Severe Communication Disorders SCD321E Notes PDF

SEVERE COMMUNICATION DISORDERS: SCD321E LECTURER: Mrs Chumani Mnto Contents Teaching Schedule…………………………………………………………………………………………………………………………………… Intended learning outcome 1..........................................................................................................................

SEVERE COMMUNICATION DISORDERS: SCD321E LECTURER: Mrs Chumani Mnto Contents Teaching Schedule…………………………………………………………………………………………………………………………………… Intended learning outcome 1....................................................................................................................... 2 Readings for ILO 1.................................................................................................................................... 2 Corresponding ppt content...................................................................................................................... 3 Autism Spectrum Disorder (ASD).......................................................................................................... 4 Intellectual disability............................................................................................................................ 6 Cerebral Palsy (CP)............................................................................................................................... 7 Childhood Traumatic Brain Injury (TBI)................................................................................................. 9 Self-directed learning task..................................................................................................................... 10 Teaching Schedule Date Day Descrip,on What you need to do 24 July Wed Self study Ar,cle 25 July Thur Course introduc,on Course Outline Assignment 30 July Wed Understanding the basics: What is Severe Communica,on Disorders 31 July Thur ETIOLOGY: Understanding the Root Cause 7th Aug Wed Block Lecture WIREs Cogn Sci 2016 Au,sm Spectrum Disorder Dow et al., (2017) Ae#ology of Communica#on Kaderavek, J.N. (2015) Disorders in ASD Boucher, J., (2012). Characteris#cs of Communica#on Disorders in ASD 8th Aug Thur Block Lecture Schalock et al., 2010 Intellectual Impairment Kaderavek, J.N. (2015) Ae#ology of Communica#on Disorders in ID Characteris#cs of Communica#on Disorders in ID 14th Aug Wed Recap Lecture 15th Aug Thur Cerebral Palsy Donald, K. A., Samia, P., Ae#ology of Communica#on Kakooza-Mwesige, A., Disorders in CP Bearden, D. (2014). Oskoui, M,. Cou,nho, F., Dykeman, J., JeZé N., & Pringsheim, T. (2103 21st Aug Wed Cerebral Palsy Coleman, A., Fiori, S., Weir, K. Characteris#cs of Communica#on A., Ware, R. S., Boyd, R. N. Disorders in CP (2016). GMFCS; Palisano, Cameron, Rosenbaum, Walter & Russell, 2006 22nd Aug Thur HIV/AIDS communication disorders in children infected with or affected by HIV/AIDS) 28th Aug Wed Class test Paul, R & Norbury, C.F. (2012) 29th Aug Thur Other Condi,ons Savage, R. C., DePompei, R., Down syndrome Tyler, J., & Lash, M. (2005) FAS Molteno, C., Smart, R., Peadiatric Trauma,c Brain Viljoen, D., Rauf Sayed, R., & Roux, A. (1997). May, P.A., et al., (2008). 4th Sept Wed Block Lecture Describing and classifying child’s overall communication level and stage of language development Language phases and associated language characteris,cs When is communica,on also language. 5th Sept Thur Block Lecture Tager-Flusberg, H., et al., (2009) The Process of Assessment Beukelman, D & Mirenda, P (2014). Principles of assessment. Assessment aims, tools and outcomes. 11th Sept Wed Assessment considerations when Tager-Flusberg, H., et al., working with children with (2009). developmental disabilities 12th Sept Thur Assessment protocols and schedules 18th Sept Wed Craniofacial Syndromes 19th Sept Thur Assessment of Craniofacial Syndromes 9 Oct Wed Block Lecture Jones, E.A., & Carr, E.G. (2004) Class Test Downing, J.E., Peckham- Therapeu,c Hardin, K.D., & Hanreddy, A. /Management of SCD (2015). 10 Oct Thur Block Lecture Assignment Submission Therapeu,c /Management of SCD 16th Oct Wed Revision 17th Oct Thur Revision Overarching principles guiding the content of this course: I want to introduce you to 5 principles of working with children with developmental disabilities who have language and communication difficulties: 1) You can’t describe (and treat) what you don’t observe (see) 2) Every child can and does communicate 3) Communication function before communication form Intended learning outcome: To compare the language abilities of 4 established disabilities commonly associated with language delay in children Autism Spectrum Disorder Intellectual Disability Cerebral Palsy Childhood Traumatic Brain Injury Craniofacial Disorders and speech impairment Readings: Boucher, J., (2012). Research Review: Structural language in autistic spectrum disorder – characteristics and causes. Journal of Child Psychology and Psychiatry 53(3), 219–233. doi:10.1111/j.1469-7610.2011.02508.x Coleman, A., Fiori, S., Weir, K. A., Ware, R. S., Boyd, R. N. (2016). Relationship between brain lesion characteristics and communication in preschool children with cerebral palsy. Research in Developmental Disabilities, 58, 55-64. DOI: https://doi.org/10.1016/j.ridd.2016.08.015. Donald, K. A., Samia, P., Kakooza-Mwesige, A., Bearden, D. (2014). Pediatric cerebral palsy in Africa: A systematic review. Seminars in Pediatric Neurology, 21(1), 30-35. http://ecommons.aku.edu/eastafrica_fhs_mc_paediatr_child_health/65 Dow, D., Guthrie, W., Stronach, S. T., & Wetherby, A. M. (2017). Psychometric analysis of the systematic observation of red flags for autism spectrum disorder in toddlers. Autism: The International Journal of Research and Practice, 21(3), 301–309. http://doi.org/10.1177/1362361316636760 Fuentes J, Bakare M, Munir K, Aguayo P, Gaddour N, Öner Ö. Autism spectrum disorder. In Rey JM (ed), IACAPAP e-Textbook of Child and Adolescent Mental Health. Geneva: International Association for Child and Adolescent Psychiatry and Allied Professions 2014. Hedge, M.N., & Maul, C.A (2006). Children with Developmental Disability. Language Disorders in Children. An Evidenced-based Approach to Assessment and Treatment. Pearson, Boston, MA: pp. 359-386. Library location: M 618. 92855 HEGD  Hedge, M.N., & Maul, C.A (2006). Language Disorders in Three populations: Children with Traumatic Brain Injury, Cerebral Palsy and Hearing Loss. Language Disorders in Children. An Evidenced-based Approach to Assessment and Treatment. Pearson, Boston, MA: pp. 420-456. Library location: M 618. 92855 HEGD Hoon, A.H., & Tolley, (2013). Cerebral Palsy. In: M.L. Batshaw, N.J. Rozien, & G.R Lotrecchiano (eds): Children with disabilities, 7th edition. Paul H. Brookes, Baltimore Maryland, pp 423-450. Library location: M 61892 CHIL Kaderavek, J.N. (2015) Children with Intellectual Disability. In: Language Disorders in Children. Fundamental concepts of assessment and intervention. Pearson: New Jersey, USA, pp 235-269. Library location: M 618.92855 KADE Kaderavek, J.N. (2015) Children on the Autism Spectrum. In: Language Disorders in Children. Fundamental concepts of assessment and intervention. Pearson: New Jersey, USA, pp 271-293. Library location: M 618.92855 KADE Ke X, Liu J. Intellectual disability. In Rey JM (ed), IACAPAP e-Textbook of Child and Adolescent Mental Health. Geneva: International Association for Child and Adolescent Psychiatry and Allied Professions 2014. May, P.A., et al., (2008). Maternal Risk Factors for Fetal Alcohol Syndrome and Partial Fetal Alcohol Syndrome in South Africa: A Third Study. Alcoholism: Clinical and Experimental Research, 32(5), 738-753. DOI: 10.1111/j.1530-0277.2008.00634.x Molteno, C., Smart, R., Viljoen, D., Rauf Sayed, R., & Roux, A. (1997). Twenty-year birth prevalence of Down syndrome in Cape Town, South Africa. Paediatric and Perinatal Epidemiology, 11, 428-435. Moolman-Smook, J. C., Vermoter, C.L., Buckle, J., Lindenberg, L., (2008). Of rain men and snowcakes: The presentation, pathology, aetiology and management of autistic spectrum disorder. South African Journal of Child Health, 2, 8-12. Oskoui, M,. Coutinho, F., Dykeman, J., Jetté N., & Pringsheim, T. (2103). An Update on the Prevalence of Cerebral Palsy: A systematic Review and Meta-Analysis. Developmental Medicine and Child Neurology, 55(6), 509-19. doi: 10.1111/dmcn.12080. Paul, R & Norbury, C.F. (2012). Special considerations in special populations. In: Language disorders from infancy through adolescence, 4th Edition, pp. 100-136. Library location: M 616.855 PAUL Savage, R. C., DePompei, R., Tyler, J., & Lash, M. (2005). Paediatric traumatic brain injury: A review of pertinent issues. Pediatric Rehabilitation, 8(2), 92-103. doi:10.1080/13638490400022394 Trovato, M. K., & Schultz, S.C. (2013). Traumatic Brain Injury. In: M.L. Batshaw, N.J. Rozien, & G.R Lotrecchiano (eds): Children with disabilities, 7th edition. Paul H. Brookes, Baltimore Maryland, pp473-485. Library location: M 61892 CHIL Corresponding ppt content: CP overview ASD overview ID overview Craniofacial overview In this module, I will briefly describe the common developmental disabilities/conditions. For more detailed information about each of these conditions, please refer to the lecture slides. It's important to focus on how children with these developmental disabilities learn to communicate and use language. You will also learn about the motor-speech and feeding disorders associated with these conditions in another course. Before we delve into the material, let's take a moment to go over the terminology used throughout this course. I want to clarify that when I use the term developmental disability (DD), I am referring to a broad category encompassing a range of conditions and diagnoses that typically manifest in childhood and impact a child's social (including language development), behavioral, intellectual, physical, and emotional development. I use intellectual disability (ID) to refer to a group of conditions in which an impairment in intellectual ability is evident when standardized measures of intelligence are administered (verbal and/or non- verbal IQ). Some conditions such as autism spectrum disorder (ASD) and cerebral palsy (CP) may co- occur with intellectual disability (or not) whereas other conditions, like Down syndrome, are always associated with a degree of intellectual disability. There are some texts that use developmental disability and intellectual disability interchangeably, so please pay attention to how the authors define and use these terms. Autism Spectrum Disorder (ASD): To receive a diagnosis of autism spectrum disorder (ASD) a child must meet 4 criteria described by the DSM- 5 (Diagnostic and Statistical Manual of Mental Disorders). The term ASD is used to diagnose individuals who have: 1. Deficits in social communication and social interaction and who 2. Demonstrate restricted, repetitive set of behaviours, activities and interests (often stereotypical). These symptoms must: 3. be present in early childhood 4. limit and impair everyday functioning. Kadaverak (2015) provides more detail on the DSM-5 criteria for ASD Using the terms “spectrum” in ASD allows clinicians to account for the way behaviours and symptoms present differently in each individual with ASD. There is a wide variation in the severity of symptoms experienced by children with ASD, ranging from mild (children diagnosed as having high-functioning autism) to severe (children diagnosed as having low-functioning autism).Some, but not all, children with ASD have a language impairment. Thus, form and content may be impaired in some children with autism, i.e. some children have difficulties with semantics, morphology and syntax. The grammar skills of some children with ASD resemble the grammar skills of children with SLI (specific language impairment). However, pragmatic deficits (which relate to the first criteria of social communication and interaction) are present in all children with ASD. Young children with ASD will find it difficult to engage in joint attention with adults and may not display age appropriate pretend/imaginative play, interaction and social skills. Older children with autism, may have more subtle semantic difficulties such as understanding figurative language, may have impaired peer interaction, and may have impaired discourse and narrative skills. Children with more severe forms of ASD, may be non-verbal or have limited language comprehension and expression. Some, but not all, children with Autism have an intellectual disability. Research indicates that genetics and environment play a complex role in causing autism spectrum disorders. There are no studies specifically documenting the prevalence of ASD in South Africa. According to the Center for Disease Control (CDC), 1 in 59 children worldwide are diagnosed with autism spectrum disorder (ASD). ASD occurs in all racial, ethnic, and socioeconomic groups and is about 4 times more common among boys than among girls. There are also several associated conditions which often co-occur with ASD. These include intellectual disability; epilepsy; anxiety; ADHD and tuberous sclerosis (a genetic disease that causes benign tumors to grow in the brain and other organs). Many children (especially those in developing country contexts) are not diagnosed with autism until at least age four or five (or older). Because early intervention improves outcomes for most young children with autism, we want to confirm the diagnosis of autism as early as possible. Currently there isn’t a routinely available “medical test” to diagnose autism. Autism is diagnosed by medical specialists (often developmental paediatricians) by observing the child’s behaviour. There are a number of rating scales and observational schedules which are available to help to diagnose ASD, these include the Childhood Autism Rating Scale (CARS; Schopler, Reichler, & Renner, 1988) as well as the Autism Diagnostic Observation Schedule (ADOS; Lord, Rutter, DiLavore, & Risi, 2001). Although you need to be trained to administer the CARS and/or the ADOS, there are several “red flags” which frequently occur between 12-24 months of age, which anyone can learn to look out for. Children displaying a number of these behaviours are at greater risk for being diagnosed with ASD. Here is a list of the most common red flag behaviours associated with an eventual diagnosis of ASD. They are usually visible by 12 months of age: not babbling not pointing – i.e. to ask for things or to “comment” on something of interest in the environment. not showing objects to caregivers i.e. lifting up an interesting object as if to say: “Hey look at this!” lack of other gestures – i.e. waving bye-bye, and shaking their head for no lack of shared enjoyment -i.e. smiling or laughing when playing with a caregiver or sibling) repetitive actions or movements – this can be with toys (i.e. spinning a car wheel repeatedly) or repeating actions that don’t rely on anything other than what the child has with them (i.e. flapping their hands etc) poor eye contact - not looking at caregivers when communicating or playing with them. not looking in the direction of a caregiver’s finger when he or she points to something (i.e. when a caregiver points to a bird in the sky). paying more attention to objects than people, even familiar people. limited play with toys or playing with toys in non-typical ways, like lining up cars, or just a part of the toy (the wheels of the toy car) rather than the whole toy. not copying actions or sounds - not imitating actions like clapping hands, banging on a drum, or people’s speech sounds.  not responding to his or her name when called The Dow et al., (2017) prescribed reading describes the development of a checklist of red flags for screening young children at risk for developing Autism. In addition to the presence of these red flags, approximately 20% to 50% of parents of children who are diagnosed with autism report a regression in their toddlers’ child’s social interaction abilities, which usually happens between 18-24 months. Parents typically describe this regression as a loss of words, interaction skills, or desire for social connection. Intellectual disability: Intellectual disability (ID) has been defined as …. “Being characterized by significant limitations both in intellectual functioning and in adaptive behaviour, which covers many everyday social and practical skills” (Schalock et al., 2010). This disability is usually evident and diagnosed in early childhood. Generally intellectual ability has been measured with IQ scores, with a score of around 70 or lower (2 standard deviations below the mean) indicating an intellectual disability. Difficulties with adaptive behaviour have been categorized into 3 skill types: Conceptual skills (thinking and reasoning etc) Social skills (interpersonal skills; self-esteem, and “naivete”) Practical skills (personal care, healthcare, safety, occupational skills) There are several risk factors for ID. Kadaverak (2015) groups these risk factors into two categories namely timing (prenatal, perinatal and postnatal) and the type of risk factor (biomedical; social; behavioural; and educational). For instance, maternal malnutrition can be classified as a prenatal social risk; maternal alcohol abuse as a prenatal behavioural risk factor, and lack of adequate stimulation can be classified as a postnatal social risk factor. Kadaverak (2015) provides a more comprehensive list in table 8.1 (on pg 240). A child’s genetic makeup (a biomedical risk factor according to Kadaverak (2015)) is a significant prenatal risk factor and many genetic syndromes result in ID. Down syndrome (DS) is arguably the most well-known of these, with an incidence of 1 in 750 live births. Down syndrome accounts for 5- 6% of all individuals with ID. However, there are many other genetic syndromes. Kadaverak (2015); list 5 of the more commonly identified genetic syndromes which result in ID including Down syndrome, Williams syndrome, Prader-Willi syndrome and Fragile X syndrome in table 8.2 (pg 241). When describing the language skills of a young child with ID, many clinicians say that children with ID mirror the language developmental sequence seen in typically developing children. Language thus often follows a typical trajectory, but often at a slower rate of acquisition. Some children with intellectual disability may find it difficult to develop intentional communication, but once this skill is established children with intellectual disability are generally able to connect with others using language. In terms of language characteristics, language content and pragmatic skills are usually a relative strength. School-aged children with ID may have language learning difficulties (i.e. may struggle to use their language to learn new academic skills). This is compounded by their difficulties with short-term memory (and other cognitive processing difficulties). There is some relationship between non-verbal IQ and language abilities in children with ID, but each specific syndrome also has its own unique pattern of strengths and weaknesses. Let’s look at these patterns in children with DS. Many children with DS have delayed communication milestones (and often only produce their first words between ages of 2-3). Vocabulary is a relative strength for children with DS whereas morphosyntax abilities (including grammar) is generally more affected. Most children with DS will have difficulty producing various grammatical morphemes, including, third person singular, present progressive -ing, regular plurals, regular past tense, using the copula and auxiliary. They may also struggle with prepositions and pronouns. Children with DS may also have significant phonological difficulties, which impact on speech intelligibility. Some older children with DS may also have poor narrative skills, inadequate topic maintenance, and limited conversational repair skills (i.e. higher- level social communication (pragmatic skills). Many children with DS learn to read at a functional level. Cerebral Palsy (CP): “Cerebral palsy is a disorder of movement and posture. Cerebral palsy is caused by damage to the immature brain and always starts in childhood. Cerebral palsy is a non-progressive but not unchanging disorder of movement and posture starting in the early years of life.” (Finnie, 1997). Cerebral palsy is the result of a brain injury or a brain malformation. Neurological deficits may only become evident in the first few months and consequently CP may be diagnosed anytime during the first two years of life. The brain lesion is a result of a one-time injury and will not produce further degeneration of the brain. It was once thought that cerebral palsy was caused by complications during the birthing process. While this does happen, it is now widely agreed that birthing complications account for only a small percentage, an estimated 10 percent, of cerebral palsy cases. Current research suggests most of cerebral palsy cases result from abnormal brain development or brain injury prior to birth or during labour and delivery. As with ID, risk factors for CP can be grouped into prenatal, perinatal and postnatal factors. I have listed some examples below, but for a more comprehensive list see Hedge & Maul (2006 pg 43): Prenatal factors include maternal rubella Perinatal factors include prolonged labour, anoxia, breach delivery, negligence or medical malpractice, Postnatal factors include infections such as meningitis and encephalitis, accidents, abuse, or injury There are some risk factors which are not easily classified into the above categories and these include low birth weight (under 1500g at birth), prematurity (born before 28 weeks) and multiple births. Although many potential causes are known, it can be difficult to clearly attribute these causes in up to 40% of cases of children with CP. The overall birth prevalence of CP is approximately 2 per 1,000 live births (Oskoui, Coutinho, Dykeman, Jetté & Pringsheim, 2013). CP is diagnosed clinically based on the presence of delay in motor development and may be confirmed using brain imaging techniques (such as a MRI). One of the key features of CP is the persistence of primitive reflexes. Within the first year of life a typically developing infant integrates these reflexes into voluntary control patterns. However, with children with CP these reflexes persist beyond early infancy and are not under the child’s voluntary control. The asymmetric tonic neck reflex and the tonic labyrinthine response are 2 reflexes which are often present when the diagnosis of CP is being investigated (Bathsaw, Roizen & Lotrecchiano, 2013). The forms of cerebral palsy are generally classified as spastic (70%-80%), athetoid (10%-20%), ataxic (5%-10%), or a mixture of these. Each of these forms has specific motor patterns. Spastic CP is caused by damage to the upper motor neurons of the central nervous system tract. “Because opposing muscles are simultaneously active, the resulting movements are awkward, rigid, jerky and stiff.” (Hedge & Maul 2006, pg 436). In athetoid CP the basal ganglia and/or cerebellum is affected which results in uncontrolled, involuntary writhing, uncoordinated and/or slow movements. In ataxic CP the most common symptoms are imprecise motor skills (clumsy and uncoordinated movements), trouble walking and balancing (stumbling and awkward gait), issues with depth perception and tremors and shakiness. The muscles may be flaccid (i.e. lack tone). Ataxic CP results in damage to the cerebellum, which controls balance and coordination. A diagnosis of mixed CP is a mixture of forms, as the name implies, and the most common is a combination of spastic and athetoid CP. Extensive brain damage is present when a diagnosis of mixed CP is made. Although CP is often classified according to neuromotor characteristics (movement patterns affected) there is variability in the amount of functional movement even within the same subgroups. For this reason, several functional assessment systems have been developed. The most widely used is the Gross Motor Function Classification System (GMFCS; Palisano, Cameron, Rosenbaum, Walter & Russell, 2006). The system describes 5 levels of functioning as well as key indicators for each level across several age bands. A summary of the GMFCS can be seen in table 24.2 (Bathsaw, Roizen & Lotrecchiano, 2013, pg 434). The advantage of this system is that it is more predictive of long-term functional outcomes that the impairment focussed classification systems (Bathsaw, Roizen & Lotrecchiano, 2013). All individuals with CP present with conditions which affect movement, posture and co-ordination. However, they may also have behavioural, cognitive (intellectual) and/or communication impairments. We sometimes classify these conditions in terms of primary, secondary and associated conditions. Primary conditions result directly from brain injury sustained to areas of the brain associated with movement. So primary conditions would include difficulties with gross motor, fine motor and oral motor functioning. Secondary conditions are the result of primary conditions. For example, poor motor control (including poor oral motor functioning and positioning) may lead to feeding, swallowing and communication difficulties, which are all examples of secondary conditions. Associated conditions are not a direct result of the brain lesion in the areas of the brain controlling movement, co-ordination and posture, but often co-occur in children with CP and some of these include, epileptic seizures, hearing impairment, visual impairment and cognitive impairment/ intellectual disability. Many, but not all, children with Cerebral Palsy have an intellectual disability. A child’s language and communication ability will depend on the child’s physical as well as the degree of intellectual impairments. A general rule of thumb is that the more severe the intellectual disability the more severe the receptive language impairment. Some classifications of CP (such as children with dyskinetic /athetoid CP) may have average IQ and average receptive language abilities, but still present with severe expressive language difficulties. Many children with CP will have speech intelligibility issues relating to dysarthria, as well as feeding and swallowing difficulties. You will learn more about these characteristics in the paediatric dysphagia course. Childhood Traumatic Brain Injury (TBI): TBI is an injury to the brain sustained by physical trauma or external force. There are several risk factors for TBI which are well established. Boys are more likely that girls to experience a TBI. TBI incidence is reportedly higher in dense urban communities with low socio-economic status. According to Hedge & Maul (2006), some common causes of TBI in children include: falls motor vehicle accidents social and family violence/abuse sports related injuries domestic accidents (such as near drownings) Symptoms after a TBI vary greatly depending upon the severity and location of the brain injury. However, impairments in cognitive functioning, physical abilities, communication, and/or social/emotional behaviours are common. These impairments may be either temporary or permanent in nature and may cause differing degrees of impairment or disability. Childhood traumatic brain injury (TBI) is often referred to as "the silent epidemic," because many children have no visible impairments after a head injury. A CT scan is commonly used to detect bleeding and swelling in the brain following TBI. This may be followed up with other neuroimaging techniques such as an MRI. According to Bathsaw, Roizen & Lotrecchiano, (2013) there are 2 ways to determine the severity of TBI using clinical tools: the Glasgow Coma Scale (GCS; Teasdale & Jennet, 1974) & describing the duration of post traumatic amnesia (PTA). The Rancho Los Amigos Cognitive Scale (RLAS) is also frequently used to describe the patterns or stages of recovery typically seen after a brain injury. The scale has eight levels of the scale which describe a person’s response to the environmental stimuli and events. As individuals progress to higher levels, they demonstrate improved cognitive and behavioral states and move toward greater independence. Children who sustain TBI may experience any combination of the following characteristics: Medical/Neurological Symptoms: speech, vision, hearing and other sensory impairment, decreased motor coordination, difficulty breathing, dizziness, headaches, impaired balance, loss of intellectual capacities, partial to full paralysis, Cognitive Symptoms: decreased attention, organizational skills, and problem-solving ability; difficulty with abstract concepts; memory deficits; perceptual problems; poor concentration, poor judgment; slowed information processing, and poor memory. Behavioural/Emotional Symptoms: aggressive behaviour, depression, difficulty accepting and responding to change, loss of reduction of inhibitions, distractibility, feelings of worthlessness, lack of emotion, impulsivity, difficulty controlling their emotions. Social Skills Development: difficulties maintaining relationships, inability to respond to social interaction appropriately, inappropriate responses to the environment, insensitivity to  others' feelings, limited initiation of social interactions, difficulties with understanding to social clues and nuances, and social isolation. The nature of the injury and resulting difficulties can range from mild to severe, and although recovery will occur, the degree and rate of recovery is very difficult to predict for any given child. In addition, these children, due to the “hidden” nature of their disabilities, may be at risk for academic difficulties when returning to school after their injury. While most children with TBI return to school, their educational and emotional needs are likely to be very different from what they were prior to the injury, but it might take a while for key stakeholders to realize this as they cannot “see” any lasting effects of the injury, and so they assume the child has made a full recovery. As a result, teachers may have difficulty in setting realistic academic goals as they overestimate what the child is capable of after the injury. Language difficulties in children with TBI are often described as global or diffuse and may also be influenced by the co-occurring cognitive and emotional/behavioural TBI sequalae. Children with TBI often “appear” to regain/retain their pre-morbid spoken language skills, but wording finding difficulties and difficulties to maintain, and repair conversations, may persist for long periods after the injury. These diffuse language difficulties are often most evidence in social interaction and conversations (i.e. in the area of pragmatic and social communication). Self-directed learning task: Paul and Norbury (2014) present the general language characteristics of each of these groups in a table format on page 135 (except CP). Please consult this prescribed chapter which can be found on VULA (and the other readings in your reading list), as and develop a summary of each of the developmental disabilities discussed above. table below as a summary of the communication abilities of each group. (I have also included several additional readings for each type of developmental disability, and these texts provide additional information which is helpful). Start with the readings in bold and work your way through them first. Task 1: Describing key characteristics of developmental disabilities Autism spectrum disorder (incidence/prevalence; causes and risk factors; classification; co-occurring and/or associated conditions, language abilities (expressive language; receptive language; as well as specific issue relating to form, content, use (social communication), literacy (focus on reading comprehension); executive functioning abilities. Task 1: Describing key characteristics of developmental disabilities Intellectual disability (ID) (focus on Down syndrome (DS) (incidence/prevalence; causes and risk factors; classification; co-occurring and/or associated conditions, language abilities (expressive language; receptive language; as well as specific issue relating to form, content, use (social communication), literacy (focus on reading comprehension); executive functioning abilities. Task 1: Describing key characteristics of developmental disabilities Cerebral Palsy (CP) (incidence/prevalence; causes and risk factors; classification; co-occurring and/or associated conditions, language abilities (expressive language; receptive language; as well as specific issue relating to form, content, use (social communication), literacy (focus on reading comprehension); executive functioning abilities. Task 1: Describing key characteristics of developmental disabilities Childhood Traumatic Brain Injury (TBI) (incidence/prevalence; causes and risk factors; classification; co-occurring and/or associated conditions, language abilities (expressive language; receptive language; as well as specific issue relating to form, content, use (social communication), literacy (focus on reading comprehension); executive functioning abilities. Task 1: Describing key characteristics of developmental disabilities Craniofacial Disorders (incidence/prevalence; causes and risk factors; classification; co-occurring and/or associated conditions, language abilities (expressive language; receptive language; as well as specific issue relating to form, content, use (social communication), literacy (focus on reading comprehension); executive functioning abilities.