SLI/DLD and ASD

Question 1

Information Processing

Answer 1

Information Processing
1. Attention
2. Discrimination
3. Organization
4. Memory/Retrieval

Question 2

Attention:

Answer 2

Attention: Automatic activation of the brain, orientation, focusing/attending
to stimuli around us

Question 3

Discrimination

Answer 3

Ability to attend to identify stimuli from a larger field of surrounding/competing stimuli
Decisions based on the model in the individual’s working memory

Question 4

Organization

Answer 4

Organization: Categorization; information associated, categorized and
stored for later retrieval; efficient processing requires organization

Question 5

Memory/ Retrieval

Answer 5

Memory/Retrieval: retrieving the information at a later time; limited and
based on age, frequency of retrieval, was learned recently and well etc

Question 6

Generalization

Answer 6

Generalization: transferring application of learned to previously unlearned
material–learning!)
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Question 7

Bottom-up processing

Answer 7

Bottom-up processing–Simpler, less complex stimuli are first
processed “via perceptual analysis at bottom levels and then
forwarded to working memory for more elaborate coding” (Owens,
2014, 22) before storing in long term memory
○ Using too much energy in bottom-up processing can limit the
amount of information that can be processed
○ A child with poor attending, poor working memory may have
limited language processing skills
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Question 8

Working memory

Answer 8

Working memory– “‘place’ where information is kept active through a
system of coding, storage, access, and retrieval” (Gillam & Bedore,
2000)
○ Short term holding onto information when it’s being cognitively
processed
○ Requires large capacity to hold information while also being
flexible to code, store, access, and retrieve changing input
○ Important for acquiring complex academic skills across
literacy-based language areas of reading/writing/mathematics
◉ Many children with SLI have deficits in working memory–learning
difficulties
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Question 9

What is SLI/DLD?

Answer 9

SLI: Specific Language Impairment
DLD: Developmental Language Disorder
◉ SLI: significant difficulty learning, understanding, and using spoken
language
◉ Numerous terms for SLI over years; consensus: DLD
◉ 7% K students→SLI/DLD
◉ Typical non-verbal intelligence
◉ Characterization based on exclusion of other disorders/contributing
factors
**Other terms for language impairments? *DLD: new term!
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Question 10

What causes DLD?

Answer 10

Cause is not based on any sensory, neurological, intellectual, or
emotional deficits (Owens, 2014)
◉ Genetics + environmental risks–gene mutations may possibly play a
role, but still a question (RADLD, 2021)
◉ Neurobiology- subtle differences in brain symmetry/development
may exist
○ Different patterns of brain activation & inefficient coordination
◉ Familial-more prevalent in males; familial pattern; premature births
○ 60% children with SLI have an affected family member
○ 38% children with SLI have an affected parent
**Overall, much needs to be learned about causes of DLD
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Question 11

DLD: Comorbidities

Answer 11

Often co-occurrence with other diagnoses/conditions (i.e. ADHD, learning
disorders, dyslexia)
○ Dyslexia: basis is linguistic (Leonard, 2000)
○ Dyslexia is not diagnosed until school age, but possibly child had
spoken language difficulties at a younger age (Leonard, 2000)
◉ Difficulties with WM: working memory & processing speed
○ Limitations in phonological short-term memory capacity, which is
important for word learning, matching sound to meaning
◉ Children with DLD–higher prevalence of difficulties with mental health
○ Internalizing behaviors: anxiety/depression
○ Externalizing behaviors: aggression
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Question 12

DLD: Overall Characteristics

Answer 12

Hidden disability”–not evident to a non-professional
○ Simpler sentences
○ Difficulty organizing sentences/communication
○ Make more errors in output
◉ Common (1 in 14 have symptoms of DLD) (7% kindergarten
students)
◉ Affects people around the world, in every language
◉ Important: affects social/emotional life and success in life
◉ Semantic and phonological deficits which affect word learning
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Question 13

DLD: Characteristics (Owens, 2014)
◉ Delayed

Answer 13

Delayed in one area/few areas of language
◉ Language difficulties not result of delay
◉ Language difficulties will not remediate on their own and require
intervention
◉ Will often exhibit much lower scores on standardized language
testing when compared to intellectual performance on nonverbal
tasks
○ Won’t display perceptual/intellectual disabilities

Question 14

DLD: More Characteristics

Answer 14

Language impairment: expressive/receptive or combination, affecting
different areas of language (affecting form of language)
◉ Slower vocabulary growth than TD peers
◉ Smaller lexicons than TD peers
◉ Poorer sentence comprehension than TD peers
○ More difficult sentences create additional processing demands
on the working memory
◉ Do not have active processing strategies (slower linguistic
/non-linguistic processing)
○ Slower word recognition
○ Inefficient fast-mapping in turn taking conversation
○ Ineffective language comprehension
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Question 15

DLD: Toddlers to School-Age Children

Answer 15

Toddlers: DLD begins in early childhood, persists into adulthood (assist
with treatment):
○ **¼ to ½ of late talkers at risk for SLI by school age (Leonard, 2000)
◉ School Age: Less experience socially (Owens, 2014)
○ Less successful at initiating play interactions than typically
developing (TD) children
○ Less successful responding to TD children in play
○ Poor pragmatics skills negatively affect social
experiences/friendships
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Question 16

DLD: School-Age Children

Answer 16

Many children with DLD show deficits in phonological short-term
memory, which helps in word learning by matching sound to meaning
○ Slower processing and limited working memory
◉ Difficulties in attentional capacity
◉ Difficulties ‘updating’ working memory contexts–maintaining focus
when adding in new content
◉ Difficulty sustaining attention
*If processing speed of child with SLI lags far behind the TD child, what can
occur?
○
○ 15

Question 17

DLD: Diagnostics and Intervention

Answer 17

Diagnostic techniques:
○ Story recall, grammatical completion (focus on verb
markers), memory and responding while reading
and writing,speech sample, rote memory tasks (i.e.
subsequent digit recall), nonsense word repetition
◉ Intervention strategies:
○ Categorization of words/objects, rhyming games,
melody as a memory aid, acting out
pictures/rhymes etc.

Question 18

Definition of ASD:

Answer 18

Diagnostic & Statistical Manual of Mental Disorders: authoritative guide
Old DSM-IV definition and terminology: ASD:
○ Individuals with a well-established DSM-IV diagnosis of autistic disorder,
Asperger’s disorder, or pervasive developmental disorder not otherwise
specified should be given the diagnosis of autism spectrum disorder. Individuals
who have marked deficits in social communication, but whose symptoms do not
otherwise meet criteria for autism spectrum disorder, should be evaluated for
social (pragmatic) communication disorder. (DSM-5)
○ Autistic disorder, child disintegrative disorder, pervasive developmental
disorder-not otherwise specified (PDD-NOS), & Asperger syndrome
◉ Many types of autism with broad range of conditions–overall
challenges with social skills, speech/nonverbal communication
and repetitive behaviors 18

Question 19

DSM-5 Definition A

Answer 19

A. Persistent deficits in social communication and social interaction across multiple
contexts, as manifested by the following, currently or by history (examples are illustrative,
not exhaustive, see text):
1. Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach
and failure of normal back-and-forth conversation; to reduced sharing of interests,
emotions, or affect; to failure to initiate or respond to social interactions.
2. Deficits in nonverbal communicative behaviors used for social interaction, ranging, for
example, from poorly integrated verbal and nonverbal communication; to abnormalities in
eye contact and body language or deficits in understanding and use of gestures; to a total
lack of facial expressions and nonverbal communication.
3. Deficits in developing, maintaining, and understanding relationships, ranging, for example,
from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing
imaginative play or in making friends; to absence of interest in peers.

Question 20

DSM-5 Definition B

Answer 20

B. Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at
least two of the following, currently or by history (examples are illustrative, not exhaustive;
see text):
1. Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor
stereotypies, lining up toys or flipping objects, echolalia, idiosyncratic phrases).
2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns or verbal nonverbal
behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns,
greeting rituals, need to take same route or eat food every day).
3. Highly restricted, fixated interests that are abnormal in intensity or focus (e.g, strong attachment to
or preoccupation with unusual objects, excessively circumscribed or perseverative interest).
4. Hyper- or hyporeactivity to sensory input or unusual interests in sensory aspects of the environment
(e.g., apparent indifference to pain/temperature, adverse response to specific sounds or textures,
excessive smelling or touching of objects, visual fascination with lights or movement).
**Specify current severity: Severity is based on social communication impairments and
restricted, repetitive patterns of behavior. 20

Question 21

DSM-5 Definition C

Answer 21

Symptoms must be present in the early developmental period (but may not become fully
manifest until social demands exceed limited capacities or may be masked by learned
strategies in later life)

Question 22

DSM-5 Definition D

Answer 22

Symptoms cause clinically significant impairment in social, occupational, or other
important areas of current functioning

Question 23

DSM-5 Definition E

Answer 23

These disturbances are not better explained by intellectual disability (intellectual
developmental disorder) or global developmental delay. Intellectual disability and autism
spectrum disorder frequently co-occur; to make comorbid diagnoses of autism spectrum
disorder and intellectual disability, social communication should be below that expected
for general developmental level.
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Question 24

Important Facts about ASD

Answer 24

CDC: Estimated 1 out of 36 children diagnosed with ASD
◉ Spectrum: Individuals display very different
strengths/weaknesses, challenges
◉ Learning: vastly different across spectrum
○ Large range of skills–learning, thinking, problem-solving
◉ Some signs of autism evident by 18m, 2-3 years
○ Repetitive movements, ritual play, frequent tantruming,
extreme reactions to certain stimuli, lack of pretend and
social play, lack of attention/joint attention, difficulty with
communication (even gestures)
○ Early intervention: very beneficial, positive outcomes
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Question 25

Important Facts about ASD
Difficulty initiating

Answer 25

Difficulty initiating communication/responding to initiation
◉ Turn-taking, topic maintenance
◉ Stereotypical utterances (i.e. possibly bizarre,
inappropriate)
◉ Semantics: definitions extremely concrete (lack of
flexibility)
◉ Figurative language very difficult
◉ Difficulty matching content and form of language to the
context
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Question 26

Important Facts about ASD
More frequent

Answer 26

ASD: 4x more frequently in males
◉ SMD: sensory modulation dysfunction
○ Sensory modulation within central nervous system
(CNS)-balances excitation & inhibition inputs arising
within one’s sensory mechanism with those occurring
external to the body
○ Child with ASD: sensory stimuli must be within their
own limits of tolerance and expectation
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Question 27

ASD: Pragmatics

Answer 27

Difficulty matching content and form of language to the context
-Use of questions too often; repetition
-social monologues
-Gaze aversion; lack of eye contact (peripheral vision)
-Echolalia/routine utterances
-Difficulty with initiation and responses to questions
-Difficulty with joint attention
-Few gestures used; misinterpreting complex gestures
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Question 28

ASD: Comprehension

Answer 28

Impaired communication: varies
-Noted difficulty in connected discourse
-Some children with ASD have difficulty processing/analyzing and
then integrating information
-Fixation-focus on one aspect of complex situation (i.e. minor
detail)
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Question 29

ASD: Semantics & Syntax/Morphology

Answer 29

Semantics
-More inappropriate answers to questions than age-matched peers
-Difficulty with word-retrieval
Syntax/Morphology
-Overreliance on word order/superficial form of sentences
-Focus on form–little regard for underlying meaning
-Less complex sentences than peers of similar mental age
-Morphology–pronouns, verb ending difficulties
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Question 30

ASD: Phonology

Answer 30

Varied, often disordered
-Developmental order similar to TD peer
-Least affected of language characteristics
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Question 31

Echolalia

Answer 31

Echolalia-whole or partial repetition of previous utterances–often with same
intonation
○ Many children with ASD–echolalia when learning to speak
○ Immediate echolalia: variable and can increase in various situation that
may be uncomfortable (unfamiliar, unknown words, following inability to
comprehend, with adult, face-to-face communication with eye contact…)

Question 32

Hyperlexia

Answer 32

Hyperlexia– spontaneous early ability to read (2.5/3 yrs), but minimal reading
comprehension
○ Preoccupation/fixation with letters/words
○ Extensive word recognition by age 5
○ Often show language disorders
○ Often display difficulty with connected language in all language modalities,
specifically deriving meaning from context

Question 33

ABA Therapy

Answer 33

Techniques/therapy used with individuals with ASD,
based on science of behavior
○ Positive reinforcement-very important part
○ Understanding why of the behavior
○ ABCs: antecedent-behavior-consequence
○ Child: learning and practice is key!
○ Very effective for variety of individuals of all ages

Question 34

ASD: Variety of Programs in NYC (NYCDOE, 2023)
◉ NEST Program

Answer 34

Child: average to above average intelligence
○ Development: verbal/nonverbal skills, working memory, language, attention
skills (delayed, developing)
■ Grade level academics
■ Language delayed; social skills focus of delay
■ Mild to moderate social delays–affecting play/interaction
■ Mild behavior difficulties; may have difficulty controlling emotions etc.
■ Small Integrated Co-Teaching (ICT) class; 1 GenEd teacher, 1 SpEd
teacher
■ SLP: Social Development Intervention (SDI); NYU developed
social-based therapy (evidence-based)
● Social Thinking Curriculum–Social-language skills (Winner, 2008)
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Question 35

ASD: Variety of Programs in NYC (NYCDOE, 2023)
◉ Horizons Program

Answer 35

Horizons Program:
○ Child: academic skills on/near grade level
○ Mild to moderate language difficulties, with social difficulties
■ Principles of ABA–basis for instruction
■ Students: ability to work independently with support
■ Entering K students: language, with delays: 2-3 word sentences
■ Older students: communicate wants/needs, difficulty with higher
language and social language
■ Special education classroom; 8 children, 1 SpEd teacher, 1
paraprofessional
■ SLP: works with teacher (ABA principles; ‘Rethink Ed’ platform) to
increase/improve child’s language
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Question 36

ASD: Variety of Programs in NYC (NYCDOE, 2023)
◉ AIMS Program

Answer 36

AIMS Program (Acquisition, Integrated Services, Meaningful
Communication, and Social Skills)
○ Child: Special Education program
■ Developmental delays in communication, behavior, & social
skills
■ Moderate to severe delays in play/interaction
■ Moderate-to-severe delays in academics, working memory,
reasoning skills, speech, language, and attention
■ SpEd teacher, SLP, and paraprofessional
■ Individual and small group instruction using Applied Behavior
Analysis (ABA) and Verbal Behavior (VB) techniques
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