Oral Language Difficulties - Problems and Learning Difficulties PDF

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This document presents information on problems and learning difficulties related to oral language. It discusses various aspects of oral and written language disorders, including classification and potential interventions.

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Problems and learning difficulties Tema 2. Problems and learning difficulties. 2. UNIT 2.1 1 Written and spoken language problems in the classroom. 2. UNIT 2.2 2 Emotional, behavioural and motivational problems Written and spoken language problmes in the classroom...

Problems and learning difficulties Tema 2. Problems and learning difficulties. 2. UNIT 2.1 1 Written and spoken language problems in the classroom. 2. UNIT 2.2 2 Emotional, behavioural and motivational problems Written and spoken language problmes in the classroom 2. 1 Unit aims Differentiate oral and Analyze orientations for Describe their written language their educational basics symptoms disorders observed answer and in the school guidelines for action in the class Spoken and written languages problems in the classroom Introduction Functional classification of oral language: types, decription and aetiology: Alterations in: voice, spoken language and communicationn. Basic aspects of intervention in oral language difficulties. Orientations and action guidelines. Written language difficulties: Dislexia Dysorthography Disgraphia Oral language difficulties Introduction n Communication Previous condition Development Language is Oral language the most precedes written Basic instrument primary for the construction of instrument of language and is a knowledge and communication precondition for its personal and social mastery development Functional classification of oral language Compulsory reference for oral Learning Difficulties (OLD): PHONOLOGICAL MORPHOSYNTACTIC Normative development of child language LANGUAGE It exists a link between SEMANTHI PRAGMATIC different language C components Oral Language difficulties: CONCEPT Any alteration, that is, There are different childhood difficulty, disorder, pathologies in which language may be affected. dysfunction, disorder, There is no agreement on the defect, disability, etc., classification of oral language disorders that interferes or hinders the ability to communicate with others through spoken language (Gallego, Oral linguistic 2005). pathology Clasificaciones de dificultades del lenguaje oral: clinical perspective (DSM-5). Fluency disorder Language Phonologica starting in infancy Disorder l disorder Social Non-specific communication communication disorder disorder (pragmatics) Classifications of oral language difficulties: descriptive perspective (Gallego, 2005) Communication Grave problems of communication: autism, psicosis, severe intelectual disability Selective/elective Mutisms Language Simple Language Delay /Retraso simple del lenguaje (RSL) Moderate Language Delay /Retraso moderado del lenguaje (disfasias/dysphasia). Severe Language Delay/ Retraso grave del lenguaje (afasias/aphasia). Speech Dyslalias Dysglossias Dysarthrias Dysphemias Voice Disphonies/Aphonies Voice problems Voice problems especially affect boys and girls between the ages of 6 and 10 in a frequency that ranges between 6 and 23% of the total.. Problems in the voice area Definition: Alterations in the larynx, the respiratory system and/or the resonance cavities that affect the emission of the voice in any of its qualities (tone, timbre, intensity and duration). Etiology: laryngitis, polyps, nodules, inflammation, asthma... Incidence: It occurs more in boys than in girls (1:3). It is progressive in nature. It usually affects between 6-10 years. Prevalence: 6-9% of the school-age population. 20-30% of Preschool and Primary teachers. Fuente: https://medlineplus.gov/spanish/ency/esp_imagepages/19708.htm Resonance disorders Abnormalities in the tone Excessive nasality and intensity of the voice ("nasal twang") or and voice effects of reduced nasality ("stuffy whispering, gruffness* and nose") hoarseness (dysphonia). Phonation disorders Problems in the voice area: Dysphonies Concept Etiology Classification Alterations in the voice Combination of factors: Disphonia (dys) functionals: Simple (dys)functional dysphonia: that affect one or more of Persistent vocal overstrain. defect of vocal fold closure during its basic parameters: emission but without laryngeal lesion. Triggering factors: pitch, timbre, intensity. Complicated (dys)functional dysphonia Appreciation of emotional inflammatory processes of complicated: lesions in the vocal folds: the airway (respiratory tract). vocal folding nodule, laryngeal polyp, nuances. edema. Favorable factors: Differentiation aphonia: Particular forms of (dys)functional total and transitory loss of perfectionism, anxiety, dysphonia. voice (rare in childhood). imitation. Organic Dysphonies: Congenital Acquired (chronic or acute) Dysphonies: detection and intervention in the classroom Detection Intervention Aggravated voice Body: achieving a facilitating posture Visible laryngeal effort during phonation with Respiratory: breathing awareness thickening of the neck Breathing hesitant, shortness of breath* Auditory sensory discrimination: learning to caputre and clavicular ascent up on the characteristics of one's own voice Auditory sensory discrimination: learning to pick Frequent screaming up on the characteristics of one's own voice Vocal hygiene Classifications of oral language difficulties: descriptive perspective (Gallego, 2005) Communication Grave problems of communication: autism, psicosis, severe intelectual disability Selective/elective Mutisms Language Simple Language Delay /Retraso simple del lenguaje (RSL) Moderate Language Delay /Retraso moderado del lenguaje (disfasias/dysphasia). Severe Language Delay/ Retraso grave del lenguaje (afasias/aphasia). Speech Dyslalias Dysglossias Dysarthrias Dysphemias Voice Disphonies/Aphonies Problems in the field of speech Verbal fluency Articulation problems problems Dyslalias Dysglossia Dysarthri Dysphemia a Articulation disorders due to CNS Organic dyslalias: alterations in the Difficulty in pronouncing certain lesions and diseases of the nerves or Alteration of the rhythm of speech articulation of phonemes produced by phonemes or groups of phonemes, muscles of the tongue, pharynx, characterized by a series of lesions or malformations in the which may affect any vowel or larynx, etc. (e.g. cerebral palsy). repetitions or spasmodic blocks peripheral organs of speech (lips, consonant. Extreme form: anarthria (inability to during the delivery of speech. tongue, palate....) articulate sounds).) Speech problems: Articulation problems Definition: Wrong production of one or several sounds combined during the articulation of a spoken chain They are a consequence of inability, anomaly or diffitculty of the child in the normal emission of the sounds from his tongue Types: Dyslalias: (Functional Dyslalia) Difficulty to pronunce determined phonemes o groups of phonemes that could affect any vowel or consonant fonemas o grupos de Video: https:// www.youtube.com/watch?v=4N2I9AHo2DA&t Functional Dyslalia E R Mecotó It´s the most common language O n Tes problem among children between R Fante 3 and 5 y.o. E Camelo Multifactor aethiology: S D E Tasa Lack of control of fine psicomotor skills Deficit in auditory discrimination A Tola Tao Perceptual mistakes or lack of Agüelo R capacity to imitate movements T Togo Poor lingüistic stimulation I C Bificlet Psychological type: overprotection, U a trauma… L Pelúlica A Permio C I “Pasxaj Dysglossias Dysglossias: (Organic Dyslalias) Alterations in the articulation of phonemes produced by lesions or malformations in the peripheral speech organs (labial, palatal, lingual, mandibular, nasal and dental). Protruding or retracted lower jaw Ogival Palate/Paladar Dental malocclusion ojival Dysglossias Dysglossias: (Organic Dyslalias) Alterations in the articulation of phonemes produced by lesions or malformations in the peripheral speech organs (labial, palatal, lingual, mandibular, nasal and dental). Cleft lip Lips frenulum Lingual frenulum Dysarthria Dysarthria: Articulation disorders due to CNS lesions and diseases of the nerves or muscles of the tongue, pharynx, larynx, etc. (e.g. cerebral palsy). Extreme form: anarthria (inability to articulate sounds). More frequent symptoms: Hypertonia or hypotonia of the muscles of the phonoarticulatory organs. Alteration onbreath, phonation, resonance, articulation and prosody. Speech unundertandable with omissions, substitutions, additions or distorsions of one ore more phonemes Dyslalia, dysglossia and dysarthria: detection in the class Facial, labial, Respiratory lingual, palatine Facial dynamics muscles motricit y Alterations in the articulatory Phonemes organs articulation Dyslalia, dysglossia and dysarthria: detection in the class Tipo de error Características Example in Spanish A phoneme is replaced by another, more easily emitted phoneme, in Substitution either initial, middle or final position. “Datón” por “Ratón” Omission of a phoneme that you do not know how to pronounce “Oche” por “Coche” Omission of a phoneme that closes a syllable “Pueto” por “Puerto” Omission Omission of a phoneme that is part of a symphoneme “Fesa” por “Fresa” Omission of a syllable often located in the middle of a word “Teéfono” por “Teléfono” Addition Introducing a non-existent vowel sound in a word in order to “Palato” por “Plato” overcome the difficulty in producing that syllable. “Terés” por “Tres” Deformed articulation of a phoneme resulting in a weak or /r/ francesa por Distorssion incomplete sound without replacing it. /r/ española Modification of the order of the sounds of a word during its “cocholate” por Invertion articulation “chocolate” Dyslalia, dysglossia and dysarthria: detection in the class Collaboration with primary caregivers, hearing and speech professionals, speech therapists, phoniatrists, etc. Orofacial gymnastics: strengthening the tone and motility of the organs of the articulatory apparatus (tongue, lips, palate, jaw). Addressing specific phoneme articulation errors: Correct positioning of articulatory elements. Train the positioning first on simple elements: phonemes and syllables. Continue training with words to generalize. Establish alternatives to errors, reinforcing correct articulations. Dyslalia, dysglossia and dysarthria: detection in the class Dysphemia: characteristics Definition: speech rhythm disturbance characterized by a series of spasmodic repetitions or blocks during speech. Characteristics: Lack of phono-respiratory coordination and muscular tension. Initial blocks, repetitions and syllable partitions, phonemic lengthening, intonation and inadequate pauses. Excessive pressure in labiolingual movements. Anxiety and psychological tension. Lalophobia (fear of speaking in public= before certain phonemes or words. Dysphemia: types EVOLUTIVE DYSPHEMIA TONIC-CLONIC DSYPHEMIA Symptoms of short duration (a few weeks or Symptoms of long duration (more than one year). months). No awareness of the problem, no avoidance Awareness of the problem, presence of behaviors. avoidance behaviors and emotional reactions He does not use obvious force when speaking. Obvious strength when speaking. Repeats whole words, especially function words Presence of pause-blocks with easily or syntagms ("me, me, me", "my mom, my noticeable tension. mom" "is that me, is that me".) Lengthening of vowels. Interruptions of words in any syllable. Repetition of stressed syllables. There are no associated movements There are associated movements Dysphemia: types CLONIC TONIC MIXED Syllabic repetitions and With initial blockages and Combination slight repetitive strong spasms. tonic-clonic spasms. Combination of both It is characterized by It is characterized by blockages when emitting types It´s the most involuntary and frequent compulsive repetition of a the words. The blockages syllable in a word (usually are caused by spasms the first one) or of a word that immobilize the within a sentence. As a musculature involved in consequence the speech the emission of the voice. is repetitive(p.ej. Lo lo lo As a consequence, the que pa pa pa pasa es speech is choppy (e.g. un ca ca carro”. "what h... happens is a c...car"). Dysphemia: implicated aspects Linguístics Psicophysiologicals Social and Psychological Blockages Breath Anxiety Repetitions Muscle tension Expectations M ood state Dysphemia: aetiology Triggering factors of dysphemia: Heredity. Left-handedness. Linguistic disorders (alterations in semantic competence and dysfunctions in morphosyntactic organization). Psychological disorders: Negative experiences. Inadequate learning https://youtu.be/zfBJ8HrMZUI Dysphemia: class detention Observation of vasomotor disorders Repetitions and/or Breathing dynamics (paleness, reddening of blockages in the with/without the face, sweating) emission phonation Behavioral Measurement of manifestations (mutism, physiological variables inhibitions, (respiration, muscle communicative tension) avoidance) Dysphemia: intervention in the class Answer questions and read aloud in class. Direct intervention (relaxation, breathing, voice and prosodic elements of speech): class: We will ask him only if he raises his hand and Speak at a slow, relaxed pace (modeling). questions that can be answered in a few words. Avoid making comments (he feels evaluated). Regarding reading aloud, we will discuss it with Do not congratulate him when he comes out of the block. him. He should not avoid stuttering ("paradoxical intention" to avoid that focusing on how he speaks increases anxiety). How to handle teasing and jokes: Sharing experiences of other teasing or jokes Focus on what he/she says and not on how he/she says it. and commenting in a personalized way on the Do not make observations or corrections in the effect the teasing has on his partner. language. Encourage theatrical games so that he/she adopts different roles. Control facial expression. Classifications of oral language difficulties: descriptive perspective (Gallego, 2005) Communication Grave problems of communication: autism, psicosis, severe intelectual disability Selective/elective Mutisms Language Simple Language Delay /Retraso simple del lenguaje (RSL) Moderate Language Delay /Retraso moderado del lenguaje (disfasias/dysphasia). Severe Language Delay/ Retraso grave del lenguaje (afasias/aphasia). Speech Dyslalias Dysglossias Dysarthrias Dysphemias Voice Disphonies/Aphonies Problemas en el ámbito del Level lenguajeSimple Delay (RSL) Moderate Delay (TEL, Dysphasia) Severe Delay (Aphasias) Significant reduction of phoneme use. First words: after the age Reduction of the phonological system (at a Jakobson's minimal consonance of three Fhonological global level) ("baby talk"). Phrases as a combination of several words: four years and older Schematic language after Altered logical sentence structure, use six years of age Simple sentences, poor linguistic exp., poorly of plurals and omitted/altered Morphosintactic structured sentences, juxtaposed words and nexuses, diff. gender, number or verb sound gaps tenses Normal comprehension, reduced vocabulary, 1st words: after the age of two Comprehension same lag as in Semantic years. expression, reduced vocabulary Useful and functional language Altered language use Pragmatic Problems in the field of language Retraso Retraso Moderado Simple (TEL, Disfasias) (RSL) Persistent intrinsic impairment of Nature Chronological lag language processing Affectation degree Mild Moderate or grave Evolution Transitory Persistent Answer to specific therapy Fast recovery Slow recovery and variable Reading and writting effects Scarce consequences Frequently affected Simple Language Delay: Class detection Ámbito Disfunción Nivel Tendency to omit the second consonant of direct complex syllables (Consonant + Vowel + Consonant) which are reduced to Consonant + Vowel and of inverse syllables (Consonant + Consonant + Vowel), which are reduced to Consonant + Vowel. Fonológico Reduction of vowel diphthongs. Delay in the emission of the first words and guttural manifestations until 2 years of age. The union of two words is delayed until 3 years of age. Excessive use of simple sentences. Nivel Use of juxtaposed words without the appropriate links. Morfosintáctico Telegraphic language, without articles and possession markers. Noticeable delay, up to 4 years of age, in the proper use of pronouns (I). Difficulties in the use of articles, pronouns and plurals. Possible alterations in the conjugation of some verb tenses. Syntactically incorrect or unstructured sentence construction. Use of gestural compensation. Semántico Apparently normal, but linguistic updating of cognitive content may be scarce. Slightly reduced vocabulary at times. Pragmátic Usable and functional language apparently normal. o Dysfunctions in the repetition of pseudowords. TEL: characteristics Disfunction Difficulty in discriminating and processing verbal sounds. Difficulty in the execution of the articulatory motor plan. As syntactic complexity increases there is often a decrease in articulatory accuracy. Nivel Delay in phoneme acquisition. Fonológico Priority use of simple syllabic combinations. High frequency of deviant forms. Difficulty in auditory discrimination of monosyllable pairs. Limitations in phonemic awareness, syllable awareness and rhyming tasks. Deficits in articulating sequences of sounds while operating with specific instructions. When we ask him to read the word "GLOBO", he says "GOBO". he says "GOBO". When pronouncing the R in "RED", Juan does not put his tongue on the roof of his mouth. tongue on the roof of his mouth. When you ask Juan to select the picture that represents the word "PELA", he chooses "PERA". TEL: area characteristics DisfuncTION Difficulty in the knowledge and handling of morphemes and inflections (difficulty with verbal desinences of mood, tense MORPHOLO and person). GICAL Omissions of morphemes or necessary elements in the sentence ("en la mesa estaban platos"). LEVEL Difficulty in establishing gender and number relationships with articles. General deficits in grammatical comprehension. Special difficulties in making sentences with verb + predicate structure. General propositional errors. SINTACTIC LEVEL Problems accessing the meaning of unfamiliar terms and phrases. Addition of unnecessary elements. Difficulties in producing articles and pronouns. Grammatical errors in sentence construction: temporal, comparative, etc. Juan says "María takes away ball, María doesn't give". Juan says "Nene played with park". Juan says "Here are the chairs". Juan says "Mama dresses and... in chair". TEL: Ámbito characteristics Disfunción Difficulties in recognizing, confronting and organizing lexical meanings. Problems choosing alternative meanings, identifying absurdities, and accessing deeper meaning. Limitations in naming figures of speech. Nivel Deficits in handling function words, such as demonstratives, possessives, prepositions and conjunctions. Semánti Errors in the production of definitions. co Reduced vocabulary. Difficulty in learning new words incidentally. Difficulty in establishing complex representations between words. When you ask Juan to tell you animals, he says cat and lion. When you ask Juan what an "OLA" is, he makes de gesture of ”hello”. TEL: Ámbito characteristics Disfunción Difficulty maintaining coherence and cohesion in narrative discourse. Nivel Difficulty in showing empathy and adopting roles appropriate to the characters in a scene. Pragmáti Alterations in the ability to encode relevant meaning in conversational situations. co Significant difficulties integrating into communicative discourse. Totally irrelevant responses to questions. Juan got into a fight with a boy in class when he touched his arm to ask for the eraser. Juan said he wanted to annoy him. When you ask Juan something he starts by answering you, but changes the subject easily. When you ask Juan what is your favorite color? He he answers 5. Showing you the following picture, Juan does not know how to answer why the boy is pointing to his dog. TEL: characteristics Phonology Semantics Delays in gross and fine Syntax Linguistic Motor psychomotor skills Morphology characterist characteri Pragmatics ics stics Limitations in sustained attention, in the Difficulty relating to others, ability to inhibit responses or to isolating and isolating him/her. discriminate figures (equality/inequality) Socio-affective No slowness Cognitive Better relationships with younger characteristics children. Limitations to integrate sensory (visual) characteristics patterns. Diminished ability to play. Difficulty in planning and executing. Enclosure in himself/herself. Problems organizing notions of time. Abrupt changes of character. time. Repetition of habits. TEL: characteristics Juan's father notices (...) that he is a little clumsy when walking and picking up small objects. 10 seconds after showing Juan the following objects, he remembers the pencil and the chair. Juan's mother notes that he is very affectionate with the family, but prefers to play with his younger cousins rather than with those his own age. In addition, she indicates that he takes a long time to do his homework and often does not arrive on time. He makes many mistakes on the "A" test. These mistakes are both omissions and errors. His previous teacher notes that Juan has a hard time relating to others and tends to isolate himself and be reclusive. In addition, he is easily distracted and organizes his time very poorly. TEL: Class detention Non-standardized language assessment procedures Spontaneou s verbal Registration of a sample (video) production Presentation of plates Orovoked Completing sentences verbal Role-playing by adopting the role of their mother, father, teacher (to elicit negative sentences) productio n Substitution of words or groups of words in a text (paradigmatic and syntagmatic relations). Explanation of disordered stories (temporal exercises). To point out, from a given number of drawings, the one that best expresses the meaning of a given sentence. Comprehension To determine which sentence best expresses the meaning of a drawing. Reconstruct a sentence with the help of objects and drawings. Provoked imitation Repeating phrases or words. TEL: intervention in the class (suggestions for teachers) Speak clearly, correctly and at a Go from the concrete to the abstract. moderate speed. Ask questions and facilitate moderate speed. expression. Pronounce all the syllables of the Present motivating situations. words. Use modeling to clarify messages. Do not join the final syllable of a word Offer models of expression. with the initial of the following one. Avoid infantilized language. Make the curriculum more flexible. Reinforce any initial oral utterance. Use conversation in a contextualized Highlight positive qualities. way. Reinforce small achievements. Do not force the child to repeat in a group. Provide time. Use facilitation systems. TEL: class intervention (basic tasks) Breathing exercises. Buccophonatory exercises (mirror, candle, etc.). Word-drawing matching. Articulation exercises of different phonemes. Word segmentation. Onomatopoeias. Rhyming from given words. Identification of letters from visual discrimination Joining syllables to form words. activities. Word formation (adding or removing phonemes). Discrimination/recognition of phonemes. Copying and simultaneous articulation of words. Association of images, drawings or real objects Ordering letters to form words. with their phonetic sound. Ordering words to form sentences. Identification or written form of a word. Forming words from one syllable. Searching for synonyms and antonyms. Phonemic decomposition. Identification of the elements that make up a Reading words included in a picture. sentence. Repetition of simple, easy and complex Association of the picture with the meaning of the phonemes. sentence and vice versa. complex phonemes. Construction of different types of sentences. Repetition of pseudowords. Choosing answers. Classification of drawings and words into Completion of sentences categories. Identifying definitions of concepts. Definition of concepts What is it like to have TEL? https://www.youtube.com/watch?v=zWFlF31Ibjw Aphasia Motor or expressive aphasia Broca's region Language expression Sensory or receptive aphasia Wernicke's region Expression and understanding of language of language Mixed aphasia Extensive lesion Comprehension and expression Aphasia Classifications of oral language difficulties: descriptive perspective (Gallego, 2005) Communication Grave problems of communication: autism, psicosis, severe intelectual disability Selective/elective Mutisms Language Simple Language Delay /Retraso simple del lenguaje (RSL) Moderate Language Delay /Retraso moderado del lenguaje (disfasias/dysphasia). Severe Language Delay/ Retraso grave del lenguaje (afasias/aphasia). Speech Dyslalias Dysglossias Dysarthrias Dysphemias Voice Disphonies/Aphonies Communication problem spectrum: Selective MUTISM Definition: difficulty communicating in unfamiliar environments and social situations and with strangers. These are children with age-appropriate linguistic competence (not put into practice in certain environments). Essential feature: persistent inhibition of speech in specific social situations. Differential diagnosis with other disorders (mental disability, T2DD, language disorders, anxiety disorders, emotional problems, etc.) is necessary. Consequence: personal suffering and problems of adaptation to the environment (personal, social and academic development). Problems in the field of communication: selective mutism. WITH PEOPLE FEAR OUTSIDE THE INTIMATE AVERSION SPHERE TOSPEAK SPEECH PRESENCE ONLY WITH PEOPLE SELECTIVE OF THE INTIMATE MUTISM SPHERE WITHOUT SPPECH PROGRESSIVE MUTISM TOTAL FEAR Problems in the field of communication: selective mutism "Miren has joined the school this year in 1st grade. During the first trimester, her attendance has been somewhat irregular as she suffers from continuous colds. She does not initiate verbal interactions with her teachers or classmates, nor does she respond to simple questions from either teacher or classmates. When the teacher addresses her, she averts her gaze, lowers her head and nibbles her fingers. When they perform activities such as singing songs, reviewing numbers, learning vocabulary... Miren vocalizes and sometimes hisses almost inaudibly; but when she notices that the tutor or a child is looking at her, she stops doing so. Sometimes, very rarely, she responds to the tutor's questions by nodding and shaking her head or pointing her finger. Miren also shows excessive body stiffness, her face is tense, with her lips slightly open. Miren's mother has commented to the tutor that at home, she speaks perfectly, that she does not shut up and that she tells her everything she has learned at school. what she has learned at school, the songs, the stories... She also commented that in kindergarten she did not talk to anyone, and that she does not talk to anyone either. and that she doesn't talk to the children in the park either". http://orientacion.educa.aragon.es/admin/admin_1/file/RECURSOS_ori entacion/ATENCION%20DIVERSIDAD/TRASST.%20EMOCI- COMPORTA/GUIA%20MUTISMO%20SELECTIVO.CASTELLANO.pdf (Description, made by a 1st grade EI teacher, of a girl with MS). Problems in the field of communication: selective mutism (etiology) PREDISPOSING PRECIPITANTS MAINTINERS Personality Beginning of schooling Reinforcement of Family overprotection Traumatic or stressful mutism by avoidance personal situations of situations. Speech demands Excessive attention Rigid school context received Family background Acceptance of non- verbal responses Accommodation of the environment Selective mutism: intervention in the classroom SCHOOL TEACHERS FAMILY It plays an Attitude of interest Respect Collaboration important role: Do not force to talk emergence and Create opportunities maintenance. for communication According to DSM-5 Neurodevelopmental Disorders Intellectual Disabilities Communication Disorders Language Disorder Phonological Disorder Childhood Onset Fluency Disorder Social Communication Disorder (pragmatic) Unspecified Communication Disorders Autism Spectrum Disorder Attention Deficit/Hyperactivity Disorder Specific Learning Disorder Motor Disorders Language impairment: Language Disorder (DSM-5) Persistent difficulties in the acquisition and use of language in all its modalities (i.e., spoken, written, sign, or other) due to deficits in comprehension or (i.e., spoken, written, sign language, or other) due to deficits in comprehension or production that production including the following: A. Reduced vocabulary (knowledge and use of words). B. Limited grammatical structure (ability to place words and word endings together to form sentences based on grammatical and morphological rules). C. Impaired discourse (ability to use vocabulary and connect sentences to explain or describe a topic or series of events or have a conversation). D. Language abilities are markedly and measurably below what is expected for age, resulting in functional limitations in effective communication, social participation, academic achievement, or job performance, individually or in any combination. E. The onset of symptoms occurs early in the developmental period. F. The difficulties are not attributable to hearing or other sensory impairment, motor dysfunction, or other medical or neurological condition and are not better explained by intellectual disability (intellectual developmental disorder) or global developmental delay. Language impairment: Language Disorder (DSM-5) Language deficits are evident in spoken, written and sign language communication. Language abilities have to be assessed in both expressive and receptive modalities. Language comprehension deficits are often underestimated. Difficulties in word finding, word play, recall of new words and/or phrases, following long instructions words and/or phrases, following long instructions, remembering telephone numbers, sequences of sounds... Etiology; genetic and physiological Language T diagnosed after the age of 4 years is usually stable over time and usually persistent into adulthood. Comorbidity with other disorders (Autism, ADHD, specific learning disorders, etc). Speech problems: Phonological Disorder (DSM-5) A. Persistent difficulty in phonological production that interferes with speech intelligibility or prevents verbal communication of messages. B. The impairment causes limitations in effective communication that interferes with social participation, academic achievement, or job performance, individually or in any combination. C. The onset of symptoms occurs early in the developmental period. D. The difficulties cannot be attributed to congenital or acquired conditions, such as cerebral palsy, cleft palate, hearing loss, brain trauma, or other medical or neurological conditions. Speech problems: Phonological Disorder (DSM-5) In normally developing 4-year-olds, overall speech should be intelligible, whereas by age 2 years only 50% of speech is intelligible. By age 7, most speech sounds should be produced clearly and most words should be pronounced correctly according to age and community. Etiology; genetic and physiological. Usually responds well to treatment and difficulties improve with time. Dysphemias: Childhood Onset Fluency Disorder (DSM-5) Disturbances in the normal fluency and temporal organization of speech that are inappropriate for the individual's age and language abilities, persist over time, and are characterized by the frequent and noticeable occurrence of one (or more) of the following: A. Repetition of sounds and syllables. B. Prolongation of consonant and vowel sounds. C. Fragmented words (e.g., pauses in the middle of a word). D. Audible or silent blocking (pauses in speech, full or empty). E. Circumlocutions (substitution of words to avoid problematic words). F. Words produced with excessive physical strain. G. Repetition of complete monosyllabic words (e.g., "I-I-I-I-I see it"). H. The disturbance causes speech anxiety or limitations in effective communication, social participation, academic or work performance individually or in any combination. I. Symptom onset occurs early in the developmental period. J. The disturbance is not attributable to a motor or sensory speech deficit, dysfluency associated with neurological damage or other medical condition and is not better explained by another mental disorder. Dysphemias: Childhood Onset Fluency Disorder (DSM-5) The extent of the disturbance varies in different situations and is often more severe when communication is subject to some kind of pressure. Dysfluency is often absent during oral reading and when singing or talking to inanimate objects or pets. Infantile-onset fluency disorder may be accompanied by motor movements. It occurs before the age of 6 years in 80-90% of cases. Age of onset between 2-7 years. Usually begins gradually with repetition of initial consonants, first words of a sentence or long words. The child may not be aware. As the disorder progresses the disfluencies become more frequent and interfere more. When the child is conscious he/she may use avoidance mechanisms. Etiology; genetic and physiological Stress and anxiety may exacerbate dysfluency. Problems in the field of communication: social communication disorder (pragmatics). A. Persistent difficulties in the social use of verbal and nonverbal communication manifested by all of the following factors:: 1. Deficits in the use of communication for social purposes, such as greeting and sharing information, in ways that are appropriate to the social context. 2. Impaired ability to change communication to fit the context or the needs of the listener, such as speaking differently in a classroom or park, conversing differently with a child or adult, and avoiding overly formal language. 3. Difficulties following conversational and storytelling rules, such as taking turns in conversation, expressing oneself differently when not being understood, and knowing when to use verbal and nonverbal cues to regulate interaction. 4. Difficulties understanding what is not explicitly said (e.g., making inferences) and non-literal or ambiguous meanings of language (e.g., idioms, humor, metaphors, multiple meanings that depend on context for interpretation). B. Impairments cause functional limitations in effective communication, social participation, social relationships, academic achievement, or job performance, either individually or in combination. C Symptoms begin early in the developmental period (but the impairments may not become fully manifest until. the need for social communication overcomes the limited abilities). Symptoms are not attributable to another medical or neurological condition or to low ability in the domains of morphology D. and grammar, and are not better explained by an autism spectrum disorder, intellectual disability (intellectual developmental disorder), global developmental delay, or other mental disorder. Problems in the field of communication: social communication disorder (pragmatics). By the age of 4-5 years most children should have sufficient speech and language skills to allow identification of specific deficits in social communication. The course of this disorder is variable. Etiology; genetic and physiological. Problems in the field of communication: Selective mutism (DSM-5). A. Consistent failure to speak in specific social situations where there is an expectation to speak (e.g., at school) despite speaking in other situations. B. The disturbance interferes with educational or occupational achievement or social communication. C. The duration of the disturbance is at least one month (not limited to the first month of school). D. Failure to speak cannot be attributed to lack of knowledge or comfort with spoken language necessary in the social situation. E. The disturbance is not best explained by a communication disorder (e.g., childhood-onset fluency [stuttering] disorder) and does not occur exclusively during the course of an autism spectrum disorder, schizophrenia, or other psychotic disorder. Differential diagnosis: F. Communication disorders. G. Neurodevelopmental disorders, schizophrenia and other psychotic disorders. H. Social anxiety disorders (social phobia) Problems in the field of communication: Selective mutism (orientations) It is relatively uncommon: 0.03-1% More frequent in young children than in adolescents or adults. It usually starts before the age of 5 years. The longitudinal course of the disease is unknown. Etiology; temperamental, environmental, genetic and physiological. Intervention is necessary: tendency to worsen. Objective: improve personal and social conditions of the student and work on verbal interaction. Guidelines for action: Increase activities interaction between students (physical contact, group and cooperative work). Location in the classroom: avoid isolation Relaxation activities for the whole group Design situations to progressively bring the student closer to linguistic interaction (mimicry, body sounds...). Progressively increase the number of children involved and the context (support classroom, regular classroom...). Carry out masked speech activities and games (puppets, playhouse...). Reinforce any approximation of the child to the required response. Encourage bonding with the child and assign small responsibilities. Stimulatory fading (people with whom he/she speaks in contexts where he/she does not speak). Avoid making comments about not talking, punishments or comparisons with other children. Eliminate overprotective behaviors of peers. Do not show negative reactions to mutism Do not expose him/her to high anxiety situations. SELF-ASSESMENT V F 1. The designations of moderate language delay and aphasia are synonymous. 2. Selective mutism is a problem in the communicative domain in which comprehension is not affected. 3. Simple Language delay is characterized by articulatory difficulties of some phonemes and by phonological- syntactic difficulties. 4. Dysphasia is related to hearing loss, intellectual disability or brain injury. 5. Simple Language delay is difficult to solve in the short term. 6. Dyslalias are problems in the production of phonemes due to physiological or anatomical alterations or malformations of the speech organs. 7. Slurred speech* is typical of tonic dysphemia (habla entrecortada) 8. Infantile dysphonia is a form of dysfunctional dysphonia. 9. TEL affects both the expression and comprehension of language. 10. One of the differences between Simple Language Delay and dysphasia is that in the latter, comprehension is impaired.

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