Flashcards in Topic 1 Deck (48):
Name a variety of terms used to describe language difficulties in children (6)
language impairment, language disorder, language delay, language disability, language deviance, and childhood aphasia.
A language disorder/ impairment may involve what 3 parts of language?
(1) the form of language (phonologic, morphologic, and syntactic systems)
(2) the content of language (semantic system)
(3) the function of language in communication (pragmatic system), in any combination
How does Fey describe a language impairment/deficit?
a significant deficit in the child’s level of development of the form, content, or use of language
How far below the mean would a standard score qualify a child for a diagnosis of language impairment?
A standard score of 1 to 2 SD below the mean for the child’s age is used to diagnose a child as having language impairment and qualify him for services
What is the DSM scale related to language disorders?
According to the revised DSM, the level of severity of the language disorder can range from 1 to 3, with 1 suggesting that the child will require very substantial support and 3 suggesting that the child will require some support.
According to the DSM-5, for a diagnosis of Specific Learning Disorder the individual must have at least one of the following: (8)
1. Inaccurate or slow and effortful word reading
2. Difficulty understanding the meaning of what is read 3. Poor spelling
4. Poor written expression
5. Difficulties remembering number facts
6. Inaccurate or slow arithmetic calculation
7. Ineffective or inaccurate mathematical reasoning.
8. Avoidance of activities requiring reading, spelling, writing, or arithmetic.
To qualify as SLD, a child's learning difficulties should not be better explained by...
The learning difficulties are not better explained by Intellectual Developmental Disorder, Global Developmental Delay, neurological, sensory (vision, hearing), or motor disorders.
What are descriptive feature specifiers? What are the three domains?
Specify which of the following domains of academic difficulties and their subskills are impaired, at the time of assessment. Domains include reading, written expression, and mathematics.
Reading Descriptive Specifiers cover...
a) Word reading accuracy
b) Reading rate or fluency
c) reading comprhension
Written Expression Specifiers cover....
a) Spelling accuracy
b) Grammar and punctuation accuracy
c) Legible or fluent handwriting
d) Clarity and organization of written expression
Mathematics Expression Specifiers cover...
a) Memorizing arithmetic facts
b) Accurate or fluent calculations
c) Effective math reasoning “
When is a child considered to have a language delay?
A child is considered to have a language delay if he exhibits typical development in all areas except language.
When does a language delay become a language impairment/disorder?
For many children with language impairment, the early delay involves not only the late emergence of language but also the slow development of language until the point of mastery.
This slow development can continue until adulthood. It opens a gap that widens as children get older, making it difficult for them to “make up” for lost time. At this point the language delay can be viewed as a language impairment/disorder.
What is language deviance?
Suggests that the child’s language development is not just slower than the typical but is different in some qualitative way.
Not true for most children exhibiting language difficulties.
Tend to follow the same developmental patterns as typically developing children suggesting that the order of typical language acquisition should guide intervention.
When describing language impairments in children, what is the "correct" word order?
‘children with language impairment’ and NOT ‘language-impaired children’
‘children with autism’ and NOT ‘autistic children”
What is language difference?
Paul (2001) defines language difference as a rule governed language style that deviates in some ways from the standard language used by the mainstream culture.
Some children from culturally diverse backgrounds may also exhibit language impairment.
Distinguishing between a language difference and a true language impairment is one of the challenges of the SLP.
What is the cause of children language disorder's?
Causal factors that put children at risk for developing communication and language disorders are either biological or environmental
What are congenital (biological) factors of children language disorders?
Congenital factors: influence before or during birth:
Prenatal exposure to toxins (substance abuse)
Infections that affect the central nervous system
What are some post natal (biological) factors related to language disorders?
Postnatal factors: occur after birth
Trauma to the brain from injury (TBI, Acquired aphasia)
Acquired sensory impairments (HL, visual impairment) - recurrent and persistent OME (middle ear infection)
Toxins (lead poisoning)
Ingestion of dangerous substances (poisoning from prescription drugs, pesticides).
What are some environmental factors related to language disorders?
Poverty – malnutrition
Abuse or neglect
Primary Prevention for Language Disorders
Avoiding the occurrence of the disorder by:
Vaccination (rubella, measles)
Genetic counseling (Fragile X)
Family centered early intervention programs that encourage:
good maternal nutrition and parental care
teach parents how to maximize interaction
educate the public about the effects of drugs and alcohol on the fetus.
Secondary Prevention for language disorders
Early identification and intervention to minimize the impact of the disorder on the child’s development, communication abilities, and everyday leaving.
Mass screening and early identification
Preventative Intervention for language disorers
target children who are at risk for developing a language or communication disorder; such as
Language disorder in the family
Environmental – poverty, deprivation.
traditional prevention for language disorders
Providing services to children exhibiting language and communication impairment
Helping children achieve optimal levels of functioning within the constraints of their preexisting conditions.
The central role of the SLP
What is the purpose of intervention in children? (4)
1. Elimination of underlying problem – reaching normal/typical language
2. Changing the disorder – improving the child’s function by teaching new behaviors/linguistic forms to improve communication.
3. teaching compensatory strategies instead of specific linguistic forms
4. focusing on changing the child’s environment (may be in conjunction with one of the formers)
Elimination of underlying problem – reaching normal/typical language
Not frequently achievable when etiology is unknown or the conditions are incurable (MR, ASD)
Can be achieved in some cases (early detection of HL, Articulation disorder)
if alleviating the basic deficit is the purpose, the SLP can discuss with the family how much intervention is needed and for how long.
Since the long term goal is normal language, SLP discusses only short term goals.
Changing the disorder – improving the child’s function by teaching new behaviors/linguistic forms to improve communication.
Does not guarantee that the child will not need further therapy at a later time
Most common when working with children with developmental language disorders (SLI/PLI, LLD)
Both long term goals and short term goals need to be discussed with the family
Discussion of length of therapy is tricky and difficult to do.
teaching compensatory strategies instead of specific linguistic forms
Providing tools to support better communication and overall functioning with the deficits
WF – teaching retrieval strategies in stead of vocab.
Both long term goals and short term goals need to be discussed with the family
focusing on changing the child’s environment (may be in conjunction with one of the formers)
Justin’s example – p#62
The child’s environment and learning context can include: the physical space (home, school), the use of devices, the family, teachers, peers, etc.
Identifying the purpose of intervention is based on:
The child’s age
Intervention history of the child
The nature of the disorder
The child’s environment
Data collected during assessment
Once the purpose of intervention is determined, are long or shorts intervention plans devised.
Both. Once the purpose of intervention is determined, an intervention plan (long term and short term goal) is devised.
What must every intervention plan be based on?
External evidence (published literature) and Internal evidence
Notes on External Evidence
Not all published research is true or accurate!
Should be critically reviewed and assessed by the SLP before implementation
Should be reviewed critically based on the studied population.
Notes on Internal evidence
The client and the family’s willingness to participate in the treatment process and their preferences
The SLP’s professional competency, expertise, preferences and values
The values, policies, and culture of the institution in which the SLP works
Incorporating EBP into your intervention plan (PICO)
Patient or problem (ASD – increase communicative acts)
Intervention being considered (Floor Time)
Comparison treatment (or no treatment) (ABA)
Outcome (evaluate decision by documenting outcomes – baselines)
There are 3 aspects of the intervention plan:
The objectives (the goals)
The processes (the strategies or approaches used to achieve the goals)
The context (the environment in which the intervention takes place)
How are goals and objectives set?
The selection of intervention goals and strategies is guided by the information obtained in the assessment
What are long term goals?
they are a general statement about the best performance that can be expected of a client in one or more targeted communication areas
It suggests that the ultimate outcome of intervention planning is improved communication
When is a client dismissed?
The achievement of a long term goal can be equivalent to the termination of therapy
Or if a Client reaches a plateau and stops progressing
Short term goal
a specific linguistic form that has been given priority within a hierarchy of linguistic forms to be targeted in therapy
It includes the skill to be learned, the context in which the skill is expected, and the criteria to evaluate the goal
Should short term goals be prioritized?
Since children with developmental language disorders have multiple linguistic deficits, there is a need to prioritize the short term objectives.
what should prioritization be based on?
Age of acquisition – typical language acquisition
Communication needs – functional communication (particularly important for children with ASD and Intellectual Disabilities, who are unlikely to achieve adult communicative levels)
how do we show accountability to achieve our goals"?
We should be able to show (based on data collected, baselines) that the changes in the child’s performance are the result of the intervention plan and would not have happened if the intervention had not taken place.
How do we show that objectives have been met?
One way to show that the objectives have been met is by determining a termination criterion.
what is termination criterion?
The termination criteria for each objective is the level of use of a targeted structure, the child must achieve (typically 80-90% in structured activity and at least 50% accuracy in spontaneous speech) in order to consider the structure learned.
ASHA's discharge criteria
Communication is now within normal limits
All goals/objectives have been met
The client’s communication is comparable to those of others of the same age, sex, and ethnic and cultural backgrounds
The individual’s speech or 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 setting.
The client has attained the desired level of communication skills.