
what percentage of people have a language disorder ?
9.9%
TRUE OR FALSE
disorder is an overarching term ?
TRUE
in simplest, shortest way, what is the difference between a language disorder and language difficulty ?
- A language disorder is a long-term issue with understanding or using language that significantly affects daily life.
- A language difficulty is a temporary or mild challenge with language that doesn’t usually disrupt daily activities as much.
how many different branches are there of language disorders ?
language disorder associated with a biomedical condition
OR
developmental language disorder
what percentage of the people who have language disorders (9.9%) have a language disorder associated with a biomedical condition ?
2.3%
what percentage of the people who have language disorders (9.9%) have a developmental lnaguage disorder (DLD) ?
7.6%
what is an example of a language disorder associated with a biomedical condition ?
autism (evidence based causal linked)
what is an example of a developmental language disorder (DLD) ?
An example of a Developmental Language Disorder (DLD) is when a child has trouble forming sentences correctly, like saying “Him go school” instead of “He goes to school.” Children with DLD may struggle with vocabulary, grammar, and organizing thoughts, even though they don’t have hearing loss or other developmental delays
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developmental language disorder is as common as _________
dyslexia
in regards to child language disorder labels; language disorder associated with “x” (LDx) … what do some associated conditions include :
- acquired epileptic aphasia
- autism
- brain injury
- cerebral palsy
- genetic conditions (e.g., down syndrome)
- intellectual disability
- neurodegenerative conditions
- sensorineural hearing loss
in regards to child language disorder labels; developmental language disorder (DLD) … what do some associated conditions include :
- difficulty with language
- significant functional impact
- persistent or likely to persist into middle childhood and beyond
- no known cause
TRUE OR FALSE
developmental language disorders can be life-long
TRUE
what is DLD more common than ? (an example)
DLD is more common than autism despite autism being more “known”
when do we usually diagnose kids ?
essentual to diagnose as kids, however its never too late
in regards to child language disorder labels …. what about preschoolers (e.g., late talkers) and kids in JK?
Out of the following three points what are likely to be true ?
a) language diffriculties
b) functional impacts
c) likely to persist
a) language diffriculties
b) functional impacts
c) we dont always know if it will persist
what are the 3 labels in the “decision tree” for kids under 5 in regards to child language disorder labels ?
- Ldx
- DLD
- Language Difficulty
what does it mean if a child’s language disorder continues beyond 5 ?
will always persist
under the age of 5 will LDx persist ?
we dont know if it will persist
what is the clinical population of LDx ?
- children with a diagnosed condition known to be associated with LD
- if waiting for diagnosis, use language disorder
what is the clinical population for DLD ?
- children with no known casual condition
- when reasonable to think the condition will persist … even if <5!
what is the clinical population for Language Difficulty ?
- children <5 when the SLP is unsure whether the difficulty will persist and/or the child has few risk factors
In speech, language and communication needs, what are some areas of impairements for developmental lnaguage disorder?
- syntax
- morphology
- semantics
- word finding
- pragmatics
- discourse
- verbal learning/memory
what characteristic is shared between developmental language disorder and speech sound disorder ?
phonology
“disorder vs. difference” - what is disorder ?
language skill below environmental and norm-referenced expectations
“disorder vs. difference” - what is difference ?
rule govered language style that deviates in some way from standard use in mainstream culture
how common are child language disorders ?
affects up to 10% of children
TRUE OR FALSE
are child language disorders heterogeneous ?
TRUE
explain how child language disorders can be heterogenous :
- can include difficulties, with phonology, syntax, morphology, semantics, and/or progmatics
- can affect receptive and/or expressive language
- often additional difficulties in areas of cognitive functioning, organization, attention, memory, peer interactions and/or behaviour
TRUE OR FALSE
child language disorders can affect multiple or one category ; looks different on everyone
TRUE
TRUE OR FALSE
child language disorders are often enduring ?
TRUE (a thing people tend to have,make adjustments and practice and eventually can get somewhat stable performance
what percentage of young offenders in a study has language difficulties ?
43%
who are the 3 major age categories of who are at risk ?
1) infant/toddler
2) preschool
3) school-age
define “infant/toddler” :
- pre-intentional (birth-8 months)
- prelinguistic (around 8-18 months)
- emerging language (18-36 months)
define “preschool” :
- developing language (3-5 years)
define “school-age” :
- 6+ years
in the pre-intentional stage : who needs help ?
1) infant identified at birth as high risk for language impairment
2) infant identified as high risk
3) older children functioning at pre
define “infant identified at birth as high risk for language impairment” :
e.g., prenatal drug/toxin exposure, prematurity, obvious genetic or congenital disorder
define “infant identified as high risk “ :
e.g., hearing impairment, global developmental delay, autism, neglect
what is the prelinguistic stage : who needs help ?
- risk for language disorder at 18 months …
- limited range of communicative functions/purposes (low rate of asking for things)
- low rate of communicating (10-12 consonants sounds)
- difficulties with receptive language
what is the emerging language stage : who needs help ?
- risk for language disorder at 24 months …
- fewer than 50-100 words
- no two-word combinations
- risk factors are present e.g., family history of language or learning problems, low socioeconomic status, and high parental concern (counsilling families to support them during this though time)
for the emerging language stage, define late talkers :
- around 20% of toddlers will have : low expressive vocabulary for age and delayed onset of word combinations
- as a group, higher risk for language disorder
- however, around 3/4 are just late bloomers and will go on to have normal language development
late talkers for the emerging language disorder : if delayed expressive language but have all of the below :
- using some language by 30 months
- no risk factors
- normal receptive language
- normal play
- normal nonverbal communication
then …..
more liekly to catch up with no long term effects (i.e., late bloomers not lnaguage disorder)
- monitor closely between ages 3-4 years old
developing language stage: who needs help ?
1) children with developmental language disorder (DLD)
2) children with language disorder associated with biomedical condition
define “children with developmental language disorder (DLD)” :
- formely known as specific language impairement
TRUE OR FALSE
the earlier we intervene the better ?
TRUE
define “children with language disorder associated with biomedical condition” :
- children with language disorders and other area(s) of difficulty (intellectual impairement) (sometimes wont know if its an intellectual impraimrent or a DLD
- e.g., ASD, TBI, Sensorineural hearing loss
TRUE OR FALSE
kids who have a DLD could also have a intellectual impairement ?
TRUE
what could minor difficulties with impairements be diagnosed with ?
DLD (but definetly not always)
school-aged and beyond: who needs help ?
1) children with DLD and LDx
2) children with specific learning disability
3) dyslexia/specific reading disability
4) others
describe “children with specific learning disability” :
- academic underachievement over or equal to 1 of :
- receptive language (listening and reading)
- language processing (thinking, conceptualizing, integrating)
- expressive language (talking, spelling, writing)
- intelligence is otherwise average or higher
- not primarily the result of vision, hearing, physical impairement, emotional disturbance, or cultural difference
define “others” :
- language disorder associated with specific biomedical conditions (e.g., syndromes, intellectual impairement, ASD, TBI, HI)
define “condions with a causal association” :
- traumatic brain injury
- stroke
- seizure disorder/epilepsy
- tumours, infection, radiation
define “language characteristics” of known causes of language disorders ?
- wide range of receptive and/or expressive language impairments, with wide range of deficits severities
- acute vs persistent language patterns
majority of the time do we know or not know the cause
we dont know
how many major theories of language disorders are there ?
- behaviourist
- nativist
- interactionist
- statistical learning
define “behaviourist” theory :
children learn lanuage through imitation and reinforcement
define “nativist” theory :
biological make-up is critical (language acquisition device)
- says that people are born with a built-in ability to learn language. For kids with language disorders, this theory suggests there might be a problem with this natural language ability, meaning they may need extra help to learn language skills
define “interactionist” theory :
role of social environment x biological features
- (lack of opportunities) x (maybe born with certain features)
define “statistical learning” :
repeated exposure
- is the ability to learn patterns by observing how often things happen together. For language, this means that people (especially young children) naturally pick up on patterns in sounds, words, and grammar by noticing which ones often appear together. This helps them learn language without being directly taught
child language assessment - what is it ?
ANY ACTIVITY, wither formal or informal, designed to elect accurate and reliable SAMPLES of commuincation on which INFERENCES relative to developmental skill status can be made
explain “an activity” :
e.g., observation of play with caregiver, formal test, parent, interview, informal, probes, checklist, language sample
explain “samples” :
the younger the child, the less reliable the sample; multiple sources and measures improve reliability
explain “inferences” :
if sample does not reflect age- or stage-appropriate behaviours, infer there may be LD
how many major areas of assessment are there ?
2
what are the 2 major areas of assessment ?
receptive and expressive
define “receptive” :
decontextualize (standardized tests)
- in context, (familiar situation, nonverbal cues)
define “expressive” :
decontextualized (standardized tests)
- in context, (spontaneous language sample)
within receptive and expressive areas of assessment, what are the three main categories of areas of assessment ?
- form/structure
- content/meaning
- use/communication
TRUE OR FALSE
we want to hit every area of assessment ?
TRUE
what characteristics of linguistics are under “form/structure” ?
- syntax
- morphology
- phonology
what characteristics of linguistics are under “content/meaning” ?
- semantics
what characteristics of linguistics are under “use/communication” :
- pragmatics
what is “syntax” :
the rules for how words are arranged into sentences
what is “pragmatics” :
is the study of how we use language in different social situations. It looks at how context, tone, and body language help us understand what people really mean
what is “semantics” :
the meaning of words and sentences
what is “morphology” :
the study of word parts (like roots, prefixes, and suffixes) and how words are formed
what is “phonology” :
the study of sounds in language and how they are organized
how many main categories of methods of assessment are there ?
4
what are the 4 main methods of assessment ?
1) case history (includes caregiver interview)
2) standardized testing
3) criterion-references testing
4) language sampling
what is “case history” method of assessment ?
- questionnaire/interview with parents/caregivers
- collect information about concerns, development, communication, behaviour, etc.
- very important for young children
what is “standardized (norm-referenced tests) method of assessment ?
- child performs series of tasks
- standard score and/or percentile rank reflects how child performed compared to children the same age (on whom test was normed)
what is “criterion-references testing” method of assessment ?
A criterion-referenced test is an objective assessment that compares a test-taker’s performance to a set of fixed standards or objectives. Some criterion-referenced tests are standardized, while others are not.
what are examples of “single verb comprehension” ?
“kiss the ball”
“grab the toy”
(instructions to observe what the child understands)
what is “language sampling” method of assessment ?
is a method used to assess a person’s natural language abilities by collecting and analyzing samples of their spoken or written language in real-life situations. It helps identify strengths and areas for improvement in communication skills
(Collecting natural speech to assess language skills)
what are the 4 spontaneous language use observing methods of how someone naturally uses language :
1) recorded during naturalistic interaction
2) transcribed verbatim
3) analyzed for target linguistic structures or uses
4) compared to age related criterion
what is 1) recorded during naturalistic interaction ?
Speech is recorded in a real, everyday setting.
what is 2) transcribed verbatim ?
Speech is written down exactly as spoken
what is 3) analyzed for target linguistic structures or uses ?
Specific language features are examined.
what is 4) compared to age related criterion ?
Language skills are compared to typical levels for that age.
what are the outcomes of assessment ?
- confirm presence / absence of a language disorder
- describe language disorder (e.g., normative score, areas of impairment) and its impact on function…. language difficulty vs. disorder
- goal setting and intervention planning
- referrals if needed (OT, PT, etc.)
TRUE OR FALSE
we want multiple sources of results ?
TRUE
in simplest way, what is a languge disorder vs language difficulty ?
- Language Disorder: A long-term problem affecting a person’s ability to understand or use language correctly.
- Language Difficulty: A temporary challenge with language that may improve over time, often due to specific situations or learning environments.
how many service delivery approaches are there to child language intervention ?
4
what are the 4 service delivery approaches of child language intervention ?
1) modify environment
2) compensation
3) prevention and promotion
4) remediation
explain “modify the environment” in regards to a service delivery approach of child language intervention :
- reduce language/literacy demands
- adjust expectations
- teach facilitative language techniques to those interacting with child
- add supports
- nonverbal (pictures, graphics, demonstrations)
- frameworks, outlines
what is an example of an intervention that modifies the child’s language learning environment ?
“it takes two to talk” (Hanen program)
what is the “it takes two to talk” (Hanen program) ?
- intervention to support parent-child communication at prelinguistic and emerging language stages
what are the 3 parent training components of the “it takes two to talk” (Hanen program) ?
1) build parent’s awareness of normal communication pattern of infants/toddlers and how to tune in to child’s communicative capacities
2) provide instruction and modelling of adult-child communication
3) help parents develop self-monitoring skills to evaluate and modify own performance
who founded the “behaviourist” theory of language disorders ?
Piaget & Skinner
who founded the “nativist” theory of language disorders ?
Chomsky
explain “compensation” in regards to a service delivery approach of child language intervention :
give child/student tools to function better with limitations they have
- model compensatory strategies
- support practice of strategy
- systematically withdraw support until used independently
“teaching the child alternative ways to communicate when language skills are limited. For example, if a child struggles to speak clearly, they might use gestures, pictures, or devices to express themselves. This approach helps them communicate effectively while they work on improving their language skills”
what type of service delivery would describe the following scenario :
“teaching the child alternative ways to communicate when language skills are limited. For example, if a child struggles to speak clearly, they might use gestures, pictures, or devices to express themselves. This approach helps them communicate effectively while they work on improving their language skills”
compensation
explain “prevention and promotion” in regards to a service delivery approach of child language intervention :
- for children at risk for language disorder
- symptoms not yet apparent, but risk factors there
- creating optimal environments to facilitate language development
what is an example of something SLPs or professionals could do to creating optimal environments to facilitate language development ?
having websites accessible with milestones so parents can observe and measure where their children are at / provide teachers and other caregivers with the information to future educate themselves to know what may or may not be considred normal
explain “remediation” in regards to a service delivery approach of child language intervention :
focuses on directly improving a child’s language skills. This approach aims to strengthen specific areas of language, like vocabulary, grammar, or comprehension, through targeted exercises and practice. The goal is to help the child catch up to expected language abilities for their age.
- traditional role of SLP
- can take many forms
what are 3 remediation approaches ?
1) adult centered
2) child centered
3) hybrif
define the “adult centred” remediation appraoch :
- aka clinician-directed
- highly structured behaviourist approach
- Main Idea: The adult directs the learning process, often using structured activities and explicit teaching.
Example: An adult might use specific exercises to teach vocabulary or grammar rules, guiding the child step-by-step.
define the “child centered” remediation appraoch :
SLP provides indirect lnaguage stimulation during natural interactions
- Main Idea: Focuses on the child’s interests and needs. The adult follows the child’s lead in activities.
Example: If a child loves dinosaurs, the adult might use dinosaur books or toys to encourage language and learning.
define “hybrid” remediation approach :
SLP arranges environemnt to elicit specific target and provides naturalistic reinforcement
what is the Hybrid Milieu ?
is a type of language intervention that combines structured teaching with natural interactions. In this approach, the therapist creates a playful, engaging environment where specific language skills are taught in the context of everyday activities and conversations. It’s designed to help children learn language in a natural way while still focusing on specific goals
what could be some examples of Hybrid Milieu intervention technique?
use of bubbles or cookie jar (make requests)
define the “child-centered expansion of two word combinations at developing language stage” :
- SLP and child playing with toy house and people
- Child puts toy baby in house and says “baby house”
- SLP says “the baby is in the house”
- increases likelihood of spontaneous imitation, which gives practice in more mature form
what is Ms. Cunningham’s fave speacial population ?
ASD (autism)
what does ASD stand for ?
ASD stands for Autism Spectrum Disorder
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1 in ___ children aged ____ have autism in canada
1 in 66 children aged 5-17
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what % of people recieve autism diagnosis by age 6
56%
how many children in Ontario Autism Program ?
45,437
what does DSM - 5 stand for ?
diagnostic statistical model (5 criteria)
what are the 5 criterias for DSM ?
1) social communication deficit
2) fixed interest
3) present since early childhood
4) behaviours impact daily functioning
5) impairment is not better explained by intellectual disability
what are the 3 levels of support ?
1) level 1 = requiring support
2) level 2 = requires substantial support
3) level 3 = requires very substantial support
MULTIPLE CHOICE
what % of people recieve autism diagnosis by age 6
a) 65%
b) 52%
c) 58 %
d) 56%
d) 56%
MULTIPLE CHOICE
1 in how many children aged 5-17 how autism ?
a) 44
b) 66
c) 33
d) 55
b) 66
what are some early signs and symptoms of ASD commuication patters :
- delays in development of spoken language
- difficulty with pragmatic language
- idiosyncratic repetitive language
- difficulties initiating or maintaining communication
- has difficulty communicating needs or desires
what are some early signs and symptoms of ASD social patters :
- struggles with verbal and non-verbal behaviour
- difficulty developing peer relationships
- struggles with social and emotional reciprocity
- difficulty understanding feelings
- does not share interest or achievements with others (e.g., drawings, toys)
what are some early signs and symptoms of ASD behavioural patters :
- restrictive, receptibe and stereotyped patterns of behaviour
- sensory sensitivities (e.g., sounds, smells, textures)
- may prefer inanimate objects
- distressed by a change in routine
- lining up toys, head banging, rocking back and forth
further explain restrictive, receptibe and stereotyped patterns of behaviour :
only being extremly intrested in one particular thing such as dinosaurs or cars … or in specially a certain type of dinousaur or part of a car such as wheels
TRUE OR FALSE
those with ASD typically have later on in life communication impairements/difficulties
FALSE
those with ASD typically have early communication impairements/difficulties
what are some examples of typical early communication impairments/difficulties ?
- fewer conventional gestures (pointing, showing, waving, nodding)
- reduced communicative intents (lack of commenting/joint attention)
- immediate or delayed exholalia
what are some typical features in those who are verbal with ASD ?
- strengths in form (phonology, syntax, morphology) … but some can have profile like DLD
- weaknesses in semantics and pragmatics
what are some exmaples of weaknesses in semantics and pragmatics for those with verbal ASD ?
- pronoun reversals
- difficulties with pragmatics
- nonreciprocal communication (not involving others)
- monotone, staccato prosodu
what two things are our main concers with those with verbal ASD ?
pragmatics and social communication
in what age group of individuals typically have strengths in form (phonology, syntax, morphology) ?
older kids
what are some common features in those who are highly verbal ?
- may be described as having “high-functioning ASD” or “asperger syndrome”
- average or advanced intellectual ability
- normal or precocious oral language with imapaired pragmatics
- “active-but-odd” social communication
- topic-obsessions
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__________________ are one of the most commonly accessed services by autistic individuals and their families
speech-language pathologists
what is neurodiversity ?
a word used to explain the unique ways people’s brains work
whats the difference between medical model and neurodiversity paradigm ?
what is the “medical model” ?
Medical Model: Views autism as a disorder that needs to be “fixed” or treated
what is the “neurodiversity paradigm” ?
Neurodiversity Paradigm: Sees autism as a natural variation in human thinking, valuing and accepting differences rather than trying to change them
what are some traits of the medical model ?
- normal way of being
- autism is a disease or disorder
- disability is a deficit within in the person
- deficit based, ignores strengths
what are some traits of the neurodiversity paradigm?
- no normal way
- autism is part of human biodiversity
- disability results from poor fit between a person and their environment
- difference based, include strengths
what is the goal of the medical model ?
goal : cure and reduce autism
what is the goal of neurodiversity paradism ?
support person to be authentic self in their life
what are some neurodiversity affirming approaches ?
- support individuals’ strengths and talents
- presume competence
- goal is NOT to fix or cure autism
- consider how you interact with and speak about autistic individuals
what are some common autistisc strengths ?
- passionate interests
- intense focus
- attention to detail
- memory
- curiosity
- integrity
- fairness
- sincerity
- loyalty
- helpfulness
