midterm Flashcards
(101 cards)
1
Q
Most children with language impairments are not identified until what age?
A
2;0
2
Q
In the absence of other significant disabilities, the first evidence for a language delay is:
A
The late onset of the production of first words
A slow development of vocabulary growth
3
Q
Children who fail to meet linguistic milestones ( age appropriate first words and vocabulary) are referred to as:
A
late talkers
4
Q
Characteristics of late talkers
A
Follow similar patterns & order of acquisition, however, phonological and semantic development is extended over a longer period of time
less vocal and verbal
less accurate in their consonantal production
smaller consonantal and vowel inventories
Restricted and less complex array of syllable structures
Babbling period is extended and less complex
Phonological processes persist over a longer period of time
5
Q
Consonantal inventory for late talkers
A
Consonantal inventory consisting primarily of the voiced stops (/d/, /g/, /b/), nasals (/m/, /n/), and glides (/j/, /w/)
6
Q
syllable structure of late talkers
A
Using predominantly single vowels and CV syllable shapes
7
Q
At what age are morphosyncratic delays more prominent?
A
3;0
8
Q
What can you use as a reliable predictor of the complexity of a child’s language?
A
MLU
9
Q
Describe some morphosyntactic delays for late talkers
A
Delayed in syntactic complexity and morphological maturity based on MLU scores
Deficits are apparent on both noun and verb morphology
10
Q
Nominal morphemes
A
Articles (the, a ) – “I want _ ball”
Pronouns (she, his) – “me want ball” ; “the boy, she happy”
11
Q
Verbal morphemes
A
Verbal morphemes such as contractible copula (she’s a teacher) and auxiliary (he is swimming) being the most difficult
12
Q
Chronic morphosyntactic deficits at the sentence level are apparent at what age for late talkers?
A
Chronic morphosyntactic deficits at the sentence level are apparent in the narratives of 4-year-old late talkers
13
Q
content
A
semantics
14
Q
form
A
phonology, morphology, & syntax
15
Q
language use
A
pragmatics
16
Q
Early difficulties in what is a good predictors of later academic skills?
A
Difficulties in content, form, and language use.
17
Q
Measures of narrative skills
A
(cohesion, semantic content, lexical diversity, and syntax)
18
Q
4-year-olds who were identified as late talkers at age 2, performed more poorly on…?
A
All measures of narrative skills.
Their narratives reflected their difficulties in encoding, organizing, and linking schemes, as well as retrieving precise and diverse words from their lexicons
19
Q
Late talkers versus Late Bloomers
A
Many late talkers ‘catch up’ in expressive language skills by age 3;0 or 4;0
20
Q
Late Bloomers
A
Late bloomers make progress in vocabulary development after their 2nd b-day and by their 3rd b-day look very similar to their typically developing peers in their expressive language skills
However, many toddlers with expressive language delays never really ‘catch up’ to their peers and continue to show persistent language delays even after the age of 3;0.
21
Q
How to distinguish transient language difficulties (i.e., late bloomers) from persistent language impairments (i.e., late talkers)?
A
According to ASHA, while you really can never know there are several factors that may increase that a late talker’s language difficulties may persist.
Namely, their use of receptive language, use of gestures, age of diagnosis, and progress in language development.
22
Q
Use of gestures: Late bloomers vs. late talkers
A
One study has found that the number of gestures used by late-talking children with comparably low expressive language can indicate later language abilities. Children with a greater number of gestures used for different communication purposes are more likely to catch up with peers. Such a result is supported by findings that some older children who are taught non-verbal communication systems show a spontaneous increase in oral communication.
23
Q
Age of diagnosis: late talkers vs. late bloomers
A
More than one study has indicated that the older the child at time of diagnosis, the less positive the outcome. Obviously, older children in a study have had a longer time to bloom than younger children but have not done so, indicating that the language delay may be more serious. Also, if a child is only developing slowly during an age range when other children are rapidly progressing (e.g. 24-30 months) that child will be falling farther behind.
24
Q
Gestures: late bloomers vs. late talkers
A
Late bloomers use more communicative gestures in order to compensate for their lack of words. In contrast, late talkers fail to show an increase in communicative gestures as a compensation for their verbal delay (Thal & Tobias, 1992).
Compensatory use of communicative gestures is a positive prognostic sign for later typical language development.
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Can children who are late talkers “recover”?
A recovery rate of about 50% per year from age 2 to age 5 - 75 to 85% of the later talkers identified at age 2;0 recovered and scored within normal range at age 5;0
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Several procedures can be used to assess the emerging language abilities of toddlers:
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play based assessment
communication-based assessment
parent questionnaires
comprehension assessment
language sample
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Play-based assessment
Provides information about the child’s skills in naturalistic, meaningful activities
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Parents Questionnaires
Direct testing is expensive, time consuming, and often not representative of the child’s linguistic abilities due to child’s unwillingness to cooperate
Parents report is an efficient technique to assess toddlers’ language abilities without actually testing them
Parent report is based on extensive experience the parents have with their child over a long period time and across many situations and contexts.
It is less influenced by performance factors (e.g., fatigue, unfamiliar environment, etc.)
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Comprehension Assessment
One of the predictors of later language development
One of the means to distinguish between late bloomers and late talkers
Very few standardized tests of receptive language for children under the age of 3.
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Informal Comprehension Assessment Includes
Does the child understand single words without the support of nonlinguistic cues (e.g., visual cues)?
Does the child understand two-word combinations or semantic relations?
Does the child comprehend simple sentence form of agent-action-object (SVO)?
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Does the child understand single words without the support of nonlinguistic cues (e.g., visual cues)?
A collection of several objects are placed in front of the child, and the SLP asks the child for each object using a simple sentence form as “give me ______” or “where is _______?” without using nonlinguistic cues such as pointing, or looking at directly at the object
To test for the comprehension of verbs, the SLP can provide the child with an object and ask the child to manipulate it, as in “throw it” or “kiss it”
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Does the child understand two-word combinations or semantic relations?
The SLP can use the word-order rules (semantic-syntactic rules) children in the 2-word stage use to produce and understand multi-word combinations. For example, “throw ball” or “eat apple”.
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Does the child comprehend simple sentence form of agent-action-object (SVO)?
The SLP can present several sentences to the child and asks the child to act them out, for example “show me….the baby eats the banana”.
34
Collecting a language sample
Spontaneous language sampling is a commonly used tool in clinical practice to assess the strengths and weaknesses in all language areas:
morphosyntax, phonology, semantics, pragmatics.
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Morphosyntax
- examining the length and complexity of utterances and the use of grammatical morphemes
36
Collecting a language sample
Spontaneous language sampling is a commonly used tool in clinical practice to assess the strengths and weaknesses in all language areas:
morphosyntax, phonology, semantics, pragmatics.
Is usually collected while the child is engaged in a free play with the caregiver or SLP. Data is then transcribed and analyzed for the presence or absence of age appropriate linguistic forms
Children in the emerging language stage with slow language development are less talkative making the collecting of a language sample more difficult.
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Semantics
– examining vocabulary size (nouns and verbs), lexical diversity
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Pragmatics
- examining communicative intents, conversational skills.
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. Two ways to overcome this obstacle: (Less talkative children are more difficult to get language sample from.
Parents’ diaries
Audio-taping the child at home or at the daycare
Audio-taping the child at home or at the daycare
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times a child may be most vocal
interacting with siblings. bath times, lunch time, and other daily activities
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What is the goal of early intervention with infants?
The goal of early intervention with infants is the development of basic skills that are critical to successful language learning
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What are primary therapy strategies for early intervention?
Repeated exposure and stimulation are the primary therapy strategies for infants
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What main characteristics of motherese are higly recommended when working with infants?
Exaggerated intonation
Short utterances
Simple vocabulary and syntactic structures
Frequent repetitions
Talking about topics that are “here and now”
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What can a therapist do to maximize the effectiveness of early intervention therapy?
Select activities, materials, and toys that are developmentally appropriate for the infant
45
True or False: Many infants with communication delays may exhibit deficits in other areas of development
True: (ex. cognitive, hearing)
46
Parents are encouraged to start reading to infants right away. What books are ideal?
Ideal books are those that include touching (tactile stimulation), colorful pictures (visual stimulation), and language that is repeated over and over again (language stimulation)
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Follow the child’s attentional lead
Infants attend more closely to objects or events of their choosing
Following the child’s attentional lead is used to sustain the child’s interest on the activities and social interactions
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What is Prelinguistic Milieu Teaching?
Most appropriate for children who are functioning developmentally between 9-15 months
Designed to increase the frequency and complexity of intentional nonverbal communication
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What does Prelinguistic Milieu Teaching include?
Rearranging the environment to increase opportunities for communication (needs/wants)
50
What are the main therapy goals for infant intervention regarding prelinguistic and early language skills?
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Localization of Sounds
Joint attention (joint reference)
Eye contact
Joint action
Vocalizations
Communicative intentions
```
51
What are the main therapy goals for infant intervention regarding prelinguistic and early language skills?
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Localization of Sounds
Joint attention (joint reference)
Eye contact
Joint action
Vocalizations
Communicative intentions
Symbolic and non-symbolic play
Initial Vocabulary (12+)
```
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Localization of Sounds
(mark the beginning of infant’s grasp of cause-effect relations)
Enhance localization by presenting a sound stimulus (rattle or other noisy object) outside of the infant’s visual field.
Turn infants head if infant doesn’t do so alone
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Ages for localization of sound
3-4 months – primitive attempt to turn head
4-7 months – localization to side only
7-13 months – localization to side or below
13-21 months – localization to side, below, or above
21-24 months – direct localization to any angle
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Eye contact
Accompany your eye contact with smiling and other facial expressions that may attract the infant.
Use novel vocalizations
Gently lift the infant’s head to allow eye contacts
Bring toys/object the infant is playing with close to your face to force eye contact.
With older infants – use request “look at me”
Use a mirror
55
Joint Action (by months)
Approx. 6 months – infants enjoys when caregiver initiates sound-gesture routine (peekaboo)
by 7 months – infants anticipates the game when caregiver produces the verbal component alone, independent of the gesture
8-9 months – infants initiates as well as participates in the game
follow typical acquisition to anticipate the target response
Activities for older infants – 10-12 months – picture book, rolling a ball, building with blocks, etc.
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Communicative intentions (by age)
Approx. 9 months – infant uses gestures and vocalizations to communicate intentions (Read Review Article on Gestures)
Requests and statements are the earliest to emerge
Approx. 12 months – infant uses single-word utterances to communicate intentions
The rate of preverbal communication in young children with developmental delays is a strong predictor of later vocabulary usage
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Communicative intentions (by age)
* Approx. 9 months – infant uses gestures and vocalizations to communicate intentions (Read Review Article on Gestures)
* Requests and statements are the earliest to emerge
* Approx. 12 months – infant uses single-word utterances to communicate intentions
* The rate of preverbal communication in young children with developmental delays is a strong predictor of later vocabulary usage
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Communication intervention should aim at:
Increasing the number of different types of intentions an infant can understand or express
Increasing the variety of forms (vocalizations, gestures, words) understood or used to express a given intention
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Symbolic and non-symbolic play
* Follow the developmental stages of play
* Explore with the infant common objects such as blocks, rattles, spoons, pots and pans, through banging, mouthing, manipulating, and visual inspection
* Show the child the proper use of objects like bouncing and rolling a ball, drinking from a cup, putting the doll to sleep in a bad, etc.
* Use object to represent other objects like a tissue for a blanket, a ball for an orange, or a plate for a steering wheel.
* Use pretend play with the child by pretending to eat, to drink, to sleep, etc.
* Manipulate a doll to act out activities such as kissing, hugging, dancing, and waving bye-bye.
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Initial Vocabulary (12+) intervention aims
– repeated presentations of a target word
– the use of exaggerated vocal intonation patterns to highlight the object or event produced.
– Use of objects/toys with the word – let child manipulate/ explore
– Use of multiple exemplars of object/word
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Initial Vocabulary (12+) Expressive vocabulary growth:
* 15 months – 4-6 words
* 18 months – 20-50 words
* 24 months – 200-300 words
* 3 years – 900-1000
* 4 years – 1500-1600 words
* 5 years – 2100-2200 words
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```
Initial Vocabulary (12+)
Considerations for selecting words to target in therapy:
```
* Words that the child comprehend
* Words that can be used in many contexts during the child’s daily activities (frequent words in the language)
* Words that are important to the child such as names of family members, or favorite foods or toys
* Words of object that the child can manipulate such as ball or spoon rather than tree or wall
* Concrete words
* Words that are simple with regards to phonological complexity (syllable structure and sound composition)
63
```
Initial Vocabulary (12+)
Considerations for selecting words to target in therapy:
```
* Words that the child comprehend
* Words that can be used in many contexts during the child’s daily activities (frequent words in the language)
* Words that are important to the child such as names of family members, or favorite foods or toys
* Words of object that the child can manipulate such as ball or spoon rather than tree or wall
* Concrete words
* Words that are simple with regards to phonological complexity (syllable structure and sound composition)
* Introduce a container/box filled with objects and reveal them to the child one at a time. Wait for the child to label and in the absence of labeling, label the object. Let the child explore the object and manipulate it. Repeat productions of object’s label
* Present an attractive object to the child and then hide it or place attractive objects out of child’s reach.
* Engage the child in an activity such as making pudding, that will elicit a number of different actions (open, pour, stir, mix)
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Mental Retardation
The term ‘Mental Retardation (MR)’ used to describe a condition that is characterized by a significantly lower than average level of intellectual functioning and adaptive behavior, is no longer in use internationally and in the United States.
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Intellectual Developmental Disorder
The term Intellectual Developmental Disorder is now a widely used term to describe deficits in cognitive capacity that begin in the developmental period.
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DSM 5 definition of IDD
According to the DSM-5 (updated April 2012), “Intellectual Developmental Disorder (IDD) is a disorder that includes both a current intellectual deficit and a deficit in adaptive functioning with onset during the developmental period. The following 3 criteria must be met:
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characteristics of IDD
IDD is characterized by deficits in general mental abilities such as reasoning, problem-solving, planning, abstract thinking, judgment, academic learning and learning from experience.
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adaptive functioning
Adaptive functioning refers to how well a person meets the standards of personal independence and social responsibility in one or more aspects of daily life activities, such as communication, social participation, functioning at school or at work, or personal independence at home or in community settings. The limitations result in the need for ongoing support at school, work, or independent life.
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When do IDD symptoms appear?
All symptoms must have an onset during the developmental period.
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What IQ score suggests IDD?
According to the DSM-IV (APA, 1994), an IQ score of at least two standard deviations below the mean suggests the presence of mental retardation.
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mild MR IQ score
IQ ranging from 50 to70. Approximately 85% of individuals who have mental retardation fall into this category.
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moderate MR IQ score
IQ ranging from 35 to 50. Approximately 10% of individuals who have mental retardation fall into this category.
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severe MR IQ score
IQ ranging from 20 to 35. Approximately 3–4% of individuals who have mental retardation fall into this category.
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profound MR IQ score
IQ less than 20. Approximately 1–2% of individuals who have mental retardation fall into this category.
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Are there IQ scores for IDD in the DSM-5?
No. The DSM-5 proposed to remove the IQ scores and standard deviation from the criteria for IDD.
It suggests that psychological testing should accompany clinical assessment and that assessment and diagnosis should take into account factors that may limit one’s performance (e.g., socio-cultural background, native language, associated communication/language disorder, motor or sensory handicap).
It advocates for the use of cognitive profiles for describing intellectual abilities as opposed to a single IQ score.
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Genetic Disorders- Fragile X
Hereditary disorder – X-linked genetic disorder in which the mother is usually the contributing parent
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Which gender is affected by fragile X more?
Males are primarily affected (1 in 4000 in males and 1 in 800o in females)
Most males exhibit a range of mild to severe MR. Cognitive deficits can be seen in females but usually as mild MR or learning disabilities
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facial features of fragile X
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Elongated narrow face
Prominent jaw
Increase head circumference
Prominent forehead
Drooping eyelids
Prominent, long ears
About 30% of these children may have normal facial appearance
High palatal arch – increased risk for cleft palate
```
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Physical Features for fragile X
Hypotonicity
Small hands and feet
A mildly short stature
Deficits in visuospatial skills
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Autism with Fragile X
Approximately 10-15% of children are nonverbal and these individuals are usually also autistic
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Fragile X and hearing
Hearing is generally within normal limits but there is a high incidence of OME
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How does hypotonicity manifest itself for Fragile X?
The hypotonicity manifests intself in the oral-motor region
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Early warning signs for Fragile X:
Initial feeding and pre-speech difficulties are noted early.
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Some Language issues with Fragile X
– Language sequencing, organization, and syntax are poor
• Narratives are disorganized
– Poor topic maintenance, and tangential comments
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fragile X behavior
– limited eye contact, hand flapping and stereotypic behaviors present, although usually are socially responsive and affectionate with an interest in social interactions
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down syndrome cause
The genetic cause: trisomy of chromosome 21
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down syndrome prevalence
1 out of 700/800 births
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down syndrome by gender
Males and females are equally affected and the incidence increases with maternal and parental age.
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Cognitive Impairments for Down Syndrome
IQ score are reported to be between 30-60
| General cognitive abilities appear to be better than general language skills.
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Facial Features of Down Syndrome
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Small head with a flat looking face
Small ears and mouth
A large protruding tongue
Broad neck
Upward slant to the eyes
```
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Other physical features of down syndrome
Short stature
| Hypotonia
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medical concerns of down syndrome
- 50% have congenital heart defects
- 66-89% have hearing loss – conductive hearing loss is most common (i.e., middle ear infections)
- Vision impairments
- issues (e.g., missing teeth, fused teeth, malocclusions – open bite and posterior cross bite) all significantly affecting speech production
- Obesity in 50-60%
- DS is associated with a reduced life span
- At high risk for developing Alzheimer’s disease
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Speech and language characteristics for Down Syndrome
articulation problems
Onset of meaningful speech is delayed
Disfluencies
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Down Syndrome Articulation Problems
Unintelligible speech
The restriction of tongue movement within a smaller oral cavity with a narrow palate affects speech articulation
General hypotonia also affects speech
Inconsistent speech errors affect intelligibility
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Down Syndrome Disfluencies
Sound prolongations
Pauses
Repetitions of sounds, syllables, part of words and whole words
96
Down Syndrome Significant language impairments
Expressive language is more impaired than receptive language
Poor verbal short-term memory skills
Onset of first words is delayed as late as 24 months with continued delays in the onset of multi-word utterances
Syntax is more affected than lexical development
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AAC Considerations:
System Selection
Vocabulary
Motor Planning
Hardware
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Considerations in System Selection
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access
vision
user/family/school preference (implementation)
cognition (with great, great caution)
long term language potential (ROBUST)
```
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(Hardware)Considerations for Implementation:
durability (cases)
portability (weight, straps, handles, size, stands, kickstands, angle of access)
amplification (internal/external)
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“Roles and Responsibilities of Speech-Language Pathologists With Respect to Augmentative and Alternative Communication: Position Statement” - ASHA (2005)
It is the position of the American Speech-Language-Hearing Association (ASHA) that communication is the essence of human life and that all people have the right to communicate to the fullest extent possible.
Recognize and hold paramount the needs and interests of individuals who may benefit from AAC and assist them to communicate in ways they desire.
Integrate perspectives, knowledge and skills of team members, especially those individuals who have AAC needs, their families, and significant others in developing functional and meaningful goals and objectives.
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Does AAC support speech development?
Yes, AAC supports speech development:
consistent auditory model
removal of pressure
General leaning toward speech
