Day 1 Working Knowledge- Developmental Disability

●​ Description of a difference in development that impacts daily life

●​ Early milestones
●​ Not acquired
●​ Since birth or utero

-​ reflect on this wording in the context of disability studies

-​ “special challenges”
-​ “typical and disordered communication”
-​ “if spoken language is not working we must find other ways of communication”,
assumption: spoken language is primary mode of communication

CDS 460

Communication: BROAD concept of the exchange of meaning between a sender and receiver
-​ body language, spoken, silence, pictures, eye gaze, gestures, texting, talking,
self-expression, driving, presenting, emails, etc.

Asynchronous communication; social media, texting, music

Language: Set of symbols and knowledge of how to use these symbols (sign, written, pictures,
electronics)

Spoken Language- speech component + set of sounds in the spoken language

Speech: Respiration, phonation, and articulation

Form (rules): syntax (grammar), morphology (word formation), phonology (sound formation),
suprasegmentals (loudness, rate, and intonation)

Semantics (content): meaning or interpretation of word

Pragmatics (use): rules vary by culture, situational context within which utterances are made,
knowledge and beliefs of the speaker & the relation between speaker & listener

Metalinguistics: use of language to talk about language

Speech: Breath stream, articulation, fluency, voice

Hearing: Receiver, voice feedback

Communication Impairment: speech (articulation, voice, resonance, fluency), oral-motor,

language, swallowing, cognition, hearing, balance
Etiology- origin of disorder

Advocacy for cultural difference vs disorder

Childhood Language Disorders- Overview

Childhood LD
●​ differential diagnosis
-​ parsing out hypotheses to identify diagnoses
●​ special ed

Early LD (birth-5)
●​ assessing early LD

School-age LD (5-21)
●​ new demands
●​ school-age assessment

Intervention Examples and Case Study

Language Delay -> Disorder

Delay: slightly outside wide window of typical development, potential to catch up
developmentally
-​ expressive language delay/disorder
-​ receptive language delay/disorder
-​ mixed expressive and receptive language delay/disorder

Late Talker or Specific* Expressive Language Delay (SELD)

Toddlers slow to talk (2-3 years of age)
●​ no other symptoms
●​ good pre-linguistic skills
●​ good comprehension?
Specific = no other explanation/ dual diagnosis

Language Impairment
SELD + time = Specific language impairment (SLI)
●​ Preschool age and early school age (4-7)
-​ Distinguish from linguistic differences
●​ Info processing
●​ Cog. difficulties

IDEA= Specific Learning Disability (SLD aka LLD)

 ●​ implies typical development in other domains
●​ diagnosis in 2nd-3rd grade
●​ will manifest across genres (speaking, reading, writing)

Rewind: Development Delay

●​ Broad; temporary dx, indicating delay in 2 or more developmental areas
-​ Communication
-​ Cognition
-​ Physical
-​ Social/Emotional
-​ Adaptive Skills

●​ Diagnosed by team of professionals

Developmental Disability (DD)

●​ Physical or cognitive impairments beginning before the age of 22 that alter or
substantially limit a person's ability to do at least 3 of following
-​ Not used in school system
-​ More for governmental processes; social security

Intellectual Disability (ID)

●​ Low IQ and challenges with adaptive behavior
●​ Processing, attention, expression etc.

Autism Spectrum Disorder

●​ DSM-V differentiate btw
-​ Social (Pragmatic) Communication Disorder
-​ Comorbidity with other disorders

Specific LI- Prevalence and Incidence

●​ Most common type of communication impairment affecting children
●​ Most frequent cause of EI and SPED
●​ 15% of toddlers are late talkers
●​ 10-15% of school-aged children
Secondary Language Impairment
●​ 1 in 1,000 children
●​ 1 in 88 children with ASD

Special Education Services

●​ Federal IDEA (2004)
-​ should be updated
-​ funding
●​ Includes:
-​ FAPE
 -​ fundamental pieces; required appropriate, individualized, free, provided
-​ LRE
-​ weighs pros and cons of environment of education
-​ What level of support? What environment is most supportive?

●​ Regulations for intervention;

-​ 3-21 - Part B
-​ birth-3- Part C

●​ Requirement of individualized plan:

-​ IEP
-​ structured support educational plan
-​ ISFP
-​ structured family support plan

●​ Part C- Agencies vary state

-​ Early Special Education (ESD)

●​ Part B- Department of Education

-​ Early Childhood Special Ed (Pre school)
-​ School-age services (Kinder- high school)
-​ Transition services (age 18-21)

●​ IDEA: Oregon eligibility

-​ Part C: Early Intervention
-​ 1.5 SD or more below mean in two or more developmental areas or
-​ 2.0 SD below the mean in one area
-​ Based on a physician's statement of physical or mental condition kiley to result in
developmental delay

-​ Part B:
-​ Significant delay in one or more developmental areas
-​ 1.5 SD below or more below the mean

Assessment
-​ Qualification for special education services

Typical Development (Videos)

Assessment

Informal assessment
 ●​ Interview with family and other care providers
●​ Language/communication sampling
-​ contexts
-​ parent-child intervention (birth-3)
-​ play sample (preschool)
-​ purposes
Standardized
●​ Questionnaires: non-comparative snapshot of skill(s)
-​ Ex: MacArthur Communicative Development Inventories (16-30 months)
●​ Criterion-Referenced Test: compare against particular milestones and skills at a
particular age range
-​ Ex: Rossetti (birth-3)
●​ Norm Referenced: comparative test to sampled norm (be weary: who was sampled?) at
a particular age range
-​ Ex: School Language Scale-5 (PSL-5) (birth-7;11) or Clinical Evaluation of
Language Fundamentals-Preschool 3 (3-6;11)

Language and Academics

●​ mindfulness of directions and language in the classroom
●​ processing load of language
●​ social demands
●​ grounding pictures and gestures in 1st grade moves to language based direction
throughout school

LLD: Areas to Assess

moving from grasping concrete language to understanding more abstract language; analyze,
categorize, wonder, question

Content:
●​ vocabulary knowledge
●​ retrieval of words

-​ younger: on, under, between

-​ later elementary: before, after, when
-​ quantity: all, some, non, subtract, add
-​ relational words: together
-​ explanations: expansion, vocab check
-​ organization: categories & synonyms; fluffy, green, transportations,
-​ overlap of categories (flexible?)

Storage & retrieval

●​ Without making file folders-> throwing words into a bucket
 ●​ -> Need a file folder to store language in
-​ Treatment: building file folders
-​ Describing and retrieving directions
Form:
●​ Basic grammatical rules
-​ Assessment & Treatment; tell a story

Use:
Formal Assessment & Functional Assessment
●​ Social/conversational
●​ Engagement in class
●​ Teachers; one on one interactions

●​ making predictions
●​ inferring
●​ answering cause/effect
●​ important aspects

Literal interpretation- EX: what did the bear last eat? berries

Sequential: what did the bear do after he swam across the river? after, suddenly, yesterday

Inferrencing: what happened to the forest? the fire burned, no food, running around. what do
you think the bear is going to do with the acorn? vocab, what bears eat, presume that bears eat
these things.

Running inference-
Language demand of holding onto language and changing lines of thinking, constant storage
and retrieval
Background knowledge needed- accumulation or teacher

Narratives: chapter books,

-​ Narrative production
-​ Recount story
Sentence structure, social use, vocabulary

Metalinguistic skills
Metaphorical language

Children with reading problems read less than proficient readers and read less challenging text

Matthew effects
LD: assessment
Emergent literacy
Morphological components
Rhyming words
Sounding out

Preliteracy

Literacy skills
Decoding
Blending
Sight words
Reading comp

Spelling
Segmenting
Writing composition

Informal assessment measures

-​ Curriculum based assessment
-​ Dynamic assessment
-​ Language samples
-​ Interview

Standardized assessments
CELF-5
CASL-2

Multilingual learners?
-​ Sequential vs simultaneous

Intervention- EI
●​ Natural environment; routines,
●​ Focus on family support and coaching

●​ Play, social relationships

●​ Pull out services; teaching in focused environment
●​ Consultative services; coaching on implementation
●​ Collaboration and classroom-based context; encourage skills in group setting

Naturalistic communication interventions (NCI)

Interactive activities that are carefully arranged to necessitate social communication and provide
a natural consequence.
 -​ Make a request
-​ Comments
-​ Statements
-​ Questions
-​ Greet
-​ Creative language

Components
Positively reinforce any communication attempt; positive behavior support (PBS)
Environmental arrangement- changing incremental details, working with kids flexibility(what
might be successful if changed?)
Responsive interaction- any attempt at language is met with a response which maintains
communication
Milieu teaching (MT) - set of strategies that use child’s natural environment to encourage
communication skills; follow child’s lead, narration, expansion
ex: child likes balls, child says b-, clinician- ball, yes ball-big ball-throw ball, give choice of two
balls, place ball out of reach
Focused stimulation; intentional usage and emphasis of language

NCI most benefits

Pre linguistic children
Emergent language
Children with disorders

NCI
Form
Content
Use

Narrative production
Metalinguistics
Metaphorical
Sentence comprehension and processing
Story/passage comprehension
Narrative intervention

Fluency Disorders

Disability study perspective:

Spoken language most efficient?
”Dissipates and then they’re ok”
Why is learning about stuttering when pictures of famous/successful people who have lived
experience are pulled out? “neurodiversity movement”

Fluency disorder: Interruption of respiration, phonation, and/or articulation

Flow of speech during conversation

Dysfluency: speech behavior that disrupts the fluent forward flow of speech; alters from normal
amt of dysfluency at the age

Characterized with:

Sounds repeated
Sound prolongations
Interjections- adding sounds to get out of moment where stuck
Words broken by pauses -> sounds in middle of words more indicative of disfluency disorder
Pauses in speech
Word substitutions to avoid problematic words- anticipation of dysfluency word
Excess physical tension- body tension

Any combination of these characteristics

Social anxiety, academics stress, aggravation of dysfluency when presented with stress

Stuttering prevalence- low incidence in caseloads, more common in boys 7 to 1

Early childhood, school-age, adolescent

Many adolescents/adults recover

Developmental Stuttering
Emerges 2-5 years
Normal disfluency; trial and error, play, exploring, risk, attempts, making leaps in language
learning, hold your own in a conversation when learning language- may produce normal
stuttering
Parents concerned during this age -> is stuttering rlly developmental disfluency?

Core features to differential:

Part word repetitions: b-b-b-baby, ba-ba-ba-baby, bay-b-b-b-by

Prolongations: puuuuuulease give it to me, please gaaaaa-ive it to me
Blocks: ——please give it to me, please—-give it to me
Significance and impact varies
Attention of receiver is a societal factor

Normal-like; normal disfluencies that may add to developmental disfluency OR not

Phrase repetition: he is in the-in the- in the house
Interjections: um, hm, uhh
-> rate, how long?
Revisions: I gave it to, uh, wait a minute, I got in from Frances

Have sentences gotten longer, using bigger words in the past few months? -> if yes, likely
normal disfluency

Secondary Behaviors
tend to accompany core behaviors
-> purpose: escape or avoidance, strategies to get around stuttering
different levels of severity

-> escape: physically pulling self out of block; eyes closed, flaring nostrils, tensing lips, tensing
jaws, tensing of vocal cords, tensing chest, clicks, nodding

-> word and sound avoidance

substitutions: anticipation of sound and choosing other word
circumlocution: explaining, describing using other words
postponement: pausing in anticipation

-> Situation avoidance

Social aspect; social isolation, social anxiety
Phone calls, public speaking, presenting, recess, asking questions in class
Working through uncomfortableness in order to take part in interesting activities

Feelings and Attitudes

Feedback from others
Can cause stress, anxiety, and tension
Exacerbates core and secondary behaviors
By age 4- children prefer friend who is fluent
Bullying and isolation
Lower-status jobs
Acquired Disfluency
Neurological stuttering often accompanied by other communication disorders (aphasia,
dysarthria)
-​ Stroke
-​ Auto accident
-​ Projectile wound
-​ Disease
-​ Drugs

Psychogenic stuttering

Cluttering

-​ less common, often begins in childhood

-​ sometimes co-occurring

-​ disorder of speech and language processing

-​ results in rapid, dis rhythmic, sporadic, unorganized, and frequently unintelligible speech
-​ an impairment of formulation language
-​ academic struggles; reading, written language
-​ tend not to realize how abnormal their speech sounds to listener

video examples

Kate
small block on my
block lu-pause-luhhh
luhhh prolongation
insertion of sounds
inhalations
fleeting secondary behavior
blinking of eyes

Daniel
part word repetitions se-se-seven, i-iiiii
prolongations iiiiii
head movement
jaw movement, tension
longer core and secondary behavior

looking up
neck tension
6 repetitions

predisposing factors
family history /genetic disposition
gender; males more
neuroanatomical differences
motor speech coordination

precipitating factors
age
stressful adult speech models
stressful speaking situation
self awareness/temperament

empowering/normalization
creating safe spaces
integrated approach
not just strategies to not stutter

assessing fluency
case history/interview
speech observation
questionnaire/survey
direct testing

tension in their body?

effect on quality of life
observations across different settings; free play, circle time
teacher feedback and kid
norm referenced standardized tests
speech observation
analyzing
-​ avg number of disfluencies per 100 words/syllables
-​ # of disfluency words/total # of words X 100

type and amt of disfluency speech

existence of secondary features

quantifiable
+​ quality of life
Kiddy cat questionnaire
appropriate language
TOCS -

single words
Intervention
modification; managing the moment of stuttering
shaping: creating less disfluent speech

Integrated approach to fluency intervention

Fluency Shaping —-> Integrated <—- Stuttering Modification
Counseling- core part

Already experiencing core behavior moments; techniques to aid and decrease secondary
behaviors
-​ cancellations and pull-outs to modify disfluencies
-​ reduce escape and avoidance behaviors
-​ reduce fear and anxiety

Pull-out technique:
-​ slowly reduce tension in the moment
-​ pseudostuttering
Cancelation:
-​ pause
-​ think about where tension is
-​ reduce tension
-​ say word again

Client agency: Do you want to take part in an activity?

Fluency shaping: strategies to eliminating moments of stuttering

-​ slower rate of speech
-​ relaxed breathing
-​ easy onsets
-​ soft contact while speaking

Easy onset:
-​ starting airflow before vocal cords

Light contact:
-​ touch articulations lightly
 -​ when the light contact occurs depends on analyze what’s going on with the client

Client agency: I don't want to talk slow, I don't want to sound like that
Loose vs tense; What does the body feel like to be tense? Where do you feel loose? Where do
you feel tense? Imbed counseling

Tell others about stuttering

Highly structured approach

Lidcombe Program (Onslow)

Parents implement program at home

SLP: demonstrates various features of the treatment, observing parent going the treatment
feedback

SLPs and parents take weekly data

-​ % of syllables at clinic
-​ severity rating
Requires a very motivated family
Providing praise for fluent moments

Beginning child’s awareness of their own stuttering

Introducing smooth vs bumpy; maybe stuttering resolves or not
Myths and facts around stuttering

Goal: minimal to no stuttering

Works well in preschool, ideally in private setting

Comprehensive intervention approach (Elementary and on)

Impairment: addressing timing and tension of speech to help

Activity limitations: education, self-advocacy, and generalization
Personal context: negative reactions, beliefs, and attitudes
Environmental factors: family and others education, cultural

Speech Sound Disorders

Speaking the written word

Primary visual context / Primary auditory cortex
Wernicke's area- interpreters
Broca’s area- planning, speech production, production of asl
Primary motor complex- sends signal to muscles
Speech production / perception
Impacts intelligibility?
Unexpected errors?
Etiology might modify intervention
Articulation
Phonological

Speech sound disorders

Articulation disorders
Phonological disorders

Articulation disorders
-​ Phonetic level
-​ Organic etiology
-​ neurological (dysarthria, apraxia, cerebral palsy)
-​ physical abnormalities (cleft palate, lip, muscle tone)
-​ deficits of motor learning
-​ Give families an expectation of sound production
-​ Functional, no known cause, 80% of cases, maybe genetic component, trends in family

Characterized by:
Omissions- seep instead of sleep
Substitutions- easier sound, sweep instead of sleep
Additions- less common, throw in extra sound
Distortions- lisp-y sounds

2 years- p, h, n, b, k
3 years- m, w, g, f, d
4 years- t, “sh”, j, (“y”)
5 years- s, v, “ng”, r, l, “ch”, z
6 years- “th”
7 years- consonant blends and clusters “spr” “str”

Range of acquisition for many of these sounds

Katie doesnt start working on r and l sounds until 7
Debates on when sounds come in
What kinds of errors? Intelligibility? -> Impacts intervention

Dentition- Kids lose teeth -> consider, determines what sounds are realistic
Ex: No F sounds if top teeth are lost to tooth fairy, palate expansion impacts art.
Oral Mechanism- assess how things move and structure of the mouth, full range of motion?
purse lips? move tongue up in and out?
Non speech tasks- No adjacent practice of working ex: eating muscles
Phonological disorders
breakdowns in perception and production of phonological rules of a language (form)

cognitive-linguistic
-​ widespread patterns of errors
-​ deletion of consonants at end of words (final consonant deletion)
-​ dropping whole sounds and syllables
-​ limited speech sound repertoire
-​ limited syllable structures
-​ trouble with multisyllabic words
-​ interactions of sounds and syllable structures

Both impact literacy

Phonological disorders impact more bc phonological awareness is basis of reading
-​ Skills ex: rhyming, identification of beginning and end of words, breaking words into
syllables

Omissions/Deletions:
Probably -> pobably
School -> cool, sool
Mushroom -> muroom, mushroo, mush, ushroom

Additions:
Spider -> skpider
Mushroom -> Mushuhroom

Substitutions:
Spider -> Spiduh

Distortions:
Lateral lisps- air escapes out of side
Nasality- making sound not nasal, nasal
Frontal lisps- thamwitch

Gymnastics -> bajastics (unpredictable)

Multilingual learners- sounds errors that are not present in native language
Consider dialects

Factors associated- Speech perception &&& Audition- phonological disorder

Hearing screening needed prior to intervention
History of ear infections/ newborn hearing screening

Intelligence
How much repetition is needed?

Childhood/Developmental apraxia of speech (DAS/CAS)

Apraxia- uncoordinated motor movement
Apraxia of speech- difficulty sequencing motor movements to produce speech
Inconsistent errors
Less common errors
-​ syllable omission
-​ consonant substitutions
-​ vowel errors
Controversial, can be overdiagnosed/under-diagnosed

60% SSD specific, 40% secondary to motor speech disorder or DD

Screening
Compare against developmental norms

Case history & interview questions

Oral mechanism screening- structure and function
-​ Lips- push out, smile, muscular? neuromotor?
-​ Teeth, dentition
-​ Tongue range of motion
-​ Hard & soft palate- cleft? wide? small?
Hearing screening
Language Screening
-​ Language sample; how is a student communicating?

Sound inventory test ~ 10 mins

Goldman Fristoe Test of Articulation-2
Arizona Articulation Proficiency Scale-4

Phonological pattern test: elimination of phonological patterns

Khan Lewis Phonological Analysis- 2

Elicited sample- structured, planned sample

Spontaneous sample- toy and play conversation

Cue fading-
Cue + model -> model
K sound peace sign to throat cue
Cold -> Told & Cookies -> Tookies
Phonological pattern of fronting?

Percent consonants correct- specific sounds, what interventions?

Percent of intelligible words- general information of intelligibility

Dynamic assessment- what cue system? where to start?

Auditory “Use fish lips”, “Use your smile”
Visual cue: K to the throat, fingers to puckered lips, fingers sides of smile
Tactile: “SSSSS” *slide down arm + tap wrist on next consonant*, on self and coach

Traditional Articulation Therapy

Appropriate for small number of errors
No underlying deficit in phonology

One sound targeted at a time, in specific position of a word (finale, medial, final)
progress to next sound at ~80% accuracy

Home practice, generalization, structured conversations

~75 repetitions
Adjusting of cueing to improve accuracy

60% accuracy with visual & tactile cues -> work on fading cues
Multiple cues + modeling
Cut down on cueing
Phrases/ formulaic sentences
“Interesting sentence” = sentences with more phonetic context

Phonological Therapy
Minimal pair / contrast approach
Feedback of utilization of pattern
Bow-Boat, Owe-Oat
Use pictures
Perception and production tasks
Point at which one is said
Student becomes teacher and slp points to what is said

Metaphonological Approach
Simultaneous targets
Suppression of speech error patterns
Ex: fronting k -> t
Phoneme awareness
Ex: fishing for objects and say first sound/recognize first sound
Letter-sound correspondences; literacy component
Ex: tat vs cat, still working on fronting but also phonemic awareness and production

Complex communication needs

Speech, language, visual, motor, and/or cognitive impairment that prevent individuals from
communicating in conventional ways

Alternative diagnosis- focuses on needs

What is their communication method? How can I build this up?
Large collaborative approach

AAC- Augmentative, alternative

Some spoken language- tool supports spoken language
Alternative- little to none spoken language

Multi-disciplinary considerations: motor planning and eyesight

Assistive Tech-
Aids for daily living
Communication aids
Environmental controls
Prosthetic and orthotic devices
Sensory aid
Seating and positioning
Mobility and transportation aid

AAC
Visual pieces, size, colors, contrast
Cognitive representation
Aided? Unaided

Types of Symbols
Acoustic; ex: verbal cue on AAC
Graphic; images
Manual; ex: sign, modified sign
Tactile; ex: brail
Variations?

What are goals for the future? Independence? How can communication intervention & specific
communication methods work toward this goal?

Aided (electronic system, low tech cards/sheet) vs unaided system (gestures, signs)
Electronic or non electronic
High tech, low tech, no tech
Display- fixed (static) or dynamic

No tech: velcro sheets

No tech considerations; can be highly motivating and effective to highlight/teach topics but are
limiting to breadth of topics/limits voice

Low Tech; simple technology

High tech: electronic devices

Time delays?
High contrast?
System match language development?

Does AAC improve message transmission?

Processing time? Motor skills?

Direct Select- direct motor act

Key guards? if point is shaky

Sensitivity of the system?
Time delay?

Ex:
Tech-speak
Sign language

Start with robust system to build to full robust system of communication

Start with one page and add on to make dynamic

Eye gaze system considerations- no trunk support, hand movements, head stability, time delay?
.