Midterm 2 Flashcards
Receptive language
term used when talking about comprehension → language processing that allows you to understand spoken, written, and signed
language
Expressive Language
use of language → production of spoken, written, or signed language, can also be the use of alternative or augmentative language
(AAC)
Phonology
the sounds and rules that govern which sounds are
allowed to go together in a language
morphology
internal structures of words and how these structures change the meaning of words (-ing or plural s, things that change verbs to nouns when you add a prefix or suffix)
What are the subcategories of language?
- phonology
- semantics
- syntax
- morphology
- pragmatics
syntax
has to do with sentences + the arrangement of words to form those sentences
semantics
word meaning of vocabulary, has to do with the relationships between words (semantic knowledge allows you to
put spoons and forks in the same category)
pragmatics
use of language, the social use of language → subtle elements of language to read social cues (communication with
friend vs with professor), knowing the difference between literal and non-literal (understanding sarcasm), and reading between the
lines
Learning more than one language during development:
- Does not lead to language delay
- Does not cause a smaller vocabulary
- Is not inherently more difficult for children
- Is critical to preserve heritage language and culture, and in many cases, participation across generations
- Bilingual children with language disorders should not be limited to
learning one language
What are the prelinguistic stages?
- Reflexive vocalizations (birth - 2 months)
- Cooing and laughter (2-4 months)
- Vocal play (4-6 months)
- Canonical Babble (6 months+)
- Jargon (10 months+)
Cooing and laughter (2-4 months):
Sounds of comfort, velar (back sounds made with tongue and pharynx)
○ Volitional and controlled
○ Back-and-forth is important to build interaction and shape language
development
Jargon (10 months+):
Adult-like timing with intonation (sounds like they are telling stories but they are non-sensical), may include some real words but is mostly jargon
Reflexive vocalizations (birth - 2 months):
Non-volitional baby sounds
■ Burping, crying, hiccuping
Vocal play (4-6 months):
○ Sustained vowels, squeals, growls, raspberries, and bilabial trill (signals
control of the lips)
Canonical Babble (6 months+):
Emergence of consonant vowel (CV) syllables
○ Paired with adult-like timing (intonation)
○ May sound like a word, but the attached meaning does not yet exist
○ Two kinds:
■ Reduplicated: duh-duh → same consonants
■ Variegated: buh-doo-muh-doo (around 12-13 months) → two
different consonants in the chain, advanced babble that signals
even more control
Expressive Language Development at 2 and 3 years old
2 years old: using directives and verbs
○ 3 years old: using complete sentences, asking questions, engaging in
back and forth conversation
Connection between babble and speech
Preferred sound sequences in babble are likely to be found in first words
○ Babble as a predictor:
■ Frequency of canonical babble correlates with expressive
vocabulary and accuracy of production between 24-36 months
First words and beyond
- Speech sound production: consonants
■ Place of production: consonants that are produced in the front of
the mouth (p, b, d, t, m, n, w)
■ Manner of productive: nasal, stops, fricatives, and approximates
(w, j) - Expressive language
■ Nouns (ball, baby, mama, dada, doggie, milk)
■ Bye-bye, no, all done, mine, up, go, more, uh-oh, moo, woof, wee-oo
Receptive Language Development: 1.5-2 years old
■ Understands basic words, nouns, verbs, and adjectives
■ Follows simple 1-step directions in contexts they are familiar with
■ Takes in 1 semantic element at a time (no putting boot AND puppy
in the box)
Variation in Development (that may present with speech and language
challenges)
- Genetic syndromes
■ Down syndrome, Velocardiofacial syndrome, Fragile X syndrome,
Angelman syndrome, Landau-Kleffner syndrome - Developmental/neurological differences
■ Cerebral palsy, autism, epilepsy - Anatomical and sensory differences
■ Cleft palate (develops in utero), repairs early on can lead to more typical speech, but it is a pretty intensive process
■ Deaf or Hard of Hearing
Receptive Language Development: Beginning to understand
■ Semantics (high frequency vocabulary)
■ Simple directions
■ “No”
■ “All done”
■ Wh- questions (Where’s the doggie? Who’s home?)
Receptive Language Development: 4 years
■ Understands exclusionary concepts (all, but, except)
■ Is beginning to understand temporal terms (before, after) – still
uses order of mention for these
■ Begins to understand passive voice: still interprets with
assumption of subject-verb-outcome or of probable event
(understands rather than uses themselves)
Receptive Language Development: 3 years
■Beginning to take language out of the “here and now” – understands conversations about recent past events, future plans
→ “We are going to the park tomorrow”
■ 3 to 4 semantic elements of information in a direction
■ Understands many basic concepts (colors, shapes, size,
prepositions)
■ Identifies objects based on conceptual attribute (category,
function →A doggie is an animal)
Receptive Language Development: 2 years
■ Takes in 2 semantic elements
■ Understands relational terms such as pronouns, prepositions
■ Attend/respond to language requiring a shift in attentional focus
■ Identifies objects and actions in pictures
Diagnosis of speech and language disorders
○ Can be challenging sometimes as typical development varies greatly
■ Speech and language errors are observed in most children at
young ages
■ Important to understand nature and severity of challenges
○ Tools: diagnostic
■ Help to discern typical development and differences (e.g.,
dialectical) vs delay vs disorder → and then educate
■ Nature vs severity
Scope of pediatric speech-language pathology
- speech sound production
- language
- fluency
- voice
- feeding and swallowing
Major life activities
- self care
- learning
- receptive and expressive communication
- mobility
- self direction
- capacity for independent living
- economic self sufficiency
Types of Language Support
Special education, 504 plans, caregiver training, AAC, outpatient services, and referrals and consults
Developmental disabilities (DD)
○ Umbrella term
○ Impact individual’s ability to complete major life activities in 3 or more areas
○ Criteria: begins before age 22, sustained overtime
Types of DD’s
- Intellectual disability (most common)
- Cerebral palsy
- Autism
- Others
Causes of ID
○⅓ genetic, ⅓ trauma/toxins, and ⅓ unknown
○ >350 causes
○ 3 main times
■ Prenatal, perinatal, postnatal
Developmental disabilities vs Intellectual disabilities (ID)
DD: diagnosed before age 22 and results in significant functional limitations in 3 or more major life activities
ID: diagnosed before 18 and IQ < 70
7 Prenatal conditions associated with ID
- Down syndrome
- Fragile X Syndrome
- Fetal Alcohol Syndrome
- Phenylketonuria
- Klinefelter Syndrome
- Williams Syndrome
- Prader Willi Syndrome
Prevalence of DDs
ID < Autism spectrum disorder (ASD) < Other developmental delay
○ Diagnoses increase over time: due to increased awareness, refined
screening tools
○ Diagnosed at higher rates among boys > girls
■ Disabilities showcased differently across boys and girls
○ Cultural differences could be due to distrust of the medical system (all
subjective)
Prevalence of ID
○Boys also diagnosed at higher rates, but the difference in rates between
boys and girls is smaller
○ Many children diagnosed within 8-12 year and 13-17 year age ranges
Down syndrome
■ Most commonly occurring chromosomal condition
■ ~1/700 babes in US
■ Increased life expectancy—most people with down syndrome remain under the care of a pediatrician, but they can benefit
from transitioning to an adult physician
■ Common physical traits: low muscle tone, small stature, upward slant to eyes, deep crease across palm
■ Ranges & unique
Fetal Alcohol Syndrome Disorder (FASD)
3 types:
1- Fetal Alcohol Syndrome (FAS)
2- Alcohol Related Neurodevelopment Disorder (ARND)
3- Alcohol Releated Birth Defects (ARBD)
■ Diagnosis characteristics: 2 or more craniofacial malformations and growth below 10th percentile
■ Prevalence : 40,000 babies each year in the US
■ Common characteristics: ID, sleep disturbances, motor dysfunctions, hyperactivity, hyper irritability, aggression, conduct issues
Klinefelter syndrome (47-XXY)
■Condition that affects male physical and cognitive development
■ Prevalence: 1 in 500/1000 males
■ Common physical traits: sterile, underdevelopment of male sex organs, abnormal body proportion, less body hair, tall, big breasts
■ Characteristics: mild ID, SLD, poor social skills, auditory perception, and language
Fragile X Syndrome (FXS)
■ Most common inherited cause of ID (most common after Down
syndrome)
■ Females more mildly affected
■ Gene abnormality
■ Common physical traits: large ears, elongated facial appearance, flexible joints, flat feet, large testicles
■ Characteristics / common conditions: social anxiety and avoidance
■ ⅓ of children with FXS are also diagnosed with autism
■ ~2-8% of children with autism are diagnosed with FXS
■ Impact of FXS & autism diagnosis simultaneously
Williams Syndrome
■Cause: deletion of material on 7th chromosome
■ Prevalence: 1 in 10,000 people worldwide
■ Common characteristics: elf features, friendly, mild to moderate ID, learning problems, hyperactive
Phenylketonuria (PKU)
■ Genetically inherited metabolic disorder
■ Born w/o an enzyme responsible for breaking down phenylalanine
→ tyrosine; resulting in brain damage and physical disabilities
■ Characteristics: severe ID, aggressiveness, hyperactivity
■ Eliminated with screening in the US!!!!!
■ Treated with special diet
Prader-Willi Syndrome
■ Most common known genetic cause of life-threatening obesity in
children
■ Continuously hungry w/ lower metabolism
■ Chromosomal cause (#15)
■ Prevalence: 1 in 10-25,000 births
■ Physical characteristics: hypotonia, small hands and feet, short incomplete sexual development
■ Behavioral characteristics: mild ID, learning difficulty, impulsivity, aggressiveness, tantrums, OCD, delayed motor skills
■ May be classified as DD if IQ > 70 or as ID if IQ < 70
Autism Criteria (must know)
Check slide 26!
■ 3/3 symptoms (A1, A2, and A3)
■ 2/4 symptoms (among B1, B2, B3, and B4)
■ 2 additional symptom criteria (C and D)
prevalence of autism
more in boys
delay in diagnosis
General Characteristics of autism
■ Cognitive
■ Social skills
■ Communication and language deficits
Characteristics of autism
- prefer to play alone
- prefer predictable play
- may not respond to verbal cues
- late speech or not at all
- poor eye contact
- hard to express needs and emotions
- repetition in language or movement
- distressed by changes
- strong interests
Echolalia
Functional vs unintentional
■ Functional: when child memorizes a saying but it has a purpose
■ Unintentional: involuntary repeating of something they have
heard
Rates and Impacts of EDs (most likely an underrepresentation of the truth due
to individuals having to disclose that they have an eating disorder)
○Globally: 7.9%
○ In-college: 10-20% of women and 4-10% in men (increasing)
○ BIPOC: similar rates of EDs across non-Hispanic white, Black, and Asian -
BIPOC significantly less likely to receive treatment
○ LGBTQ+
■ Transgender people - higher rates of incidence compared to
cisgender peers
■ Homosexual and bisexual teens report higher rates of ED
symptoms
■ Homosexual and bisexual men have greater lifetime prevalence of
any subclinical (below clinical threshold) ED and clinical (meets
diagnostic criteria) BN
ED Etiology and Risk Factors
○ Eating disorders are multi-determined biopsychosocial disorders
○ Biological + social + psychological factors → overlap to influence mental
health
Optimized nutrition
■ Healthy attitudes to eating, exercise, and body image
■ Body neutrality - no thoughts of wanting to change your body
Eating disorder behaviors that don’t meet diagnostic criteria
■ Unhealthy attitudes or relationship with eating, exercise, and
body image
■ Thinking about changing your body, introducing some behaviors
(i.e. restricting some food groups)
Diagnostic criteria for ED
■ Eating disorders and related conditions
■ Can be very serious and life threatening
■ Involves persistent disturbance
■ EDs are progressive - typically worsen over time
Binge Eating Disorder (BED)
■ Binge Eating Disorder Cycle (may be no visible signs)
■ DSM: An episode where an individual feels a loss of control and eats more than what a person would eat in a 2-hour period
(consumption tends to be more relative to how a person normally eats → ex: eating more than usual for someone who restrictively
eats)
■ Almost half affected are male (~40%)
■ Most common
Bulimia Nervosa (BN)
■ Bulimia Nervosa Cycle
■ Compensatory behaviors
Anorexia Nervosa (AN)
■ Intense fear of weight gain underscores AN
■ ALWAYS has a restrictive component
■ Many experience body dysmorphic disorder
■ Sometimes there is a component of denial (changes in brain
chemistry can make people feel like they are not suffering the way other people are)
Other Specified Feeding/Eating Disorder (OFSED)
least common
Orthorexia: An emerging ED (NOT in DSM)
○ People with orthorexia may be diagnosed with OFSED
○ Can sometimes start out as people with genetic/hereditary health
concerns that progress
○ Unable to go out to eat due to loss of control
Positive Nutrition
○ Health-seeking through including nutritious foods
○ Motivated by a desire to live a healthy life
○ Promotes a feeling of accomplishment – yet allows for flexibility
○ Allows for enjoyment of food as one of many aspects of a balanced life
○ Promotes social interactions and relationships
○ Promotes health and successful physical functioning
Pathological Nutrition
○ Causes isolation and interferes with relationships
○ Views food as source of fear and danger that must be controlled
○ Success depends on adherence to food rules… mistakes are unacceptable
○ Motivated by a need to manage anxiety
○ Health-seeking through excluding unacceptable foods
○ Seeks health but deteriorates it and impairs functioning
REDS: Relative Energy Deficiency in Sport
○ REDS Health Conceptual Model
○ REDS Performance Conceptual Model
○ 70% Basal energy requirements + 30% activity energy requirements
■ For athletes, the activity energy requirements are higher
■ Meeting less than 70% of needs for a prolonged period of time =
low energy availability
■ Body will pull back on essential bodily functions if energy
requirements are not met
Prevention of eating disorders
Building supportive environments and social connections - since EDs thrive in isolation
Diagnosing Autism
○ ⅓ of parents noticing differences before child’s first birthday
○ Age 2 diagnosis = reliable, valid, and stable diagnosis at age 9
○ Majority of kids do not receive diagnosis until they are between the ages
of 4 and 5.7
Clinical Diagnosis Standards for autism
■ CARS-2 - observing and rating items, more interaction-focused
(4-5 years old)
■ ADI-R
■ ADOS assessments
