Language development/disorders Flashcards
1
Q
Is the language of children with ID delayed or deviant?
A
Delayed.
It is believed that children with ID will follow the same sequence of language development as typically developing children. However, they reach language milestones more slowly.
2
Q
Cerebral Palsy that is characterized by disturbed balance, awkward gait, and uncoordinated movements (due to cerebellar damage)
A
Ataxic
3
Q
Cerebral Palsy that is characterized by slow, writhing, involuntary movements (due to damage to the indirect motor pathways, especially the basal ganglia)
A
Athetoid
4
Q
Cerebral Palsy that is characterized by increased tone, rigidity of the muscles, as well as stiff, abrupt, jerky, slow movements (due to damage to the motor cortex or direct motor pathways)
A
Spastic
5
Q
Is dysarthria common in children with CP?
A
Yes
6
Q
Does paternal alcohol consumption, drug use, smoking or exposure to environmental toxins negatively affect fetal development?
A
Yes. Sperm can be damaged by cigarettes smoke, marijuana and alcohol.
7
Q
Do babies with fetal alcohol effects meet the diagnostic criteria for FASD?
A
No. Although FAE are signs that have been linked to the mother’s drinking during pregnancy, they do not qualify the diagnostic criteria for FASD.
8
Q
When children are prenatally exposed to drugs and alcohol, what is critical?
A
Early intervention. These children seem to benefit from structure and routine.
An enriched environment may help to ameliorate some effects of early exposure to cocaine. Some studies have shown that cocaine-exposed children in foster or adoptive care attained similar IQ scores to those of children with no cocaine exposure.
9
Q
Equation for type-token ratio. What’s TTR used for?
A
TTR = # of different words in a sample / # of words in a sample.
TTR is used to asses the child’s semantic or lexical skills.
10
Q
What’s a concern for late-talkers?
A
Recent research shows that even children who appear to have recovered by age 4 from early delay are at modest risk for continuing difficulties.
It is recommended that they receive continued monitoring, even if they are in the low-normal range for language development.
11
Q
Can a child with a known genetic syndrome be diagnosed with DLD? Why?
A
No. Children with another known biomedical condition would no be diagnosed with DLD. Rather, they would be given the diagnosis of a “Language disorder associated with _____”
12
Q
If intellectual disability is suspected but waiting for reviews from MD team, can the SLP use term “DLD” to diagnose?
A
If unsure, use term “Language Disorder” until diagnosis is given or rejected.
13
Q
Can a child with diagnosed ASD be also diagnosed with DLD? Why?
A
No. There is evidence that ASD is a genetic factor, therefore it would most likely be “Language Disorder associated with ASD”
14
Q
If Ax of biomedical condition will NOT occur in timely fashion, should the SLP diagnose the child with DLD?
A
Yes, but only if the Ax will not happen anytime soon. When Ax arrives and if given a different diagnosis, change the Dx to “Language disorder associated with X”
15
Q
At what age should we be concerned regarding a DLD diagnosis?
A
4-5 years +
16
Q
T or F? DLD affects memory
A
True. DLD can affect memory and auditory learning.
17
Q
What are some possible or required therapy goals for at-risk children in poverty?
A
- Parent attachment and emotional responsiveness
- Increased exposure to language to build expressive and receptive vocabulary
- Increased exposure to abstract language, verbal elaboration, problem solving
- Pre-literacy and phonological awareness (*mother’s education level is the highest predictor of SES)
- Exposure to academic talk and the hidden curriculum
18
Q
What are some language disorders that have family history links but no identified gene?
A
Stuttering
Late-Talker
Hearing Loss
Cleft Lip and Palate
Developmental Disabilities
Autism
ADHD
Dyslexia
19
Q
What is the two/too rule for genetic testing referral?
A
When describing a patient or family history with words like “two” or too
Too tall/short, too many, too young/old
Two congenital anomalies
Two (or more) family members/generations affected
20
Q
How is communication impacted by the developmental domains?
A
Physical - developing motor skills for speech/sign including breathing
Emotional- emotions overriding communication skills
Socially - communication requires turn-taking, learning what not to communicate, correct communication level or topic for conversation partner
Cognitive -comprehension difficulties impact communication
21
Q
What can influence childhood development?
A
Environment- input - activities they get to participate in, experiences they are given, what is praised and encouraged or discouraged by important adults
Cultural norms around children’s speech
Genetics
Development of “prerequisite” skills in that area
22
Q
What case history information should you make sure to include for a late talker and ASD?
A
Family history
Access to peers
Family and cultural communication styles and values
Other developmental milestones
23
Q
What is phonological development?
A
The gradual acquisition of an adult-like system of speech sounds that are used to convey meaning in a language. Phonological development can be considered in terms of both perception and production of speech sounds.
Being able to perceive the differences in speech sounds is critical to comprehending and developing language and is also an essential precursor to speech production. Speech scientists have hypothesized that babies come “prewired” to perceive minimal differences in speech sounds.
24
Q
What is included in phoneme awareness?
A
Identify and match the initial sounds in words, then the final and middle sounds (e.g., “Which picture begins with /m/?”; “Find another picture that ends in /r/”).
Segment and produce the initial sound, then the final and middle sounds (e.g., “What sound does zoo start with?”; “Say the last sound in milk”; “Say the vowel sound in rope”).
Blend sounds into words (e.g., “Listen: /f/ /ē/ /t/. Say it fast”).
Segment the phonemes in two- or three-sound words, moving to four- and five- sound words as the student becomes proficient (e.g., “The word is eyes. Stretch and say the sounds: /ī/ /z/”).
Manipulate phonemes by removing, adding, or substituting sounds (e.g., “Say smoke without the /m/”).
25
Name the phonological skills that should be present at age 5.
Rhyme recognition, odd word out
Recognition of phonemic changes in words (Hickory Dickory Clock)
Clapping, counting syllables
26
Name the phonological skills that should be present at age 5.5
Distinguishing and remembering separate phonemes in a series.
Blending onset and rime (ex. what word - th-umb)
Producing a rhyme
Matching initial sound, isolating initial sounds.
27
Name the phonological skills that should be present at age 6.
Compound word deletion (Ex. say cowboy but don’t say cow)
Syllable deletion
Blending of two and three phonemes.
Phoneme segmentation of words that have simple syllables with two or three phonemes (no blends) (ex. sh-e, m-a-n)
28
Name the phonological skills that should be present at age 6.5.
Phoneme segmentation of words that have simple syllables with two or three phonemes (with blends) (ex. b-a-ck)
Phoneme substitution to build new words that have simple syllables (no blends) (eg. change the /j/ in cage to /n/)
29
Name the phonological skills that should be present at age 7.
Sound deletion (initial and final positions)
30
Name the phonological skills that should be present at age 8.
Sound deletion (initial position, include blends)
31
Name the phonological skills that should be present at age 9.
Sound deletion (medial and final blend positions)
32
Describe speech sound acquisition for birth to age 1.
Reflexive (0–2 months):
restricted to crying and partial vowel sounds
Control of phonation (1–4 months): “cooing”
progress to vowel-like sounds, consonant-like sounds,
combinations of vowel-like and consonant-like sounds, Anderson and Shames (2011) describe this stage as “cooing”
Expansion (3–8 months).
vocal play and exploration
begin to try new vocal postures and gain more control over their oral musculature
produce isolated vowels, vowels in sequence, glides, squeals, and the beginning of babbling sounds.
Basic canonical (C+V) syllables (5–10 months).
begin of babbling.
Advanced forms (9–18 months).
increased babbling complexity + adult-like utterances called jargon
children say first words during this stage around one year of age, and produce immature versions of adult words (e.g., “da” for “dog,” “wawa” for “water,” “di” for “drink”)
33
Describe speech sound acquisition for 1-2 years.
Children use around 50 words (but not with 100% intelligibility)
produce most (but not all) vowels
reduce many adult word forms to simpler forms (e.g., “baba” for blanket, “do” for “dog,” and “kaka” for cracker)
produce an average of 10 consonants (McLeod, 2013, pp. 86), often including /p m h w b n/
34
Describe speech sound acquisition for 2-5 years.
Most English consonant sounds are acquired by the end of the third year:
plosives, nasals, and glide sounds
selected fricative and affricate sounds
Some fricative sounds (particularly /s, z, ɵ, ð, ʃ, ӡ/), affricates (ʤ, ʧ), and liquids (/r, l/) tend to be more variable in age of acquisition and may not develop until the end of the eighth year.
Acquisition of certain speech sound like /s r/ varies widely!
35
Describe speech sound acquisition after 5 years.
As children reach school age, most begin to apply their knowledge of sounds to literacy skills.
One foundational literacy skill is the ability to understand the rules that allow sounds to be blended or taken apart, and how sounds relate to each other in words-> phonological awareness
36
What purposes does the oral mechanism serve at birth?
Nutrition
Breathing
Gaining attention via crying.
37
What is a typical DDK for a 2 year old?
Typically developing 2 year old children can produce 3-4 syllables/second, and sustain a vowel for 5-6 seconds
38
How does sound perception change after birth?
Babies only a few days old can perceive differences in phonemes (e.g., differences in manner & place). Vowels [i], [i], and [a] are particularly salient to infants. Infants can also differentiate between phonemes that are not contrastive in their native language.
By 12 months, the infant has the capacity to categorize only those phonemes which are in its native language.
By 2 years children’s speed and accuracy for identifying words in speech is similar to adults –but is not fully adult-like until they are 12.
39
What are some phonological characteristics associated with a language-learning disability?
May have intelligible speech without obvious errors in speech production
More likely to have a speech sound disorder than the general population (e.g., 25% of children with LLD have delayed speech)
Reading outcomes are poorest for children with the most severe phonological disorders, however language skills were a better predictor of later reading difficulties
Often have difficulty with speech perception, phonological memory, and phonological awareness. Need specific assessment tasks
40
What are some syntactic characteristics associated with a language-learning disability?
Deficits in comprehension and production of complex syntax are common in children with LLD
They have difficulty understanding passive voice, negation or relative clauses
High error rates and less complex sentences in written language (e.g., fewer prepositions and descriptive words), also more morphological errors in writing.
Syntax and morphology errors decline by age 8 in oral speech, but are prevalent in writing.
50% of children with LLD had syntactic deficits
41
What are some semantic characteristics associated with a language-learning disability?
“Children with LLD have small vocabularies that are restricted to high-frequency, short words” (p422)
Limited vocabulary may reflect limited words acquired through readings
Weak word knowledge (e.g., meaning, categorization).
Retrieval difficulties were noted.
Receptive difficulties with complex directions, figurative language and integrating information from a large discourse
Hard time with reading to learn
42
What are some pragmatic/social/emotional characteristics associated with a language-learning disability?
“Many children with LLD have limited verbal fluency (Oetting & Hadley, 2009). They don’t talk much, and what they say is brief and unelaborated” (as cited in Paul, Norbury, Gosse, p422)
Many reported conversational challenges, e.g., not sensitive to the needs of listeners, difficulties with repair, miss responses to others initiations, language may be more hostile, less assertive, tactful and polite.
“Conversational pragmatics may be the area of the most significant deficit in the oral language of some students with LLD”
“Children with LLD have been shown to be less accepted by peers, have poorer social skills, and have higher levels of problem behaviors than children with typical school achievement” (Weiner, 2002, as cited in Paul Norbury, Gosse p426)
May be withdrawn or join social groups with higher levels of problem behavior (boys especially have challenges with emotional regulation)
43
What are some attention and activity characteristics associated with a language-learning disability?
“Many students who have learning problems also have behavioral and emotional difficulties that make it harder for them to take advantage of the instruction, both regular and special, that they receive” (426)
Unclear whether the behavioral causes the learning disorder or the learning disorder causes the behavior or if a third factor affects both
Many children with LLD also have attention deficit hyperactivity disorder (ADHD). Challenge with selective attention.
“Children with attention disorders are easily distracted and have short attention spans, low frustration tolerance, inability to recognize the consequences of their actions or learn from mistakes, and difficulty organizing and completing tasks”
44
What are the key language assessment criteria for children 3-5 years old?
Risk Factors
Vocabulary
recommendations are to formally test receptive language first, but to treat expressively (unless the are speech sound disorders or difficulty with word recall)
Syntax and morphology
Both need to be assessed expressively and receptively because children commonly produce sentence forms (e.g., agent-action-object) before they can understand those forms when nonlinguistic cues are removed
Usually assessed by obtaining a speech sample
Pragmatics, play and literacy
45
Compare simultaneous vs. sequential language learners.
Simultaneous bilingualism (or multilangualism) is when a child acquires two (or many) languages simultaneously, for example when they are raised by parents speaking more than one language.
Sequential is when the child acquires the second language(s) after having considerably learnt the first language, for example when the parental tongue is different from the main language of the community or education system.
46
How does the quantity/quality of language input effect language development in bilingual children?
Most children exposed to two languages hear one of those languages more than they hear the other
This feature of dual language input creates a common feature of bilingual children’s language skills—that they are more advanced in one language than the other
There are several properties of child-directed speech that are positive predictors of children’s language development, including use of a diverse vocabulary, diverse syntactic structures, and decontextualized language use
47
How is the rate of language development impacted by dual language input?
Children who hear and acquire two languages build linguistic knowledge at a rate comparable to or greater than is observed in children who hear and acquire only one language. But the language growth of bilingual children, like their language input, is divided between two languages. The result is that young bilingual children tend to lag behind monolingual children of the same age in vocabulary and grammatical development when measured in each language separately.
Some evidence suggests that in grammatical development, bilingual children catch up to monolingual children in single language skills by the age of 9 or 10
The bilingual–monolingual difference in vocabulary size may be lifelong, because vocabulary development does not have a point at which it is complete.
48
Define the catch-up period for bilingual children.
The size of the lag associated with bilingualism varies depending on the domain of language under consideration and age. Bilingual children’s phonological skills and higher-level narrative skills are often closer to monolingual levels than their vocabulary and grammar, and their receptive abilities may be stronger than their expressive abilities…. some evidence suggests bilingual children catch up to monolingual children by the age of 10 years
49
Compare language difference and language delay.
Some common misidentifications during these phrases are Language Disorder and Specific Learning Disability. Be careful that the years refer to a 12-month period of constant and consistent exposure. Our academic calendars are typically nine months, so it may take more academic years to acquire conversational and academic language.
There is a difference between the terms ‘delay’ and ‘disorder’. A delay means that a child is developing language in a typical manner, but is doing so more slowly than other children his or her age. A disorder means that a child is not developing language as one would expect, or abnormally
50
What forms might intervention take for language delays
Indirect treatment and monitoring
Provide activities for parents and caregivers to engage in with the child, such as book-sharing and parent-child interaction groups.
Check in with the family periodically to monitor language development.
Direct intervention, including techniques such as:
Expansions—repeating the child’s utterance and adding grammatical and semantic detail.
Recasts—changing the mode or voice of the child’s original utterance (for example, declarative to interrogative).
Build-ups and breakdowns—the child’s utterance is expanded (built up) and then broken down into grammatical components (break down) and then built up again into its expanded form.
51
What are the basic requirements for reading?
Word-level processing: see letters, convert letters into speech sounds (aka decode), map the speech sounds to the word meaning
Higher-level processing:, Combine words to form sentences and understand syntax to obtain sentential meaning, link sentences and paragraphs and obtain global meaning representation for a given text
52
Describe the dual route model.
This model describes two routes of reading and can be used to help determine where a breakdown is occurring and what parts of the brain are involved.
The roots are indirect (lexical) and direct (non lexical)
The man argument is whether or not we just use the indirect or both routes.
53
Describe the indirect route of the dual route model.
Indirect route = Goes through meaning. converting letter units orthographic input lexicon semantic system phonological output lexicon phoneme system speech. Involves meaning (explaining how if you have background information, you have something to map the word onto which helps with this process of print to speech.)
You cannot do non-word reading with this route
The lexicon is a dictionary, when reading a familiar word you access this word from the lexicon and how it’s pronounced
should be able to use the phonological representation of the words they have acquired through experience with oral language to access the meanings of those words in their printed form.
54
Describe the direct route of the dual route model.
Direct route = on the right-hand side of the dual route model, It goes from letter units to grapheme-phoneme rule system to phoneme system to speech. This indirect route can bypass meaning (e.g. child with ASD hyperlexic, can read well without comprehension
You skip accessing the mental lexicon (dictionary) by using rules instead to sound out words, while not attaching previous knowledge of word meaning.
You can “sound out words” (read non-words)
55
What language comprehension skills are required for reading?
Background knowledge
Vocabulary
Language structures
Verbal reasoning
Literacy knowledge
56
What word recognition skills are required for reading?
Phonological awareness
Decoding
Sight recognition
57
What are most kids able to do by the end of SK in terms of writing?
show they understand that text is written left to right, words have spaces between them, and words have capital and lowercase letters
print most letters of the alphabet
print their own name, names of family members, and some short words (e.g., "cat" and "dad")
use a variety of instruments to communicate, including crayons, markers, pencils and paper; computers or tablets; and chalkboards or whiteboards
contribute words or sentences to a class story written down by the teacher
write messages using a combination of pictures, symbols, and letters
58
What are most kids able to do by the end of grade 1 in terms of writing?
use phonics to decode or spell basic words
write simple but complete sentences
correctly form the plural of single-syllable words
use periods and capitals when writing
correctly spell high frequency words that have been taught in the classroom (e.g., “and”, “the”, “as”, “it”)
print recognizable letters
leave spaces between words when writing
59
What are most kids able to do by the end of grade 3 in terms of writing?
use correct subject-verb agreement when writing
use nouns, verbs, adjectives and adverbs correctly
use irregular plurals correctly such as deer, children
use apostrophes in contractions, for example cannot = can’t
use exclamations
use phonics (letter sounds) and spelling rules when spelling
use different sources to check how to spell unfamiliar words
divide words into syllables
use prefixes, suffixes and compound words
use titles and subheadings to organize writing
print words clearly
60
How does the communication environment impact language development?
Being in treatment settings where infants endure painful procedures like
suctioning and intubation can lead to oral defensiveness, aversion,
trauma, or tissue damage to the larynx
Parents are not able to spend as much time with newborns who require
hospitalization and medical treatment→ fewer early interactions, compared
to parents of larger babies
Perception of child receiving treatment as weak and sick can result in less
willingness to hold, handle, and play with the child
Children who experience abuse/neglect
SES
61
What might you see in a child in preschool with DLD?
Sentences that are short and not grammatical in his or her dialect. For example:
○ Car go
○ Me happy
○ Him running
○ She not going
○ She play last night
Difficulty following directions when not embedded in a routine.
Difficulty understanding what is being said.
Difficulty asking questions.
Difficulty finding words to express thoughts.
62
What might you see in a child ages 6-11 with DLD?
Difficulty following multistep directions.
Difficulty producing grammatical utterances.
Difficulty writing grammatical utterances.
Difficulty with reading, writing, spelling, or math.
Unorganized stories with few details.
Limited use of complex sentences.
63
What might you see in an adult with DLD?
Difficulty understanding complex written material.
Difficulty writing grammatically correct sentences.
Difficulty finding the right words when speaking.
64
What could you watch for during low-structure observations?
Expressive language (length of utterance, intelligibility and complexity of utterances),
fluency and grammar
Comprehensive language (is child able to respond to questions/comments, follow
directions)
Pragmatics (facial expressions, eye contact, asks for calcification, can initiate and maintain conversation)
Motor skills
65
How could you assess communicative intent in children ages 18-36 months?
We want to evaluate communicative behavior independent of conventional language used
When assessing communicative intention think: frequency, form, function!
Between 2-3 years old children’s communication becomes more frequent,
increasingly verbal, and with a range of intentions.
Recall: proto-imperatives (get an adult to do something e.g., request an object, request action, protest), proto-declarative(get an adult to focus on an object or
event: starts with comments, by 24 months they request information, acknowledge previous utterance, and answer questions
66
What assessments might we complete on a child in the perlocutionary stage of language?
Feeding assessment
Hearing assessment
Overall development
Parent-child communication and relationship (formal
and informal)
Vocal assessment
67
What assessments might we complete on a child in the illocutionary stage of language?
Has the child made the jump to intentional communication?
Observation of play
Parent report instrument
Can initiation be elicited?
68
What assessments might we complete on a child in the locutionary stage of language?
Play assessment (formal or
informal)
Relationship between use of words as labels and functional play
Receptive language assessment: Start with familiar words, be careful not to give away non-verbal cues
Communicative function
assessment: frequency, form, function
69
What can you gain from a language sample?
Analyze sample for the number, types and consistency of errors, accurate sound production, intelligibility, speech rate, prosody and language errors
Calculate mean length of utterance (MLU) for number of morphemes/utterances and Brown’s morphological markers
70
What impact might DLD have on psychosocial and educational wellbeing of a child?
Psychosocial: difficulty making friends and difficulties with pragmatics. “DLD cohort had significantly worse social adaptation (with prolonged unemployment and a paucity of close friendships and love relationships)”
Education and Vocation: individuals with DLD were associated with lower academic and vocational
qualifications than typical population
71
How might we determine a prognosis?
1) The patient’s previous level of functioning
2) Current level of functioning
3) Amount of family support (i.e. family can help with homework, can monitor health concerns, etc.)
4) Amount of motivation
5) Insight into deficits
6) Any comorbidities and the severity of each
72
What are some target areas for intervention relating to receptive language?
Receptive Vocabulary (e.g., identification, categorization, antonyms, synonyms,
associations etc.)
Receptive Grammar (e.g., plurals, pasttense, pronouns etc.)
Receptive Narrative Skills
Following Directions (length and complexity) – Working Memory
Understanding of Complex Language (e.g., inferencing, determining main idea
etc.) – Cognition
73
What are some target areas for intervention relating to expressive language?
Mean Length of Utterance (increase in meaningful
linguistic units)
Expressive Vocabulary (e.g.,labelling of vocabulary,
antonyms, synonyms, categories, associations etc.)
Word Retrieval Difficulties
Expressive Grammar (e.g., plurals, past tense,
pronouns etc.)
Expressive Narrative Skills
Use of Complex Language (e.g., metaphor, humour, negotiation etc.)
74
What might intervention look like for a child in the perlocutionary stage?
Rich - tactile, visual, auditory, kinesthetic
Providing enriching and
responsive communication
TIPS - Take turns, Imitate, Point things out, Set the stage
Developing self-monitoring
skills
Using songs and rhymes especially those with actions
75
What might intervention look like for a child in the illocutionary stage?
Work closely with parents
Communication temptations
Parent scaffolding
Pairing words with actions or objects
Use of books (early literacy)
Baby games and routines
AAC can be introduced (i.e.
PECS)
Use of songs, books, toys and routines
Observe the child's interests
model and wait
Scaffold the language
Lots of repetition and routine
76
What might intervention look like for a child in the locutionary stage?
Hanen parent training program:
- Important not to make parents feel that the delay is their fault
Hybrid:
- Prelinguistic Milieu Teaching Methods
- Principles: follow the
child’s lead, use social
routines, provide positive
feedback, time delay
prompts, imitate and
model
Child focussed:
- Do not respond to the use of gestures or vowel sounds, provide specific models for early words and respond
when they use consonant sounds or words.
- Use language that says you
understand what the child meant and need them to show you by x (e.g.,
gesture or word)
Strategies include:
- Routines or script therapy (May promote generalization to everyday use)
- Using funny or unusual events
*Strategies may depend on your goal:
- Building receptive or expressive vocab -> focussed stimulation
- Building expressive or receptive phrase length -> imitate and add
77
What should be considered when choosing target words?
The more familiar, the better
Use a variety of word categories (nouns, verbs, adjectives)
Consider the sound and syllable complexity of the word, as well as the child’s interests
78
Describe the cueing hierarchy.
Imitation: direct, delayed
Choice: of incorrect and correct, varied presentation
Repetition up to error: with verbal and visual cues, with visual cues only, w/o verbal or visual.
Repetition of error: with questioning intonation, with statement intonation
Pardon
79
What is the most reliable benchmark to reference language skills when identifying a language disorder?
Chronological age
80
Can a child with a culturally different background be considered for DLD diagnosis?
No, because they cannot access the school curriculum.
81
Discuss the impact of bilingualism on DLD
Exposure to 2+ languages does NOT cause or compound DLD. It is not a risk factor.
82
Discuss the comorbidity in DLD
Comorbidity = situation where child may experience 2 or more disorders simultaneously.
Child presenting with language disorder as a primary concern are likely to experience co-occuring symptoms such as:
- Behaviour problems
- Motor/coordination deficits
- Reading disorders
83
At what age does comprehension and production develop?
Comprehension: 6 months
Production: 12 months
84
Describe protowords vs. words
Protowords: Phonetically consistent forms used to represent objects
- Ex: "gaga" to request water
Words: Approximations of adult form
- Ex. "wa" to request water
85
Describe dyslexia vs. reading disability
Dyslexia: Deficit specific to word decoding - trouble with phonological awareness, phonemic segmentation/synthesis. NOT a comprehension deficit
Reading disability: Primary weakness in language skills result in reading difficulty - comprehension deficit
86
