Chapter 10: Children with Acquired Language Disorders

TBI Statistics

- Boys are more than 2x more likely to acquire a TBI at all ages. -Nearly 4% of the general population of children KDG through 12th grade have experienced a head injury and as high as 20% in the SpEd population! -Injuries resulting from accident are reported and treated more quickly than injuries resulting from abuse.

TBI is defined as:

- an alteration in brain function, or other evidence of brain pathology, caused by an external force.

Types of Acquired Brain Injury

-LOCALIZED OR FOCAL LESIONS: confined to a small area of the brain, such as penetrating injuries (gunshot, open wounds), cerebrovascular lesions (strokes, aneurysms) or tumors. -Diffuse lesions: VAST, may encompass large areas of the brain and may be a result of traumatic head injury, poisoning or infections

Strokes and Tumors

-Strokes are usually uncommon for children -Left hemisphere strokes and cerebral incidents in children yield similar characteristics of adult aphasia. 1/3 of all childhood strokes occur before the 2nd birthday. Strokes may occur due to: -vascular malformation -cardiac disease -vascular occlusion -sickle cell disease -hemorrhage

Child Aphasia

-Typically identified as confluent regardless of the lobe affected. -Shows disturbances across all language modalities (auditory comprehension, writing, reading, naming and working memory)

What is Brocas Aphasia?

-When a stroke injures the frontal regions of the left hemisphere, different kinds of language problems can occur. -This part of the brain is important for putting words together to form complete sentences. -->Injury to the left frontal area can lead to what is called BROCAS APHASIA Survivors with Broca's aphasia: •---> Can have great difficulty forming complete sentences. •----> May get out some basic words to get their message across, but leave out words like "is" or "the." •---> Often say something that doesn't resemble a sentence. •---> Can have trouble understanding sentences. --- >Can make mistakes in following directions like "left, right, under, and after."

The most pronounced language impairments affect:

-interpersonal communication -academic performance.

What are the differences btw. developmental and acquired language disorders in children?

-they understand what their prior level of functioning was

Causes of TBI in Children:

1) INFANTS AND TODDLERS: Falls and Abuse 2) PRESCHOOLERS: Falls 3) EARLY SCHOOL AGE: Sports injury and..... Accidents: -pedestrian -bike -skateboard riders -MVA (passengers) 4) ADOLESCENTS: -Motor vehicle accidents (MVA) -Assaults

Overview of Acquired Aphasia in Children:

Aphasia, historically speaking has been used to describe 2 different conditions: 1) specific language impairment (SLI) 2) childhood/acquired aphasia. Children with acquired aphasia will develop normally, but due to a neurological trauma, they will lose all or part of their communicative ability.

Language Development and Recovery

Brain injured children differ from brain injured adults: 1. Lower risk of aphasia 2. Different language symptoms 3. Recover faster and more fully

Traumatic Brain Injury (TBI)

Every year children under the age of 14.... 1) 2685 die from TBI 2) 37,000 hospitalizations 3) 435,000 ER Visits

For children with TBI, what kind of behavioral changes do you see in them? How about for children with strokes?

For children with TBI, they turn more impulsive, more outbursts in the classroom and the they lack motivation, they have apathy, a lot of anger, depression, etc. For children with stroke, they just get very distracted and lose attention very easily.

What are the causes of the TBI in children?

Infants and Toddlers-falls and abuse preschoolers- falls (ex- in playground) early school age- sports injury and accidents adolescents- motor vehicles and ASSAULTS

Prognosis of child aphasia:

Prognosis: Language recovery is dramatic, but lowered for children who suffer seizures. Complete recovery is rare. Age interacts with factors such as anatomical development, type of injury and language development. Additionally, SES, severity, pre injury adaptive abilities are considered.

Language Development and Recovery

Since cerebral dominance develops slowly over childhood, language functions are less localized in the child's brain. Uninjured parts of the brain may be able toassume the functions of the damaged areas.

What are some social problems that are specific towards kids with TBI vs. kids with stroke?

TBI- kids behave more immaturely stroke- they are more withdrawed

Language Characteristics of Children with Acquired Aphasia

There is no single way to characterize the language abilities of children with acquired aphasia due to variability.

How is the syntax for children with acquired aphasia?

They are not talking as much- shorter utterances, shorter MLU's, hesitations, pausers, fillers

How is the language development and recovery for children with brain injuries?

They tend to have a lower risk of aphasia as compared to brain injured adults, their brains are able to develop much faster due to neuroplasticity. They have enough plasticity to help with recovery as compared to older adults.

Adult vs. child aphasia

adult- fluent or non fluent childhood aphasia- we're less apt to identify the area that has been affected.

Neuroplasticity

allows for children's brains to reorganize (by forming new neural connections) after trauma, thereby reducing the severity or even eliminating or possibility of aphasia.

Anomia

cannot name objects so there are a lot of hesitations

younger children

developmental approach to language and speech remediation

Spontaneous recovery

occurs during the first 3-12 months post incident and the nervous system is able to recover mostly functions without any need for intervention (body's ability to heal itself due to neuroplasticity )

Prognosis of adult aphasia

related to age, etiology, aphasia, type, and severity A younger age is a positive prognosticator. Prognosis: Language recovery is dramatic, but lowered for children who suffer seizures.

How is the speech production for children with acquired aphasia?

slurred speech slow rate of speech sound substitution omissions a lot of word finding and word retrieval difficulties

What are the pragmatics of people with acquired learning disorders?

they lack a lot in metalinguistic and metacognitive skills. For metalinguistic, they are not able to summarize cohesively and put their thoughts into main ideas. for their metacognitive skills, they are not aware of their impaired communicative abilities. They have a really hard time planning their responses, which are very slow (poor planning of responses)- which affects their ability to initiate a conversation, maintain, and keep up with a conversation,

TBI and CVA kids have a hard time with word finding and word retrieval:

unable to find the words they want to use- word retrieval hesitations

Toddlers and young children (< 5) recover more fully:

1. Their brains withstand the injury better 2. They have mostly spoken and some written language skills pre injury 3. They have enough plasticity to aid recovery.

Adult Aphasia

Nonfluent: speech is abrupt; speech comprehension is good; the site of the injury is the frontal lobe. Fluent: speech contains errors but produced without effort; poor speech comprehension; site of injury is the parietal and temporal lobes