Week 4: secondary language impairments: ASD and SCD

SCD

"Symptoms must be present in early childhood even if they are not recognized until later when speech, language, or communication demands exceed abilities."

ASD: Three conditions for diagnosis:

(1.) Impaired social interactions with others (2.) Moderate to severe impairment of communication skill • Echolalia: stereotypical repetitions of specific words or phrases (3.) Restrictive, repetitive, and stereotypical behaviors and interests Neurodevelopmental disorder that can lead to severe developmental disability with symptoms that emerge in early childhood.

What Are the Major Types of Child Language Disorders?: 5 conditions typically associated with language disorders among children and adolescents:

1. Specific language impairment 2. Hearing loss 3. Autism spectrum disorder 4. Cognitive Impairment 5. Traumatic brain injury

Parts of the Brain Affected by Autism

Cerebral cortex: A thin layer of gray matter on the surface of the cerebral hemispheres. Two-third of this area is deep in the tissues and folds. This area of the brain is responsible for higher mental functions, general movement, perception, and behavioral reactions. Hippocampus: This makes it possible to remember new information and recent events. Amygdala: This is responsible for all emotional responses including aggressive behavior. Brain stem: The brain system located in front of the cerebellum and serves as relay station, passing messages between various parts of the body and the cerebral cortex. It controls the primitive functions of the body essential to survival including breathing and heart rate Basal ganglia: This is gray masses deep within the cerebral hemisphere that connects the cerebrum and the cerebellum. It helps regulate automatic movement. Corpus callosum: This consists of closely packed bundles of fibers that connect the right and left hemispheres of the brain and allows them to communicate with one another. Cerebellum: This located at the back of the brain. It fine tunes motor activity, regulates balance, body movements, coordination, and the muscles used for speaking.

Brain Imaging and ASD

Compared brain scans of adolescents and adults with ASD and controls • Information transfer (connectivity) between brain areas, causal influence of one brain area on another, was weaker in individuals with autism. • The individuals with ASD processed social cues differently as a result of the weaker brain connectivity. --This may be one way to identify autism in the future. • Children with autism also showed less connectivity between different regions of the brain involved in coordinating and executing movement • Supports theory that a decreased ability of distant regions of the brain to communicate with each other forms the neurological basis of autism Frontiers in Human Neuroscience (October, 2013)

SCD Characteristics

Difficulty with: • Responding to others • Using gestures (like waving or pointing) • Taking turns when talking or playing • Talking about emotions and feelings • Staying on topic • Adjusting speech to fit different people or situations—registers • Asking relevant questions or responding with related ideas during conversation • Using words for a variety of purposes such as greeting people, making comments, asking questions, making promises, etc. • Making and keeping friends

Restrictive, Repetitive, and Stereotypical Behaviors and Interests

Restricted pattern or stereotypic behavior that is abnormal in intensity or focus • Lining up items, fantasy character, facts on certain topic Inflexible adherence to specific nonfunctional routines or rituals • Same route for shopping Stereotypical and repetitive motor acts • Hand flicking or twisting, spinning, head banging Persistent preoccupation with parts of object • Sniffing objects, repetitive feeling of material, attachment to unusual objects (string) • Watch video links 4.1.2, 4.1.3, and 4.1.4

ASD: Vocabulary; phonology articulation; morphology; syntax; pragmatics.

Vocabulary (content); -Similar to MA ability in some areas of spectrum -May not use words in appropriate contexts -Limited use of mental or state words "know," "think" Phonology/ Articulation; -Often intact when present Morphology; Possible delays Syntax; -Often intact when present, possible delays -Pronoun errors (case, gender) -Also, first-person I, you, me confusion Pragmatics; -Joint attention deficits -Do not follow adult gaze or gesture -Do not respond to name or sound source -Do not mimic facial expressions -Lack of protoimperatives and protodeclaratives -Generally not responsive -Fewer communication acts

SLI

Vocabulary; -Delayed in their number of words that they're -They too could struggle with mental or state words as well.

SCD

Vocabulary; -don't know

Secondary language impairment:

language disorders resulting from other conditions • Common types include cognitive impairment, autism, traumatic brain injury, syndrome

Primary language impairment:

significant impairment of language in the absence of any other developmental difficulty • Commonly called specific language impairment, or SLI

Children with ASD who have spoken and written language disorders need ....

to receive a diagnosis of a language disorder on their intervention plan.

Characteristics of SCD

• "A persistent difficulty with verbal and nonverbal communication that cannot be explained by low cognitive ability. Symptoms: • Difficulty in the acquisition and use of spoken and written language as well as problems with inappropriate responses in conversation. • The disorder limits effective communication, social relationships, academic achievement, or occupational performance."

Early Diagnosis

• ASD can be reliably identified at two years of age. • Most children with ASD are not identified until four years of age. • 20-30% regress in language skills between two and three years of age.

Comorbidity

• ASD tends to co-occur more often with genetic or chromosomal conditions. • 10% of children with autism are also identified as having Down syndrome, fragile X syndrome, tuberous sclerosis, or other genetic and chromosomal disorders. • 46% of children identified with ASD have average to above-average intellectual ability.

ASD prevalence (CDC, 2017)

• Autism spectrum disorder (ASD) is a group of developmental disabilities that can cause significant social, communication, and behavioral challenge • One in 68 children identified with ASD • More prevalent in males (5:1) • More prevalent in white children • More prevalent in higher SES

Predictors of Language Outcome (Weismer & Koval, 2015)

• Children with better comprehension or production language skills at 30 months had faster rate of language development during preschool. • Cognition and severity of ASD predicted outcome. • Joint attention (RJA): More children with little to no RJA at 30 months were in the minimally verbal group at 66 months.

Risk Factors

• In identical twins, if one child has ASD, then the other will be affected about 36-95% of the time • In nonidentical twins, if one child has ASD, then the other is affected about 0-31% of the time • Incidence of having a second child with ASD is 2-18% when a sibling is diagnosed with ASD • Advanced parental age at time of conception (both mom and dad) • Maternal illness during pregnancy and certain difficulties during birth (especially if the baby's brain is deprived of oxygen) • Maternal rubella

ASD

• Many with ASD are highly talented in a particular area (music, art, math, etc.). • Others with ASD have significant disability and are unable to live independently. • 25% percent with ASD are nonverbal but can learn to communicate using other means. • A great video about ASD is called "Loving Lamposts." You can stream this for free. Highly recommended.

Recent Findings

• Nature • Eye contact in children with autism • Gazing at another's eyes declines from two to six months of age in children who are later diagnosed with autism, compared with children who were not later diagnosed with autism

Social (Pragmatic) Communication Disorder

• New diagnosis of social (pragmatic) communication disorder is used for children who have difficulty with social skills but do not show restricted or repetitive patterns • Different diagnosis for some children who may have previously been diagnosed with ASD • ASD has to be eliminated as a diagnosis in order for SCD to be diagnosed

Most Recent Definition of ASD according to Diagnostic and Statistical Manual of Mental Disorders (DSM-5) (May, 2013)

• No longer has categories such as Asperger's, Autism, CDD, and so on; instead child is given a diagnosis of ASD with degree of severity

Response to joint attention vs. initiate joint attention

• Previous studies: Better RJA skills equals faster language acquisition and better outcome in language. • Previous studies: Intervention targeting IJA led to better spoken language outcomes. There is no difference between IJA skills across groups of children.

Causes

• Seizure disorder is seen in 25% of children with autism, suggesting a commonality in the brain structures affected by ASD and seizures • Extreme sensory deprivation • A number of rare gene changes, or mutations, associated with autism • Most cases of autism are caused by a combination of autism risk genes and environmental factors influencing early brain development

Ellawadi and Weismer (2015) (toddlers)

• Toddlers with ASD • Expressive language benchmarks • Intrareferencing • Most had uneven profiles • Fewer difficulties with phonology • Primary difficulty with vocabulary, grammar, and pragmatics