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Flashcards in Communication Disorders Deck (25):

The Importance of Communication

 Human beings communicate through a variety of symbols (e.g., verbal, gestural, visual)

 Symbolism as fundamental and unique to human evolution and cognition (e.g., Deacon, 1997)


Typical Language Development

 Receptive language (i.e. understanding) at approx 9-10 months (Adamson, 1999).

 Expressive language (i.e. speech) at approx 18 months (end of sensori motor period, Piaget, 1952)

 Relatively rapid acquisition and progress (e.g., single to multi-word utterances, grammatical tenses, plurals etc)


The Importance of Language

 Important social functions (e.g., share attention and communicate with others, develop and maintain relationships)

 Crucial role in cognitive development (mental processes such as thinking, memory, and self regulation; Vygotsky 1962)

 Central to the acquisition of academic skills (particularly reading and writing; Catts & Kamhi, 2005)

 Children with impaired communication skills are disadvantaged in many ways

 Impact upon educational achievements, friendships, job opportunities etc

 Associated with behavioural problems due to frustration in being unable to understand others, or to express themselves (e.g., Willinger et al., 2003)


What is a Communication Disorder?

A limited or lack of ability to understand or use
speech and language to relate to others in society
Key areas:
◦ Receptive & expressive
◦ Articulation
◦ Voice


What are Specific Communication Disorders (DSM-IV)?

 Expressive Language Disorder

 Mixed Receptive-Expressive Language Disorder

 Phonological Disorder

 Stuttering


DSM 5 Changes

 DSM-IV Receptive and mixed receptive-expressive language disorder àLanguage Disorder (see Leonard, 2009)

 Phonological disorder àSpeech-Sound Disorder

 Stuttering à Child-onset Fluency Disorder

 Addition of Social (pragmatic) Communication Disorder


Language Disorder

 Persistent difficulties in the acquisition and use of language across modalities (i.e., spoken, written, sign language, or other)

 Due to deficits in comprehension or production

 Language abilities that are “substantially and quantifiably” below age expectations


Language Disorder: Expressive Components

 Absence of single words by 2 yrs, & two word phrases by 3 yrs (ICD 10)

 Limited vocabulary

 Developmentally inappropriate sentence length and / or complexity

 Difficulty with word recall and substitution


Language Disorder: Receptive Components

 Difficulty understanding words, sentences or specific types of words

 Difficulty with grammatical structures (e.g., questions, negatives)

 Lack of understanding of subtle aspects of language (e.g., tone of voice)


Speech-Sound Disorder (Phonological Disorder)

 Persistent difficulty with speech sound production that interferes with speech intelligibility or prevents verbal communication of messages

 Problems in recognising or processing the
sound components of language

 Age-inappropriate use of speech sounds

 Substitutions and omissions of sounds (e.g. ‘t’ for ‘k’)


Child-onset Fluency Disorder (Stuttering)

 Disturbances in the normal fluency and time patterning of speech …and the disturbance causes “anxiety about speaking”

 Repetitions of consonant, vowel sounds or whole words

 Sound prolongations

 Hesitations

 Complete verbal blocks (Ramig & Shames, 2002)

 Anxiety may be situational


What is the General Criteria for Communication Disorders

A. Language skills substantially lower than a standardised measure of non-verbal intelligence

B. Significant interference with academic or occupational achievement or with social communication

C. Criteria are not met for a Pervasive Developmental Disorder

D. . If mental retardation, a speech-motor or sensory deficit, or environmental deprivation is present, the language difficulties are in excess of those usually associated with these problems


Social (Pragmatic) Communication Disorder

 Persistent difficulties in the social use of verbal and nonverbal communication

 Deficits in using communication for social purposes

 Impairment in the ability to change communication to match context or the needs of the listener

 Difficulties following rules for conversation and storytelling

 Difficulties understanding what is not explicitly stated and with nonliteral or ambiguous meaning of language


Is this classification necessary?

 Children who meet the criteria for ASD should not be diagnosed with this communication disorder

• ASD does encompass communication problems but it also includes restricted, repetitive patterns of behaviour, interests or activities

• Social (pragmatic) communication disorder introduced to ‘catch’ individuals who fell ‘between’ disorders

• Aim is to improve diagnosis and care of such individuals



 Lack of reliability and validity as a separate diagnosis? (e.g., Ozonoff, 2012; Skuse, 2012)

 Lack of clinical utility in practice?

 Lack of standardised measures to assess pragmatic knowledge

 Vagueness of age criterion

 Subject to cultural / interpretation bias


Prevalence of Childhood Communication Disorders

 Different incidence rates for specific disorders, but generally higher in boys than girls (e.g., stuttering)

 Expressive disorders are most prevalent (Carr, 2006)

 Mixed receptive- expressive disorders are considered to be the most debilitating (Bishop, 2002; Whitehurst & Fischel, 1994)

 Recovery rates are good, but persistent conditions particularly influence literacy achievements (Bishop & Adams, 1990)


Psycho-Social Factors in Communication Disorders

 Likely to play a maintaining rather than causal role (Whitehurst & Fischel, 1994)

 Language environment (re-visit the nature vs. nurture debate)


Parent-Child Interaction

 Verbal interactions between parent and child are bi-directional

 Overall, little evidence that suggests parents child-directed speech is a primary cause of communication disorders (e.g., Whitehurst et al., 1988)

 However, parents may modify their speech in response to a child’s limited language skills (e.g., less complex /more intervening) which may have some influence



Influence of:
◦ Low socio-economic status (e.g., Rescorla, 1984)

◦ Large family size

◦ Co-morbidity with conduct disorder (negative and coercive interactions)


Assessment of Childhood Communication Disorders

 Multi-disciplinary

 Full medical and neurological paediatric assessment

 Psychometric assessment of receptive and expressive language, and non-verbal intelligence

 Use of interviewing, observation and behavioural checklists to distinguish from other disorders (Bishop, 2002)


Psychological Intervention: Central Goals

(1) Help children to develop and improve their communication skills

(2) Develop coping strategies and alternative communication options

(3) Practice and use of communication skills and coping strategies in real-world environments


Methods of Psychological Intervention

 Individualised speech therapy

 Behavioural therapy / management

 Environmental modification


Parent-Child Interaction Therapy (PCIT) for Stuttering (Rustin et al. 1996)

 Flexible and individual approach

 Open acknowledgement and discussion of communication problems and their impact

 Emotional awareness and coping strategies

 Use of praise and child-led play

 Parents takes the lead role rather than the therapist


Evaluation of PCIT

 Matthews et al., (1997) and Millard et al., (2008; 2009) found significant reductions in stuttering using single-case and small group designs

 Further studies are needed, but small samples also have advantages (e.g., clinical relevance, internal validity)

 Five phase model for treatment outcome research (Robey, 2004)


The Child as an Agent for Change (Weiss, 2004)

 As far as possible, it is important to see the child as an active client

 Rapport, belief, motivation and responsibility are still relevant for the child-therapist relationship but may need to be approached differently

 Internalisation of perceived ‘locus of control’ (Rotter, 1966) is crucial for the treatment of communication disorders