Week 1 (Ch. 1 &3) Flashcards
ASHA definition of language disorder
An impairment in the “comprehension and/or use of
a spoken, written and/or other symbol system.
3 things a disorder may involve in any combination
The form of language (phonology, morphology, syntax) The content of language (semantics) The function of language in communication (pragmatics)
Define: Naturalist perspective
Impairment is characterized as a deviation from the average
level of ability achieved by a similar group of people
Naturalist perspective (does, Does not) help the clinician decide what differences in language behavior constitute an impairment or what level of impairment intervention is warranted
does not
Define: normative perspective
Considers impact of language impairment on the child’s
overall development and ability to function in everyday situations
Normative perspective States a language disorder exists when __________________
it interferes with the
child’s ability to meet societal expectations now or in the future
Deficits (do, do not) always occur together, although
impairments in one area may influence development in another
do not
Important to make a distinction between ______, _______, and _______ in order to highlight __________
order to
speech, language, and communication. The child’s most salient difficulty.
Very often impairments occur in the context of __________ with a _________
another developmental disorder, recognized label (ASD, Down’s).
Some of the other names for language problems
Specific language impairment, language delay, language disability,
language disorder, or developmental language disorder
Bloom and Lahey (1978) and Lahey (1988)- 2 major findings
Provided the framework for examining language
competencies
Suggested that language is comprised of three major
aspects: form, content and use
(All, Not all) of these features will be present in all children
with a diagnosis of DLD and the features that characterize a child at one age (may, may not) be very different to the features that stand out as the child gets older
Not all, may
Bloom and Lahey’s taxonomy of language: 3 major aspects
Form, content, use
3 key linguistic characteristics of disorders in form
Errors in speech production and poor phonological
awareness
Errors in marking grammatical tense
Simplified grammatical structures and errors in
complex grammar
3 key linguistic characteristics of disorders of content
Delayed acquisition of first words and phrases
Restricted vocabulary
problems finding the right word for known objects
3 key linguistic characteristics of disorders of use
Difficulties understanding complex language and
long stretches of discourse
Difficulties telling a coherent narrative
Difficulties understanding abstract and ambiguous
language
Mental age is an index of __________.
Developmental age
One way to describe children with developmental disability is
to say that ____________.
their developmental level is significantly lower than their chronological age
ASHA (2000) argued against cognitive referencing in making
decisions about eligibility of services. Why? Define cognitive referencing?
Comparing oral language skills to IQ to determine if language
intervention would benefit a student – make student eligible for
services in public schools
Sometimes language functioning can surpass cognitive levels
A Full Scale IQ score is comprised of what 2 things?
Verbal IQ and non-verbal IQ
Define: verbal IQ
measure of oral language skill
Define: non-verbal IQ
measure of the ability to carry out motor tasks
or analyze and solve problems using visual reasoning
When measuring IQ in children with language
impairments, best to use _______________.
cognitive tests that do not involve the production or comprehension of language
Nonverbal IQ is used as a measure of __________.
general intelligence in
individuals with language impairment
Nonverbal IQ is sometimes used to qualify or deny
services in individuals with ID. Why?
The assumption is that language skills cannot improve beyond
one’s language ability
In many states, SLPs cannot provide services to a student
when his/her________ and ________ are equivalent
nonverbal IQ and language ability
Longitudinal studies of children with language disorders
have reported a (drop, increase) in (verbal, nonverbal) IQ over time
drop, nonverbal
Degree of discrepancy between verbal and nonverbal
abilities does not necessarily predict a child’s __________
responsiveness to intervention
Denial of services to children because of depressed
(verbal, nonverbal) IQ scores (is not, is) consistent with the tenet of IDEA
nonverbal, is not
Standardized scores give us some useful information
about ______________, but sometimes we need more information to determine if speech-language services are needed
a child’s abilities relative to their peers
Tests with adequate psychometric data are (always, not always)
available for all age levels, for all _________, __________, or _________.
not always; age levels, language communities, or aspects of language/communication
The __________ stresses that a language
disorder must be big enough to be noticed by ordinary people
Normative position
Some problems are more readily apparent to non-specialists,
while others are more ______ and _________.
Subtle and easily missed
(A, no) single cause of DLD.
No
4 risk factors that co-occur to give rise to diagnosable conditions
Biological, cognitive, behavioral, environmental
Define: biological factors
Biological factors Differences in genetic risk and neurological structure and function
Define: cognitive factors
Cognitive factors Differences in perception and information processing
Define: behavioral factors
Behavioral features Overt differences in behavior
Define: environmental factors
Environmental factors External experiences that either increase risk of disorder or that
are protective in the face of biological risk
4 genetic factors of DLD
Primary DLD tends to run in families, suggesting
that genes may influence susceptibility to disorder
Cannot be sure of this because families also share
environments
Genes that have been implicated in DLD have also
been implicated in a host of other neurodevelopmental disorders, including Tourette syndrome, ADHD, dyslexia, ASD, epilepsy and ID
Partially overlapping etiologies may help to explain
the high rates of co-morbidity seen in developmental disorders
Human brain starts developing ______ and
continues to grow and develop throughout adolescence
in utero
Current neurobiological theory of DLD
Initially regional differences in the brain favor different types
of input for processing and computations
Smaller regions within these areas become more specialized
through activity-dependent processes that respond to environmental input
Increased cortical specialization and learning require
_________________ in order for effective communication within the brai
changes in the number and strength of connections between neurons
__________ eliminates weak or underused
connections and helps strengthen remaining connections
Synaptic pruning
Results in _____________ – specialized
neural networks that are more finely tuned to process particular inputs
functional specialization
Language in the adult brain is a great example of ________ and ___________.
Localization and functional specialization
In most individuals, language processing occurs in
the (right, left) hemisphere…this is called _____________.
left, left lateralized
As a result cortical structures that process language
tend to be larger in the (left, right) hemisphere than in (right, left) homologous structures
left, right
2 critical cortical areas for language
Frontal lobe and temporal lobe
Frontal lobe language functions
Inferior frontal gyrus includes pars opercularis and pars
triangularis…together they form Broca’s area
Important for speech motor planning needed for spoken
language
Temporal lobe language functions
Includes Heschl’s gyrus, superior temporal gyrus and the
planum temporale
Important for auditory processing and language
comprehension
5 things MRI studies of DLD find
as a group individuals with DLD show atypical patterns of
asymmetry of the language cortex (Leonard and Gauger
studies)
Abnormalities in white matter volume Cortical dysplasia
Additional gyri in frontal and temporal regions
Unusual proportions of anatomical structures implicated in
language processing
3 fMRI findings of brain function in DLD
Hugdahl et al. (2004) studied language processing in 5 Finnish
family members with DLD and 6 age-matched peers. The family members with DLD showed bilateral activation in the temporal lobes which was much weaker and more focal than
activations in the comparison group
Weismer et al. (2005) studied working memory abilities in 8
teenagers with primary DLD and 8 individuals with NL. The individuals with DLD exhibited hypoactivation in frontal and parietal regions and inferior temporal gyrus
Whitehouse and Bishop (2008) found that adults with DLD
showed reduced blood flow to the left hemisphere when engaged in language tasks
Language learning is remarkably robust in the face of _________________
impoverished language input
___________ factors alone cannot account for the
deficits that characterize DLD
environmental
Environmental factors can have an important role in
mediating _________ and ____________
the developmental course of the disorder, impact of the disorder on the child’s adaptation and wellbeing
Children from families with ________ have (slower, faster)
rates of language development relative to peers from __________ environments
low SES, slower, affluent
Relationship between ___ and _______
not straight forward
SES, language impairment
DLD in the context of _______ should alert clinicians
and educators to the need for ________ and ____________
Low SES, careful monitoring and language support
3 cognitive models of DLD
auditory processing, limited processing capacity, procedural deficits
Auditory processing model of DLD
Auditory deficits have been shown to be neither necessary nor
sufficient to cause DLD
Limited processing capacity model of DLD
Evidence for limited capacity system stems from poor
performance on tasks of working memory and phonological short term memory
Procedural deficits model of DLD
Children with DLD are impaired on measures of learning that
tap into procedural memory systems (important for rule based
learning such as grammar)
Children with Autism and DLD share ________________ (including _____ and ______)
language problems, vocabulary and grammar
Children with autism typically demonstrate 6 deviant features
that would not be regarded as typical at any age
Repetitive use of stereotyped phrases Unusual and exaggerated intonation Pronoun reversal
Idiosyncratic words
Echoing the speech of others Pragmatic skills
Skilled reading requires ______ and ______ …_______-based skills
reading accuracy and
reading comprehension; language
Individuals with ________ also have some oral
language difficulties
dyslexia
Poor comprehenders (good decoding, poor reading comprehension) have oral language weaknesses in \_\_\_\_\_, \_\_\_\_\_\_, and \_\_\_\_\_\_\_\_\_\_
vocabulary, grammar, verbal working memory
Many children with DLD end up having _____________
reading difficulties
4 purposes of intervention
1). Change or eliminate the underlying problem
Rendering the child a normal language learner
2). Change the disorder
Improve specific aspects of language behaviors by teaching
specific behaviors
3). Teach compensatory strategies
Rather than trying to make their language normal, the
clinician attempts to give them tools to function better with the deficits they have
4). Change the child’s environment
Try to influence the context in which a child must function
Identification of the basic purposes of intervention are based on what 5 things?
Age
Intervention history of the client Nature of the disorder
Way the environment interacts with the child’s
communication function
Data collected from the evaluation
3 interventions to change the disorder
facilitation, maintenance, induction
Define: facilitation
Helps children achieve language milestones sooner than they
would have if left alone, but it does not mean that they ultimately achieve higher levels of language function than they
would have without intervention
Define: maintenance
To preserve a behavior that would otherwise decrease or disappear
Define: induction
Intervention completely determines whether some endpoint will be reached
Define: evidence-based practice
“the conscientious, explicit, and unbiased use of
current best research results in making decisions about the care of individual clients” by integrating clinical expertise with the best available external clinical evidence from systematic research (Sackett et
al. 2000)
Evidence-based practice includes what?
Includes evaluating internal evidence…from
characteristics of the client and family, their willingness to participate in a treatment approach, and their preferences as well as our own clinical preferences, professional competencies and values
(Fey & Justice, 2007)
3 aspects of evaluating external evidence
Opinions of experts should be viewed with
skepticism
All research is not created equal. Some studies
are better, and therefore better suited to inform clinical decisions, than others
Clinicians must be critical about the quality of
evidence they use to guide clinical decision-making
Step 1 in incorporating EBP
Formulate your clinical question
4 steps to formulating your clinical questions
P – Patient or Problem
I – Intervention being considered
C – Comparison treatment (can be no treatment)
O – desired Outcome
Step 2 in incorporating EBP
Use internal evidence, such as clinical experience and family preferences to determine what your typical “first stab” approach would be
Step 3 in incorporating EBP
Find the external research evidence base
3 considerations in finding the external research evidence base
Use the ASHA database
Databases such as MEDLINE or PsychInfo
Start by reading the most recent review articles
Step 4 in incorporating EBP
Grading studies
3 things you grade studies for
Relevance to the clinical question
Level of evidence provided by the study based on its design and quality
The direction, strength, and consistency of the observed outcomes
Step 5 in incorporating EBP
- Integrate internal and external evidence
Step 6 in incorporating EBP
- Evaluate the decision by documenting outcomes
3 aspects of the intervention plan
Intended objectives of the intervention processes used to achieve these objectives Contexts, or environments, in which the intervention
takes place
3 levels of goals
Basic goals – correspond to long-term objective (e.g., new grammatical forms)
Intermediate goals (e.g., auxiliaries, articles, pronouns)
Specific goals (e.g., is are; a, the; he, she)
In setting goals, you should target the _____
ZPD
Define: ZPD
the distance between a child’s current level of
independent functioning and potential level of performance
Don’t want to select goals _______ or ______ the ZPD
below or beyond
May need to use ___________________ to
establish ZPD
dynamic assessment techniques
4 other factors to consider when setting goals
Communicative effectiveness
Choose objective not only on developmental grounds, but also
on the grounds of how efficient the targeted behaviors will be
in increasing a child’s ability to communicate
Require child to do only one new thing at a time
Use new form to serve a communicative function that has
already been expressed or new function with a form already
used by client
Phonological abilities
Teachability
Teach easier forms and functions before harder ones
Teachable forms include what 3 things?
Those that are easily demonstrated in pictures Taught through stimulus materials that are easily
accessed and organized
Used frequently in naturally occurring, everyday
activities in which the child is engaged
3 intervention approaches
Clinician-directed approaches (CD approaches) Child-centered approaches (CC approaches) Hybrid approaches
________- centered is the most natural on the continuum, and includes what 2 things?
child; daily activities and facilitated play
________ is the “middle” natural on the continuum, and includes what 3 things?
hybrid; Milieu therapy, focused stimulation, script therapy
________-directed is the least natural on the continuum, and includes what 3 things?
drill, drill play, CD modeling
During clinician-directed approach, the clinician specifies all the aspects of intervention including what 4 things?
materials to be used and how the client will use them
the type and frequency of reinforcement
the form of the responses to be accepted as correct
the order of activities
Clinician-directed approaches are also referred to as ________ or ________.
drill, discrete trial intervention
4 things clinician-directed approaches attempt to do
make the relevant linguistic stimuli highly salient
Reduce or eliminate irrelevant stimuli
Provide clear reinforcement to increase frequency of desired language behaviors
Control the clinical environment
4 advantages of CD approaches
Allows the clinician to maximize the opportunities
for a child to produce a new form, producing a higher number of target responses per unit time than other approaches
Unnaturalness of approach
Research finds that these approaches are
consistently effective with various disorders
Research finds that individuals with lower IQs or
more severe disabilities perform better with CD approaches
2 disadvantages of CD approaches
Not good at getting the client to generalize new skills
into real communication outside clinical setting
Research finds that using more naturalistic methods
can provide a more efficient means of addressing language targets
3 types of CD activities- name and define
Drill
Most highly structured activity Clinician instructs the client on what is expected and provides
a training stimulus
Drill Play
Like Drill, but provides some motivation into the drill
structure
Modeling
Child’s job is to listen as the clinician provides numerous examples of the structure being taught
Child-centered approaches also called what 3 things?
Also called indirect language stimulation,
facilitative play, pragmaticism and developmental or developmental/pragmatic approaches
What does the clinician do, and what is the clinician not allowed to do, during child-centered approach
Clinician arranges an activity so that opportunities
for the client to provide target responses occur as a natural part of play and interaction
No tangible reinforcers, no requirement that the
child provide a response to the clinician’s language and no prompts or shaping or incorrect response
2 keys to the child-centered approach
Key to this approach is to respond to the client
with one of several specific verbal techniques
Our responses model communicative language
use
Unlike in CD approaches, we are not trying to
__________________…instead we _____________________
elicit specific structures from the client.
react to the child’s behavior, placing it in communicative context and giving it a linguistic mapping
6 verbal response techniques
Self-talk and parallel talk Imitations Expansions Extensions Buildups and breakdowns Recast sentences
Define and explain: self-talk
We describe our own actions as we engage in parallel play with
the child
Provides a clear and simple match between actions and words
By using the child’s actions and matching our own words and
actions to them, we model how to comment on our actions with language
Define and explain: parallel talk
Provide self-talk for the child
Talk about the client’s actions, providing a running
commentary
Define: imitation
Imitating what the child says
Research has showed that adults often ____________ and that when they do, there is a substantial probability that the child will ___________
repeat what normal toddlers say, imitate the imitation
Research shows that children who imitate show
advances in ____________
language development
The more the child says, the more the opportunities
exist for practice of _____, ______, and ____ forms and the more opportunities there are for _________
phonological, lexical, and syntactic forms; feedback
Define: extensions
Comments that add some semantic
information to a remark made by the child
We take what the child says and add the grammatical
markers and semantic details that would make it an acceptable adult utterance
Expansions have been shown to increase the
probability that a child will ____________________
spontaneously imitate at least part of the expansion
Expansions have been shown to increase
_______________ for a number of structures in a number of diagnostic group
grammatical development
Buildup and Breakdown: explain, purpose
Build up and breakdown a child’s utterance to show
them how sentences get put together
Start by expanding the child’s utterance to a fully
grammatical form (build up)
Then break it down into smaller, phrase-sized pieces
This type of buildup and breakdown response has been associated with _________?
This type of response has been associated with
language development in typically developing children
Define: recast sentences
Like expansions, but instead expand the
child’s utterance into a different type or more elaborated sentence
3 characteristics of hybrid approaches
Target one or a small set of specific language goals
Clinician maintains a good deal of control in selecting activities
and materials but does so in a way that consciously tempts the child to make spontaneous use of utterances of the types being
targeted
Clinician uses linguistic stimuli not just to respond to the
child’s communication but to model and highlight the forms being targeted
4 types of hybrid approaches
Focused stimulation, vertical structuring, milieu teaching and script therapy
Define: focused stimulation
Clinician arranges the context of interaction so that
the child is tempted to produce utterances with obligatory contexts for the forms being targeted
Clinician provides lots of models of the target form in
meaningful context
Focused stimulation is effective for __________?
Effective for improving comprehension and
production of a form
During focused stimulation, a clinician gives ___________________
Clinician gives feedback similar to an expansion
when the child makes an unsuccessful attempt
Define: vertical structuring
Particular form of expansion used like focused
stimulation to highlight target structures
Why is vertical structuring Less naturalistic than standard ILS technique?
the clinician provides a specific nonlinguistic stimulus, but does use a naturalistic response
Vertical structuring is effective at targeting ___________?
early developing language forms
3 major components that characterize Milieu Communication Training
Environmental arrangement
Responsive interaction
Conversation-based contexts that use child interest and initiation as opportunities for modeling and prompting communication in everyday settings
4 main methods of Milieu Communication Training
Incidental teaching
Mand-model
Prelinguistic milieu teaching
Enhanced milieu teaching
5 steps of incidental teaching
Clinician arranges the setting so that things the
client wants or needs to complete a project are visible but out of reach
Clinician first responds with focused attention
If client does not respond as expected, clinician asks
question to get child to use verbal request
If response produces target response, clinician
provides confirmation with a model of target form
If response does not produce target response, a
prompt is provided
Define: mand-model
Clinician observes child and when the child seems to
show some interest in some aspect of the environment, the clinician “mands” or requests an utterance with a stimulus
During mand-model, clinician is trying to elicit ____________ rather than __________.
Clinician is trying to elicit general one-word, two-
word or complete grammatical sentences, rather than specific form or meaning targets
Prelinguistic Milieu Teaching is designed for what age group?
Designed for nonverbal children between 9 – 18
months of age developmentally
Goal of prelinguistic milieu training
Goal is to develop the basic intentional
communication skills necessary for early language development by increasing the frequency, maturity, and complexity of nonverbal communicative acts
5 major goals of PMT
Establish interactive routines to serve as contexts for
communication
Increase frequency of vocalizations Increase frequency and spontaneity of coordinated
gaze
Increase use of nonconventional and conventional
gestures
Encourage combinations of gaze, vocalization and
gesture
Enhanced Milieu Teaching is effective for children who meet what 3 criteria?
Produce some verbal imitation
Have at least 10 productive words
Are in the early stages of language development, with MLUs from 1 – 3.5
Enhanced milieu teaching incorporates methods of both _________ and _________.
incidental teaching and the mand-model approaches
Define and explain: script therapy
A way to reduce the cognitive load of language
training by embedding it in the context of a familiar routine
Clinician can develop some routines or scripts with
the child in the intervention context or re-enact scripts the child already knows
In the intervention the known script is violated in
some way, this does what?
challenging the child to communicate to call attention to or repair the disruption
Script therapy includes what 2 things?
Includes literature-based scripts and interactive
book reading
Fey’s 4 guidelines for increasing naturalness of CD activities
Make the language informative
Increase the motivation to communicate with the task Use cohesive texts
Move from “here and now” to “there and then”
10 essential ingredients of successful therapy
Intensity Active engagement Feedback Reinforcement Repetition Use distributed practice Specificity Control complexity Minimize error responses Work within schemas
Think carefully about the (output, input) you present to the
child in terms of both its _____________ and ______________.
input, meaning and its formal properties
5 ways Linguistic input can be manipulated many ways to
make it more effective
Rate Repetition Increasing perceptual saliency through prosody and word
order
Controlling complexity Obligating pragmatically appropriate response
(A lot of, Very little) empirical evidence exists to guide us in determining ____________ for the wide range of communication skills that SLPs address
very little, optimal intensity
Proctor & Williams (2007) found that _____________ appears to be more effective than ______________.
Proctor & Williams (2007) found that distributed
practice within sessions and throughout the treatment program appears to be more effective than massed practice involving long periods of repetitive practice
Daily, intensive practice sessions involving
distributed practice for a few weeks or months is (worse, better) than two to three sessions/wk for a year
better
Requiring the child to respond: comprehension vs. production
Not always necessary to train comprehension before having the
child produce a target form
For forms and functions that are comprehended but not produced,
production training is indicated…think within the child’s ZPD
For structures and meanings that are neither comprehended or
produced… production in imitation should be first step
Requiring the child to respond: augmentative and alternative modalities
Beukelman & Mirenda (2005) advocate a “communication needs”
model
Children who need a means to communicate because of a lack of
speech are provided with some communication system, regardless of whether they have identifiable barriers to vocal expression
2 types of consequences that can be provided to the client based on their production
Reinforcement or feedback
Define: reinforcement
The intent of reinforcement is to increase the frequency of the
behavior being reinforced
Define: feedback
Not intended to increase the frequency of the client’s behavior Intent is to give the client information about the communicative
value or linguistic accuracy of an utterance
The goal of language intervention is to?
The goal of language intervention is to get the client
to use appropriate forms in real interactions…this process is generalization
Generalizing language gains is thought to be the (first, last) step in intervention, but
should really be incorporated into every session.
last
Research tells us that children (do not, do) always
generalize the forms learned in CD activities, or even naturalistic approaches, to spontaneous conversations
do not
____________ needs to be built consciously into our
intervention programs
Generalization
6 ways to increase generalization
Use many exemplars of target forms and functions Provide many exemplars of target form in multiple
settings
Make treatment material similar to things used in
natural environment
Intermittent or delayed reinforcement Use distractor items Teach self-monitoring
You choose non-linguistic stimuli based on what 2 things?
Types of stimuli timing
3 intervention service delivery models
consultant model, language-based classroom model, collaborative models
Define: consultant model
SLP determines the intervention targets, procedures and context Meets with agent of intervention (parent, teacher, SLP aids, peers)
Define: language-based classroom model
SLP is classroom teacher for group of students with language disorders
Define: collaborative models
SLP works with one or more students with language disorder in the mainstream classroom in collaboration with classroom teacher
Define and explainThe: intervention termination criteria
One way to demonstrate accountability Level of use of a targeted structure that the client must achieve
for the structure to be considered achieved
Usually 80% to 90% correct usage in structured situations Better way…50% correct in spontaneous speech
Define and explain: determining responsiveness to intervention
Designed to overcome the problem of identifying children with
language and learning disorders based on a discrepancy
Using RTI children are exposed to a series of levels of instruction
6 discharge criteria
- Communication is now within normal limits
- All goals and objectives of intervention have been met
- The client’s communication is comparable to those of others the same age, sex, and ethnic and cultural backgrounds
- The individual’s speech and language skills no longer adversely affect social, emotional, or educational status
- The individual uses an AAC system and has achieved optimal communication across partners and settings
- The client has attained the desired level of communication skills
3 levels or RTI (Response to Intervention)
Tier, I, Tier II, Tier III
Define: RTI Tier I
Classroom instruction for all children that is evidence-based
Define: RTI Tier II
Targeted, short-term research-based instruction designed to
address weaknesses in children who struggle with language
and literacy
Intervention delivered in small groups
Define: RTI Tier III
Intensive, therapeutic intervention
National trend away from exclusive attention to
__________ and toward ________.
rehabilitation, prevention
Prevention before rehabilitation trend partially arises from
our knowledge of the
enormous cost of rehabilitation and the burden it places on the economy
CDC (2003) estimated that preventing one case of ID can
result in long-term savings of $1 million
US public health service has developed goals for what 4 things?
improving health, reducing risk factors, providing screening and early identification resources and increasing public awareness
ASHA (2005) and Marge (1993) identified 6
primary prevention strategies that can be applied to disabilities that lead to communication disorders. What are they?
Wellness promotion Proper health and medical care, including immunizations and
prenatal care
Public education Genetic counseling Mass screening and early identification Elimination of poverty
