SLP language disorders 3 – Flashcards
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developing language stage
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-normally speaking children between 3-5 years old -referes to Brown's stages II-V (MLU bw 2 and 5) -have expressive vocabularies larger than 50 words -have begun combining words into sentences -haven't acquired all the basic sentence structures -IDEA requires the inclusion of family in the eval and intervention processes and involvement in the IEP team
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screening for language disorders in the developing language stage
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-pont of screening: to get an idea about the child's general level of functioning in both comprehension and production -should use standardized measures -consider the child's level of risk (children with high risk who fall at the low end may benefit from additional evaluation)
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using standardized tests
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-choose a standardized test that is age appropriate and comprehensive (vs. single deficit) -may want to do a language sample as well, and analyze to get an intelligibility measure Typically assess the following areas: -receptive vocab -expressive vocab -receptive syntax and morphology -expressive syntax and morphology Not typically assessed: -pragmatics -semantic areas other than associating pictures with words
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intelligibility in developing language stage
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24 mo- 50% intelligible 36 mo- 80% intelligible 48 mo- 100% intelligible
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assessment: vocabulary
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-generally, the size of a child's receptive vocab is larger than their expressive vocab -just bc a child can produce a word doesn't mean that he knows the meaning -can be fast mapping
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fast mapping
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-child picks up a notion of a word's meaning from very brief exposure -meaning is quite limited until the child acquires additional experience with the word -child's understanding of the word meaning is more limited than the adult's understanding of the word
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assessment: receptive syntax and morphology
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-should be assessed separately -use a standardized test of receptive syntax and morphology to determine whether deficits exist -if the client performs below normal, use criterion-referenced decontextualized procedures to probe -if the child does better in contextualized format, target forms and structures that the child comprehends well but doesn't produce -if the child does not do better in contextualized format, provide more structured, less-complex input using hybrid and CD activities for both comprehension and expression
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assessment: comprehension strategies
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-important to look at what children do when they don't understand all the words and sentences in decontextualized activities-- if they use strategies that normally developing children do, they are most likely proceeding along a normal course -clients who do not may be able to take advantage of naturalistic communicative cues for comprehending and may need more structured input -ex. normally developing 2-3 y/os are able to comprehend agent-action-object, but still rely on "probable event strategy" for deciding which noun represents the agent and object of action
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assessment: expressive syntax and morphology
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-best to do this with a speech sample -spontaneous speech sample provides the most valid look at how a client uses words and sentences in natural situations advantages: -more sensitive than standardized tests for identifying preschoolers with language delays -more effective for treatment planning and outcome monitoring -a more valid reflection of a child's use of language in everyday contexts
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assessment: pragmatics
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Variety of ways to assess: -parent reports -observations of natural communication Categories of analysis when examining conversational skills: -social vs. nonsocial -topic initiation -topic appropriateness -turns/topic -discourse management -contingency -discourse comprehension
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profile of pragmatic skills of children with language disorders
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Request -less likely to be grammatically correct -fewer indirect forms used -less flexibility in choice of form Comment -less frequent than in typical pops -may be stereotypic in form Presupposition -may have difficulty judging what listeners want/need to know -marking depends more on pronouns than does that of normal speakers Turn-taking -more inadequate forms used in relating to preceding discourse -turns are shorter in length -utterances are less adjacent than those of same-age mates -less assertive about gaining turns Respond -responses are variable-- do not always provide a conversationally obligated response -responses to requests for clarification are less focused on the informational needs of the requester -more likely to be unrelated or inappropriate Speech style adjustments & register variation -speech style adjustments are made (e.g. for younger speakers) -modifications reflect fewer questions about listeners' internal states -adjustments of utterance length and complexity less finely "tuned" to the needs of the listener
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older students functioning at the developing language stage
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-older, more severely impaired clients, who may have multiple handicaps, have probably been involved in intervention for some time -for students whose nonverbal/verbal skills are at expected levels, our role may be consultative to increase client's opportunity for participating in activities with mainstream peers as much as possible
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AAC devices for older students
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-older, severely impaired clients may never complete the developmental sequence of language acquisition, even if speech is their primary mode of communication -use situations and props that are chronologically age appropriate -consider the client's functional efficacy of communication -ecological inventory: what they need to get done and how well current communication skills enable them to do it
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ecological inventory
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-allows us to assess the needs of particular environments in which the person must function, rather than the client's communication skills -with clients who are severely impaired and will probably never complete the developmental sequence, primary goal of intervention is to allow them to function as independently as possible within their world -to complete an ecological inventory, look at the major domains in which clients function and assess the communicative needs of each (domestic, occupational, recreational, general community)
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children with ASD
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When talking in multiword utterances: -70-80% of preschoolers with ASD use speech as their primary means of communication -two major patterns of language develop: 1) lang development is appropriate or superior for age, 2) lang is delayed in a way similar to that seen in other children with developmental language disorders
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assessment: children with ASD
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Standardized language measures may be misleading. -speakers with ASD can do well on structured tasks but have greater difficulty in social interactions -pragmatics is likely the area of lang most affected Parent-report measures -allow us to document a gap bw the strengths in language form and weaknesses in language use that are typically seen in ASD Direct observation of conversational skills -focus less on syntax and morphology and more on pragmatic aspects of communication -responsiveness, echolalia, pronoun use, vocab and syntax, communicative functions
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communicative functions
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-requesting -protesting -directing others -commenting -social interaction- "Hi let's play" -self-directing- "I'm gonna hide the ball" -reporting on past and ongoing events -reasoning- "The gerbil ran away 'cause we forgot to lock the cage" -predicting- "Mom will get mad" -empathizing- "She's crying 'cause she fell down"
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intervention policy issues for children in developing language level
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Individualized Education Plan -Individuals with Disabilities Education Act (2004) mandates free, appropriate education to all children with handicaps -Part B of IDEA is concerned with school-age children, but extends to 3- to 5- y/os as well -IEPs differ from IFSPs bc they're written for preschoolers and older, focus on the child rather than the family, different in content and format
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intervention goals for children in DL stage: general
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-help child acquire intelligible, grammatical, flexible forms of communication -enable the child to understand others -give tools to make communication effective and efficient so that social interaction can be as normal as possible -strengthen the oral language basis for success in literacy
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intervention goals for children in DL stage: phonology
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-children in this stage are not generally candidates for speech sound intervention unless their intelligibility is significantly impaired -speech sound and language disorders often co-exist in the same child -when an unintelligible child demonstrates syntactic and semantic deficits, morpho-syntactic deficits should be addressed first, followed by phonological targets -consider the connection bw phonology and metaphonology
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metaphonology
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-AKA phonological awareness -ability to detect rhyme and alliteration -to segment words into smaller unit, such as syllable -several studies have found that children with productive phonological impairment during the DL period sometimes have trouble acquiring PA and are at risk for reading problems
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intervention goals for children in DL stage: semantics
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-children with DLD appear to acquire words similarly to normal children, but may need to hear a new word twice as many times as other children -have difficult time learning verb vocabulary -less able to identify semantic features -need enriched input with repeated opportunities to see connections bw words and their referents -providing both semantic & phonological cues aid learning new words by preschoolers w DLD!!!
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intervention goals for children in DL stage: syntax and morphology
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-bound morphemes, articles, and pronouns are especially difficult -guided production activities facilitate both comprehension and production of new meanings and forms -production training should be a high priority for forms and meanings for which the child demonstrates comprehension -for forms and meanings that the child doesn't yet comprehend, an input component should be part of intervention as well as a production practice (focused stimulation, ILS, auditory bombardment)
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intervention goals for children in DL stage: pragmatics
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-don't define pragmatics as an additional set of rules that a child needs to learn-- see it as the context in which intervention takes place, and make sure that each new form learned is practiced in a variety of pragmatic contexts
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intervention goals for children in DL stage: play and thinking
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-much of the learning about concepts, categories, and the physical world in the preschool period comes about through language, instead of through direct perception and experience like in the sensorimotor period -children structure symbolic play through language both when they play alone and with peers -children with lang problems lag behind in these skills -in therapy, incorporate activities that encourage the child to use their language forms for pretend play, problem solving, and exploring new ideas
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intervention goals for children in DL stage: preliteracy
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-most effective interventions for children at risk for later reading problems focus on oral language instruction in preschool/kindergarten, and include explicit teaching of PA, letter-sound relationships, vocab, and lang comprehension Domains of pre literacy intervention: -phonological awareness -print concepts -alphabet knowledge -literate language -explicit preliteracy instruction in these areas have positive effects on children's readiness to read
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phonological awareness: instructional goals
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-segment words in sentences -segment syllables in words -produce rhymes -synthesize words from syllables -identify words with the same beginning/end sound
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print concepts: instructional goals
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-book reading conventions -understand metalinguistic terms (word, letter, sound) -link text to experience -recognize environmental print
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alphabet knowledge: instructional goals
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-alphabet song -recognize own name in print and the letters in it -sort upper and lower case letters -write own name
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narrative and literate language: instructional goals
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-retell stories heard -use causal conjunctions in story retells -use mental and linguistic verbs in story retells
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intervention procedures: phonology-speech sounds
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-discrimination training should only be done with sounds on which production errors occur prior to therapy -articulation drills: contrastive drills- minimum pairs, maximal opposition -drill play -computer-assisted drill practice
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articulation drills
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-contrastive drills with minimal pairs -minimal pairs: 2 words that differ by only one feature of the target phoneme -ex. sew/toe, zoo/do -contrastive drills with maximal opposition -maximal opposition: contrasts words that differ by several features -ex: sew/no, zoo/moo, fat/cat
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intervention procedures: phonology-phonological awareness
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-drill play activities that focus on sound structure of words -many packaged programs are available
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intervention procedures: semantics
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-many CD programs working on vocabulary are available -many use drill or drill play format -can use "themes" format
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intervention procedures: syntax and morphology
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-many CD commercial programs are available -preferable to supplement drill and drill play activities with more naturalistic methods that elicit imitation of the targeted forms
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indirect language stimulation
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-can take place in a variety of contexts, including play with toys or role-playing, during outdoor play, shared book reading, cooking, crafts, etc. -can provide a more contrived play setting, one in which materials have been selected for the child, activities are suggested by the clinician, play behaviors are modeled to elicit a target form Major characteristics: -contingent feedback (saying something that relates to what the child said/did) -balanced turn-taking (letting the child lead and then responding) -extension of the child's topic
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language elicitation techniques
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-violate routines (targets protest, request, negative sentence) -violate expectations (targets comment, protest, negative sentence) -withhold objects or turns (targets protest, request, negative sentence) -misuse objects (targets comment, verbs) -misname objects (targets comment, negative sentence, spatial terms) -misplace objects (targets comment, negative sentence, spatial terms) -provide inappropriate objects for activity (targets comment, labels, negative word combinations) -pass it on (request for information) -"strong, silent type" (request for information) -expansion invitation (infinitive)
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child-centered approaches: facilitative play
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Play has many advantages: -highly motivating -permits the integration of content, form, and function -encourages the child to bring knowledge of "scripts" for everyday events to the foreground where this knowledge can support language use -provides opportunities for elaborating existing scripts through enacting a wider set of roles/possibilities that are present in reality
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child-centered play contexts
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Can be used to develop a variety of language skills: -enhanced narrative ability -facilitating turn-taking -increasing opportunities for decontextualized language -enhancing the expression of communicative intentions -increasing vocabulary -developing emergent literacy
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hybrid approaches: phonology
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Hodson's Cycles Approach -intervention for unintelligible children
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Hodson's Cycles Approach: principles
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Based on the following principles: -need to develop strong auditory models for target sounds -developing kinesthetic patterns to match these auditory images -use of a phonetic environment to facilitate correct sound production -child's active involvement in phonological acquisition
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Hodson's Cycles Approach: session layout
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Each session has the following components: -review the targets from the previous session -provide auditory bombardment for target sounds using amplification -practice production of a small number of words containing the target sounds or syllable shapes in drill play -identify new words for the next cessions production practice by identifying 2-5 target words in which the child can pronounce the target sound or syllable correctly -repeat the auditory bombardment segment -give parents the list of words for auditory bombardment to read to the child at home bw sessions
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focused stimulation
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-focuses on specific grammatical forms and uses multiple models with a variety of forms of clinical feedback to stimulate language -can be used for targets including syntax, morphology, vocabulary, pragmatics, and phonology -forms that the child uses less than half the time correctly in obligatory contexts are considered high priorities
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focused stimulation procedures
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-demonstrating use of targets -expansion -recast -buildups and breakdowns -false assertions -feigned misunderstandings (clinician pretends not to get the child's message) -forced choices -other contingent queries (used to encourage client to provide missing info) -violating routines -withholding objects and turns -violating object function -"syntax stories"
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script therapy
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-scripts reduce the cognitive load of language training by embedding it in the context of a familiar routine -can establish a routine, then violate it, encouraging the child to comment on or correct the violation -can also "play" with the script by changing it up -use event structures that the child is familiar with -songs and nursery rhymes can be used -finger plays or songs and rhymes that lend themselves to acting out -using literature-based script therapy provides "homework" activity for families
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literature-based scripts
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-joint book reading provides an excellent opportunity to scaffold the child's contribution to the interaction -joint book reading can promote vocabulary growth, grammatical development, social communication, and pre literacy Joint book reading must be structured in these 3 important ways to be effective: 1) use carefully planned, scaffolded language input, 2) select books that provide opportunities for the client to practice forms and meanings being targeted, 3) use the books as an opportunity for language production practice
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activities for enhancing interactions with preschool storybooks
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-questions -joint story retell -expectancy violation detection (retell the story making errors) -picture walk (before reading the book, hand it to the child and ask him to say what the story will be about) -print referencing activities
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print organization
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-page order -author -page organization -title -print direction
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print meaning
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-print function -environmental print -concepts of print
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letters
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-upper and lower case -letter names -concept of letters
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words
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-word identification -short vs long word -letters vs words -concept of word
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structured play: conversation
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-SLP ensures that the guided conversation supports the skills being targeted Two types of conversational behaviors can be targeted: 1) assertive skills 2) responsive skills
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assertive skills
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engage child in entertaining interaction in which they must do something to sustain the interaction
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responsive skills
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set up turn exchanges in fairly structured situations so that turn exchange points are explicitly marked
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structured play: narrative
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-narrative skills are closely related to academic success -narrative contexts provide opportunities for addressing a variety of other aspects of communication including vocabulary, syntax, morphology, and verbal memory -story re-enactments
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service delivery models
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-clinical model -language-based classroom -consultant model -collaborative model
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clinical model
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-one-to-one or small group intervention -good for children with attention problems -may be less effective at achieving generalization
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language-based classroom
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-a classroom especially designed to provide intensive language stimulation and training -provide opportunities to work as a team to improve language and preliteracy skills for children
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consultant model
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-SLP and teacher jointly identify ways to provide IEP based instruction that is embedded into everyday classroom routines
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collaborative model
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-demonstration teaching and team teaching
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ESSA
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-Every Student Succeeds Act (ESSA) replaces No Child Left Behind- signed Dec 2015 -takes affect 2016-2017 school year -returns much of the authority and decision-making on student testing and accountability for student testing and accountability for student progress to states and local school districts -expands early intervention services -expands literacy services
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READ Act
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-Research Excellence and Advancements for Dyslexia Act -supports important research to further our understanding of dyslexia, including better methods for early detection and teacher training -Dear Colleague: Dyslexia Guidance clarifies that there is nothing in IDEA that would prohibit the use of the terms dyslexia, dyscalculia, and dysgraphia in evals, eligibility determinations, or in developing IEPs
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Section 504 of the Rehabilitation Act of 1973
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-provides equal protection for individuals with physical and mental disabilities -does not provide funding for services -requires accommodations to allow students to participate in general education -children with 504 plans do not receive an IEP -504 plans used to support children who don't qualify for one of the twelve diagnoses
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types of accommodations on 504
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-physical arrangement -lesson presentation -assignment/worksheets -tast taking
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pre-assessment and referral under RTI
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-many school systems use the RTI model to resolve learning problems within the regular education setting by providing classroom modifications and accommodations that can prevent the need for special ed or for labeling a student as special ed -RTI approaches most often seen in reading instruction in the primary grades
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tiers of RTI
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Tier I- high quality, scientifically research-based classroom instruction for all students in general education, with ongoing curriculum-based assessment and continuous progress monitoring Tier II- students who lag behind peers receive small group, more specialized instruction to prevent failure within general education Tier III- students who continue to struggle after small group instruction in tier II. individualized instruction may be provided. if adequate progress isn't made, evaluation is conducted to determine special ed eligibility
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SLP's role in the implementation of RTI
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-participating in the design of Tier I instruction -collaborating with general education teachers in presenting Tier I instruction -serving students by providing small group and individual instruction at Tiers II and III and assessing to identify struggling students and monitor progress
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determining eligibility
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-responsibility of school SLP to decide whether a student referred for SLP services meets district eligibility criteria -eligibility criteria vary from state to state (and sometimes district to district) -in districts that employ RTI, a student may be required to be tried at all three RTI levels before a referral for special ed can be made -IDEA requires that whatever impairment the child has MUST adversely affect academic performance if services are to be provided
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Individualized Education Plan
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-when a student is deemed eligible for special ed services, the IEP includes a summary of the assessment information gathered on the child -the law requires that multiple assessments be used, so that children are not identified as having a disability based on only one test -informal, observational, parent or teacher interview, and language sampling, as well as standardized tests can be part of the assessment -assessment must also include info on how the child's disability affects participation and progress in academic and social environments
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annual goals on an IEP
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-IDEA requires that annual goals be designed to help the child participate and make progress in the general curriculum -goals must be linked to the general curriculum and be measurable and achievable within 1 calendar year
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short-term objectives
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-discrete steps toward the annual goal -objects should conform to the SMART acronym -each short-term goal as 4 components
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SMART
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-used for short-term objectives Specific Measurable Attainable Relevant Teachable
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components of short-term objective
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-conditions (given a list of 10 words and 10 meanings) -descriptive of specific behavior (match word to its meaning) -criterion (with 80% accuracy) -evaluation (as measured by end of unit tests)
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benchmarks
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-describe the amount of progress a student is expected to make during each segment of the school year -translate made level standards into concrete things the student can do
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services, modifications, and accommodations
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-IEP must state the amount and type of educational services the student will receive -for children over 14 years of age, transition planning to post-secondary settings must also be part of the IEP -support, such as assistive devices, modification of transportation, educational accommodations must be stated on the IEP
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delivery of services
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-under IEP regulations, SLPs no longer work separately on a set of language goals and activities they develop on their own -whether seeing students in individual therapy sessions, with a small group within a classroom activity or alongside the classroom teacher in the collaborative model, language activities are drawn from the general education curriculum -goals address helping the student progress through it
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inclusion
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-IDEA 2004 reauthorization places greater burden on local education agencies to justify any placement that is not full-time in a mainstream classroom -the law requires that there be a continuum of services to meet the needs of children who are not placed i the mainstream full-time
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learning disability: definition
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-a disorder in one or more of the basic psychological processes involved in understanding or in using language (spoken or written) that may manifest itself in an imperfect ability to listen, think, speak, read, write, spell, or do mathematical calculations -includes conditions such as perceptual disabilities, brain injury, minimal brain dysfunction, dyslexia, and developmental aphasia -do not include learning problems that are primarily the result of visual, hearing, or motor disabilities, ID, emotional disturbance, or of an environmental, cultural, or economic disadvantage
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language-learning disorders (LLD)
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-LDs that affect primarily reading, writing, spelling -Reading disorder is most common LLD -refers to a group of poor readers whose weak language skills play a causal role in their reading difficulty
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LLD- expressive phonological characteristics
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-school-age children with LLD do not necessarily have obvious errors in their speech sound production -speech is generally intelligible -findings suggest a higher prevalence of speech sound disorders in children with LLD -reading outcomes are the poorest for children with the most severe phonological disorders -even though children with LLD don't have significant artic disorders, they often show difficulty with speech perception, phonological memory, and PA
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LLD- phonological processing
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-weak phonological processing (phonological awareness, phonological memory, rapid naming) -source of these difficulties is in establishing and retrieving accurate phonological representations of verbal material -no difficulty with memory tasks of nonverbal stimuli or environmental sounds
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LLD- syntactic/morphologic characteristics
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-deficits in comprehension and production of complex syntax are widely reported in children with LLD (understanding sentences with relative clauses, passive voice, or negation) -they do not make many errors in spontaneous speech, but more than typically developing peers -error rates are higher in writing -language output is considered simple or immature -morphological problems are common, accounting for 2/3 of the syntactic errors (/s/ in plurals, possessives, third person singular; comparative and superlatives; irregular forms; advanced prefixes and suffixes)
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LLD- semantic characterisitics
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-have smaller vocabs that are restricted to high-frequency, short words vocab deficits likely a result of reading problems rather than the cause -knowledge of word meanings is restricted -difficulty with multiple meaning words -excessive reliance of nonspecific terms (thing, stuff) -beyond word level, difficulties in understanding complex oral directions, producing and understanding figurative language, producing narratives
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LLD- pragmatics
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-limited verbal fluency -prone to disruptions such as false starts, circumlocutions, and other forms of dysfluency -don't talk much, and what they say is brief and unelaborated -conversational pragmatics may be the most significantly impaired area for the child
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LLD- general characteristics
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-commonly have problems in a variety of language domains -many students with LLD continue to have "underground" deficits in phonological processing, even when phonological production sounds okay -semantic deficits may be related to phonological processing problems -some have errors in morphology and syntax, but these errors aren't obvious -pragmatics may be an area of obvious deficit
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language, learning, and reading comprehension
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-teacher talk and the hidden curriculum -decontextualized language -classrooms and culture clash -metalinguistic skills -metacognitive skills and self-regulation
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teacher talk
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-classroom discourse- school talk is different from how we talk to our friends and family -teacher chooses topic and students must comment -turn-taking rules -students must be able to read subtle verbal and nonverbal cues about when they can speak, what they can say
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hidden curriculum
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-only a small part of the structure of classroom discourse is ever verbalized by the teacher -the rest is part of the hidden curriculum -unspoken set of rules and expectations about how to behave and communicate in the classroom -for many students with LLD, difficulties in classroom discourse are likely to trigger the referral of special ed than academic failure
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decontextualized language
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-great deal of classroom language is decontextualized -differs greatly from typical conversation in most homes -children from middle class homes are more likely to be exposed to decontextualized language than children from poor homes
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classroom and culture clash
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-classroom discourse is a structure peculiar to mainstream Western culture -different cultures use language for different purposes-- each culture has own rules about how children participate in interactions -knowledge of the way to talk in school is often assumed by teachers and never taught explicitly
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metalinguistic skills
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-the ability to use language to talk about language-- necessary for success in school -much of classroom curriculum involves the ability to focus on or talk about language -defining words -synonyms, antonyms, and homonyms -diagramming sentences and identifying parts of speech -recognizing grammatical and morphological errors in writing -skills needed to acquire reading and spelling all require the awareness of language beyond the ability to use words and sentences to communicate
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metacognitive skills and self-regulation
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-metacognitive ability = the ability to reflect on, talk about, and manage one's thinking processes -student needs to figure out what needs to be done and do it -create a plan, carry it out, evaluate completion -comprehension monitoring is one example -ability to control impulses is important -metacognitive skills provide the foundation for executive functioning or self-regulation (attention, planning, impulse control, organizing when faced with a complex task)
