Transcript How Dysfluency Impacts Assessment

How Dysfluency
Impacts Assessment
© 2009 Office of Deaf Services
All Rights Reserved
“Psychiatry is unique among the
medical fields in that most of the
symptoms are conveyed by or
through communication, and
communication also is the primary
method and nature of treatment.”
Robert Q. Pollard
Who We Are, Why It Matters
Office of Deaf Services established 2003
Long standing interest in language issues with
deaf people who have mental illness
First efforts in the early 90’s
DeafBlind in DD Habilitation Centers
Who We Are, Why It Matters
Small, “old South” rural state with limited
resources
Need to maximize what’s available
Focus on supplementing direct services with
interpreting
Led to MH interpreting standard and then to
trying to figure out how to deal with dysfluent
consumers
Improve CDI/Visual-Gestural
communication services
Collaboration with Neil Glickman’s
program
Who We Are, Why It Matters
We learned that this stuff helps our
clinicians too
Better diagnosis
Better intervention strategies
Better communication strategies with
consumers
Able to better discuss symptoms with
Psychiatrists and other hearing
clinicians
“Deaf – Hearing Different”
Hearing Thought World
Deaf Thought World
Language = English
Language  English
Language is a positive
Language can
indicator of intelligence
indicate intelligence
but not by itself
Language impairment
= organic disorder
Language impairment
likely means “no signs
at home”
No Language = No Sense
“Those who are born deaf all become
senseless and incapable of reason.”
Aristotle, 355 BC
In hearing people absence of language as an
indicator of pathology
Birth defect (mental retardation)
Trauma/disease (aphasia)
Exceptions were extremely rare
“Wild Boy of Aveyron”
Genie
Language Deprivation
v. Dysfluency
Dysfluency is an umbrella concept
Disruption of language - may be:
Thought disorder/psychosis
Trauma/Etiological
Aphasia/TBI/Stroke/other illness or injury
Cognitive Disability
Developmental (i.e. lack of exposure)
Language Deprivation
v. Dysfluency
Language Deprivation is a form of
dysfluency
Literally lack of exposure to language
Sometimes called “low functioning”
Extremely rare with hearing children –
not so rare with deaf
Glickman argues that it is not as common
as advocates say it is
Has specific markers
Markers of Language Deprivation
Fund of knowledge deficits
Poor vocabulary
Sign features formed incorrectly
May be missing (Topic-comment, Clear
referents, Time indicators, Grammar)
Repeated signs
Isolated signs/phrases
3rd person
Visual space
Adapted from: Glickman, Neil. 2007. The Journal of Deaf Studies and Deaf Education 2007 12(2):127-147
Deprivation or Thought Disorder?
It is important to know the difference!
Easy to confuse the two
Diagnosis may be confounded if not
clear
Big trap (and clue) for many clinicians:
Fund of Information/Knowledge Deficits
Is FOI deficit or thought disorder?
Trap: “Hearing people don’t understand it
either” ignores vastly different starting places
Deprivation or Thought Disorder?
Thought Disorder
Inappropriate facial
and/or emotional
expression.
Bizarre language
content.
Behaviors suggesting
hallucinations.
Guardedness and
volatility.
Deteriorated language
skills.
Appearance and
behavior.
Language improves
with medication
Language Deprivation
Fund of knowledge
deficits
Poor vocabulary
Sign features formed
incorrectly
May be missing (Topiccomment, Clear
referents, Time
indicators, Grammar)
Repeated signs
Isolated signs/phrases
3rd person
Visual space
Adapted from: Glickman, Neil. 2007. The Journal of Deaf Studies and Deaf Education 2007 12(2):127-147
Make or Break Assessment
The communication
assessment will be crucial
to treatment planning
Provides basis for
differential diagnosis
Identifies areas where
remedial work can be done
Documents needs for
collaterals
Baseline for improvement
or decompensation
Helps “NFC” hearing team
members understand
issues
A Digression:
We call it a communication
assessment rather than a
language assessment for several
reasons
We are not SLPs
Considers more than just
language
Focus on functionality rather
than linguistics
Assessment Questions
The Big Four
Severity of hearing loss
Cause of hearing loss (etiology)
Genetic? Syndromic?
Disease? Trauma?
Age of onset
Family communication
Let’s see why this stuff is important
Assessment Questions
Assessment Questions
Rule out any medical causes for the
dysfluency
Also rule out co-morbidity
Supporting information:
Identifying specific linguistic errors for
patterns
Establishing baseline for future
comparison
Identifying strengths
When It’s Both… (or More)
Working with Deaf people who have SMI, you
likely you will encounter people with both
language deprivation and thought disorders
Does it matter?
Better language gives tools for better coping
skills
(aka, Aristotle was not all wrong!)
If psychotic, medication will improve
functioning but if language deprived,
medication will not improve functioning
Implications for forensics and treatment
Questions?
Contacts
Office of Deaf Services
Alabama Department of Mental Health
PO Box 301410
Montgomery, AL 36130
www.mh.alabama.gov/MIDS
www.mhit.org
Steve Hamerdinger
Charlene Crump
Director, Deaf Services
Voice/VP 334 239 3558
[email protected]
Statewide MHI Coordinator
VP 334 353 3558
[email protected]