Developmental Language Disorder (DLD)

Developmental Language Disorder (DLD)

• DLD is a severe language disorder where language skills are -1.25 SD or more below the mean
• Diagnosis is by exclusion of other conditions like hearing loss, psychiatric disturbance, or intellectual disability
• Heterogeneity occurs in language symptoms, but cognitive profiles remain consistent
• Morpho-syntax (grammar) and morphology show grammatical relations
• Limited capacity of verbal short-term and working memory is reflected through poor repetition of words and sentences
• Difficulties exist in phonology (speech sounds), semantics (vocabulary), discourse (narrative and conversation), and pragmatics
• Observed difficulties exist with a skill relating to the behavioral profile
• Morphological problems impact grammatical morphology, specifically expressing tense and agreement
• Languages differ in which morphemes are affected

General DLD Information

• DLD is diagnosed by excluding hearing loss, psychiatric disturbance, or intellectual disability
• DLD affects 7% of the population
• Language intervention with speech therapists and language development experts aims to improve language abilities
• Specific Language Impairment (SLI) is the old name for DLD
• Children with DLD struggle with categorical speech perception, which impacts word learning, comprehension, and production
• Categorical perception emerges early in infancy
• Difficulties with rhyming suggest issues with phonological awareness
• Non-word repetition tasks are good diagnostic tools for DLD

Extended Optional-Infinitive Stage

• DLD children omit determiners, auxiliaries, and verb inflection
• Children with DLD remain in this stage after age 5, while typically developing children exit by age 2.5
• There can be major issues with repetition of inflected verbs

Syntax in DLD

• Problems exist comprehending passive structures and cleft sentences
• Difficulties with the reference of pronouns appears

Lexical Deficits in DLD

• Small vocabulary
• Word finding difficulties
• Superficial word knowledge
• Inaccurate word naming
• Poor semantic representations
• Inefficient organization of the mental lexicon

Other Deficits and Considerations in DLD

• Notable deficits occur in phonology and morphosyntax
• Rapid auditory processing deficits create problems with processing auditory material
• Sign language is excluded from study due to the challenges of researching it
• Children are victims of late language exposure, impacting naturalistic research
• DLD can be investigated in signing populations to test theories of DLD
• DLD is different from language delay and language deviance
• Language delay involves meeting the same milestones, but slower
• Language deviance involves differential language development compared to a control group

Forms of Deviance and Theoretical Views of DLD

• Uneven profile means some aptitudes lag further behind
• Plateau means no improvement occurs after a certain age without catching up
• An abnormal frequency of errors means more errors than typically developing children make
• Deficits happen in sensory and cognitive processing
• DLD can be explained as a deficiency in statistical learning

Statistical Learning

• Children are born with the capacity to compute rules
• Rule formation stems from tracking regular linguistic input and computation of probabilities
• Statistical learning involves co-occurrences of linguistic elements
• Children use regularities to compute the rules of a language
• Children form patterns based on statistical computations that may be impaired in DLD
• Meta-analyses support statistical learning limitations, with effect sizes depending on the domain, item-specific characteristics, and age

Assessment of DLD

• 1.25 SD below the norm equates to the 13th percentile
• The Peabody picture vocabulary test examines comprehension
• The Celf examines vocabulary, syntax, morphology, phonology, and sentence comprehension
• IQ must be measured using the Wechsler intelligence test (WISC-R) or Raven Matrices
• Spontaneous speech can be measured with the Frog story or Bus story elicitation tasks
• UTT measures the number of complete and intelligible utterances
• NDW measures the number of different words, reflecting semantic diversity
• MLU-w measures the mean length of utterance in words
• CD measures clausal density and the average number of clauses per UTT

Test Sensitivity

• Sensitivity is the proportion of truly impaired individuals correctly identified by the test
• Specificity is the proportion of truly non-impaired individuals correctly identified by the test

Treatment Approaches for DLD

• Imitation involves the child repeating what the clinician produces
  • Production of meaningful sentences is filtered through their linguistic system
• Modelling involves a model giving examples of utterances
  • Clinician corrects if needed
  • More actively involved with sentence formulation
• Focused stimulation involves extensive exposure to target forms
• Milieu teaching happens in play settings, focused on communicative attempts
• Clinician provides model sentences in response to the child

Efficacy vs. Efficiency of DLD Treatment

• Efficacy measures treatment effects under highly controlled conditions
• Efficiency measures treatment use in real-world circumstances

Investigating the Effects of DLD Treatment

• Pre-test assessment is followed by treatment, post-test assessment, and delayed post-test assessment
• The control group receives no treatment or a different treatment
• Individual differences within clinicians or children can make results hard to interpret

Williams Syndrome: General

• Double dissociation occurs between language and non-linguistic cognition
• Relatively low IQ and a variety of cognitive delays happen
• Patients experience weakness in visuospatial constructions
• Seemingly, unimpaired language abilities
• Rare genetic condition affecting calcium metabolism

Williams Syndrome: Symptoms

• Facial features( ‘starburst’iris pattern)
• Congenital heart defects and weak muscle tone
• Poor growth and early puberty
• Hyperacusis (sensitive hearing)
• Volume of the brain will only be 80-85% of a healthy brain
• No lesions or damage to brain tissue.

Williams Syndrome: Language Profile

• Patients talk like a cocktail party
• Talkative, complex narration, and good vocabulary occurs
• Complex syntax and morphology occurs.
• Use unusual/sophisticated vocabulary

Dissociation of Language and Non-linguistic Cognition

• DLD: yes
• William’s no
• Double dissociation occurs (one condition where language is impaired but cognition is intact, and another where cognition is impaired but language is intact)
• Challenges the idea that language is a byproduct of general intelligence with modularity in the brain.

Down’s Syndrome

• Extra chromosome 21
• 1/1.000, prenatal diagnosis, low IQ (40-60)
• Stunted physical development, low muscle tone, heart disease, respiratory infections most frequent cause of death.
• Patients have large tongues, increased neck skin, frequent ear infection, and severe delay in motor development.

Down’s syndrome: Delayed Development

• substitutions of phonemes, omissions
• Poorer phonological processing
• Poor phonological output

Down’s syndrome: More General Delays

• vocabulary
  • first word spoken between age 1-6
  • Delayed vocabulary explosion
  • Receptive vocabulary seems relatively well developed but is delayed

Down’s syndrome: Morpho-syntax

• Lack of syntactic complexity with a reliance on simple syntactic structure
• Problems with grammatical morphology
• Use of repetition, imitation (echolalia)
• Production seems more affected than comprehension with low intelligibility due to the big tongue
• Communicative skills(turn-taking, gesturing, ect.) less impaired

Conclusion of Williams and Downs:

• Williams: Disbalance
• Down’s language development is different from TD children including cognitive development
• Linguistic skills are associated with intellectual development.

Autism Spectrum Disorder (ASD):

• Affects around 60 per 10.000

ASD: Biological Level

• Genes and brain play a role in if siblings of those with autism have a 50x higher chance of ASD. Concordance is 60-90% with identical twins
• Neurodevelopmental disorder: Impairments in nervous system leading to abnormal brain function
• Brain is larger and anomalously connected
• Abnormal functional connectivity occurs
• Interplay exists between genetic and environmental factors.

ASD: Cogntive Level

• Less Capacity to form the theory of mind Thinkings about other people’s thoughts or feelings
• More complex than thinking about objects in the world Other people’s mental representations do not necessarily resemble those of your own / factual world

ASD: Relation theory of mind and language development

• Lessened capacity in establishing joint attention. Joint attention is needed for establishing relationships and language development
  • Vocabulary development
  • Sentence comprehension/ communicative turns affect

ASD: Theory of Mind

• Driving force in language development
• Talking about events that are not here and now (mastering Mental State Language)

ASD: Behavioral level

• Present behavioral characteristics in social interactions such as:
  • Language & communication (verbal / non verbal)
  • Repetitive behaviors (motoric/play/ linguistic through Echolalia) and walking on toes

ASD Conclusion

• Brain: genetic/neurological component and Atypical connectivity
• Cognition: theory of mind / Linguistic development in the Pragmatics
• Behavior: repetitive behavior and communicative difficuties

ASD: Diangosis

• Must meet all criteria: language/ social issues and deficits in interaction/ non verbal comms/ developing/maintiaing interactions
• Need two of the four restricted activities/ behaviors like speech/echolalia rigid adherence and high intensity interests and reactivity/sensory input

ASD Language Dev

• Huge differences exist
• Non verbal converation skills
• Echolalia is possible as a self stimming or to form communicate in replacement of new original words. Can be from TV and outside sources

ASD linguistic profile

• Language deficits in :
  • Pragmatics- are hard as well as using formal language to tell a story They struggle in: Register use/ expressions/turn taking/ body eye gaze/conversational responsiveess/fixing misunderstandings Prosody- is less appropriate and Syntax is as well
• Morphology may have pronoun problems, prepositions, syntax ad phonology and semantics and gestures

SD Echolalia

Asking, starting or getting attention and protesting Answering

Dyslexia General

• 5-12% of the population is dyslexic
• Most studied and known is Dyslexia
• boys are more diagnosed, Diagnosis by exclusion and no sensory difecit
• discrepancy found in reading relative to verbal skills
• It can be co morbidity with ADHD, DLD and OCD

Defciet theories

• Phonological: impairments of sounds
• Magnocelleular- processing movement
• Limited implicit learning of implicit type

Dyslexia Cognitive level

Issues in:

• Phonological memory and
• Awareness and blending words, verbal rapid and work memory and rapid access to lexicon

Skills with it

• Hard to turn sounds to grapheme

• Inaccurate skills and not so good with text

• not seen until texts are exposed

• Not too serious in those who have consistent orthography problems but in reading with consistency and issues with behavior

• The more consistency there is the more reading acuracy but slow Transparent sound letter Opaque irregular Also Mandarin

• Brain Genes. 40% chnace if parents have it

Dyslexics have brain diff And no neuronal migration and Magnocells

• Language Lack in vocab is a perceptual problem Moro problems or symantics are also issues

Diagnose

Only ed specialist Tests for Reading writing memory intelligence and phonological skillls

Results 1.5 below average Count how many you can and how mistakes there are ‘types’ main Dyslexia Phonological with non real words Visual in memory Atenntioal as it jumps around and neglect Dyslexia conclusion is in: Brain anatomy And limitation of processing

Head n neck cancer

Bad between skull and col Factors Alcohol and smoking

Treat Curing Morbidity

Life Swallowing and the speaking stuff Causes

Surgery or chemo Orolarynx And it had cure rates

Speech adaption is to fix problems in speaking And after things get fixed

And 45 after CCRT is hard

Synthesis of speaking is hard

There are options

Esoph speaking where air moves throat lips work Robot with battery Or in other ways

Billion is the first cancer surgery

With the pressure on the voice

Mri or mouth for research

You predict it with the emg for surgery

Big data tells the story with speech patterns

Defecits can be fixed from speaking Research has opened minds

Acquired is where you have Stoke or cancer

Aposhiasia

Damage les on. Left Non fluent Effort Agrammatic

Rep Wernerske is fluent and is the other side with comprehension Lesion Trouble

Hard to say words and not good condition Hard to comphrension and fix wordind

Broca Trouble Hw Glob all the same Aphasia Left Emo Flat Not good and hard to be ok

Dementia

Bad memory performance and communication skills

Alzers is memory PPaa

Gets progressivly degenerated where people forget words or cannot speak or hear or read

Alexia is pure Harding reading Or seeing thing

You have to see work and not make them

Agraphj

Good in speech but hate to write at all Dypo

Not good to make conections in thew to word tree