Unit 2 Flashcards
Intellectual disability IQ requirement
IQ below 70
language ability should be equivalent to
mental age
those with intellectual disability go through the same
language acquisition and in TD children, only slower
any language irregularities are due to
environmental experiences
Mental Retardation
the less politically correct term for intellectual disability
AAMR
American Association on Mental Retardation
(an old organization)
now called American Association on Intellectual and Developmental disabilities
Intellectual disabilities
problems in:
intellectual funcitoning (IQ)
adaptive behavior
***no just raised on IQ
occurs in developmental period up to 18 years of age
heterogeneous population- language characteristics will vary
adaptive behavior
particular tasks and behavior you would expect developmentally
-being able to care for yourself
Vineland Adaptive behavior Scales II
measures adaptive behavior, norm-referenced instruments
receptive and expressive language, written communication, daily living skills, domestic, personal and community living skills, socialization, play, leisure, coping skills, fine and gross motor skills, maladaptive behaviors
information gained from parent or caregiver interaction.
birth to 90 years
developmental disability
describes mental or physical disabilities that occur before 22 years of age
terms used by federal government
standford binet intelligence scale 5th edition
IQ test
welcher intelligente teste for children
school age kids IQ tests
Haley Scales of Infant and Toddler Development
Measures IQ in infants and young children
Leiter international performance scale
nonspeaking or nonverbal individuals
table 6.1 on page 232 in book
labels that we use for ID
Mild intellectual disabilities (educable)
50/55-70 IQ
89% of those with intellectual disabilities (the most common form of ID)
Moderate intellectual disability (trainable)
35/40-50/55 IQ
7% of the population with ID
Severe Intellectual disability (custodial)
20/25-35/40 IQ
3%of the population with ID
Profound (Life-support)
below 20/25
1% of the population with ID
intermittent support
short term supports such as during an acute medical crisis
short term, but effects life
Kristin’s surgery
limited support
regular but brief support
an employ needing assistance to remediated a job- related skill deficit
extensive support
ongoing and regular assistance such as ongoing home living support
pervasive support
life sustaining support
skilled medical care
help taking medication
cause of ID: organic
something you can actually see in the central nervous system i.e. genetic, chromosomal cause *** a known cause IQ below 50 found across SES accompanied by health problems physical abnormalities (i.e. cleft lip/ palate) die earlier than general population dependent on care of others less likely to marry atypical patterns of development.
Cause of ID: familial
IQ rarely below 50
more predominant in low SES
relate to IQ of siblings/parents
normal health
normal appearance
mortality rate similar to GP
with minimal support, lead independent lives
likely to marry and have low IQ children
more likely to experience neglect in homes
*** these individuals have slower rate of grow but typical language acquisition patterns
table 6.3 pg 235 and 6.5 pg 242
the different syndromes associated with ID
mental capacity
the measure of intelligence: reasoning planning solving problems abstract thinking comprehending the ability to learn learning from experiences
significant ID
significant speech language and communication problems
improvement, prognosis, and learning of speech and language with ID clients
slow and inconsistent
can do a worksheet one day, but then not understand it on day two
SLPs purpose with ID
increase a person’s participation in the environment
increasing a person’s quality of life (going to church, getting a job, having friends, etc.)
developing a sense of community
augmentative/alternative communication
helping a person become more involved in the participation of their environment
language characteristics of ID
pragmatic problems
poor presuppositional capabilities (see other’s perspective, modifying conversation)– related to theory of mind
telegraphic speech (2-3 word phrasal repetition)
limited repair strategies
frequent communication breakdowns
passive communicators
-easier answering questions than initiating
poor peer interactions
poor conv. turn-taking
language characteristics of ID- semantic problems
nouns and vocabulary words are easier abstract adjectives and verbs are worse understand talking about the now rather than yesterday or tomorrow clauses take idioms literally only include key content words (telegraphic speech) word order using morpheme longer utterances
language characteristics of ID- phonology
over 70% of ID will have problems with speech sound productions related to phonological problems
down syndrome stats
1 in 733 live births there can be a diagnosis of downs
results from extra genetic material on chromosome 21
some literature argues that women over 35 have a higher risk of having a child with downs, but this is highly debated
4:1-5:1 male female comparison
15% meet the criteria of children with Autism Spectrum Disorders
multiple diagnoses in 1 individual
down syndrome ID problems
lack of communication abilities- theory of the mind
mild to moderate cognitive deficits
down syndrome physical appearance
short in stature small nose and chin chronic protraction of tongue large young small oral cavity excessive skin on the back of the neck small ears- possible absence of ear lobs hypotonic muscle tone (flaccid) obesity
down syndrome medical issues
chronic hearing issues- conductive, sensorineural, or mixed (middle ear problems)
-unilateral or bilateral; mild to profound
mouth breathing
sleep apnea
thyroid disease
vision disorders
Alzheimer’s disease and dementia increase
happy and willing, enjoy engagement and participation
meaningful relationships- will often get married
down syndrome language components
unintelligible- phonological in nature
receptive language is stronger than expressive language
combination of phonetic (articulators) and phonemic (knowing the parts of words) issues
dysarthria- may have difficulty with rate, range, and motion of articulators
may have childhood apraxia of speech- problems sequencing of sounds (the sequencing of saying sounds)
initiation, elaboration, and linguistic aspects of narratives
short and less com[ed sentence structure
slow and delayed vocabulary acquisition
between 3-6 there is a regression of syntactic development
between 3-6 years of age
expressive language decreases
down syndrome is also referred to as
Trisomy 21
young children with down syndrome
will be unintelligible
AAC can be introduced as early as 18 months of age
greater severity of DS=
more severe speech ad language deficits
common characteristics from 6.5 table
receptive typically better than expressive language, difficulty with morphology + syntax
phonology awareness+auditory verbal memory deficits, difficulty with abstract language, limited vocab, reduced use of grammatical morphemes
chronic otitis media
65-80% have some type of hearing loss
conductive hearing loss 21-58%
sensorineural/mixed hearing loss 4-40%
William’s syndrome physical features
small up-turned nose long philtrum wide- mouth with full lips puffiness around the eyes blue or green eye-color white starburst pattern of the iris of eyes small widely spaced teeth shortening of jaw WS presented at birth large amigdlia in the brain
what causes william’s syndrome?
some genetic material present on chromosome 7
can be confirmed by blood test- 96% diagnosed with some degree of intellectual disability
William’s syndrome personality
hyper-social
“cocktail” speech- superficial conversation
prevalence of William’s syndrome
1 in 20,000 births males and females equally affected
Developmental problems
feeding problems- due to low muscle tone severe gag reflex when food enters oral cavity tactile defensiveness (pull back when you bring spoon to them) poor sucking ability talking, walking, and toiling delays excessive worrying difficulty modulating emotions aversion to loud noises difficulty with visuo-spacial tasks cardiovascular difficulties
strengths of William’s syndrome
long term memory auditory memory speech is articulate/ intelligible less chance of high blood pressure good syntax
language problems for William’s Syndrome
receptive language skills cannot support expressive language- sometimes they may not understand what they are saying incessant chatter with syntactically complex sentences long words with sophisticated vocabulary stereotype phrases word finding difficulties some with hoarse vocal quality excessive echolalia meaning of words compromised circo locution
FISH test
used to identify William’s syndrome
Fetal Alcohol Syndrome (Fetal Alcohol Spectrum disorders) prevalence
CDC- estimates over 2 million people in the US have some form of FAS
1 for every 1000 to 1 in 2,400
many times the features go unnoticed until they are school aged
what causes FAS symptoms
low brain development
FAS physical problems
retardation of physical growth could have cranial-facial abnormalities -velopharyngeal insufficient (VPI) chronic otitis media sensorineural hearing losses underdeveloped jaw small teeth, malocclusion problems with vision, heart, kidney, and bone -global developmental issues hearing loss attributed to alcohol impairing the developing brain sane of infant
FAS mental developmental problems
Executive funcitoning
memory
FAS Personality components
could be seen as noncomplient
FAS language difficluties
deficits in vocabulary and pragmatics
reduced MLU
poor conversational and narrative skills
FAS language difficulties
deficits in vocabulary and pragmatics
reduced MLU
poor conversational and narrative skills
language problems attributed got lack of theory of mind
problems with mental state verbs (i.e. think)
articulation problems- due to craniofacial abnormalities + phonological disorders/ problems with sound acquisition
apraxia
angleman syndrome
severe cognitive-intellectual impairments with seizures
non-progressive genetic neurological disorder
angleman syndrome causes
at least 50% is due to a piece of chromosome 15 missing
- attributed to mother’s chromosome
this results in brain development and lacking in motor movement and language
angleman syndrome prevalence
1 in 10,000 to 1 in 25,000
angleman physical attributes
spaced teeth jaw protrusion deep-set eyes fair complexion stiff-legged gate jerky movements of extremities -hand flapping normal hearing -some otitis media will hold objects in mouth poor joint attention -eye contact
angleman speech and language
speech and langauge do not develop
-non speaking
(AAC suitable)
communication through gestures
angleman diagnosis
unrecognized at birth
diagnosed through FISH test
FISH test
florescent in situ hubidization
angleman personality/ other symptoms
80% will demonstrate seizures
typically happy and affectionate
Fragile X diagnosis
hereditary- X lined through mother
long are on X Chromosome
identified through blood test
Fragile X prevalence
high in prevalence causing ID
males more effected 1 in 1,000
severity if in female, is much higher 1 in 2,000
Fragile X physical attributes
long face/ears droopy eyelids flate nasal bridge small hands low muscle tone flat feet blink rapidly hyperextended finger/ other joints -poor coordination mitral valve prolaps vision difficulties
Fragile X personality/ other characteristics
hyperactivity
sensory integration
tactile defensive
Fragile X speech/language
echolalia- Hallmark of these children perseverate (persistent with one word) false start/frequent syllable repetition poor sequencing/organizing -sytax abilities -pragmatics speech unintelligible
Rossetti
infant toddler test
“can I hold your child”
Augmentative Alternative Communication (AAC)
area of of clinical practice that attempts to compensate (temporarily or permanently) for impairments or disabilities
For people with severe expressive communication disorders
E.g. speech generated devices for communication only
For people with severe expressive communication disorders
Mobile devices sign language
It can also be used for augmented input i.e receptive
-Using some sort of visual aid input
-like how mom uses a sheet with pictures to tell her so that’s what she wanted them to do or where they are going
Number one parent concern with AAC
That it will stop the child from talking
AAC actually facilitates expressive communication
You are still prompting any unaided speech and nonverbal communication
AAC can be used with
Stroke, TBI trach/laryngectomy, Parkinson’s, apraxia, aphasia, ALS – Lou Garricks disease
Dave Bukelman
“father of AAC”
University of Nebraska
Lyle Lloyd
Purdue
Janice Light and Krista Wilkinson
Penn State
Goal of AAC
Not to find a technological solution but help people engage in a variety of interaction
Communication purpose
Communicate wants, information transfer, social closeness, social etiquette, internal dialogue
Multimodal communication
Use AAC with speaking and gestures
unaided communication
Communication with body gestures, facial expression, sign
Aided communication
Anything outside of your body
AAC for children that are not illiterate or too young
Visual graphic symbols, photographs, line drawings, pictures
Problems with AAC
Time-consuming for programming
physical access issues
typical AAC speaker can only say 7 to 13 words per minute
AAC videos
-anything other than speech used to communicate
SGD- speech generating devices
Can be mounted on the wheel chair
How can I support the use of AAC?
Provide lots of opportunities for communications
Model the use of AAC
Wait and allow time for the child to communicate
Respond to the child’s attempts to communicate
Have fun
Visual scene displays
being able to scan a picture into the AAC system and then the child can click on the parts of the photo for different responses
Autism Spectrum disorders used to mean
there are different severities to characterize disorder
DSM 5
refined some of the subtypes of ASD in 2012
ASD is now
used as a global term- does not differentiate different severity levels
Leo Kanner 1943 Psychologist description of autism
the first to define autism aloof withdrawn from social interaction echolalia fascination with objects intolerable to change normal or near normal intelligence everyone he worked with had normal intellegance
Asperger Syndrome
subtype of the ASD spectrum in DSM 4
dropped in DSM 5
but many still recognize it
Asperger’s S characteristics
considered high functioning
schedule oriented
primarily a disorder of pragmatic
semantic deficits
often get in trouble for using words atypically
most likely a lot of undiagnosed people with Asperger’s
typically strong visual memory
servant abilities (super natural abilities) i.e. music
not aware/unsure of their social behaviors
Autism Diagnosis
occurs frequently in families
can occur before, during, or after birth
ASD can be diagnosed by 18 months- trying to diagnose during 1st year
neurodevelopmental disorder
prevalence of ASD
1 in 68
more predominant in males
DSM 4- pervasive developmental disorder not otherwise specified (PDD-NOS)
children that met some of the criteria for ASD, but not all
delays in development and social communication
ruled out any type of psychiatric disorders
infantile autism (DSM-4)
autism before 30 months of age
Autistic disorder (DSM-4)
type of Autism that is most severe
Heller Syndrome (childhood disintegrative disorder)
progressive disorder
normal developmental until age 2
after 2, begin to lose abilities until age 10 (social, emotional, cognitive, motor)
Associated with severe intellectual disabilities, dementia
Normal life expectancy
Retts syndrome
Progressive neurological disorder (not fit under autism spectrum)
Shares some symptoms that can present as autism
Pervasive developmental disorder
Everything appears intact for the first 5 months of life
Then you see deficits in social, motor, and cognitive abilities
Impaired language development
neurological problems: seizures
Sudden cardiac death
Many will survive into adulthood
Hand flapping
Apraxia
Metalinguistic deficits
Major oral- motor and feeding issues
ASD Characteristics personality
Primary deficits: social, emotional, communication skills
Social- pragmatics/interaction
Emotional- difficulty with regulating emotion
Communication- deficits in reciprocity
Gestural communication impaired
Problems with joint attention (precursors to comm. Development)
No interest in others
Eye contact avoidance
Want to be left alone
Deficits in ToM (theory of the Mind)-
difficulty understanding other people
Difficulty talking about own feelings
Stanley Greenspan- University of North Carolina- intervention focused upon emotions
Aloof- doesn’t seem to care for closeness unless on their terms
Imaginative play deficits
Difficulty with pretend play
Actions are repeated over and over again
-Speech and movements
Difficulty adapting to routine changes
Unusual reactions to taste, smell, sight, or sound
Sensory system deficits
Show aspects of normal development and then regress at one time
Poor proximity
Better with construction play (like Legos)
ASD Characteristics language
Unaware when people talk to them
Language abilities parallel with their IQ (cognitive abilities)
Echolalia
Immediate
Mitigated
Delayed
Speech intelligibility is fine
Monotone- No rhythm, stress or intonation (suprasegmentally)
Some use idiosyncratic language- a phrase or an utterance that they use that is unique to them
Sound prolongation
Avoid social interaction
Trouble with pronouns
Him for he you for themselves I for others
echolalia
a person will hear something and then they will repeat it back
immediate echolalia
preserves the exact utterance they heard and then repeats it back immediately
mitigated echolalia
parts of the utterance are preserved and repeated
delayed echolalia
child will repeat what they heard at a later date and time
ASD diagnosing
Challenging to administer a standardized test to this population
Parent-interview often used as means of assessment
SLPs so not diagnose ASD- group of professionals collaborate to make it
Causes and risk factors of ASD
There are multiple causes
There is an environmental contribution
Biological contribution (brain development)
Genetic factors – higher risk if sibling has ASD
ASD occurs more frequently with Fragile X syndrome
Children born to older parents have higher risk for ASD
Can occur before, during or immediately after birth
Prescription drugs: valproicacid, thalidomide
SCERTS model
Barry Prizant
Social Communication, emotional regulation, transactional support
Helping them participate in the world
At a high risk for emotional difficulties
A team of multiple disciplines makes a plan with the family
Behavior is secondary to primary communication
**is trying to understand the behavior before trying to provide remediation what is causing the behavior
Social communication
Focus on joint attention
Using symbol use with them
**we are trying to provide more traditional and conventional ways to communicate with their environment
importance of developing symbolic play
Emotional regulation
Self-regulatory skills -impact on communication -we all need language where we use an internal dialogue to Mutual regulation -teachers and SLPS can help them regulate -holding a child's hand -What others do to help us regulate Recovery from dysregulation
Transactional support
dynamic and on going
Interpersonal support
-How do others include them, how do we support them
Learning or educational supports
-Visual strategies- visual learning is a strength for ASD
Support to families
-Educational support, what do you need to teach the parents to help the children learn
-Emotional support
Support among professionals
berry prizant
brown university
amy wetherby
florid state university
increase in ASD
700% in 10 years
ASD and seizures
15%
ASD and gastrointestinal problems
40%
symbolic play and ASD
if a child has symbolic play than they will be able to understand speech because language is symbolic as well
DSM-5
2013
used for diagnosis/labels- needed for repayment of services from insurance companies
DSM-5 changes for autism
no longer uses aspergers or PDD-NOD, childhood disintegrative disorder, or autistic disorder
broad term of ASD now used
diagnostic # 299.00
backlash from change
people are still using old labels, especially children already diagnosed
Criteria for ASD persistent deficits in social communication and interaction
across multiple contexts
- deficits in social/emotional reciprocity
- abnormal social approach, failure of normal back and for conversation, reduced interest, emotion, or affect - deficits in nonverbal communicative behaviors used for social interaction
- deficits in developing, maintaining, and understanding relationships
- difficulty adjusting behavior, imaginative play, making fiends, disinterest in others
Criteria for ASD restricted repetitive patterns of behavior, interest, or activities
must have at least two of the following:
- stereotyped or repetitive motor movements with objects or speech
- insistance on sameness (inflexible adherence to routine)
- highly restricted/ fixated interests that are abnormal in intensity or focus
- hyperactivity to sensory input (indifference to pain and temperature adverse response to specific sounds or textures, fascination with lights and movement)
other criteria of ASD
- symptoms must be present in early developmental period
- symptoms must cause cynically significant impairment in social, occupation, or other important areas of current functioning
- deficits not explained by ID or global development delay- however can co-occur
- social communication should be below that of general developmental level
severity of ASD level 3
“requiring very substantial support”
severe deficits in verbal and nonverbal social communication skills restricted, repetitive behaviors
severity of ASD level 2
“providing sustained support”
social impairments apparent
marked deficits in verbal and nonverbal communication
severity of ASD Level 1
“requiring support”
noticeable impairments, deficits in social communication cause noticeable impairments
-difficulty initiating social interactions
-a person who si able to speak in full sentences and engage in communication but whose to and fora conversation with others fail
inflexibilities causes interference with functioning
screening
- eye case
- response to name
- lack of pointing
- lack of pretend play
- reduced language development
- lack on NV communication
evaluation process
relevant case history
medical evaluation
medical and mental health history of family
administer speech and language assessment
genetic testing
metabolic testing
relevant case history includes
health
development
behavioral history
medical status
medical evaluation includes
physical
neurodevelopment evaluation
testing of hearing
instruments for ASD diagnosis
standardized test
parent/teacher/self report measures
systematic observation (naturalistic observation)
criterion referenced assessment
assessments tests us
recommendations
diagnosis of and
severity level, referrals
assessment always considered
ongoing
audiological evaluation necessary
may be challenging to obtain valid results
Autism screening instrument for educational planning- 3 (ASIEP-3)
for children 2-13.11
autism behavioral check list
sample of vocal behavior (spontaneous speech)
interaction assessments
educational assessment
functional levels (can child say in seat)
prognosis of learning rate
Child Autism Rating Scale- 3rd edition (CARS-3)
ages 2+ 15 item rating scale to id autism from developmental disabilities through direct behavioral observation looks at behaviors: -relating to people -emotional expression -body use -object use -restricted interested -adaptation to change -taste, smell, touch - anxiety -fear or nervousness
autism spectrum rating scale
2.5-6.18
5 point likerst scale
measures:
-socialization, communication, unusual behaviors, sensory sensitivity, self regulation, behavioral rigidity
Gillam Asperger Disorder Scale (GADS)
3-22
competed by parents or professionals
help with developing behavioral objectives/goals for IEPs
normed on 371 participants
what to look for with ASD diagnosis
social and pragmatic behavior!!
dynamic assessment
test, train, retest
successful model for children with ASD
most assessments are
criterion referenced
functional assessment
looking at how communication can be enhanced, participation that is relevant to client’s life
vertical goals are more appropriate for ASD
because they are focused on one goal and less intensive
horizontal goals
2, 3, or 4 goals that are complimentary of each other and worked on at the same time too cognitive demanding for ID clients
Autism and Intervention
social skills training/intervention
gentle touching
-natural, supportive interactions
AAC
social skills training
taking turns
AAC for intervention
- ideas and concepts related to the topic displayed in pictures
- Picture Exchange Communication System (PECS)
PECS
initially designed for communication with turn-taking
become more of an AAC program
for those with little to no communication abilities
scientifically accepted and proven
fondation skills in operant conditioning
6 phases of PECS
- child learns to communicate
- increasing distance between them and the comm. partner
- add more pictures to the board that you create, they learn to discriminate between pictures
- learns to produce simple sentences
- answering questions
- commenting
- 1985 Andrew Bondy, Laurie Frost
Oliver Wendt
Speak all- Purdue
-newer version of PECS that uses iPad
symbols moved to the speak window to create a communication
behavioral program
ABA
can work best with beginning communicators
more naturalistic approach should be used for higher-level language
contemporary ABA
using natural environment + behavioral techniques
Autism is a disorder of
Theory of the Mind
social stories
fits under the concept of theory of the mind
models different perspective for child with autism
something that is function that is relative to the child’s life can be represented through animation/a story that you come up
so they can understand the feelings of others
comic strips
teach child about specific concepts
similar to social stories
lack of understanding emotions
therapy target could be to understand and express emotion
board maker
Picture Communication System
DSM-5
category for social-pragmatic disorder
Mand
for of prompt to elicit communication
“say I want a cookie”
Parallel talk
providing naturalistic interactions
