Transcript Pediatric Communication Disorders

TYPES OF COMMUNICATION DISORDERS
• Primary
• Secondary - Associated with autism,
Intellectual disabilities, hearing loss etc.
• Acquired – Pediatric Brain Injury, Meningitis,
encephalitis
PRIMARY COMMUNICATION DISORDERS
Language
SLI
Speech Sound Disorders
Articulation
Phonological
Childhood apraxia of speech *
SECONDARY AND ACQUIRED
COMMUNICATION DISORDERS
Autism
Social Communication Disorder
Intellectual Disabilities
Pediatric Brain Injury
DIFFERENCES NOT DISORDERS
Dialect
Regional
AAEV
Language Interference in English Language
Learners
Phonology
Grammar or Syntax
Code Switching
LANGUAGE DISORDERS
• About 15% of toddlers are Late Talkers
• About 7-10% of school age children manifest SLI
• Many will continue to have some language difficulty
throughout life. [but can succeed with
accommodations]
• May be reclassified as Language Learning Disorder
as they get older
• Can manifest in semantics, phonology, morphology,
syntax and pragmatics [any or all]
• Vary in severity
SEMANTIC PROBLEMS
• First words late to develop
• Vocabulary may be limited
• Take longer to learn new words [curriculum words
too]
• Trouble with abstract words (remain literal longer)• Can affect academic achievement [“pioneers pushed
westward”
• Word finding difficulty (like anomia)
SEMANTIC (CONT.)
• Trouble with words with multiple meanings [affects
humor too]
• Run
• Can affect reading (oral and comprehension)
• Homographs - invalid/invalid; conduct/conduct
• Homophones – read/reed; read/red; record/record
MORPHOLOGY ERRORS
• Grammatical endings on nouns and verbs
• Most of these are developed by 5 or 6
• Past –ed
• Verb “to be”
• Plural “s”
• Be + verb + -ing (I’m going, He’s dancing)
• Common to overgeneralize (I goed, He ated, I
heared)
SYNTACTIC ERRORS
• Trouble forming correct question form
• Trouble acquiring correct negative form
• Trouble learning a variety of conjunctions to expand
length
• Remember there is a developmental pattern
PRAGMATIC PROBLEMS
Learning to use language for a variety of reasons called
“intents”[ starts out before language with gesture and
vocalizations]
• Request actions and objects
• Comment on objects and actions
• Inform
• Protest
• Deny
PRAGMATIC PROBLEMS (CONT.)
• Trouble having a conversation
-
taking turns
-
maintaining topic
-
later, able to change topic smoothly
-
later learning not to interrupt
• Trouble producing narratives
WHAT ARE NARRATIVES?
Recount
Account
Procedural
Event Casts
Stories
Expository
CHILD NEEDS TO:
• Take the listener’s perspective
• Organize in a logical manner
• Link ideas using conjunctions
• Include essential information
• Pronoun referents must be clear
LANGUAGE DISORDER CHANGES WITH
AGE
• 2 years old check-up: fewer than 35 words and/or no
two word combinations : refer for evaluation
• 4 years old: may have lingering semantic and
phonological problems
• May have problems with phonological awareness:
rhymes, identifying words with first sound, connecting
sound to letter [Virginia PALS]
CHANGES WITH AGE: RELATED TO
READING [VA PALS]
Phonological Awareness:
• Preschool: Identifying
• rhymes
• words that start with the same sound
• count words or syllables
Kindergarten
• Name printed letters
• Say sound letter makes
Older students
• Count number of sounds in a word
• Elision tasks
LATER PA
• 6-7 year olds: difficulty learning to decode (read)
• More advanced phonological awareness
• Letter-sound, phonics, spelling
• Virginia PALS includes these too
• Older Children reading comprehension problems.
• Generally related to oral language comprehension
• Not just reading or memory
SPEECH SOUND DISORDERS
• Articulation: continue with common sound
substitutions that are normal in typically developing
children: f/th, p/f, t/k, w/r
• Sounds develop at different ages [most develop all
sounds by 6 or 7]
• Parents and those close to child understand more
easily than others
WHAT IS EXPECTED?
• Age when most can understand the child (may still
make errors)
• 1;0
25%
• 2;0
50%
• 3;0
75%
• 4;0
100%
PHONOLOGICAL DISORDERS
• Patterns rather than straight substitutions or distortions
• Toddlers and preschool may drop final sound
• boo/book or boot
• May show patterns of sound errors – substituting
front sounds for back sounds [ t/k, or d/g] or back
sounds for front sounds [ g/d, ] or stops for
continuants [t/s, p/f ]
• Drop unstressed syllables e.g. ‘puter/computer
CHILDHOOD APRAXIA OF SPEECH-SLP
“ Childhood apraxia of
speech is a neurological childhood
(pediatric) speech sound disorder in which the precision and
consistency of movements underlying speech are impaired in the
absence of neuromuscular deficits (abnormal reflexes, abnormal
tone), CAS may occur as a result of known neurological
impairment, in association with complex neurobehavioral
disorders of known or unknown origin, or as an idiopathic
neurogenic speech sound disorder. The core impairment in
planning and/or programing spatiotemporal parameters of
movement sequences results in errors in speech sound
production and prosody”. ASHA
CHILDHOOD APRAXIA OF SPEECH PUBLIC
“Childhood apraxia of speech (CAS) is a motor
speech disorder. Children with CAS have
problems saying sounds, syllables and words.
This is not because of muscle weakness or
paralysis. The brain has problems (e.g. lips, jaw,
tongue) needed for speech. The child knows what
he or she wants to say, but his/her brain has
difficulty coordinating the muscle movements
necessary to say those words.” ASHA
CHILDHOOD APRAXIA OF SPEECH
• Recent dramatic increase in diagnosis
• Currently no behaviorally defined diagnostic criteria
to distinguish it from severe speech sound disorders
• Even diagnosed in preverbal or nonverbal very young
children
• May be associated with oral apraxia, verbal apraxia
or limb apraxia
• Require more intense therapy
INCREASE IN DIAGNOSIS DUE TO:
• Increased Awareness
• Emphasis on Early Intervention
• Insurance Coverage: Medical vs. Developmental
SOME EXAMPLES
Lily: oral apraxia
Joey: verbal apraxia
Ben:
possible verbal
WHAT WE MAY SEE
• Inconsistent errors even on repeated attempts of the
same word
• Groping behaviors
• Automatic production of words may be better than
volitional
WHAT WE KNOW
• Requires more frequent and intensive treatment
• Takes longer to remediate
• Often have language impairment as well
QUESTIONS?