Language Disorders Exam 1

Form- what are some characteristics of DLD

*Form: syntax, morphology* -Deficits in grammar are hallmarks of DLD across languages -The most consistently reported finding in English is that young children with DLD omit morphosyntactic markers of grammatical tense in spontaneous speech -Because these grammatical forms are typically acquired by the age of 5, persistent errors in older children are a sensitive indicator of language disorder 1. Errors in speech production and poor phonological awareness Ex: The ability to manipulate sounds of the language, particularly in the preschool years 2. Errors in marking grammatical tense, specifically the omission of past-tense -ed and third person singular -s, as well as omission of copular "is," and errors in case assignment Ex: "Him run to school yesterday." 3. Simplified grammatical structures and errors in complex grammar Ex: Poor understanding/use of (1) passive constructions (e.g., "The boy was kissed by the girl."), (2) Wh- questions, and (3) dative constructions (e.g., "The boy is giving the girl the present.") *Although grammatical errors are a striking feature of DLD, it is not the case that children with DLD completely lack grammatical knowledge. Instead, children are inconsistent in their application of this knowledge, behaving as if certain grammatical rules were "optional"*

Aspects and Modalities of Language Disorders: form, content, use: (evidence from clinical reports over time)

*Form: syntax, morphology* •Most reported finding in English: young children with DLD omit morphosyntactic markers of grammatical tense in spontaneous speech •Errors in grammatical forms in older children are an indicator of language disorder *Content: semantics, vocabulary knowledge, knowledge of objects and events* •Impoverished vocabularies throughout development •When older: the problem becomes what they know about words (e.g., that words can have more than one meaning) *Use: pragmatics* •Pragmatic skills may be immature or qualitatively abnormal, as in the case of ASD •Difficulty understanding and applying pragmatic rules *Important note: Not all of these features will be present in all children with a diagnosis of DLD, and the features that characterize a child at one age may be very different to the features that stand out as that child gets older.*

· Are there subtypes of developmental language disorder?

*Probably not* -The presence of a language disorder tends to be stable over time, the nature of that language disorder is likely to change ex: children may start off with a predominantly lexical-syntactic pattern of language disorder, but, as they grow older, may more closely resemble children with pragmatic language concerns -Instead of subtypes, usually clinicians agreed to describe dimensions of language strength and deficits.

Why do we use the separate terms speech, language, and communication when a single word label might be preferable?

*Speech, language, and communication do not always go together, although impairments in one area may well influence development or competencies in another. The three are not mutually exclusive and do not always occur TOGETHER in individuals with DLD* Ex: a child with a speech sound disorder (SSD) typically produces a restricted range of speech sounds, rendering spoken output unintelligible. This is likely to affect the ability to communicate, because conversational partners may not always understand the intended meaning. --> Nevertheless, the child may have normal language skills, understanding what others say and using grammatically complex sentences. She may also have a typical drive to communicate,supplementing impaired speech with gestures and reformulating spoken output in order to be understood.

Cognitive Models of DLD- Limited Processing Capacity pg 20

*The theory is that there is a trade-off between processing and capacity so that when processing demands increase, capacity for recall is reduced and vice versa. If this is true, children with DLD would be expected to have greater difficulty processing sentences of increasing length and complexity. Indeed, such a relationship has been consistently demonstrated in young people with DLD* perceptual deficits are more detrimental to language development in the context of a system that has limited capacity to hold information in store while processing perceptually challenging input Evidence for a limited capacity system stems from poor performance on tasks of working memory and phonological short term memory (see Vance, 2008; Archibald, 2016 for review). Measures of working memory typically require children to make true/false judgements about simple statements such as "balls are round" and "pumpkins are purple" (the processing component) and then recall the last words of each statement, "round" and "purple" (the capacity component). it has been argued that a deficit in NWR could lead to a host of language deficits

History of Language Disorders

*Timeline* Descriptions of a syndrome of language disorders in children date back to the late eighteenth and early nineteenth century For the first century of its existence, the study of language disorders was dominated by neurologists, focusing attention on the physiological substrates of language behavior In the mid-20th century, other medical professionals took an interest in children who seemed to be unable to learn language but did not have intellectual disabilities or deafness. Until the 1950s, no unified field addressed the problems of the language-learning child In the 1960s and 1970s, as child language research expanded in focus from syntax to semantics to pragmatics and phonology, language pathology followed in its footsteps, broadening our view of the relevant aspects of language that needed to be described and addressed in clinical practice As the twentieth century drew to a close, rapid developments in our understanding of genetics and our ability to study brain structure and function in situ greatly enriched the field of language pathology

Etiology of DLD- genetic factors (biological factors) pg 13

*these are differences in genetic risk and neurological structure and function associated with disorder* -The causes of both primary and secondary DLD and say that it is likely that multiple risk factors for disorder will co-occur to give rise to a diagnosable condition. - These risks may arise from a biological disposition, from the child's prenatal or postnatal experiences, or from chance events. Clinicians and researchers have known for some time that DLD tends to run in families,suggesting that genes may influence susceptibility to disorder --> We cannot be sure of this, however, because families share environments as well as genes Twin studies have been invaluable in establishing that DLD is a highly heritable disorder- MZ twins resemble each other with respect to DLD diagnosis more closely than DZ twins, with heritability estimates (i.e., the proportion of variance explained by genetic relationships) of 0.50 to 0.75 -the most severely affected children are ones who have multiple deficits. -a person with a genetic risk factor on chromosome 13 may not experience language disorder unless they also have BDNF risk alleles, in which case language disorder is highly likely -genes can have different effects in different people; genes once thought to primarily involved in autism or epilepsy, for example, can confer risk for language disorder when these gene variants occur with different background effects -it is most likely that multiple genetic variations affect the efficiency and function of gene expression in the developing brain -it is important to note that the genes that have been implicated in DLD have also been implicated in a host of other neurodevelopmental disorders including ADHD dyslexia, ASDs and intellectual disability --> these disorders show at least partially overlapping etiologies may help explain the high rates of comorbidity seen in developmental disorders -How subtle variations in genes impact neural development in a way that adversely affects the course of language development and why language should be particularly vulnerable across disorder groups are empirical questions that will occupy researchers in this field for a long time to come -knowing that genetic factors are involved can assist with prognosis and be reassuring to families in noting that they are not to blame for their child's language difficulties, because we have no control over what genes we inherit or pass on.

What are the 3 language disorders that together will form the bulk of the SLP caseload?

-DLD -Language Learning Disorder -Secondary Language Disorder

Is there a gene for language?

-Family and twin studies show that genetic factors exert a strong influence on language development and disorders -However, it is equally clear that we are unlikely to discover a "gene for language" *Instead, it is probable that multiple genes of small effect alter the way the brain develops in subtle but important ways, rendering the developmental path from genes to brain to behavior extremely complex and difficult to predict* -We now know that children with language impairments in the absence of other syndromes do not have obvious neurological lesions that could explain their language difficulty. -In fact, children with early focal brain lesions have much more subtle deficits in language learning than children with DLD

Samuel T. Orton (1937)

-Neurologist, "father of the modern study of child (or developmental) language disorders" He emphasized the importance not only of neurological but also of behavioral descriptions of the syndrome and pointed out the connections between disorders of language learning and difficulties in the acquisition of reading and writing.

Gall (1825)

-One of the first to describe children with poor understanding/use of speech and to differentiate them from those with intellectual disability. -The disorders he first identified were thought to parallel the aphasias that neurologists, such as Broca and Wernicke were studying in adults.

Chomsky's (1957) theory of transformational grammar

-The study of language itself was revolutionized by the introduction of Chomsky's (1957) theory of transformational grammar --> this innovation led to an explosion in research on typical child language acquisition that our new discipline could use. -In the 1960s and 1970s, as child language research expanded in focus from syntax to semantics to pragmatics and phonology, language pathology followed in its footsteps, broadening our view of the relevant aspects of language that needed to be described and addressed in clinical practice.

Diagnosing a language disorder

-There is no right answer. The field has not evolved a gold standard diagnostic scheme that is universally accepted -The diagnosis of language disorder rests largely on the integration of information from several sources by the clinician, whose training and experience allow the balancing of test score data with additional input about significant others' appraisal of the child's performance in important contexts (like school and home) and conclusions drawn from observing and analyzing samples of behavior and language in those settings.

Myklebust (1954)

-Went the furthest in establishing a new and distinct field of study and practice, which he dubbed language pathology. -Like Morley and McGinnis, he was interested in differential diagnosis and developed schemes for classifying language disorders in children, which he called auditory disorders, distinct from deafness and intellectual disability. -He was also concerned with the continuities between disorders of oral language and their consequences for the acquisition of literacy. *In founding the new discipline of language pathology, he pointed the way toward considering language disorders in this broad context, including difficulties not only in producing and comprehending oral language but also in the use of written forms of language.*

Language in the adult brain

-a great example of localization and functional specialization. -In most individuals, language processing is "left lateralized," meaning it is processed predominantly by structures in the left hemisphere. As a result, the cortical structures that process language tend to be larger in the left hemisphere than homologous structures in the right hemisphere. -Critical cortical areas for language are situated in the frontal and temporal lobes. Within the frontal lobe, the inferior frontal gyrus includes the pars opercularis and the pars triangularis, which together form Broca area.

Descriptive-Developmental Approach (Paul, Norbury, & Gosse, 2018)

1. Etiology •Causes of most language disorders - not known •Etiology useful to understand child's condition •Need more than etiology to develop an intervention program *as important as etiology is for understanding a child's condition, we need something in addition to develop an intervention program. That something is a detailed description of the child's current language function.* 2. Describe language skills as you see them •Work directly on language forms/functions, not memory, auditory perception, etc -don't address "auditory processing"or "verbal memory," we work on functional understanding and use of sounds, words, and sentences in real communicative contexts. -research done over the past 20 years support the notion that treating language goals directly results in improved language behavior, especially for expressive language behavior. *it is much more important to detail the child's language skills themselves than to have extensive information on memory, auditory perceptual or perceptual-motor abilities, or skills typically tested in "auditory processing" test batteries*- why? bc we don't always know the direction of causation when children with language problems perform poorly on "bottom-up" processes like these. 3. Use a developmental perspective •Normal development sequence -the best way to decide what a child should learn next in a language intervention program is to determine where he or she is in the sequence of normal development and what the next phase of normal development for that form or function would be.

Why do clinicians doubt that there are subtypes of DLD?

1. One assumption here is that the biological mechanisms that give rise to a particular subgroup differ from those that give rise to other types of language difficulty. At the moment, there is simply insufficient evidence that this is the case. 2. A second concern is that these subtyping systems rarely take development into account. Longitudinal studies have demonstrated that although subgroups appear to exist throughout the school years, the children that make up those subgroups move fluidly between them overtime

Why did people use mental age, rather than chronological age, as a reference point to decide whether a child has DLD?

1. We usually would not expect a child's language skills to be better than the general level of development, although this does sometimes happen Lahey: She took position against cognitive referencing. Lahey pointed out that many psychometric problems are associated with measuring mental age. -For one, it is not psychometrically acceptable to compare age scores derived from different tests of language and cognition that were not constructed to be comparable, were not standardized on the same populations, and may not have similar standard errors of measurement or ranges of variability -Second, there are fundamental problems in using age equivalent scores at all to determine whether a child's score falls outside the normal range. Lahey also emphasized the theoretical difficulties of assessing nonverbal cognition, centering her argument on the justification for deciding which of the many possible aspects of nonlinguistic cognition ought to be the standard of comparison. For all of these reasons, Lahey suggested that chronological age is the most reliably measured benchmark against which to reference language skill to identify language disorder

Although a child does not have a typical DLD presentation (the one who has trouble learning to put words together to make sentences) and instead has more issues in social communication, what should a clinician do to make sure that he receives the proper services?

A child's primary manifestation of a language disorder may be in social communication, not in the understanding or production of sounds, words, or sentences. -It is important that a definition of language disorder allow a child such as Tommy to qualify for services, even though his problem is confined to the use of language for communicative purposes, with structural aspects of language relatively unaffected.

Developmental language disorder (DLD)

A language disorder not associated with a known biomedical etiology *This occurs when language impairment is the most salient presenting challenge* Characteristics: Children (1) for whom language impairments are the most salient presenting challenge, (2) for whom the biological cause of disorder is not yet known, and (3) for whom no other diagnostic label is appropriate

Naturalistic perspective of language disorders

ASHA's definition assumes a naturalist perspective in which impairment is characterized as a deviation from the average level of ability achieved by a similar group of people. In this case, it is useful because it covers a broad range of language behaviors across different modalities. However, it does not help the clinician decide what differences in language behavior constitute an impairment or at what level of impairment intervention is warranted.

Cognitive Models of DLD- Auditory Processing

Auditory accounts of DLD have argued that children with DLD have difficulties perceiving sounds that are presented rapidly, are of brief duration, and therefore are not perceptually salient Such deficits could conceivably lead to problems perceiving and categorizing meaningful phonemic contrasts, leading to problems with language learning many grammatical contrasts in English are signaled with unstressed phonemes of brief duration occurring in a rapidly changing speech stream; thus, a general impairment in temporal or perceptual processing could lead to highly selective impairments in grammatical processing -while auditory deficits are more common in children with DLD, not all children are affected and some children with auditory deficits do not have any language difficulties -intervention studies have indicated that improving auditory skills does not confer improvements to other aspects of language or literacy, calling the causal relationship into question

Levels of explanation for developmental language disorder (DLD).

Biological factors: Differences in genetic risk and neurological structure and function associated with disorder Cognitive factors: Differences in perception and information processing associated with disorder Behavioral features: Overt differences in behavior that characterize the disorder *Environmental factors: External experiences that either increase risk of disorder or that are protective in the face of biological risk = this influences all levels*- examples on page 13

International Classification of Functioning: Implications for Diagnosis and Treatment: body function

Body function Includes: Speech, language, communication, and literacy Diagnosis: Q: What is the child's level of communication functioning? Method: Standardized assessment of speech, language, communication, and literacy Treatment Planning: Identify aspects of speech, language, communication, and literacy that are below chronological age expectations.

Speech-Language Impairment

CFR 300.8 (c)(11) *Speech or language impairment means a communication disorder, such as stuttering, impaired articulation, a language impairment, or a voice impairment, that adversely affects a child's educational performance* (Idea 2004)

Cognitive Models of DLD

Cognitive theories of DLD have attempted to explain why language may be disproportionately impaired relative to other developmental achievements. -->In particular, the disproportionate difficulties with grammar and morphosyntax that characterize DLD suggested a "selective" deficit in grammatical knowledge *The conclusions from theoretical studies of DLD are that there is unlikely to be a single cognitive factor that can cause the variety of language profiles seen in DLD.* -Auditory processing/perception -Limited processing capacity -Procedural deficit hypothesis -Clinical implications for descriptive developmental model of DLD

When would a child qualify for a diagnosis of Developmental Language Disorder?

Consider the components of our label: 1. Developmental indicates that a problem arises in childhood 2. Language refers to the code we use to communicate (spoken or written) 3. Disorder suggests a significant deviation from the typical developmental trajectory = DLD Issues: 1. Developmental also suggests a changeable target; the challenges that each needs to overcome require very different approaches. Ex: a 4-year-old with language disorder will look quite different from a 14-year-old with language disorder 2. Language itself is a multifaceted and highly interactive system that can be conveyed in different modalities. Ex: spoken language or written text 3. In a behaviorally defined disorder, the point at which a problem becomes a significant deviation from normality is often an arbitrary decision. *Both standardized/norm-referenced (test scores) and criterion-referenced (functional assessment) criteria are used*

Broca's area

Controls language expression - an area of the frontal lobe, usually in the left hemisphere, that directs the muscle movements involved in speech.

Language Learning Disorder

DLD + literacy disorders (e.g. dyslexia and poor reading comprehension) *must include that literacy disorder component!* -they are referred to as having language learning disorders to call attention to the consequences of their difficulties on academic achievement

Developmental language disorder (DLD) involve what in order to achieve language learning?

DLD likely involves the whole brain and altered connectivity in regions important for language learning

Evaluating the Impact of Language Disorders on Daily Living?

DSM-5 and the WHO International Classification of Disease—10 (2004) stresses the importance of evaluating the impact of disorder on everyday well-being -This framework considers the biological impairment in body structure or function (including psychological function) experienced by the individual and how that impairment interferes with the individual's activity and participation in daily events. -Finally, consideration of contextual factors is advocated. These include social attitudes and beliefs about impairment but also practical obstacles to well-being. Contextual factors are not considered in diagnosis—in other words, a child from a culturally different background should not be diagnosed with a language disorder simply because he or she cannot access the school curriculum due to language differences. However, for children with language disorder, identification of key activities and participation and the contextual factors that facilitate or hinder this participation can assist intervention planning World Health Organization- International Classification of Functioning , Disability and Health (2001): -Body function- Speech, language, communication, and literacy -Body structure- Structure of the nervous system The eye, ear, and related structures Structures involved in speech -Activity and participation- Learning and applying knowledge General tasks and demands Communication Self-care Domestic life Interpersonal interactions and relationships -Contextual factors- Products and technology Natural environment and human-made changes to environment Support and relationships

Content- what are some characteristics of DLD

Delayed acquisition of first words and phrases Restricted vocabulary and/or problems finding the right word for known objects *tend to have impoverished vocabularies throughout development, but their semantic difficulties extend beyond the number of words available to them.* 1. Children with DLD struggle with vocabulary: -slow to learn new words -have difficulty retaining new word labels -encode fewer semantic features of newly learned items -require more exposure to novel words in order to learn them Ex: uses the word "thing" for most common objects Ex: often make naming errors for words they do know, for instance, labelling "scissors" as "knife" or using less specific language,such as "cutting things." 2. As children grow older, they struggle with knowledge of the different meanings of words: -the problem may not be how many words the child knows but what the child knows about those words. Ex: children with DLD may not realize that words can have more than one meaning, for example that "cold" can refer to the temperature outside, an illness, or a personal quality of unfriendliness. This lack of flexible word knowledge may account for reported difficulties in understanding jokes, figurative language, and metaphorical language, all of which draw on in-depth knowledge of semantic properties of words, and how words relate to one another 3. Children struggle with verbs -Problems acquiring verbs may have implications for learning about sentence structure because of the unique role verbs have in determining other sentence constituents (arguments) and in signaling grammatical tense

McGinnis (1963)

Developed the "association method" for teaching language to "aphasic" children. -Identified the Aphasias -This method was very influential in the development of the field of language disorders, providing the first highly structured, comprehensive approach to language intervention. -The first to distinguish two types of language problems seen in children, what she called: (1) expressive, or motor, aphasia (also called expressive language disorder) (2) receptive, or sensory, aphasia (or receptive language disorder).

Diagnosing and clinically treating DLDs

Diagnosis •Integration of information from several sources •Balance test score data with additional input from significant others •Draw conclusions from observing and analyzing samples of behavior and language in multiple settings Clinical competence involves judgment •Draw conclusions from information integrated from a range of sources

How can children with developmental language disorders differ in their presentation?

Differ in their speech, language and communication abilities -Researchers and practitioners often make a distinction between speech, language, and communication in order to highlight the child's most salient difficulty Ex 1: one child may may not have difficulties producing speech sounds, but his ability to communicate may be limited by poor understanding of what others say to him, limited vocabulary, and reliance on simple and immature sentences. However, he may still use these limited language skills to share his thoughts and experiences with other people. Ex 2: other children may have perfect articulation, exceptional vocabularies, and be able to express themselves using long and grammatically-complex sentences; yet their communication skills are limited by odd and tangential speech, repetitive language, and a reduced ability to repair breakdowns in conversation

When is use of mental age scores helpful?

Even if we do not use mental age discrepancy criteria to identify children with DLD (cognitive referencing), information about mental age may still provide us with some guidelines to help determine the goals of intervention and can build an evidence base regarding response to treatment By getting a general idea of a child's developmental level, through standardized tests as well as through instruments that measure adaptive behavior, we can determine what behaviors are reasonable to target in an intervention program. Ex: we would not expect a child with intellectual disability to work on language goals appropriate for his or her chronological age, even if that age were used as the reference point to identify the need for language intervention--> Instead,we would want to evaluate the child's current level of functioning and target language behaviors that are both just above current developmental level and are important for success in the child's immediate home or school environment

Environment and DLD

Family socioeconomic status (SES) has long been associated with language development; children from families with low SES have protracted rates of language development relative to peers from more affluent environments the relationship between SES and language impairment is mediated by maternal education, via the quantity and quality of mothers' interactions with their children other studies have found that SES (measured by income or maternal education) is not a reliable predictor of long-term language impairment environments are often at least partially genetically influenced; limited maternal/paternal education and lower incomes may reflect parental language impairments --> DLD in the context of low SES should alert clinicians and educators to the need for careful monitoring and language support exposure to two or more languages does not cause or compound DLD (Kohnert, 2010; Paradis, 2016) and families are advised to provide rich linguistic input to their children in whichever language they themselves are most comfortable speaking.

Do phonological problems have a physical basis? (form)

For the most part, phonological impairments do not have a physical basis. -Instead, these deficits arise from problems with phonological processing. -Phonological processing encompasses a range of behaviors, including the ability to discriminate and categorize speech sounds, produce speech sounds and meaningful phonemic contrasts, remember novel sequences of speech sounds, and manipulate the sounds of the language. *Children with DLD may therefore fail to recognize which sounds are important for signaling meaning in language, with implications for vocabulary and grammatical development.*

What Is the Impact of Language Disorders on Daily Living?

Functional impact •Normative position stresses that language disorders must involve a significant deficit relative to environmental expectations --> This means that it must be a deficit big enough to be noticed by ordinary people such as parents and teachers— not just language development experts—and one that affects how the child functions socially or academically in his or her immediate environment One challenge for this perspective is that certain types of language impairment are more readily apparent to non-specialists. For example, children referred for professional assessment are more likely to have overt difficulties with speech sounds or immaturities in expressive language -Subtle problems with language comprehension may be more easily missed; however, these subtle difficulties may manifest in poor scholastic attainment, social difficulties, or behavioral problems

Gesell and Amatruda (1947)

In the mid-20th century, other medical professionals took an interest in children who seemed to be unable to learn language but did not have intellectual disabilities or deafness: -Gesell and Amatruda devised innovative techniques for evaluating language development and recognized the condition that they called infantile aphasia.

International Classification of Functioning: Implications for Diagnosis and Treatment: Activities & Participation

Includes: Learning and applying knowledge General tasks and demands Communication Self-care Domestic life Interpersonal interactions and relationships Major life areas Community and social life Diagnosis: Q: Are there daily activities that are more challenging as a result of speech, language, communication, or literacy impairments? Method: Direct observation of child in different contexts (i.e., home or school), parent/teacher questionnaires, and discussion with child Treatment Planning: Prioritize communication intervention in key areas of daily living (e.g., taking public transport, using the computer to contact friends, ordering food in a cafe). Develop strategies to alert others to communication needs.

International Classification of Functioning: Implications for Diagnosis and Treatment: Contextual Factors

Includes: Products and technology Natural environment and human-made changes to environment Support and relationships Attitudes Services, systems, and policies Diagnosis: Q: Is there anything that can be changed about the child's environment to facilitate communication and language/literacy learning? Method: Observation in different contexts, interview/questionnaires with significant others, review policies/practices of school, care, or employment services Treatment Planning: Collaborative interventions that seek to modify communication behaviors of significant others, rather than child directly; encourage use of signs and/ or symbols in school/work place; allocation of advocate or support worker; provision of computer or alternative communication device; give extra time to complete exams/coursework.

International Classification of Functioning: Implications for Diagnosis and Treatment: body structure

Includes: Structure of the nervous system The eye, ear, and related structures Structures involved in speech Diagnosis: Q: Are there any physical impediments to acquiring speech, language, communication, or literacy? Method: Hearing evaluation, oralmotor evaluation, and neurological assessment (if indicated Treatment Planning: Identify any aids, devices or medical interventions that might restore normative function (i.e., hearing aids, pharmaceuticals, oral-motor surgeries, etc.).

Do children with DLD lack all knowledge of grammar? (form)

NO. Although grammatical errors are a striking feature of DLD, it is not the case that children with DLD completely lack grammatical knowledge. Instead, children are inconsistent in their application of this knowledge, behaving as if certain grammatical rules were "optional -If children lacked knowledge, on formal tests of grammatical understanding we would expect either a systematic response bias (i.e., always interpreting a passive sentence, such as "the boy was kissed by the girl" by word order "boy kiss girl") or random guessing. -Performance on grammatical tests is typically above chance levels, even when non-syntactic strategies to support understanding are not evident --> This suggests that factors other than grammatical knowledge influence performance

Naturalistic vs normative perspective

Naturalistic Perspective: •Impairment characterized as a deviation from average ability by a similar group of people •ASHA Definition •Useful - broad range; different modalities •Weakness - what differences & when to intervene Normative Perspective: •Disorder exists when interferes with ability to meet social expectations, academic achievement, future employment prospects •IDEA Definition of Speech-Language Impairment •Weakness - how to measure impact of disorder on everyday activities

Is cognitive referencing advised?

No! ASHA (2000a) has argued strongly against "cognitive-referencing" in making decisions about eligibility for services Why? Because.. -The use of nonverbal IQ tests controversial- nonverbal IQ scores are still used in many countries as exclusion criteria, in effect limiting access to specialist SLP services for children who have low nonverbal skills (often defined as 1 or more standard deviations [SDs] below the mean, or a 1 SD discrepancy between verbal and nonverbal abilities -Uneven language profiles- Different combinations of tests can yield different eligibility recommendations for the same student. This is bc often, young children with DLD show an uneven language profile, with severe deficits in morphology and syntax and relative strengths in vocabulary knowledge. Therefore, we might expect vocabulary scores to be more in line with nonverbal IQ scores, whereas tests of morphosyntax might result in a very large discrepancy.

Are cognitive models of DLD useful in improving language performance?

No. Attempts to remediate underlying cognitive processes (such as, auditory processing or working memory) have generally not been any more successful in improving language performance than interventions that specifically target language behavior. assessing and remediating language behavior works better than focusing on potential underlying cognitive mechanisms.

The biological, cognitive, and environmental contributions to primary DLD- is one more influential on DLDs than the others

No. It is unlikely that these are the only factors, and it may be that the combination of factors that the child brings to the task of language learning is more important than any one particular risk

Phonological deficits are described in terms of? (form)

Phonological deficits are frequently described in terms of a child's repertoire of available speech sounds and the consistent error patterns a child uses in speech. Ex: An epidemiological study of 6-year-olds in the United States found the prevalence of SSDs to be 3.8% with a co-occurrence of SSD and language impairments of 1.3%. Problems with speech production are likely to be more prevalent in clinically referred samples, perhaps because they are more readily identified by parents and teachers

Use- what are some characteristics of DLD

Pragmatics is commonly associated with the notion of "social communication," which encompasses formal pragmatic rules,social inferencing, and social interaction *pragmatic skills of children with DLD are considered to be immature rather than qualitatively abnormal, as in the case of ASD (but not as severe as ASD)* Children with DLD: -Difficulties understanding and applying pragmatic rules. In conversation, these may include initiating and maintaining conversational topics, requesting and providing clarification, turn-taking, and matching communication style to the social context -May be impaired relative to peers in their understanding of other people's thinking and in understanding emotion from nonverbal cues -Difficulties integrating language and context, resulting in difficulties generating inferences in discourse -Difficulties understanding complex language and long stretches of discourse -Difficulties telling a coherent narrative -Difficulties understanding abstract and ambiguous language -Difficulties understanding figurative language

Nuerobiological basis of DLD Page 15

Researchers do this using neuroimaging techniques such as MRIs-BOLD / NIRS / EEG / MEG. -These methods have demonstrated that, unlike cases of adult stroke, there are no gross lesions of these neurological structures that could cause DLD; indeed when such lesions do occur in childhood, they rarely result in such profound language impairments. -However,researchers have identified subtle differences in brain structure and function that are associated with primary DLD, but anomalies in brain development are not deterministic—some individuals have brain differences and yet develop language as expected. *However, the presence of these anomalies increases risk for disorder.* *neurological variations serve as heritable risk factors for disorder* Bishop and colleagues have demonstrated that adults with DLD show reduced blood flow to the left hemisphere when engaged in language tasks, providing evidence of reduced lateralization of language Although our knowledge of the neurobiological origins of language disorder are increasing all the time, we still have no explanation for why children with the same IQ show differences in speech, language and social communication skills- this won't be enough to decide how to address his communication difficulties --> we'll need to know about those communication difficulties themselves, regardless of their underlying cause(s). *It is the detailed description of communicative competence that will define a communication intervention program.*

Jamie Case Study: When 6-year-old Jamie was referred for assessment in September, the school's speech-language pathologist (SLP), Ms. Reese, conducted an intensive assessment and reported that Jamie was functioning at the level of a 4-year-old in terms of his expressive and receptive language abilities. The school psychologist also tested Jamie and reported that his nonverbal skills (as measured by a standard IQ test) were borderline, not low enough to be identified as globally delayed or to warrant placement in a special classroom. Therefore Ms. Reese decided to include Jamie in her caseload, because her testing clearly indicated that his language skills were below the level expected for his chronological age. Ms. Reese moved to a different school in October, and Mr. Timmons took over her caseload. He reviewed Ms. Reese's assessment records and the school psychologist's report. He concluded that although Jaime was functioning below age level in language, he was below age expectations in several areas. The school had recently adopted a "response to intervention" model of early intervention, and Mr. Timmons decided to drop Jamie from the caseload and put him in Tier II early intervening status instead to see if he could catch up with a bit of extra help in the classroom but without full special education services. Some important questions to ask

Should the decision be based on deviation from chronological age expectations or general level of cognitive ability? • How far behind does a child's language need to be to require intervention? • Is an isolated impairment in one aspect of language as serious as a more mild impairment across a range of language skills? *Instead of worrying about absolute level of language impairment, we could ask about the impact of the language impairment on the child's overall development and ability to function in everyday situations (normative perspective)*

Naturalist perspective defined a disorder as deviation from average performance; How can we test deviations from the average and why is this problematic? p.10

Standardized tests fulfill allow us to test deviations from the average performance. -They measure a set of skills in a large number of children drawn from the general population and set normative scores based on the average performance of those children. -This enables us to compare an individual child's performance against the average abilities of his or her peer group *Where we set the cut off for significant deviation from the average is entirely arbitrary* --> in medical diagnoses, the "normal" range is often taken to be scores within 2 SDs of the mean, which encompasses 95% of the population --> A naturalist might therefore diagnose children scoring more than 2 SD below the mean (i.e., the third percentile and below) with DLD. Issues: 1. children with DLD often have uneven profiles of language skill and deficit ex: giving a child language tests and the child only achieved a "deviant" score on one of those tests- clinicians would have difficulties constituting it as a DLD 2. if a clinician takes on every child that scores 1 standard deviation of the mean = 16% of population (too many to manage) ---> a middle ground for is that clinicians determine that the bottom 10th percentile or -1.25 SD below the mean to have DLD *In reality, we should be using much more than scores to identify developmental language disorders and plan intervention*

Normative perspective

Takes into account society's values and expectations concerning individual behavior (Tomblin, 2008). -He states that a language disorder exists when the child's level of language achievement results in an unacceptable level of risk for undesirable outcomes. -A language disorder should only be diagnosed when it interferes with the child's ability to meet societal expectations now or in the future. -This could include difficulties with social relationships, academic achievement, and future employment prospects *Such a definition is neutral regarding the causes of the language impairment; instead, it focuses on those language behaviors that increase risk for adverse outcomes.*

Issues with standardized testing? How to solve this issue?

Tests with adequate psychometric properties (such as, validity; standard error of measurement; and large, representative norming samples) are not always available for testing at all age levels, for all language communities, or for all aspects of language and communication Although the situation is improving, many of our standardized instruments are culturally and linguistically biased, putting children from less mainstream cultural backgrounds at a disadvantage *One solution is to develop tests that are not reliant on cultural or linguistic knowledge and instead assess the ability to "process" novel information, such as a non-word repetition (NWR) task.* Although these tasks reliably distinguish language difference from language disorder (Rodekhor & Haynes, 2001; Windsor, Kohnert, Lobitz, & Pham, 2010), they do not provide the clinician with a picture of the child's linguistic capabilities, making them of limited used in intervention planning.

The American Speech-Language-Hearing Association (ASHA) has defined language disorder as... What is a language disorder?

The American Speech-Language-Hearing Association (ASHA) has defined language disorder as an *impairment in "comprehension and/or use of a spoken, written, and/or other symbol system.* -Involves form, content, and function -This definition assumes a naturalist perspective

What does a language disorder involve:

The disorder may involve: (1) the form of language (phonology, morphology, and syntax), (2) the content of language (semantics), (3) the function of language in communication (pragmatics), in any combination"

Why is the use of nonverbal IQ tests controversial?

The use of nonverbal IQ tests controversial- nonverbal IQ scores are still used in many countries as exclusion criteria, in effect limiting access to specialist SLP services for children who have low nonverbal skills (often defined as 1 or more standard deviations [SDs] below the mean, or a 1 SD discrepancy between verbal and nonverbal abilities) -Such decisions are not evidence-based. Longitudinal studies of children with language disorders have reported *more instability* in nonverbal ability scores and sometimes a drop in nonverbal ability scores over time --> It is unlikely that this reflects an actual loss in ability; rather it shows that language is a fantastic problem solving tool, and many linguistically able children use verbal strategies to help them reason out the answers on non-verbal tests. This puts the child with DLD at a distinct disadvantage -a categorical denial of services to children because of generally depressed nonverbal IQ scores is not consistent with the ethos of the Individuals with Disabilities Education Act (IDEA Amendments of 1997, Public Law 105-17), which stipulates that services be determined on an individual basis In addition, because children with lower nonverbal abilities are typically excluded from research studies, there is a dearth of evidence regarding the potential of these children to develop language in response to treatment, or indeed, what types treatment approach affect meaningful change

The vast amount of research done in the 1960's and 1970's led to advancements in the field of language pathology

The vast amount of new information on normal development made it possible for language pathologists to describe a child's language behavior in great detail and to make specific comparisons to normal development on a variety of forms and functions -the large database on normal acquisition provided a blueprint of the language development process that could serve as a curriculum guide for planning intervention. *This possibility has greatly influenced how language pathology is conceptualized and practiced today.*

Etiology of DLD

There is no single cause of DLD--> This must be the case, because some children with intellectual disability have additional DLD (that is, language skills that are below what would be expected not only for their chronological age but even for their developmental level), whereas other children with intellectual disability, even with exactly the same nonverbal IQ, have much better language ability -Individual differences abound within etiological categories Etiologies associated with DLD 1. Genetic factors 2. Neurobiological factors: Language in the typical brain, Brain structure in DLD, Brain function in DLD (fMRI studies, Electrophysicological studies) 3. Environmental factors

Mildred A. McGinnis, Helmer R. Myklebust, and Muriel E. Morley

These pioneers integrated the information currently available on language disorders in deaf and "aphasic" children and devised educational approaches that could be used to remediate the language deficits experienced by these children.

Ewing (1930), McGinnis, Kleffner, and Goldstein (1956), and Myklebust (1954, 1971)

These were another group of professionals there were also advancing concepts about children who failed to learn language -All educators of the deaf -They had developed a variety of techniques for teaching language to children who did not talk or hear. -They noticed that for some deaf children, language skills were worse than could be expected on the basis of their hearing impairment alone. --> This observation led them to focus more interest on the language impairment itself and to attempt to develop more effective methods of remediation for children who did not succeed with the standard approaches that were used to teach language to other children with hearing impairments.

What do clinicians focus on when considering a "specific" language impairment?

Traditionally, a focus on "specific" language impairment led researchers and clinicians to consider a child's language development relative to both chronological age and the child's overall level of cognitive ability or "mental age." Mental age is an index of developmental level; it is an age-equivalent score derived from a standardized test of cognitive ability. In measuring mental age in children with DLD, we try to use cognitive tests that do not involve the production or understanding of speech or that do so as little as possible. -We do not want to evaluate the cognitive ability of children with DLD on the basis of their language abilities, because we already know that these children's language skills are not likely to be very good. -Some tests of cognitive skill are designed to assess aspects of thinking and problem solving that minimize the involvement of language

Chapman (1992), Miller (1981), and Miller and Paul (1995) talked about language in terms of its two primary modalities

Two Modalities: (1) comprehension and (2) production -integrating understanding complex language and long stretches of discourse, telling a coherent narrative, and understanding abstract and ambiguous language within these two modalities. *From their viewpoint, language disorders would be defined according to the modalities primarily affected; the aspects or domains affected within these modalities are used to describe the language disorder once it is identified.* But whether it is the domains and their interactions or the modalities of language that are used to define disorders, *the important point is that disorders be defined broadly so we can diagnose typical and atypical representations of DLDs)

When speech, language, and communication impairments are not associated with a more pervasive disorder, what happens? WHY does this happen?

When impairments are not associated with a more pervasive (well-known) disorder, we have struggled to label them in a way that conveys a child's needs or that the wider public readily recognizes and understands --> This means that descriptive terms such as speech, language, and communication impairment are helpful in identifying strengths and weaknesses of a child's communicating conditions, risk factors, and co-occurring conditions *what people don't know, they don't understand- which is why we typically link speech, language and communication impairments to other recognized disorders* -This issue was highlighted by Kahmi (2004) who wondered why, unlike autism and dyslexia, "no one other than speech language pathologists and related professionals seems to know what a language disorder is" -Bishop (2010) found that one possible reason for this is that there are a variety of names given to the problems we have been discussing --> The terms are used just with different prefix, descriptor and nouns to reflect the same idea!

Secondary Language Disorder

a language disorder that is caused by another developmental disorder or disability, such as intellectual disabilities, ASD, hearing impairment, or brain injury -These are children with language disorders that are associated with or secondary to some other developmental disorder, such as ASD or intellectual disorder

How can we develop an intervention program for a child with DLD

as important as etiology is for understanding a child's condition, we need something in addition to develop an intervention program. That something is a detailed description of the child's current language function.

what does the NWR test actually measure? (limited processing capacity)

auditory processing and other cognitive models of DLD generally take a "bottom-up" view of language processing. -In a "bottom-up" model, lower-level processes (such as, perception and discrimination) provide input necessary to the function of higher-level processes (such as, comprehension)--> This only works in the context of prior knowledge-- Your familiarity with the stimuli strongly influences how easy they are to remember and recall -- *more familiarity = greater recall* -same goes for a 5-year-old with a DLD who is trying to complete the NWR test. Success on this task is related to the "word likeness" of the non-words or the extent to which they have real words embedded in them and may therefore reflect a child's experience with the ambient language In other words, the more a non-word resembles a known word in a person's vocabulary (e.g.,trumpet— trumpetine), the easier it is to remember. Children with DLD who have smaller vocabularies will have fewer words on which to "hook" novel words, so again, this deficit may be seen as more a consequence than a cause of DLD -the sensitivity of the NWR test in identifying DLD may stem from the complexity of the test and the fact that it taps a number of different underlying skills

Wernicke's area

controls language reception - a brain area involved in language comprehension and expression; usually in the left temporal lobe

Using Electrophysiological measures to study DLD

exploring language processing using electroencephalograms (EEGs). --This technique allows investigators to measure the electrical brain activity that is directly related to a specific external event (hence the term event-related potential [ERP] ERPs are displayed as wave forms and are described in terms of components that vary with respect to polarity (positive or negative), the latency of peak occurrence (time elapsed between when the stimulus is delivered and when the peak occurs), and their topographical distribution (location) over the scalp. the N400 (a negative peak that is seen 400 ms after a stimulus is delivered) is an ERP component that is thought to index semantic processes --> findings in DLD are inconsistent, with some finding that individuals with DLD (and their fathers) tend to show exaggerated N400 responses the P600- Another well-documented ERP component that taps grammatical processing is the P600, which is elicited by subject-verb agreement violations Another advantage of ERPs is that they allow us to investigate auditory processing without requiring children to attend to the stimuli or engage in an overt task.

Morley (1957)

instrumental in applying information on normal language development to the problem of treating children with language disorder *one of the first individuals to push language and its disorders into the purview of the speech therapist* -She fostered the use of *detailed descriptions of children's language behavior* in making diagnoses and planning intervention programs. -She also was important in providing definitions that allowed clinicians to distinguish language disorders from articulation disorders.

Nature vs Nurture in DLD

language impairments reflect differences in *nature*, the biological capacity to learn and use language AND differences in *nurture*, the frequency and quality of language input to the child *the two forces interact within a developing child*

Using MRI's to study DLD

magnetic resonance imagining subtle but significant differences between individuals with DLD and peers in inferior frontal, temporal, and inferior parietal cortex, and in white matter tracts connecting these regions The most consistently reported finding is that, as a group, individuals with DLD show atypical patterns of asymmetry of language cortex Other relevant findings have included abnormalities in cortical dysplasia (i.e., abnormalities in the organization of different types of brain cell), additional gyri in frontal or temporal regions, and unusual proportions of anatomical structures implicated in language processing, such as Heschl gyrus and the planum temporale The paucity of functional MRI studies in DLD to date have focused on the extent to which language regions in the left hemisphere become active as participants perform language tasks in the scanner. Two key studies have reported hypoactivation in relevant language areas relative to the comparison group

Benton (1959, 1964)

provided the fullest descriptions of children with "infantile aphasia" and is credited with evolving the concept of a specific disorder of language that was structured by excluding other syndromes, such as autism, deafness, and intellectual disorders, rather than by parallels to adult aphasia.

Do speech, language, and communication impairments occur in the presence of another DLD?

speech, language, and communication impairments occur in the context of another developmental disorder with a recognized label, for example, ASD or Down syndrome In these cases, descriptive terms such as speech, language, and communication impairment are very helpful in identifying the strengths and weaknesses of a child's communication profile.

How do environmental factors influences DLD?

the child's environmental circumstances can have a profound effect on language development and behavior EX: numerous studies have demonstrated a weak, but significant, link between level of maternal education and children's later language status the environment exerts strong influences on gene expression and neurological development, as well as on behavior. Intervention is therefore a powerful environmental tool that can shape development and positively influence behavioral outcome --> it appears that environmental factors alone cannot account for the full range of deficits that characterize, BUT, environmental factors can have an important role in mediating the developmental course of the disorder and the impact of disorder on the child's adaptation and well-being

Cognitive Models of DLD- Procedural benefits p21-22

theorized that DLD was the result of a primary deficit in procedural memory systems, which could potentially be compensated for by reliance on relatively intact declarative systems. -The appeal of this theory is that it makes explicit connections between brain and behavior, has the potential to explain deficits outside the language system that are also contingent on procedural learning (such as, motor sequences), and is developmentally more attractive in its emphasis on reorganization and compensation There's a distinction between procedural memory systems, which are important for rulebased learning (such as, grammar), and declarative memory systems, which underlie knowledge-based learning (such as, vocabulary) *There is now considerable evidence that children with DLD are impaired on a range of tasks that tap procedural learning and that performance on these learning measures is correlated with language scores* others have argued that impairments in procedural learning are most pronounced when learning of sequences is required and the extent to which declarative learning systems (involved in learning words, facts and associations) are also compromised or serve to compensate for procedural deficits is a matter of considerable debate

Bloom and Lahey (1978) and Lahey (1988) framework for exploring language competencies (language is comprised of three major aspects)

•*Form:* including syntax, morphology, and phonology •*Content:* essentially consisting of semantic components of language, vocabulary knowledge, and knowledge of objects and events •*Use:* the realm of pragmatics or the ability to use language in context for social purposes

Developmental perspective- What does it mean in practice to use the normal developmental sequence as a guide for intervention?

•Determine where the child is in the normal developmental sequence •Determine next phase in normal development •Establish goals for language intervention just above current level of functioning (relevant to child's communicative context) (e.g., vocabulary and grammar that will help communicate at home or school) •Normal developmental sequence for goals - other considerations for materials, activities, and intervention settings -This suggests that if a 5-year-old is producing primarily two-word utterances, our immediate goal is not to teach him to produce the sentences typical of a 5-year-old but to begin work on expanding the two-word sentences to include the next elements that would appear in normal development, such as three-word agent-action-object constructions or "-ing" marking -The normal developmental sequence provides the goals for intervention but other considerations (such as, the client's chronological age and the communicative context in which he or she must function) influence the materials and settings the intervention uses. --> So even if the child's language level is preschool and the goals of intervention target preschool-level structures and functions, the materials and equipment, the particular vocabulary items, the teaching style, and context used are influenced by considerations beyond the language level, such as the child's chronological age or functional needs (Olley, 2005) and the functional communicative demands of the child's environment.

Language Disorder

•Language disorder refers to a profile of language deficit that causes functional impairment in everyday life Impairment in comprehension and/or use of spoken, written, and/or other symbol systems

Comorbidity in DLD

•Language disorders rarely occur in isolation •Comorbidity refers to a situation where a child may experience two or more disorders simultaneously Children with language as a primary concern likely to experience co-occurring symptoms •Behavior problems •Motor/coordination deficits •Reading disorders Other conditions may mask underlying language deficits. For example, approximately 30% of youth presenting to child and adolescent mental health clinics have previously undiagnosed language disorders