Download language disorder…

Queens College, City University of New York
Department of Linguistics and Communication Disorders
Division of Arts & Humanities
LCD 323: Disorders of Language
Fall 2014
Leslie Grubler MA, CCC-SLP, TSHH
Queens Hall 315D: Office Hours, Monday 430-530; Friday 8-9 & 12-1
By Appointment
CLASSROOM OPERATIONS
Review of Syllabus
Instructor Description
As a 300-level course, Disorders of Language will provide a succinct and in depth
understanding of language disorders in both children and adult and an introductory analysis of
treatment, assessment, and reporting. Also provided is a relevant understanding of evidencebased practice, and the preparation of meaningful goals to yield desirable outcomes. During
this semester, you become an observer in the process of change to yield a keener
understanding of the scope of practice of a speech-language pathologist as well as a keener
understanding of the many language disorders you have studied thus far. As an observer in
real time, you will be privy to the confidential nature of the formation of relationships between
clinician/student clinician, patient, and family and the therapeutic necessity and
meaningfulness of the development of rapport. In this role, you will become aware of the role
of each of the participants -- the team members -- inclusive of the clinician, student-clinician,
family member(s), and Clinical Supervisor. Together, we will discuss each of these roles as
well as our own expectations for these participants. Readings of journal articles, publications,
case studies, and videos will now come-to-life in not only unanticipated and unpredictable
ways but in ways in which the unique manifestations of a communication disorder and the
unique wants and needs of the patient, result in demonstrated unique treatment approaches.
Throughout this semester, we will think on and remind ourselves of issues in quality of life; and
we will discuss how quality of life is impacted by disorder. This course will ground you in an
understanding of language disorders in children, adolescents, and adults and enable you to
consider infinite “how-to” possibilities as you embark on further developing your own potential
in the field of speech-language pathology as well as readying you holistically to embark on
your profession of choice.
Learning Outcomes
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To understand the components and relatedness of cognition, speech, and
language (ASHA Standard III BCD)
To identify and differentiate the various symptoms and classifications of language
and cognitive disorders studied this semester (ASHA Standard III BCD).
To recognize and relate the etiologies of language and cognitive disorders with
their symptoms and classifications (ASHA Standard III BCD).
To describe and demonstrate the specific diagnostic exams used with language
and cognitive disorders studied(ASHA Standard III BCD).
To outline and compare the treatment plans used for each of the language and
cognitive disorders studied (ASHA Standard III BCD) To engage in 13 hours of observation of individuals with a variety of
communication disorders and prepare observation logs according to distributed
guidelines· (ASHA Standard III BCD).
To understand the concepts of evidence-based practice, the preparation of
meaningful goals and the achievement of desirable outcomes
To demonstrate an understanding of the necessity of the human applications of six
requisite therapeutic skills inclusive of rapport-building, listening, interpreting body
language, teaming, empathy, and informed intuition throughout all observations.
Teaching Outcomes
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To increase your readiness for graduate school and assist you in
further enhancing your application via the acquisition of knowledge,
current data, and meaningful experiences
To develop a more holistic understanding of the profession of
speech-language pathology
To assist in the development of self-confidence particularly in
ensuring that you gain confidence in the foundation that you have
established
To further develop students who recognize, acknowledge and seek
to explore and experience the grandiosity of the profession ie.
develop an appreciation for the value of this field and the more
certain potential of your contribution
To develop within you an integration of the basic principals
underlying intervention and assessment with concepts of informed
intuition, the necessity for the development of rapport, and an
acute awareness of body language,
To more intimately understand the contribution of speech-language
pathologists to improvements in quality of life and to recognize both
the power and choice that we have as clinicians.
Page-Building….
10 MEMES OF
MINDFULLNESS…
I. Iceberg Theory
II. KUBLER-ROSS
III. MEANINGFUL PRACTICE
AND MORE PRACTICE . . .
AND MORE PRACTICE. . .
UNTIL…AHHHHHHHHHHHH
IV. Hierarchy of Needs
V.
PRACTICE
CREATIVITY
RECEPTIVITY
INFORMED INTUITION
EMPATHY
KNOWLEDGE
VI.On Developing Expertise
What is experienced by an expert as direct
perception is dependent on long training.
Experts chunk information into larger
meaningful units, they filter out irrelevant
information, and they rely on a large set of
mental models. This processing of sensory
information by the expert is done implicitly
(unconsciously) and for the expert it seems
like “direct perception of truth, fact, etc,
independent of any reasoning
process.”
(Mayer 1992)
VII.Ongoing Reflections
THE FIVE QUESTIONS:
1.What am I doing?
2.What am I missing?
3.Is it working?
4.What else can I do?
5.What can I do better?
VIII.
 Patience
Visionary
The Patience Monger
On Relationships
IX.
FIRST: Understand the
learning profile
THEN: proceed to
intervention…
X.Thinking/Stepping
Out of the Box
“Cando
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tobox,
do am I
"When“What
I step
out
of the
“Am
IIaware
that
Ithe
am
in allow
a and
box?”
people’s
boxes
and
“Can
step
out
of
box
to
step
out
of
the
box?”
“Am
I
in
a
box?”
stepping
intoI stepping
another
one?”
"Who
created
the box?”
"What
box
am
out
of?”
to the
stepbox?”
out?”
staythem
out of
It Can Feel Like
RU LES
Review of Language
Development
Laying the Foundation
Becoming a Clinical Decision-Maker:
– A fourth grade student is having difficulty
comprehending his reading especially in science and
geography. He is very social and gets along well with
his peers.
– A sixth grade student who has been diagnosed with a
learning disability does not appear to understand
when other students are using sarcasm; he takes their
statements literally. This situation is causing problems
at school.
– A two-year-old has 50+ words but almost all of the
words are nouns. He is not combining words into twoword combinations.
– An eighth grade student is getting poor grades in
writing composition. His teacher says his writing is
“immature” and that he does not write with enough
complexity.
DEFINITIONS
• Language is a complex and dynamic system
of conventional symbols used for thought and
communication.
• Speech is the articulation and the rate of
speech sounds and quality of an individual’s
voice.
• Communication, includes symbolic and nonsymbolic information (i.e., facial expressions,
body language, gestures, etc.).
A language disorder…
a.may be evident in the process of
hearing, language, speech, or in a
combination of all three processes.
b.is impaired comprehension and/or use
of spoken, written, and/or other symbol
systems.
c.can represent a deficit in receptive
language, expressive language, or a
combined expressive-receptive deficit
BACKGROUND INFORMATION
• Children with speech and language
disorders make up 1.79% of the total
school population.
• Late Talker
• NOT a language difference
The Domains of Language
• Form
– Syntax
– Morphology
– Phonology
• Content
– Semantics
• Use
– Pragmatics
COMPONENTS OF LANGUAGE
• Morphology
– The structure of words and the construction of word
forms.
• Syntax
– The order and combination of words to form
sentences
– Relationships among the elements within a
sentence.
• Phonology
– The sound system of a language
– Rules that govern the sound combinations.
• Semantics
– The system that governs the meanings of words and
sentences.
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Pragmatics
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The system that combines the above language
components in functional and socially appropriate
communication.
The Five Communication
Subdomains
1.
2.
3.
4.
Early Pragmatics
Vocabulary
Early Word Combinations
Morpho-syntax
5. Discourse
Subdomain 1:
Early Pragmatic Skills
• Prelinguistic communication
• Joint visual attention (JVA) - between 10 and 12 months
– One of the first interactive communication acts
• Early Development
– 8 and 15 months - Request objects or activities, refusal,
comments
– 16 and 23 months - Requesting information, answering
questions, acknowledging a response.
• Early Discourse Skills – begins in preschool and continues
• Initiating a conversation
• Taking turns during a conversational exchange
• Maintaining ongoing topic
• Conversational topic switching
• Making conversational repairs
• Code switching
Clinical Implications for
Communication Subdomain 1
• Underlie all later communication
• First aspect of communication that is
considered during observational
process
• If the clinician identifies a weakness in
the individual’s ability in early
pragmatic functions; Communication
Subdomain 1 becomes the focus of
intervention.
Subdomain 2:
Vocabulary Development
• Vocabulary development
– Begins towards the end of the first year of life
and continues to develop throughout one’s life.
• First words typically produced between 10 and 16
months.
• By two years, children typically produce 200-500
words and understand many more words than they
produce
• Semantics deficits are characteristic of many
language disorders including:
– developmental delay
– autism spectrum disorder
– hearing impairment
– specific language impairment.
Clinical Implications for
Communication Subdomain 2
• At early stages in vocabulary development,
practitioners consider whether children’s word usage
reflects a variety of semantic categories.
• The interventionist may train caregivers to facilitate a
variety of semantic forms.
• Successful vocabulary interventions should
– integrate new word meaning with familiar words,
– provide repeated, meaningful, and contextual
opportunities to learn new words,
– provide explicit and implicit learning opportunities,
– aim for fluent and automatic understanding and
use of new words, and
– teach students to be more independent word
learners.
Subdomain 3:
Multiple Word Combinations
• Once an individual produces approximately 50
individual words, word combinations begin to
emerge.
• At this early word combination level, children are not
governed by adult syntax rules and do not use
morphological forms.
• Children create combinations of words by:
– naming objects or people of interest
– stating the actions objects or people perform
– describing the object’s or person’s characteristics
– describing who owns or possesses the object.
Clinical Implications for
Communication Subdomain 3
• Once a child is able to demonstrate early pragmatic
skills and has more than 50 single words practitioners
engage children in early play activities to facilitate
multiple word combinations.
• A child’s parents and/or caretakers are trained to
facilitate semantic combinations.
• For older individuals with significant communication
impairments, practitioners may incorporate an
alternative communication approach (AAC).
Subdomain 4:
Morphosyntax Development
• Children’s utterances begin to demonstrate
characteristics of syntax and morphological
development (i.e., language form).
• Occurs between 24 and 36 months for children
developing typically.
Examples:
– present progressive ing verb
– plural s
By age 5, children’s sentences evidence complex syntax
including the use of embedded phrases and clauses.
Clinical Implications for
Communication Subdomain 4
• Once an individual demonstrates the ability to use
foundational pragmatic functions and produces
multiword combinations using a variety of semantic
categories practitioners typically evaluate a
speaker’s use of morphosyntax using the framework
developed by Brown (1973).
• Used in language analysis
• Demonstrated in students’ ability to read difficult
texts and write at the level required for school
success.
SUBDOMAIN 5:
Advanced Pragmatic & Discourse
Development
• Between the ages of 3 and 7 children’s developing
pragmatic/discourse skills include the ability to use
language to:
– reason and to reflect on past experiences
– predict events, express empathy
– maintain status and interactions with peers
– use and understand sarcasm and politeness forms
– code switch in order
• Students also have to learn to modify discourse
styles for different situations. Some forms of
discourse are called narratives.
• Narrative forms
Clinical Implications for
Communication Subdomain 5
• Skilled practitioners track children’s abilities to use
vocabulary, produce sentences, and use advanced
language within sophisticated discourse genres.
• Observe student:
– in the classroom
– with peers
– producing narratives
• Discourse analysis
• Focus on intervention for students in peer-groups,
etc.
Becoming a Clinical Decision-Maker:
– A fourth grade student is having difficulty
comprehending his reading especially in science and
geography. He is very social and gets along well with
his peers.
– A sixth grade student who has been diagnosed with a
learning disability does not appear to understand
when other students are using sarcasm; he takes their
statements literally. This situation is causing problems
at school.
– A two-year-old has 50+ words but almost all of the
words are nouns. He is not combining words into twoword combinations.
– An eighth grade student is getting poor grades in
writing composition. His teacher says his writing is
“immature” and that he does not write with enough
complexity.
On Facilitation of
Language
And … Power or
Empowerment
Interesting Facts…
Communicatively Useful Language: Research
indicates that children select and acquire the
utterances that are communicatively most useful.
This is why children typically acquire request forms,
greetings that will initiate social interaction, and
words that mark initiation or completion of favorite
activities as their first utterances. Labels and other
descriptive terms are usually not acquired very
early in the course of language acquisition and
when best acquired are almost always learned
more for the sake of the “game” of naming than
being because of intrinsic interest of the child in
such forms.
Snow et al. 1984
More Interesting Facts
Imitation: Children use imitation as a
technique to keep conversations going, to
practice unfamiliar forms, and to learn
new forms which suggests that it should
work in therapy and direct teaching. But
imitation as used by normally developing
children is highly selective, and subject to
the principle of communicative usefulness.
Children use communicatively useful forms
when they note others using them, or
sometimes by producing delayed
imitations when the need arises. Snow et al. 1984
More Interesting Facts
Semantic Contingency:
Language acquisition is facilitated
by adult utterances that are on the
same topic as the child’s own
utterances, and that continue and
expand upon the point made by
the child.
Snow et al. 1984
More Interesting Facts
Negotiation of Meaning: The process by
which adult’s react to children’s unclear,
imprecise, incorrect, or incomplete
utterances so as to elicit a more effective
form is typically not correction but involves
a number of mechanisms. The negotiation
process continues the same topic and
further encourages the child to make
another attempt at the communicative
act.
Snow et al. 1984