Chapter 11 Notes
Chapter 11 Notes 1230.0
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Date Created: 11/19/15
Chapter 11: Language Impairment in Children - Language Impairment in Children • Some children experience significant difficulties in learning and using language. • Their sentences tend to be shorter, less complex, and less grammatically correct than sentences produced by typically developing children who are their same age. • Unfortunately when these difficulties learning persist into the early school-age years, they are at risk for social impairment, behavior problems, academic failure, and vocational disadvantages. It is important for SLPs to diagnose and treat language impairment in children as soon as possible. • • What is Language Impairment? - Impairment refers to any loss or abnormality of psychological, physiological, or anatomic structure or function. - Language Impairment means significant delays in the development of language comprehension or production related to vocabulary and sentence structure. - It is common for young children to make phonological errors, morphological errors, and syntactic errors as they are learning language. - Language impairment should be diagnosed when a child’s language skills are significantly poorer than the language that is typically expected of his or her same-age peers. • Also when his or her language difficulties interfere with the ability to participate in and learn from everyday interactions with adults and other children. • Patterns of Language Impairment - Language has three interrelated components: form, content, and use. • Form refers to the structure of language including syntax, morphology, and phonology. Content refers to the meaning of language or semantics. • • Use refers to the social aspects of language or pragmatics. - Each of these aspects are important for individuals to be successful in understanding and producing language. • What Constitutes a Problem with Language Form? - Infants and Toddlers (Birth to 24 Months) • Limited vocalizations and restricted syllable productions during babbling are risk factors that are predictive of later language impairment. • Infants and toddlers with language impairments may not combine words to express relationships until well after 2 years of age. - Even then, they may use multiword phrases in a very limited way. - Preschoolers • During preschool period most children exhibit rapid growth in aspects of language form. 1 • Children with impairments often use a limited number of grammatical morphemes and have special difficulties using morphemes like: - The past tense ‘-ed’ - The auxiliary ‘is’ • Preschoolers with language impairments may have difficulties understanding more complex sentences spoken by others and may produce a limited variety of constructions in their own language. • Children with language impairment make more grammatical errors than typically developing children who are their same age. - School Age Children experience substantial growth in their understanding and use of language form, • including advanced morphological structures and complex sentences. School-age children with language impairment are likely to use fewer complex sentences • - They also use a smaller variety of complex sentence forms, and this has implications for their comprehension and composition of spoken and written language. • Children whose conversational speech is noticeably ungrammatical and does not contain a significant number of complex sentences should be referred for a language evaluation to assess the nature of their difficulties in language form. • Many children with language impairment have difficulties developing phonological awareness skills sufficiently for use in decoding. • These children may have difficulties making connection between letters and the sounds they represent. - This gives them a disadvantage when they are taught to read. • Morphologically complex forms are often the focus of language intervention for adolescents who have language impairment. • What Constitutes a Language Problem in the Area of Content? - Infants and Toddlers • Children usually start producing their first words between 10 and 14 months of age Children with language impairments often have a limited number of words that they • understand and use. Delays in the appearance of first words and difficulty learning and using new words are very • noticeable to parents. - Preschoolers • During the preschool years, children with language impairments may have trouble comprehending basic concepts. - They may have a limited range of semantic relations such as possession, recurrence and location. • They often learn words slowly, and may have trouble comprehending or producing words that are known and used routinely by others their same age. 2 - School-Age Children • Children should know 6,000 root words by the time they are in second grade. • Vocabulary in the school years can be divided into three tiers. - Tier 1. Words that are very common and occur frequently in oral language. - Tier 2. Sophisticated words used to express concepts that children already understand. - Tier 3. Complex words found in science, social studies and other curricular content of older school age children. • Children with language impairments may have difficulty learning and using words from all three tiers. • They also demonstrate difficulties with understanding and using figurative language, and words with more than one meaning, interpreting idioms, and differentiating between literal and figurative interpretations. • What Constitutes a Language Problem in the Area of Language Use? - Infants and Toddlers • One of the earliest manifestations of a language use impairment is found in children older than 6 months who fail to engage in intentional actions related to the world around them. • They may not point to objects they want, or use words to express a wide range of meanings. These differences show a restricted range of communicative functions and lack of • communicative initiation. - Preschoolers • By the time children are 3 years of age, they are able to use phrases and sentences to initiate and to respond during conversations. • Some children with language impairments interrupt often, fail to initiate or respond appropriately to questions or comments by others, or seem to be proficient in talking about specific topics. - School-Age Children • Children with language impairments experience difficulties understanding and creating coherent narratives. • They demonstrate significant difficulty understanding and producing inferences during comprehension of discourse. • Frequently have difficulties understanding the expository texts they read for their classes. - They might not understand cause-and-effect relationships. • Diagnostic Conditions That Are Characterized by Language Impairment - Language impairments may result from deficits in the growth and development of the brain. - They may also be associated with neurocognitive disorders like TBIs or sensory disorders. - They can also be related to neglect or abuse, behavioral problems, or emotional problems. - Specific Language Impairment 3 • An SLI is indicated by significant delays or deficits in comprehension or production of language form, content, or use that cannot be attributed to hearing, intellectual, emotional or acquired neurological impairments. • Other common terms for an SLI are language disorder and developmental language disorder. • They are believed to result from subtle genetic, neurological and environmental factors that lead to difficulties learning and using language. • Children who start speaking very late are often referred to as late talkers. • Late talkers whose deficits persist into the school-age years are usually identified as SLI. - Intellectual Disabilities • Indicated by severe deficits in intellectual functions and adaptive behaviors that appear during childhood or adolescence. • Often these children have obvious motor, language or social delays before they are 2 years old. • Can be caused by genetic conditions like Down syndrome or Fragile X syndrome, maternal infections during pregnancy, complications during delivery or environmental factors. • These children are significantly delayed in learning words and tend to use short, simple sentences well into the school-age years. - Autism Spectrum Disorder • Children diagnosed with ASD must have pervasive and sustained difficulties with reciprocal social communication, sharing of interests and emotions, and initiating or responding to social interactions. • They must also present restricted or repetitive patterns of behavior, interests or activities such as repetitive motor movements, insistence on sameness or inflexible adherence to routines. • These symptoms are present from early childhood, and they interfere with daily activities and the ability to learn. • The most reliable diagnoses are made soon after children are 2 years old. • There is not one single cause of ASD. - Specific Learning Disorder These are characterized by persistent difficulties learning academic skills. • • They have problems with word decodeding, reading comprehension, spelling, writing, number facts, or mathematical reasoning which are substantially below the expectation of their peer group. They cannot be explained by intellectual disabilities, visual or hearing problems, other mental • or neurological disorders or poor instruction. There is a great overlap between the kinds of language deficits that occur across • neurodevelopmental, neurocognitive and sensory disorders. • Children diagnosed with different disorders often have similar kinds of language deficits. 4 • Assessment - Two important roles of SLP are to evaluate children’s language development and to determine whether or not they have a language impairment. - Parents and teachers become concerned about a child’s language development when he or she is not expressing themselves as well as other children the same age. - SLPs use the chronological age to determine a child’s comparative age. This is done by subtracting the child’s birthdate from the date of assessment. • - Norm-reference tests are administered to compare a child’s skill in a given area with that of other children who are the same chronological age. - Most test provide index scores that are standardized for a mean of 100 and a standard deviation of 15. • Children who earn index scores of 90 or above are performing at or above the expected levels of their age. • Children who earn index scores below 90 are performing below age expectation. • Children who earn index scores below 82 on two different measures of language ability are likely to have a language impairment. - In interprofessional approaches to assessment, evaluations may be conducted simultaneously or independently by professionals from different disciplines. - A multidisciplinary assessment model may be more appropriate for children who demonstrate fewer issues and concerns, while a transdisciplinary model may be more appropriate for children with multiple needs. • Assessing Children’s Language - Infants and Toddlers • Assessment of language impairment in infants and toddlers is related to the issue of prediction. • The most severely involved infants and toddlers with known etiologies for their impairment are the easiest to diagnose. Infants and toddlers with less overt developmental delay, such as late talkers, are not as easily • diagnosed. Parent reports are often the best way to explore vocabulary knowledge in infants and toddlers. • • There are very few measures available to determine whether infants and preschoolers demonstrate delayed or impaired pragmatic language development. - Preschoolers • A combination of assessment tools and analyses is needed in order to gain a full understanding of a preschooler’s receptive and expressive language skills. • Criterion-referenced approaches to assessment are used to help clinicians develop better descriptions of performance and to plan intervention. - This includes checklists of language behaviors, inventories, and language sampling analyses. 5 • For vocabulary development, a standardized test may tell clinicians whether the child is performing below his or her expected chronological age. - School-Age Children • When classroom teachers have concerns about a child’s language ability, they must do their best to help the child in the classroom using scientific, research-based intervention methods before they refer the child for special education testing. • Before any testing can begin, the child’s parents should be informed of the reasons why the child was referred and the tests that will be administered. • One of the most critical aspects of a speech and language evaluation is the language sample. • Clinicians can tell where children are in the language development process by analyzing the length and types of their utterances. - They look for patterns of language form, content, and use errors. - Nonbiased Assessment • SLP should make sure their assessment is culturally and linguistically appropriate. • The possibility of a mismatch between parental and SLP expectations and beliefs makes it important for clinicians to understand variation in language learning and in socialization practices. • Some of these problems occur because the process of learning a second language or dialect variations is not well understood. • Other problems may occur because interaction styles reflective of different cultures do not match mainstream expectations for test-taking behavior. • Language Intervention - A number of laws affect the way language intervention services are provided to children. - In 1973 the U.S. Congress passed a law that prohibited any agency receiving federal funding from discriminating against individuals with disabilities. - The Individuals with Disabilities Education Act requires states to offer a range of identification and intervention services for children from birth through age 19. - When children with disabilities enter the public school system at age 4 or later, they receive an Individualized Education Program (IEP) • This IEP helps the diagnosis team with making decisions about the best way to provide the child with a free and appropriate public education in the least restrictive environment. - Early Intervention with Infants, Toddlers, and Preschoolers Research shows that early intervention services make a difference in the development of • language skills for children who may be at risk for language impairment. There are three basic models of early language intervention services. • - Child-centered approaches are where the clinician and child engage in conversations during play. - Clinician-centered models are based on behavioral principals of learning in which the stimulus is designed to produce a correct response. 6 - Hybrid approach is a combination where the clinician selects the activities and materials and responds to the child’s communication to model and highlight the specific forms targeted for intervention. - Language Intervention with School-Age Children • Language intervention in school settings should focus on social-interactive and academic uses of language in pragmatically relevant situations. • Strategies for improving communication skills have included modeling, practice and role- playing, discussion of behaviors, and caregiver training. - Literature-Based Language Intervention • Many clinicians use book discussions as the primary context for language intervention with school-age children. • Activities usually include prereading discussions about concepts that are contained in the books, reading and rereading the story on a number of occasions and retelling the story. - Classroom Collaboration Many SLPs who work in public school settings conduct language intervention in the regular • classroom. • Classroom collaboration is helpful when clinicians want to integrate their language-learning goals with the expectations of the academic curriculum. • SLPs and classroom teachers work together to plan and carry out language-learning activities with the whole class. 7