week 4
8
Bumps in the Road: Communication Disorders
Learning Objectives
By the end of this chapter, you will be able to accomplish the following objectives:
• Define communication disorder, and differentiate between speech and language disorders.
• Distinguish among articulation, fluency, and voice disorders.
• Differentiate between aphasia and other kinds of language disorder.
• Explain how culture can influence the perception of speech disorders.
• Explain why the early identification of speech and language disorders is important.
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CHAPTER 8Pre-Test
Introduction
Most children acquire language with little apparent effort. In fact, language acqui-sition seems so natural that we may not appreciate how truly complex it is until something goes wrong, until we encounter a child who has difficulty with some aspect of speech or language. As educators, we will encounter such children—children such as Kahlil. When he started to speak, Kahlil’s speech appeared slow to develop. He had only a few words, when other children his age were quite fluent, and those he did speak were garbled and difficult to understand. Medical examinations showed him to have a normally developing vocal apparatus and good hearing, yet he clearly had some kind of communication disorder. In this chapter, we will take a closer look at communica- tive disorders, differentiating between speech and language disorders in children such as Kahlil, whom we will get to know better. We will also discuss the impact of culture on our perception of disorders and attempt to answer the practical question of when to refer.
Although it is impossible to get accurate figures on the prevalence of speech and language disorders in the population of U.S. school children, the American Speech-Language- Hearing Association (ASHA) reports that 24.1% of the school population (ages 3–21) with reported disabilities received services for speech or language disorders, an estimate that does not include children with speech or language problems secondary to other condi- tions (American Speech-Language-Hearing Association [ASHA], 2012a). This number almost certainly underestimates the actual number because it counts only those reported under the Individuals with Disabilities Education Act (IDEA), Part B. It is important that educators learn to recognize the possibility of a communication disorder in a child in order to seek early intervention.
Pre-Test
1. Hearing loss a. is classified as a language disorder. b. has decreased in the last 30 years. c. affects fewer than 40,000 children. d. can cause language disorders.
2. Stuttering
a. usually begins during adolescence. b. usually self-corrects without intervention. c. affects about 10% of adults. d. leads to other linguistic problems.
3. Dyslexia involves
a. about 2% of the population. b. intellectual difficulties. c. speech delays. d. no trouble retrieving words.
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CHAPTER 8Section 8.1 What Is a Communication Disorder?
4. Evaluation of language disorders does NOT involve
a. diagnosis by preschool teachers. b. use of toys to get specific types of language. c. testing proper word order usage. d. assessments created for children between 3 and 8 years.
5. One important consideration when using labels is to
a. label the condition, not the child. b. use as many labels as potentially apply. c. include the term “deficit” to solidify the label. d. focus on changing the child.
Answers 1. d. Can cause language disorders. The answer can be found in Section 8.1. 2. b. Usually self-corrects without intervention. The answer can be found in Section 8.2. 3. c. Speech delays. The answer can be found in Section 8.3. 4. a. Diagnosis by preschool teachers. The answer can be found in Section 8.4. 5. a. Label the condition, not the child. The answer can be found in Section 8.5.
8.1 What Is a Communication Disorder?
In general, a communication disorder is any kind of impairment that adversely affects a person’s ability to use language. There are two types of communication disorders—speech disorders and language disorders: When a person is unable to produce speech sounds correctly or fluently, or has problems with his or her voice, then he or she has a speech disor- der. . . . When a person has trouble understanding others (receptive lan- guage), or sharing thoughts, ideas, and feelings completely (expressive language), then he or she has a language disorder. (ASHA, 2012a)
Speech and language professionals also distinguish between a language delay and a language disorder. A speech or language delay describes a child’s language that is devel- oping but at a slower rate than normal. A delay deserves attention because it may be indicative of a language or speech disorder or of more generalized delay that affects all aspects of cognitive development.
There are a myriad of causes and interventions for communication disorders, and it is beyond the scope of this book to examine all of the disorders, their causes, or pos- sible therapeutic interventions. Our purpose here is to make teachers and future teach- ers aware of some of the more common disorders that may impede children’s ability to acquire oral and written language so that they can make the necessary referrals. Because language and cognitive development are so closely linked, and because suc- cess in school depends on both, it is important to ensure that any potential problems are identified early. The earlier the intervention, the more likely it is to succeed, as we see in the story of Kahlil.
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CHAPTER 8Section 8.1 What Is a Communication Disorder?
Diagnosing Kahlil
Kahlil was born in December 2003 on his mother’s 36th birthday while his father was on active duty with the U.S. military. Kahlil was born one week past his due date and weighed almost 10 pounds. All neonatal tests were normal, and he went home with his mother when he was three days old. The first few months were a bit of a challenge for the new mother. Kahlil developed an unusually long list of infant ailments, including thrush, colic, severe diaper rash, several ear infections, and infant acne. From 4 months until the time he was 18 months old, he had seven ear infections. At 5 months, he developed Rose- ola. When he was 10 months old, he was sick for several weeks with an ear infection that turned into a bronchial infection and, eventually, pneumonia for which he was hospital- ized for five days. Despite all his minor medical setbacks, Kahlil appeared to be develop- ing normally and was a happy child.
Shortly after he was able to sit up, Kahlil began to scoot himself along the floor, propelling himself forward with his elbows and knees. At 10 months, he pulled himself up, holding onto furniture, and for the next 2 months, he walked around with support. A few weeks after his first birthday, Kahlil’s mother noticed that he appeared to be walking on tiptoe. She had seen other children do this, so she was not particularly concerned. When it per- sisted for a year, the mother consulted her pediatrician at Kahlil’s 2-year checkup. She also expressed her other concern about Kahlil, that he spoke only a few words and most of these unclearly. She had raised this before, but the doctor had explained that boys often developed language later than girls did. At this checkup, the doctor agreed that a hearing test was called for. The test showed that Kahlil had normal hearing.
Months passed. Kahlil still did very little talking, and the words he used were intelligible only to those who were closest to him and knew what he was trying to say. Kahlil and his mother were frustrated by his attempts to communicate. He would speak, but as his utterances got longer, he was increasingly unintelligible. Kahlil’s mother took him to an audiologist who did a careful examination of his mouth and tongue, but his articulators appeared normal in every way. He appeared to listen attentively, but sometimes he did not follow his mother’s instructions, although he always responded in some way. On one occasion, when she asked him to sit on the couch, he fetched his plastic toy cow from his toy box and took it to her. A few weeks before his 3rd birthday, the audiologist raised the possibility of central auditory processing disorder (CAPD). CAPD is an umbrella term for various disorders that affect how the brain processes auditory information. Hearing is normal, but something causes the brain to distort the sound so that the brain does not get the same message that the ear does.
The audiologist explained to Kahlil’s mother that she could not make a certain diagnosis of CAPD until Kahlil reached school age when it can be determined whether the written language is affected. A professional would look for any associated difficulty with reading and writing. The audiologist could tell from the testing and from recordings of his speech that Kahlil’s speech was not developing normally. She explained that the problem might not be a speech disorder per se, but a language disorder.
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CHAPTER 8Section 8.1 What Is a Communication Disorder?
In trying to determine the extent of Kahlil’s speech and language problems, the doctor and the audiologist had begun with a hearing test. Because children cannot produce what they can- not hear, the first step in the diagnosis of virtually every lan- guage or speech disorder is a hearing test.
Hearing Loss
Hearing loss is neither a lan- guage nor a speech disorder, but it can be a cause of both. It is important to identify chil- dren with hearing loss early because “children who are hard of hearing will find it much more difficult than children who have normal hearing to learn vocabulary, grammar, word order, idiomatic expressions, and other aspects of verbal communication” (ASHA, 2012b). The number of Americans with hearing loss has doubled in the past 30 years, according to ASHA, and government statistics show that more than 70,000 children a year receive treatment in public schools for hearing loss (ASHA, 2012b). That number almost certainly under-represents the actual number of children with hearing loss since
many of these children have other disabilities as well and are reported in other categories.
In order to learn language, chil- dren need to hear language and have opportunities to use it. Children with hearing impair- ments are deprived of the sen- sory experience of language in varying degrees, depending on the severity of the loss. Con- genital hearing loss means that an infant is born with a hearing impairment, either genetically inherited or because of health issues suffered by the mother during pregnancy or something that occurred during birth. If an infant is born with a hearing loss that limits perception of sounds to those exceeding 60 decibels
A hearing test is useful for diagnosing CAPD and many other speech and language problems. It is an important first step if any speech or language problem is suspected.
National Geographic Society/Corbis
A computerized analysis of speech. Even though everyone has a unique “voice print,” experts can pick out individual vowel sounds and some consonants from the patterns of time, frequency, and intensity.
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CHAPTER 8Section 8.1 What Is a Communication Disorder?
(about the intensity of a baby’s cry; see Measuring Sound), he or she is unlikely to develop oral language spontaneously. A baby born with a loss greater than 90 decibels is consid- ered deaf and will not develop speech without therapeutic intervention.
Measuring Sound
The spectrum of sounds that the human ear can detect is very broad, ranging from the sound of a finger turning the page of a book to the sound made by a jet engine a few yards away. Although we commonly think of the differences in intensity as differences in volume, scientists use the decibel (dB) to measure the intensity of sound. Total silence would be 0 dB. “On the decibel scale, an increase of 10 means that a sound is 10 times more intense, or powerful. To your ears, it sounds twice as loud” (National Insti- tute on Deafness and Other Communication Disorders [NIDCD] 2012). The decibel rating depends, of course, on how far away the origin of the sound is from the hearer. The following are some common sounds and their dB ratings:
A whisper 15 dB
Quiet bedroom at night 30 dB
A washer or dishwasher 40–55 dB
Average home 50 dB
Normal spoken language 60 dB
A baby crying 60 dB
A gas-powered lawnmower 90 dB
A diesel truck (10 yards away) 90 dB
A chain saw (1 yard away) 110 dB
A rock concert 120 dB
A jet engine (100 yards away) 110–140 dB
A gunshot or firecracker 140 dB
Stun grenade 170–180dB
A sound above 85 dB can cause hearing loss, depending on the strength and length of the sound. The louder the sound, the shorter the time before hearing loss can occur. Eight hours of 90 dB can cause damage to hearing, and the exposure does not have to be continuous. Any exposure to a 140 dB sound can cause immediate damage, sometimes temporary and sometimes permanent. Exposure of more than one minute to a 110 dB sound risks permanent hearing loss.
For further information, see Weblinks Noise-Induced Hearing Loss. http://www.nidcd.nih.gov/health/hearing/pages/noise.aspx
A more common cause of hearing loss in young children is otitis media, or inflammation of the middle ear, which is also the most frequently diagnosed illness in infants and young children. Seventy-five percent of all children will experience one or more ear infections during the first 3 years of life (ASHA, 2012b). Many of these will lead to temporary hear- ing impairment, but children who experience many severe ear infections are at risk for permanent hearing loss and serious language disorders. Kahlil’s medical history included a number of ear infections requiring medical attention, at least one severe enough to war- rant hospitalization. While no clear causal relationship could be established between his
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CHAPTER 8Section 8.2 Speech Disorders
ear infections and his eventual diagnosis of central auditory processing disorder, most children diagnosed with CAPD also have a history of chronic ear infections (Carter, 2000). Fortunately, most hearing loss can be effectively treated, the precise treatment depending on the cause and severity of the loss. Children diagnosed with speech disorders may also have experienced some degree of transitory or permanent hearing loss.
8.2 Speech Disorders
Speech disorders differ from language disorders in that they typically affect only a person’s ability to produce normal sounding speech. There is no evidence of prob-lems with language processing, oral or written. Speech disorders fall into three broad categories: articulation disorders, fluency disorders, and voice disorders.
Articulation Disorders
Articulation refers to the use of the tongue, lips, teeth, and mouth to produce speech sounds. Articulation disorders occur when sounds are added, omitted, substituted, or dis- torted. There is a broad spectrum of articulation disorders. At the low end of the spectrum is the problem in articulating a particular sound, a problem that can be very difficult to remediate. For example, Jorge, a 19-year-old who is bilingual (Spanish and English), has never learned to produce the “th” sound in either its voiced or unvoiced form in either of his languages. The sound is present in his dialect of Spanish, although not in all. In all other respects, his pronunciation is excellent. At the high end of the spectrum are disor- ders that are severe enough to render speech unintelligible.
Structural abnormalities, such as a cleft lip or palate, a tongue- tie, or other mouth deformity, cause many articulation disor- ders. Most of these can be cor- rected or improved, and gener- ally, these conditions will have been addressed before children reach preschool. Missing teeth can also result in temporary pronunciation anomalies, which are corrected when the new teeth grow in. Some articulation disorders, however, do not have a visible cause. The audiologist can determine whether the child can hear the sounds correctly, since it is virtually impossible to replicate a sound if the child cannot hear it.
Missing front teeth will cause certain sounds to be produced differently. Which sounds are likely to be affected and how?
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CHAPTER 8Section 8.2 Speech Disorders
The American Speech-Language-Hearing Association identifies six speech disorders, four of which are articulation disorders. They include childhood apraxia, dysarthria, orofacial myofunctional disorders (OMD), and speech sound disorders.
Apraxia Children with this disorder have trouble producing speech sounds correctly. They know what they want to say, but they cannot get the articulators to produce the sounds. Although apraxia is a motor speech disorder, it is not caused by muscular weakness; it originates in the brain, which is unable to “schedule” or coordinate the motor activities needed for speech. The result in young children is sometimes a failure to coo or babble, and in older children, leaving out sounds and greatly oversimplifying pronunciation. Children with apraxia may have difficulty imitating speech, but the speech they are able to imitate is more easily understood than speech they originate. Apraxia was considered a possible diagnosis for Kahlil. But children with apraxia (and no other speech or language problems) can normally distinguish between similar-sounding words. In Kahlil’s case, he could not hear the difference between Sam, jam, and dance because, as the audiologist explained, his brain “jumbled up all the sounds.” A child with apraxia would normally be able to hear the distinctions, but because the brain was imperfect in its communication with the articulators, would not be able to produce the differences.
Dysarthria Children with dysarthria also have difficulty producing speech sounds correctly, but this condition is caused by weakening of the muscles of the mouth and face and sometimes the respiratory system. It is a condition that occurs after a stroke or other brain injury and also in children with muscular dystrophy (MD) or cerebral palsy (CP). It affects both children and adults, and the condition is associated with slurring and abnormal rate of speech— it may be very slow or it may be very rapid and sound like mumbling. The rhythm of speech is often distorted, and the voice quality may also be affected causing speech to sound overly nasal. Children with this disorder frequently have difficulty in chewing and swallowing and may have trouble controlling saliva. Since Kahlil had suffered no brain trauma and had neither MD nor CP, it was easy to rule out dysarthria as a cause for his speech problems. Apraxia and dysarthria are not mutually exclusive diagnoses—ASHA makes it clear that a person may have either or both conditions, and it takes a trained speech-language pathologist to make an accurate diagnosis and recommend the appro- priate intervention.
Orofacial Myofunctional Disorders (OMD) Children with OMD usually have difficulty with sounds such as /s/, /z/, “th,” “ch” and “j.” While it is normal for very young children to simplify some of these sounds (e.g., pro- ducing sing for thing or dim for Jim), these pronunciations do not normally persist beyond the age of 3 or so. The most recognizable symptom of OMD is a “tongue thrust,” which causes the tongue to protrude between the teeth and to move forward in an exaggerated manner during speech. There are various causes of OMD, including heredity, but aller- gies, enlarged tonsils or adenoids, and excessive sucking of the fingers or thumb are a few of the other causes. Although a speech-language pathologist or a physician can usually reach a diagnosis, treatment of OMD usually requires a team of medical professionals,
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CHAPTER 8Section 8.2 Speech Disorders
including a physician, an ortho- dontist, a dentist, and a speech- language pathologist.
Speech Sound Disorders As we saw in Chapters 3 and 6, children often make develop- mental errors when producing certain sounds. By the time they are 5 or so, they are normally able to produce all the sounds of their first language correctly. Sometimes, however, a child will persist in an imperfect pro- nunciation beyond the period the correct one is normally acquired. When this happens systemically, or regularly, in the child’s speech, then the child
may have a speech sound disorder. Carmine and Thanos, both age 2, substituted a /d/ for “th” in words such as thumb, three, and this. By his third birthday, Carmine had mastered the /d/, except in rare instances—he would occasionally say dat for that, but it was com- mon for the adults in his household to make the same substitution. Thanos, in contrast, was still unable to articulate the “th” sound at age 3. Thanos, it was later determined, had a speech sound disorder. He began to work with a speech-language pathologist at age 4, and by the time he entered kindergarten, he had good control over this and most of the other sounds he had struggled with.
Fluency Disorders
Fluency refers to the production of speech with the appropriate pauses or hesitations to keep speech clear and recognizable. A fluency disorder occurs when speech sounds are very rapid, have extra sounds inserted, or are repeated or blocked. Because children first learn to talk in a social setting, disruptions to fluency can have an adverse effect on their interactions with others. If the fluency disorder is mishandled, whether at home, school, or in public, a child may become withdrawn and reluctant to speak. Although fluency disorders are relatively easy to diagnose, it is often impossible to identify a cause. Fortu- nately, effective therapy is possible even when there is uncertainty about cause.
The most commonly recognized fluency disorder is stuttering. Stuttering is the invol- untary repetition of speech sounds, particularly initial consonants. It is the most recog- nizable of all speech disorders. Approximately 5% of all children are affected, but for most of these, it does not persist for longer than 6 months. For about 1% of all chil- dren, however, the condition will continue into adulthood. Stuttering is not usually a pervasive condition, meaning that children who stutter do not stutter in all contexts or environments. It has long been noted, for example, that most stutterers become fluent when singing, reading, or speaking in unison with others, or when they whisper (Hulit & Howard, 1993), suggesting that when the speaker is saying something meaningless or
This girl is practicing tongue movements during an OMD therapy session with her speech pathologist.
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CHAPTER 8Section 8.2 Speech Disorders
has a limited audience (as with whispering), the stuttering ceases. Putting pressure on a child to “stop that stuttering” will simply make the problem worse, and teachers should consult with speech-language professionals. In general, children past the age of 4 and a half should be referred to a speech-language pathologist who will determine whether intervention is needed and what kind. See Interesting Facts About Stuttering for further information.
Interesting Facts About Stuttering
Stuttering is one of the most easily identified speech disorders. It is also responsive to therapy. Speech- language professionals have studied the disorder and its treatment for many years. The following are among the things they have learned:
• Children who begin stuttering before 3-and-a-half years are more likely to outgrow stuttering than if they begin later. If stuttering begins before the age of 3, the child is likely to outgrow it within 6 months.
• About 1% of the general population experience stuttering that persists into adulthood. • For the onset of stuttering, girls and boys appear to be equally susceptible, but boys are three
to four times more likely to continue to stutter into the school years (Felsenfeld, 1996). • Family history plays a role. Children or siblings of stutterers are at greater risk for stuttering. If
the family member outgrew the stuttering, chances are better that the child will also outgrow it.
• Between 75% and 80% of children who begin stuttering will stop within one to two years with- out intervention. Chances of the child stopping decrease the longer the stuttering persists.
• Other speech or language problems may influence whether or not stuttering persists. If a child otherwise speaks clearly and is easily understood, she is less likely to continue to stutter than if stuttering is one of several issues.
• In general, children who stutter do not have lesser linguistic abilities than children who do not stutter. In fact, according to the National Stuttering Association, children with advanced lan- guage skills are more at risk for persistent stuttering.
Source: The Stuttering Foundation, http://www.stutteringhelp.org/default.aspx?tabid=114
Stuttering is not the only type of fluency disorder. Cluttering is the name given to speech characterized by “a rapid and/or irregular speaking rate, excessive dysfluencies, and often other symptoms such as language or phonological errors and attention deficits.” Speakers with a cluttering disorder seem not to be clear about what they want to say or how to say it and usually exhibit many interjections or revisions to their own speech. Iso- lating cluttering as the cause of nonfluent speech is complicated by the fact that stuttering and cluttering can co-occur (The Stuttering Foundation, 2012; Levy, 2011).
Voice Disorders
Voice is a result of the coordinated efforts of the lungs, larynx, vocal folds, and the oral and nasal cavities. Voice disorders are said to be present when the airstream or resonance are affected, creating speech that sounds breathy, whispery, or overly nasal,
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CHAPTER 8Section 8.2 Speech Disorders
for example. Some voice disorders are caused by damage to the organs involved in articulation, but others can be caused by a speaker having developed inappropriate or improper voicing habits.
Most of us will experience some kind of voice disorder at sometime during our lives. Hoarseness and loss of voice due to a cold or other illness are common. A true voice disor- der, however, is one that affects voice quality over an extended period and does not appear linked to a transitory illness. Voice disorders may affect the pitch of the voice, the loud- ness, or the quality. Pitch disorders can be manifested as pitch that is too high, too low, or flat (i.e., monotonous). Often, an abnormally high pitch is nothing more than a symptom of slow maturation, particularly in boys. Especially low pitch is much less common, and when it does occur, it may be because the speaker has a larynx that is larger than usual for his or her overall size. Older children can train themselves to speak in a lower pitch, but generally no intervention is required. Monotonic speech in speakers is often caused by a hearing loss, but it may also have a psychological basis, such as low self-esteem.
Loudness disorders occur when a voice is too loud, too weak, or very rarely, when there is no voice at all. Hearing loss may be the culprit with both overly loud and overly soft voices because the speaker cannot judge the volume of her own speech. There can be other causes, such as person- ality traits—some people are just more boisterous than others, and some people do not like to draw attention to themselves.
Voice quality refers to conditions such as hoarse- ness, hypernasality (meaning that the voice sounds like the speaker is speaking with a blocked nasal passage), a creaky or whispery voice, and extreme breathiness. Any of these conditions may indicate a voice quality disorder if they persist for an extended time. In extreme cases, there may be distortions to the pitch, volume, or quality of the voice to the extent that the speaker is unin- telligible. In milder cases, the voice may simply sound inappropriate for the speaker ’s age or gen- der but intelligibility is only slightly impeded. There are a number of causes for vocal disorders, but only about a third of them have a physical basis—excessive breathiness and hoarseness, for example, might be caused by some abnormality in the vibration of the vocal folds. Most vocal dis- orders have other causes such as stress or abuse of the vocal apparatus. For example, this hap- pens when singing too loudly for too long and will respond to rest or medical treatment.
A simple cold can lead to vocal hoarseness due to inflammation. This hoarseness is not a permanent voice disorder and should disappear with other cold symptoms or shortly thereafter.
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CHAPTER 8Section 8.3 Language Disorders
8.3 Language Disorders
When a child fails to develop language normally, the potential consequences are severe because language is tied to cognitive development and school success (Chapters 5 and 6). Many professionals have attempted to describe and clas- sify the multitude of language disorders, but despite many attempts, none has gained universal acceptance among physicians or speech-language professionals (Simms, 2007). For example, although speech-language therapists distinguish between speech and lan- guage disorders, there may be overlap in diagnoses. Also, a child may have both a lan- guage and a speech disorder. A widely accepted definition of language disorder is “any systematic deviation in the way people speak, listen, read, write, or sign that interferes with their ability to communicate with their peers” (Crystal, 1987, p. 264). This definition covers a broad spectrum of linguistic dysfunction; the structure, the content and the use of language can all be affected, singly or in combination. Usually, a language disorder is the result of a physical impairment such as brain damage or deafness and is identified by deficits in comprehension, production, or use of language in the absence of any general intellectual disability.
Despite their failure to agree on how language disorders are categorized, professionals do agree that language disorders may be broadly classified as receptive, expressive, or both. A child with a receptive disorder has difficulty in understanding speech sounds. A child with an expressive disorder has difficulty in appropriately putting sounds together to produce comprehensible speech. Kahlil, whom we met earlier in this chapter, appeared to have both. His speech was mostly incomprehensible, but his responses to simple directions indicated that what he heard was not what the speaker intended. In other words, the brain somehow “mistranslated” the sounds that the ear received, resulting in a garbled message.
CAPD is thus a language disorder rather than a speech disorder. Language disorders vary both in the aspect of language affected—sound, word, conversation, and so forth—and in severity. They also vary in cause, and with many, the causes are unknown. Most, however, are amenable to intervention, and the earlier a child is diagnosed, the more effective the intervention.
Specific Language Impairment
Specific language impairment (SLI) is the term language pathologists use for children whose language development is 12 months or more behind their chronological age and is not associated with other sensory or intellectual deficits or diagnosed cerebral damage. Estimates on the prevalence of SLI in preschool children vary from 7% to 10%, depending on the age at which it is diagnosed. The number is as high as 10% in 2-year-olds but drops to 7% two years later, suggesting that some of the developmental delays that prompted the early diagnosis have resolved themselves (NIDCD, 2012; ASHA, 2008a). The follow- ing traits characterize SLI:
• Slow progress in speech following normal onset time. In other words, children with SLI begin to speak at about the same time as other children, but over time, their development lags behind.
• Particular problems with morphology (Chapter 2), especially producing word endings such as -ing or -ed.
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CHAPTER 8Section 8.3 Language Disorders
• Difficulty with picking up the meanings of new words from context. • Problems with generalizing of forms, for example, that -ing is used on all verbs to
indicate ongoing action. (Davidson & De Villers, 2012)
The general characterization of children with SLI is that even though they usually do not have any difficulty with social interaction, they have trouble picking up language inciden- tally as they play and interact with others. What appears to be at the root of the problem for these children is either an inability to perceive certain sound distinctions in speech or in their short-term phonological memory. They are not, however, hearing impaired. Some children with SLI may have “associated impairments in motor skills, cognitive function, attention, and reading,” but these are not causal since many children with SLI exhibit no evidence of cognitive impairment. The causes are unknown, but there is some evidence that there may be a genetic component (Davidson & De Villers, 2012; ASHA, 2012a). What is known is that children with SLI are not afflicted with brain trauma nor is there any evi- dence of brain abnormality in these children.
Some disorders do result from specific brain damage, and they are collectively known as aphasias. Aphasias are classified according to the area of the brain affected, but the three general types recognized by most professionals are receptive, expressive, and global.
Aphasia
Aphasia occurs when there is damage to the language centers of the brain, usually in the left hemisphere. Both oral and written language are usually affected. The particular type of aphasia depends on the area of the brain that is damaged. Wernicke’s aphasia, also called sensory or receptive aphasia, results from a lesion in Wernicke’s area, the upper back
part of the temporal lobe of the brain. As with all receptive disorders, those suffering from this type of aphasia generally exhibit no articulatory dysfunction, and may actually seem excessively fluent—talking rapidly and without hesitation, for example. The result may be garbled or even nonsensical to the hearer. Because this aphasia affects how well they comprehend speech, people with Wernicke’s aphasia may repeat words or parts of words and phrases or rely heavily on for- mulaic expressions, repeating them often. People with receptive aphasia may also have difficulty in retrieving words from memory.
Broca’s aphasia, also known as expressive aphasia or motor aphasia, occurs in people with damage to the lower back part of the frontal lobe. People suffering Broca’s aphasia have severe articulation and fluency problems. In contrast to Wernicke’s aphasia, this aphasia is characterized by slow, labored speech, with distortions in the individual sounds and the intonation pattern. Patients with
Wernicke’s aphasia is associated with injury to Wernicke’s area (orange), whereas Broca’s aphasia occurs when there has been damage to Broca’s area (purple).
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CHAPTER 8Section 8.3 Language Disorders
this disorder speak in very short sentences, leaving out all but essential words and some- times ignoring the rules of grammar. Unlike patients with receptive aphasia, however, they have little trouble with comprehension. Global aphasia refers to a disorder to both receptive and productive language ability. Those suffering from global aphasia will have minimal speech capability and limited comprehension. The prognosis for recovery or even significant improvement is poor for global aphasia.
Nobody is born with aphasia. The major cause is stroke, so it is more prevalent in adults than in children. But children with brain trauma due to accident or injury can suffer from aphasia as well. In general, the prognosis for recovery depends on the location and size of damage to the brain. Also, the younger the patient, the better the prognosis for recovery (Cheour, 2010).
Children with any of these aphasias would normally be diagnosed at an early age, so it would be unusual for an educator to encounter a child with untreated aphasia. If a child appears to exhibit symptoms of a mild aphasia, the first thing to rule out is hearing loss since it is far more common and can cause problems in both comprehension and speaking.
Central Auditory Processing Disorder (CAPD)
Toward the end of first grade, the professionals treating Kahlil confirmed the diagnosis of CAPD. His teachers in kindergarten and first grade had reported some of the same behaviors that his mother had observed—he appeared to have trouble following direc- tions, he was easily distracted by loud noises, and the more noisy the environment, the more anxious he became. His anxiety level decreased and his behavior improved when he was in a quieter environment. Even though he could hear across the entire spectrum of speech sounds, Kahlil could not distinguish between cer- tain pairs of speech sounds. He could not tell cow from bow, chow, or now, for example. He even had some problems dif- ferentiating vowels—remem- ber from Chapter 2 that vowel sounds are more resonant and, thus, generally easier for chil- dren to hear and to discrimi- nate. But for Kahlil, the vowels in sit, seat, and set were some- times confused. Even though he was capable of hearing the different vowel and consonant sounds, something happened in the transfer of the sound into or out of the speech center of the brain, and the sounds became confused or garbled.
Although Kahlil’s ears heard the sound waves just as everyone else did, his brain did not process them normally but scrambled them. This is a defining characteristic of CAPD.
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CHAPTER 8Section 8.3 Language Disorders
Kahlil had trouble learning letters and recognizing words as well, and it appeared to his teachers that he might have dyslexia, a condition affecting a person’s ability to read and write. It is not surprising that Kahlil had difficulty with the printed language as well because a strong foundation in oral language is essential for success in reading. Moreover, there is likely a neurological connection. Just as dyslexics can see the words, but some letters get jumbled in their brains, those with CAPD can hear, but their brains aren’t able to process some sounds (Carter, 2000). Eventually, the professionals working with Kahlil concluded that CAPD was the central diagnosis responsible for his oral and written lan- guage processing problems. A speech-language therapist had begun working with him at age 3, and once he was diagnosed with CAPD, he was referred to a clinic that dealt with CAPD and other serious language processing disorders. Initially, he spent most of the school day in the clinic, but gradually, he was able to go back into his class. Now 9 years old, Kahlil is finishing second grade, having repeated first grade when his family moved to be closer to the clinic he was attending. He says he likes school, and he is able to spend three fourths of every day in his class. His teacher coordinates her work with the other professional who care for him, and the prognosis for Kahlil is good.
Dyslexia
Although the term is not used by all school districts—some opt for the broader term learning disability instead—dyslexia refers to a category of reading disorders associated with impairment to the ability to interpret spatial relationships (in print) or to integrate auditory and visual information. The term is used to identify a broad spectrum of neu- rologically based language processing disorders and affects both reading fluency and comprehension. Symptoms may be mild to severe and include the following:
• Letter reversal or mirroring. This is the symptom most commonly associated with dyslexia, but it occurs only rarely. Letter reversal occurs among nondyslec- tic children and is, on its own, no cause for concern. Most children will reverse some letters when they are first learning, creating a “d” for a “b,” for example. This behavior may persist until the age of 6 or 7. While children with dyslexia may experience written text as a jumble of letters, they only rarely see them as reversed or mirrored.
• Delays in speech. Many children who are subsequently diagnosed with dyslexia begin to speak later than their peers.
• Distractibility. Children with dyslexia are often easily distracted by background noise.
• Difficulty with sound segments. Sometimes, children with dyslexia have problems counting syllables in words, generating rhymes, and breaking words down into individual sounds, or “sounding out” words as they learn to read.
• Retrieval problems. Children with dyslexia often have difficulty in recalling words or the names of objects.
• Tendency to omit or add letters when reading, writing, or just copying words. • Generally, writing that does not match their level of intelligence or general aca-
demic understanding.
Estimates of the incidence of dyslexia in the U.S. population range from 5% to 20%. There are no comparable data for CAPD, but although most clinicians rank the incidence much
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CHAPTER 8Section 8.3 Language Disorders
lower than dyslexia, they also acknowledge that it is not uncommon (ASHA, 2008b). While dyslexia and CAPD share many symptoms and some children have both CAPD and dyslexia, the two are different neurological disorders, and only trained professionals can determine the best intervention strategies.
Autism: Language or Cognitive Disorder?
In Chapters 5 and 6, we saw how language and cognitive development are interdependent. Even so, language disorders may exist in children who have no other cognitive impair- ment. But some children have language disorders rooted in or associated with a more generalized cognitive or learning disability. Especially in very young children, it is some- times difficult to know whether an abnormality in some aspect of language development
is indicative of a broader disorder, particularly a social-cognitive dis- order. A social cognitive disorder is a result of a brain abnormality that interferes with infants’ and children’s abilities to develop nor- mal social and cognitive skills. The medical profession has not been able to determine what causes the abnormalities to develop nor pre- cisely how the brain is affected. The most commonly recognized of these disorders is autism spec- trum disorder (ASD).
As the name suggests, autism admits of degrees of severity—the American Psychiatric Association recognizes three, not counting Asperger’s syndrome (see Asperg- er’s Syndrome). In making a diag- nosis of ASD, the medical profes-
sion confirms that beginning in early childhood, a patient exhibits (a) persistent deficits in social interaction and communication in all contexts and (b) restricted and repetitive patterns of behavior and interests, which taken together impair everyday functioning (American Psychiatric Association [APA], 2011). Patients diagnosed with ASD will have both verbal and nonverbal communicative abnormalities including difficulty in using or interpreting facial expressions or body language. They may be either abnormally sensi- tive or insensitive to sensory input, for example, being oblivious to or extremely reactive to changes in temperature, light, or movement. Repetitive behaviors, vastly beyond the routines that most children develop, are also characteristic of children with ASD.
These twin boys function at different ends of ASD. The fact that both have autism indicates there might be a genetic link, but a cause has not yet been established.
Jodi Cobb/National Geographic Stock
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CHAPTER 8Section 8.3 Language Disorders
Although autism is not a language disorder, even children with milder forms of autism will have difficulty with pragmatics, or using language appropriately in social settings. In fact, that may be the main symptom demonstrated by children who fall at the higher functioning end of the autism spectrum. Children with semantic-pragmatic-communi- cation disorder (SPCD), for example, may play well with other children and exhibit no major problems in socializing, but they are likely to misinterpret the intent of messages. For example, they may not understand that when a teacher says, “Would you please sit down?” she neither expects nor welcomes an answer. Even as teenagers, ASD patients may not understand irony or sarcasm.
Asperger’s Syndrome
At the high-functioning end of the autistic spectrum is Asperger’s syndrome, which is not a language disorder, per se. Rather, it is social-cognitive disorder affecting children’s ability to socialize and commu- nicate effectively with others. Children with Asperger’s syndrome typically exhibit social awkwardness and an all-absorbing interest in specific, sometimes arcane, subjects. They will develop language nor- mally and may even demonstrate language ability in advance of their years. For example, Piper (2007) recounts the story of Kenny, who could read before he was 3 years old. The type of language problem typically exhibited by children with Asperger’s is associated with their inability to engage in normal social interactions. That, coupled with their typically limited range of interests, means that they may have limited conversational competence (Chapter 7). Children with Asperger’s may
• engage in long monologues, appearing to be unaware of whether or not others are listening or trying to take a turn;
• fail to make eye contact or exhibit few changes in facial expression while speaking; • display awkward body posture or stances and gestures; • show a near-obsessive interest in one or two very specific subjects such as snakes, weather, or
a particular action hero; • show little or no empathy or sensitivity to others’ feelings or emotional states; • have difficulty understanding humor; • speak in a monotonous tone that may be unusually rapid; • have poor coordination; and • play alone or alongside rather than with other children.
The Viennese pediatrician Hans Asperger, who first described the condition, referred to his patients as “little professors” because they usually have very high intelligence, impressive vocabularies and facility with language (Osborne, 2000). Because they are so bright, they can sometimes be taught many of the “rules” for socializing and conversational turn-taking and how to interpret gestures, tone of voice, and sarcasm. They can also learn how to speak with a more natural rhythm. Speech- language professionals can assist such children, but the nonlinguistic aspects of the disorder will require other medical professionals.
For further information, see Weblinks at the end of the chapter.
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CHAPTER 8Section 8.4 Issues of Cultural Diversity
8.4 Issues of Cultural Diversity Sometimes, a child will arrive in preschool or kindergarten with very little English. Esti- mates in Texas, for example, are that more than one third of children under the age of 5 speak Spanish as their first language (University of Texas at Austin, 2010). For these chil- dren, assessments of their language and speech ability in English will likely place them in an at-risk category, not because they are more likely to have a speech or language dis- ability but because their English is insufficiently developed to get an accurate indication, most assessment tools were developed for use with English-speaking monolinguals and thus do not accurately gauge the language of bilinguals, or both. “In the early stages of bilingualism, children’s language skills are in flux, so there’s a huge range of proficiency in their second-language performance, which makes it difficult to distinguish between typical second-language differences and genuine language impairment” (University of Texas at Austin, 2010). As a result, it is difficult to determine with certainty whether chil- dren from linguistically diverse backgrounds have a disorder or whether they are simply exhibiting developmental errors.
Fortunately, early-childhood educators need not worry about making a precise or accu- rate diagnosis of a speech disorder. It is important, however, to recognize the possibility that one exists in order to make a referral to a professional audiologist or speech-lan- guage pathologist. One of the factors that teachers and language pathologists have to consider is cultural, because certain speech behaviors that may sound aberrant in one culture may be considered normal in another. Moreover, the fact that a child is learning two languages may have an impact both on the child’s speech and on our perception of whether or not it is developmentally age-appropriate. In the case of articulation disor- ders, as we saw in Chapter 6, most first language learners have acquired the individual sounds of the language by the time they are 5 or 6 years old, but some children will still be working out certain distinctions—producing /l, r, y, w/, for example, may take a little longer. In almost all cases, these persistent substitutions are evidence only of a slight delay and not of a deviance; they do not require remediation. If, however, there are pat- terns of deviation that are markedly different from other children of the same age, refer- ral to a speech-language professional is appropriate. But what if the child is bilingual and exhibits aberrant pronunciation?
Bilingual children may experience interference between the sound systems of their two languages. As we saw in Chapter 2, although there are many similarities, different lan- guages have different sounds, and those sounds are distributed (or ordered) differently. These differences may contribute to the articulation problems experienced by second language learners. In Mandarin, for example, the only consonants that occur at the end of a word are nasals, /m, n, ŋ/, so it is not uncommon for Chinese children to omit any word-final consonant that is not a nasal. Words such as bead and Mike might be rendered as bee and my. The Arabic language does not permit word-initial consonant clusters, so Arabic-speaking children might say “fie” for fly or “gain” for grain. These deviations from English pronunciation are developmental errors of the type we saw in Chapters 3 and 4, and remediation is unnecessary. In fact, speech language therapies can be coun- ter-productive for second language learners who need, instead, further exposure and practice with their new language.
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CHAPTER 8Section 8.4 Issues of Cultural Diversity
The perception of fluency dis- orders is also culturally depen- dent, to a large degree. For example, one researcher has noted, “Asian Americans favour verbal hesitancy and ambiguity to avoid offence. . . . One should respect such a community’s culture and thus the hesitancy should not be confused with a fluency disorder” (Kim, 1985; cited in Ndung’u & Kinyua, 2009). There is also a differ- ence in what different cultures believe should be remediated. In North American Cowichan, for example, stuttering is seen by many as supernatural and remediation considered inap- propriate. Similarly, there are some Native American commu- nities in which the victim of a stroke is believed to have been “hit by the wind,” because the person is out of harmony with nature (Westby & Begay, 2002; Ndung’u & Kinyua, 2009). Such beliefs would affect whether treatment was sought. Unfortunately, most treatments for speech and language disorders are most successful if they are begun early. The preschool years are well within the critical period for treatment since the brain retains its plasticity (Chapter 5), so chil- dren who arrive in preschool, kindergarten, or first grade with fluency problems can ben- efit from remediation.
With bilingual children, we must be extra careful to ensure that fluency orders actually exist since there is a possibility that what appears to be a dysfunction may be only a dif- ference caused by limited proficiency in English. For example, a child who has not yet learned a vocabulary appropriate to her age level in English may hesitate or even stam- mer as she searches for the words to make herself understood. Similarly, a second lan- guage learner may make false starts and use frequent repetitions that impede the flow of speech. For these children, these impediments to fluency are developmental, and speech or language therapy is not recommended. On the other hand, teachers run the risk of not recognizing a speech disorder masked by an accent or a dialect that is markedly different from the teacher’s own. The longer a disorder goes undetected, the more difficult it is to diagnose and treat (Guiberson, Barrett, Jancosek, & Yoshinaga-Itano, 2006). It is impor- tant, therefore, that someone who speaks their language or dialect assesses the children.
With regard to voice disorders, we know that “. . . voice quality is a language-specific property which may be different across different languages” (Yiu, Murdoch, Hird, Lau, & Ho, 2008) and that cultures vary in the amount of breathiness that is normal or acceptable in speech (Piper, 2007; Mattes & Omark, 1984). It is thus not surprising that the perception of voice disorders is largely culturally determined. For instance, in many African cultures masculinity and femininity are determined by paralinguistic features. A man who speaks
Language differs from culture to culture. Care should be taken not to confuse culturally specific language traits with speech disorders. How would you evaluate a bilingual child’s ability in both languages?
Randy Olson/National Geographic Stock
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CHAPTER 8Section 8.5 When to Refer
in a low volume, a high pitch, or a smooth and slow voice, would be frowned upon and called upon to “speak like a man” (Ndung’u & Kinya, 2009).
Sometimes, the developmental errors that young bilingual learners make are a result of the normal process of learning English. Sometimes, they are indicative of a speech or language disorder. It is important to know which, because the intervention that works for one will not work for the other.
8.5 When to Refer
If a child seems to be significantly behind his or her peer group in language development, then parents or educators should consider the possibility of SLI. One diagnostic tool that professionals use for children between 24 and 36 months is to ask parents to complete a standardized questionnaire in which they identify the vocabulary the child knows and provide examples of two-word sentences that the child uses. “If the child’s vocabulary contains fewer than 50 words and the child does not use any two-word sentences, that is an indication of SLI or another language disorder” (Davidson & De Villers, 2012).
Although the first person to suspect that a child might have a language or speech disorder is usually a parent or preschool teacher, it sometimes takes a number of speech-language professionals to confirm the diagnosis. Using assessment tools, often involving the use of puppets or toys to elicit specific language samples such as past tense or plural, they will test the child’s speech and language skills. They will evaluate how well the child constructs sentences and whether or not she keeps words in the proper order. They will also estimate the number of words in the child’s vocabulary and the quality of his or her speech. Tests are available for use with children between 3 and 8 years old and are best administered and interpreted by speech-language professionals.
Generally speaking, children might have a language disorder and should be referred if they exhibit the following conditions:
• They produce speech in combinations or patterns that are inconsistent with the language they are trying to speak and inappropriate for their age. For example, a 2- or 3-year-old child who says “gangershef” for handkerchief is no reason for con- cern, but a 6 year old might well be, unless it is an isolated instance and all other aspects of her pronunciation are normal.
• They appear not to understand certain words or categories of words that other children their age understand.
• They appear unable to follow directions or appear to be unaware of the “rules” of conversation by talking out of turn or failing to respond when it is their turn.
• They are significantly delayed in acquiring a number of speech sounds. For example, a child who cannot produce the entire spectrum of English consonants by school age might have a language disorder. Saying “do” for shoe or “delly” for jelly are perfectly normal substitutions in an 18-month old but not in a 4-year-old.
• They consistently produce shorter sentences than their peers. • Parents or caregivers of bilingual children report irregularities in the child’s first
language.
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CHAPTER 8Section 8.5 When to Refer
Why Labels Matter
Labels matter. Think about it. You are in a super- market, and you read the label of a product—say a breakfast cereal. In addition to processed wheat and corn, you see a list of 17 ingredients, none of which has fewer than three syllables, most of which you have never heard of and one of which has received some negative press. What do you do? You probably put the box back on the shelf. What you do not do, usually, is to take the box home and have a closer look or even taste it. But suppose the label says calciferol. Never heard of that so it can’t be good for you, right? In fact, cal- ciferol is just another name for Vitamin D, which won’t hurt you and might actually be good for you. What does this have to do with children?
While it is important to identify children with communication disorders and to identify them correctly, that is not the end-point but the begin- ning. In other words, labeling should not be confused with treatment. Although profession- als use labels as a shorthand for talking about conditions and their treatments, there are dan- gers in labeling. The biggest one may be that it is the child who often gets labeled, rather than the condition. When it comes to dealing with children with communication disorders—or, indeed, any
learning or cognitive disorder—educators need to focus not on changing the child but on helping the child overcome or cope with the condition. With children, we have to look beyond the label.
Although it is important to identify communication disorders early, it is also important what happens next. Labeling a child as having a particular disorder does not make the disorder disappear, nor does it mark the child as deficient in some way—the child may have a condition that sets his learning on a different path. But the purpose of diagnosis and intervention is to help the child either work his way back to the more commonly traveled path or, if that is not possible, to smooth the way along his own path. In no way should the child with a communication disorder be viewed as deficient. Labeling a child in a particular way, while useful for professionals in understanding and discussing treat- ment, has inherent dangers (see Advantages and Disadvantages to Labeling).
By a child’s 6th birthday, any potential speech or language disorders should have been diagnosed and treatment begun. Labels, despite their drawbacks, can help ensure success in school and life.
Hemera/Thinkstock
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CHAPTER 8Conclusion
Advantages and Disadvantages to Labeling
Labels are sometimes useful and almost always unavoidable. Educators need to ensure, however, that any labeling is done only to the child’s benefit and, above all, that labeling is not harmful.
Advantages
• Labels enable professionals to communicate with one another because the diagnostic labels convey general information about the nature of the disorder. When we hear that a child has a fluency disorder, for example, we know that her stream of speech is affected in some way but that her comprehension is unaffected.
• The human mind seems to require some kind of categorical shorthand—a mental “hook” to think about and solve problems. It is easier for educators to think and talk about the causes and treatments for SLI than to use many sentences to describe the disorder. If the label did not exist, one would quickly be created to take its place.
• Labeling a disorder can raise social awareness and assist in advocacy efforts.
Disadvantages
• Labels may shape teacher expectations. If a child is labeled as language delayed, it may be tempting to assess all the child’s behavior in that context when, in fact, all children have some troubling behaviors.
• Labels imply that the problem is with the child and may lead us to forget that the job of a teacher is to teach the child as is. Teaching and learning are interactive processes.
• Labels refer to categories of disorders and are abstract. Children are real and they are indi- vidual—no two children are the same even though they may have the same condition. No two stutterers are alike, and no two children with SLI will exhibit exactly the same behaviors.
• Diagnostic labels may be unreliable, but once they are in place they are hard to remove.
Conclusion
While the course of language learning is normally a seamless and seemingly effort-less task, there are children who experience delays or deficits in the process. Communication disorders are among the most commonly reported conditions requiring intervention reported in the U.S. public school system, collectively affecting up to 20% of the population at some time during childhood. Speech disorders are those affect- ing the oral language a child produces, consistently and over time. Language disorders affect a child’s ability to process language and may be either productive or receptive. The causes for communication are as varied as the disorders themselves—some have physi- cal causes, some are associated with other cognitive disorders, and some have no known cause. For the early-childhood educator, it is important to recognize when children might have a communication disorder, not to put a label on them but to ensure that they get appropriate intervention that will help them improve or to overcome the disability. Fortu- nately, the prognosis for many children with communication disorders is excellent if the disorder is recognized and the appropriate intervention is begun early enough.
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CHAPTER 8Post-Test
Post-Test
1. When there is evidence of a communication disorder, the first step is usually to
a. check IQ. b. interview teachers and parents. c. test hearing. d. prescribe medications.
2. An example of an orofacial myofunctional disorder (OMD) would be a
a. cleft palate influencing speech. b. tongue thrust. c. slurring. d. dysarthria.
3. Which of the following is NOT a type of aphasia?
a. inventive b. receptive c. expressive d. global
4. Symptoms of diagnoses within the autism spectrum disorder include all of the following EXCEPT
a. sensitivity to sensory input. b. preference for repetition and routine. c. excessive verbalization with others. d. difficulty reading social cues.
5. Which of the following is considered a disadvantage of labeling?
a. Labels allow for communication among professionals. b. Teachers develop expectations based on labels. c. Labels provide brief mental “hooks” for understanding. d. Awareness and assistance can be increased with labels.
Answers 1. c. Test hearing. The answer can be found in Section 8.1. 2. b. Tongue thrust. The answer can be found in Section 8.2. 3. a. Inventive. The answer can be found in Section 8.3. 4. c. Excessive verbalization with others. The answer can be found in Section 8.4. 5. b. Teachers develop expectations based on labels. The answer can be found in Section 8.5.
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CHAPTER 8Critical Thinking Questions
Key Ideas
• Most children learn language without difficulty, but some will experience one or more communication disorders.
• The presence of a speech disorder does not necessarily indicate the presence of a language disorder, although some children may have both.
• Language delay, or the acquisition of language forms later than normal, is not in itself a disorder but should be monitored.
• Early identification and intervention is important because many conditions can be remediated.
• Culture can influence the perception of speech disorders. • Assessment of communication disorders in bilingual children should involve
both languages, if at all possible.
Critical Thinking Questions
1. According to Interesting Facts About Stuttering, girls are three to four times more likely than boys to outgrow stuttering. What are some of the factors that might contribute to this difference?
2. Many Romance languages, including Spanish, have fewer consonant phonemes than English. What kinds of articulation differences might result for a child of 5 or 6 who is a beginner in English? What should the teacher do to assist the child in learning the sounds of English?
3. How is stuttering different from other kinds of fluency disorders? 4. Charley is 5 years old. English is his only language. His kindergarten teacher has
noticed the following pronunciations in his speech:
Table 8.1: Charley’s pronunciations
Intended word Charley’s form
chair sair
chip sip
bubble bobo
teacher seeshur
cookie kookoo
dog gog
cat cat
a. Should the teacher be concerned? b. What should she do? c. What are some of the possible causes for the irregularities in his
pronunciation?
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CHAPTER 8Key Terms
aphasia The name given to any language disorder resulting from specific brain damage.
articulation disorder One of the three broad categories of speech disorder, this is the name given to a spectrum of speech dis- orders characterized by speech with added, omitted, substituted, or distorted sounds.
Asperger’s syndrome A pervasive develop- mental disorder characterized by severe dif- ficulty with social relationships. Language problems associated with Asperger’s are likely to be at the sociopragmatic level.
autism spectrum disorder (ASD) A category of developmental disorders that involve some degree of difficulty with communication and social relationships as well as obsessive and/or repetitive behaviors.
Broca’s aphasia Also known as expres- sive aphasia or motor aphasia, a language disorder that occurs in people with dam- age to the lower back part of the frontal lobe. People suffering Broca’s aphasia have severe articulation and fluency problems.
central auditory processing disorder (CAPD) This is an umbrella term for a variety of disorders that affect how the brain processes auditory information.
cluttering The name given to speech characterized by a rapid and/or irregular speaking rate, excessive dysfluencies, and often other symptoms such as language or phonological errors and attention deficits.
communication disorder Any kind of impairment that adversely affects a per- son’s ability to use language.
5. Carmelita is 5 and moved to Florida from Puerto Rico 8 months ago. Six months ago, she began kindergarten in an English-language school. Her teacher, Ms. Cook, speaks only English although there are Spanish/English bilinguals on the teaching staff. At first, Carmelita said little in English, but she learned the language quickly. Still, her teacher has noticed that Carmelita uses the following forms:
a. She ride the car. b. It no red. It blue. c. Why she not go? d. Why he like me?
Should Ms. Cook be concerned? What is the most likely cause of these “errors”? What should Ms. Cook do?
6. Why is the distinction between speech disorders and language disorders important?
7. Why is it important that teachers not think of second language learners in terms of deficits or deficiencies?
8. The box Advantages and Disadvantages to Labeling lists some of the advantages and disadvantages to attaching labels to communication disorders. Can you think of others?
9. Which of the disorders described in this chapter would you consider “bumps in the road,” and which would be major barriers to success in school?
Key Terms
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CHAPTER 8Weblinks
Weblinks
To learn more about speech and language disorders, see the following: http://www.asha.org/public/speech/disorders/ http://www.speechlanguage-resources.com/language-disorder.html
Two organizations provide excellent information about stuttering and cluttering. See The Stuttering Foundation at http://www.stutteringhelp.org/default.aspx?tabid=114
and ASHA at http://blog.asha.org/2011/01/13/stuttering-versus-cluttering-%E2%80%93- what%E2%80%99s-the-difference/
congenital hearing loss A hearing impair- ment that is present at birth.
decibel (dB) Unit used to measure the intensity of sound.
dyslexia Refers to a category of reading disorders associated with impairment to the ability to interpret spatial relation- ships (in print) or to integrate auditory and visual information.
fluency disorder A speech disorder char- acterized by very rapid speech sounds that have additional sounds inserted or are repeated or blocked.
global aphasia A speech disorder charac- terized by impairment to comprehension and production of language.
language disorder Dysfunction character- ized by difficulty in understanding others (receptive language), or sharing thoughts, ideas, and feelings completely (expressive language).
social-cognitive disorder A behavioral dysfunction resulting from a brain abnor- mality that interferes with infants’ and children’s abilities to develop normal social and cognitive skills.
specific language impairment (SLI) The term language pathologists use for chil- dren whose language development is 12 months or more behind their chronological age and is not associated with other sen- sory or intellectual deficits or diagnosed cerebral damage.
speech disorder The inability to produce speech sounds correctly or fluently, or problems with vocal quality.
stuttering The involuntary repetition of speech sounds, particularly initial consonants.
voice disorder One of the three broad categories of speech disorder, this is the term used to describe abnormalities in the voice when the airstream or resonance are affected.
Wernicke’s aphasia Also called sensory or receptive aphasia, a language disorder resulting from a lesion in Wernicke’s area, the upper back part of the temporal lobe of the brain. Patients with this aphasia typi- cally exhibit no articulatory dysfunction and may actually seem excessively flu- ent—talking rapidly and without hesita- tion, for example.
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CHAPTER 8Weblinks
The Stuttering Foundation also has an excellent 30-minute video on stuttering in young children available at http://www.youtube.com/watch?v=u2_mgt87g1Y
An informative article about culture and speech disorders can be found at http://dsq-sds.org/article/view/986/1175
Examples of disordered speech and how they appear on sound spectrograms can be seen at http://www.youtube.com/watch?v=CAyuDAUfUoE
To learn more about childhood aphasia, see http://www.livestrong.com/article/182743-symptoms-of-child-aphasia/
To learn more about Asperger’s syndrome, see http://www.mayoclinic.com/health/aspergers-syndrome/DS00551
More information about central auditory processing disorder (CAPD) can be found at http://dartmed.dartmouth.edu/summer00/pdf/Scrambled_Sounds.pdf
To learn more about specific language impairment (SLI), see
National Institutes of Health: http://www.nidcd.nih.gov/health/voice/pages/specific-language-impairment.aspx
More information about CAPD is located at http://kidshealth.org/parent/medical/ears/central_auditory.html and http://www.asha.org/research/reports/hearing.htm
To learn more about the incidence of dyslexia, see http://www.asha.org/Research/reports/literacy/
For information on issues surrounding the identification of speech problems in bilin- guals, see http://ehlt.flinders.edu.au/education/iej/articles/v5n4/tzivinikou/paper.pdf
For a good discussion on determining whether a disorder actually exists or is just a dif- ference, see http://www.utexas.edu/features/2010/09/27/language-2/
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