Language Development and Disorders

**Language** **Language:** it is a socially shared code that is used to represent concepts. it a code whereby ideas about the world are represented through a conventional system of arbitrary signals for communication **Language disorders**: it is impaired comprehension and/or use of spoken, writt...

**Language** **Language:** it is a socially shared code that is used to represent concepts. it a code whereby ideas about the world are represented through a conventional system of arbitrary signals for communication **Language disorders**: it is impaired comprehension and/or use of spoken, written and/or other symbol systems. **Ares of language:** 1. **Form: morphology**: it is the structure of words. Morpheme: it is the smallest grammatical unit within a language. (no plurals, confuse between famine and masculine in correct tense(. **phonology:** the sound system in language, it is related to morphology. **syntax :** how words are arranged in a sentence. 2. **Content: semantic** : meaning of language. (low vocb, comprehension). 3. **Use: pragmatic**: the use of language in social aspect. (turn taking, eye contact, topic maintenance, and joint attention). **Language intellectual disability: Down Syndromes** - Normal IQ: 90-110 - IQ is 70 and below. - **Assess** all areas of language , and they will have overall delay, langue is the most thing that it is affected, so it will be below the level of cognition. - **Intervention:** Social and functional intervention and use of AAC. Early communication skill (turn taking, pointing, social interaction and play, speech production, spoken and written Lang, education, function. - With intervention, they will produce shorter immature language form. **Down Syndrome:** - Trisomy 21 - **Example of health problems:** cardiac problems, early dementia - **Facial features**: small head, upward-slanting oval shaped eyes, small chin, small oral cavity - Very social, can communicate through gestures and sign language, good receptive vocabulary - Risk of hearing loss (conductive hearing loss). - **Deficits in** semantic, morphology, syntax, phonology, articulation impairment, deficits in short term memory and ToM (causes difficulty in narration, referencing, understanding words like think, believe) - Can develop language with EI, but development slows down as they get older. **Language disability:** - Affect grammar, narrative, semantic limited words, difficulty find the words, pragmatic, reading, writing **Intervention:** - multidisciplinary intervention team - Speech and language - Language: morphology, semantic, cognitive skills , pragmatic - Disorders associated with LD (ADHD, apraxia, slow listener, dyslexia) **SLI** - Clinical markers: difficulty with grammatical features, and non-word repetition: syllable repetition test - SLI : it cause LD later, affect the academic - Morphology, syntax are impediment in SLI **ASD ( autism spectrum disorder )** - **Diagnosis in first year based on:** 1. Do not imitate gestures or vocalizations 2. Joint attention 3. Do not respond (names, sounds) NOT due to hearing impairment 4. Do not make requests **-Clinical markers:** 1. Impairment in nonverbal behavior, gestures, social skills 2. Failure to develop peer relationship 3. Absence of joint attention, seeking others 4. Lack of emotional reciprocity 5. Abnormal play skills 6. Lack or delay on verbal language development 7. Impaired conversation 8. Repetitive behavior 9. Echolalia 10. Impaired prosody. Phonology: phonemes, syllables are intelligible, Syntax: absence of telegraphic speech. Phonology: prosody, rate, and intonation are impaired, Nasal resonance, Difficulty with pronouns: understanding the referral, Echolalia, **-Intervention:** - nonverbal: AAC, - Verbal: work on social and pragmatic skills. **Assessment of language in general :** - Screening before case history. - Assessment - Observation - Introduce yourself, and then ask the child - play: 1. types of play 2. Prelinguistic skills 3. Pragmatic: (joint attention, turn talking, topic maintenance, eye contact) 4. respective and expressive words 5. utterance of words 6. knowledge of function 7. matching 8. following command 9. categorization 10. answering question (age, name and hobbies). 11. Ask about grammatical rules. 12. Behaviors: behaviorist, psychiatrist, pediatrician. - Language sample - Parent's interaction Then I will compared to normal children, Based on assessment, you find ZPD and **Formal assessment:** - PLS-5 (preschool language scales) form birth to 7.11 - TELD-3 (Test of early language development) from 2-7.11 - REEL-3 (receptive expressive emergent language), 0-3.11 **Cerebral palsy:** - It is a problem that affect muscle tone, movement, and motor skills. It hinders the body's ability to move in coordinated way. - It acquired early. ( brain malformation, or brain injury). - Risk of language disorder - Refer for IQ - May have hearing loss - **Dysarthria** is the most common speech disorder - Feeding ad swallowing. - Voice - Family history of reading disability - First words not produced until after 15 months of age. - Words not combined until after 24 months - Difficulty pronouncing the words past 6 years - Poor memory and awareness - Inability to segment words into syllables before 5 years. **Screened phonological awareness for children to predict later development in reading:** - phonemic awareness (divided the words into syllables, name the words begin with same sounds, make words by putting sounds together). - rapid naming of letters, numbers, and objects - print awareness **Evaluate children with reading disorder: assess all the ares of languge with emphasizing on:** - **Phonological awareness** - Phonemic segmentation (can the child count phoneme in a word, pronounce individual sounds, add or delete sound. - Phonemic synthesis: can the child blend the sounds that present in isolation to form words - Sound comparison: can the child compare the sounds of different words - **Word fluency:** ability to name symbols, words, or pictures rapidly. - **Reading fluency:** the average of number of words the students correctly reads per minute, using index cards. - **Narrative schema knowledge:** knowledge of story structure, read short passage for the client and ask Q, ask to retell a known story. **Formal assessment for reading:** - Assessment of literacy and language (ALL) from 3-6. - Contextual reading fluency, from 7-18.11 - Test of narrative language. **Aphasia** **What is aphasia?** It is an acquired neurogenic language disorder result from brain injury. **Causes:** Stroke, TBI **1-Paraphasia:** - **Phonemic paraphasia:** substitute the words with wrong or unrelated words, but some of the phonemes are similar with the phonemes of the correct words. - **Verbal or semantic paraphasia:** substitution to a another word related in meaning. - **Neologistic paraphasia:** nonwords created, unintelligible and unrelated and 50% meaningless. **2-perseveration:** keep answering with same answer, although the first one is correct. **3-Telegrahic speech:** substitution of general words (this, that) in place of important content words. **4-Agrammatisim:** omission of grammatical features: plural, past tense, articles, conjunction, preposition. **5-Anomia:** naming difficulty **6-Circumlocution** **7-Automatic language:** reciting alphabet, numbers **8-Alexia:** inability to write, forget letters, errors in spelling, write slowly. **9-Agraphia;** difficulty read, inability to discriminate between phoneme or Witten words. **Types of aphasia:** Fluent: wernicke's , transcortical sensory, conduction, anomic. Nonfluent: broca's, Global, transcortical motor. **Assessment:** - Case history: - Demographic information - Medical history - Hearing evaluation: - Language: receptive and expressive, reading and writing. - Speech: fluency, articulation + apraxia and dysarthria - Cognition 1. Naming, recognition of words, recognition of function 2. Answering yes or no questions and logic question 3. Repetition 4. Mathematics 5. Reading and writing. 6. Sequencing 7. Speech: fluency, articulation + apraxia and dysarthria. **Intervention** **Nonfluent**: **MIT** with sever nonfleuent (broca's), AAC, yes or no techniques, visual action therapy, writing. **Fluent**: **Task for naming:** Confronting naming by giving him the object, and response: verbal or writing. Confronting naming with cues (statement of category or function, initial phoneme, sentence completion, description), sentence completion (first phoneme, say the word silently, write the word, draw), picture\\ word matching. **Reading:** identify the letter, identify the word with picture. Read words with picture. Ask ather **Receptive Lang:** imitate gesture without and with object, follow one-two-three command, body part, recognition pic, ask yes\\no question, paragraph. **Aural rehab** **How we hear?** Sound go into pinna and down ear canal, the eardrum move back and forth when sound hit it, the ear drum make the bones move, then they send signal to inner ear, then the fluid in inner ear move, this movement trigger hair cells, the hair cell changes the movement to electrical signals, these signals go through your auditory nerve into your brain. **-Level of hearing:** - -10-15 normal - 16-25 slight hearing loss - 26-40 mild - 41-55 moderate - 56-70 moderately severe - 70-90 severe - 91 and above profound **Types of hearing loss:** 1. **Conductive hearing loss:** - It happens when the sound does not reach (conduct) to the inner ear, there is a problem in the structures. - **Example:** fluid in the middle ear (Down syndrome population), otosclerosis 2. **Sensorineural hearing loss:** - It happens when there is a damage in the inner ear or nervous pathways between inner ear and brain. - **Example:** meningitis, noise induced hearing loss **-Goals we target in aural rehab in children:** Audition, speech, language, cognition, communication. **Auditory skill level** - Sound awareness ( determine if the device works, or if there is a sound) - Sound discrimination (differentiate between sounds ( phone\\ door) - Identification (associate sounds with meaning, **moo** is a cow sound) - Comprehension (understand overall meaning, give them a text and ask about the meaning). **Assessment** **Prelingual:** **Children without rehab:** 1. Case history 2. Dictation of environmental sounds 3. Dictation in ling sounds 4. Prelingustic skills 5. Play skills and function of toys **Children who receive aural rehab:** 1. Case history 2. Dictation of environmental sounds 3. Dictation in ling sounds 4. Language assessment **Prelingual treatment:** 1. Awareness: respond to noisemakers, environmental, and ling sounds. 2. Meaning: associate meaning to sounds 3. Discrimination: differentiate between unsimilar sounds. ( different between phoneme and word length). 4. Auditory memory and sequencing: increase memory skills ability: request objects, and increase the objects, and increase commands. 5. Story retelling: 6. Key1 and 2: teach the parents and children the higher levels of skills: through adjust the routine and integrate all the skills together like develop language through repetition, talking about routine, expand vocabulary, increase the length of utterances, listen in quiet and then noisy environment, develop joint attention, eye contact and turn talking, use question, use intonation sounds). **Assessment:** **Post lingual:** 1. Case history 2. Respond to ling sounds 3. Identifying worda that are unsimilar in a close set. ( different phoneme, and syllables) 4. Identifying sentences that are unsimilar in a close set. 5. Complete sentences base on hearing only. 6. Repeat sentences using hearing. **Treatment** **postlingual:** 1. Identifying words vary in syllabic structure, phoneme, choices( two is easier than five). 2. Identifying sentences vary in syllabic structure of words, number of words , choices. 3. Completing sentences with choices and without. 4. Identifying words and sentences based on known topic. 5. Following passage. 6. Asking question based the passage. 7. Open set. **AAC** **Augmentative:** used with residual speech skills, enhances, aids, or supplements speech, unintelligible speech **alternative:** Completely replaces the communication mode **AAC techniques:** - **Aided:** use external devices, Picture Board, Electronic device - **Unaided:** body gesture **AAC users:** Individuals with little or no functional speech - **Congenital Disabilities** (Autism, Mental Retardation, Apraxia) - **Acquired Disabilities** (TBI, CVA, ALS, Parkinson's disease) **Choosing AAC** - We need communicative patterns - Know the strength and weakness. **Report** **Assessment report:** 1. Identifying information. 2. Background info (History (prenatal, medical, developmental, education) 3. Statement of the diagnosis 4. Assessment result (hearing, language, artic, oral mec, fluency, voice) 5. Summary 6. recommendation **Treatment plan:** 1. Identifying information. 2. Case summary (Dx, Duration/frequency of Tx). 3. Long term goal 4. Short term goal 5. Recommendation for parents **SOAP note:** 1. Identifying information 2. Subjective 3. Objective 4. Assessment 5. Plan 6. materials **Progress report:** 1. Identifying information 2. Comment or summary about the client 3. Assessment results 4. Long term 5. Objective 6. Progress about every objective 7. Recommendation Discharge note: **Code of ethics** 1. Individuals shall conduct research under expected rules: don not play with data, take consent form, do not harm people, use every resource, do not discriminate in the delivery of services on the basis of race, sex, gender, lang. 2. Individuals shall provide high level of competence and professionalism. 3. Individuals should represent an advocate for unmet communication and swallowing needs of the public and should provide accurate info involving any aspect in professions. 4. Individuals should behave professionally with the field and people in the field.