Communication Disorders

1. Communication Disorders Presented by: Eric Scattaretico, Michael Ducie, and Michael Mancuso

2. What is Communication? • Communication is the sending and receiving of information • The interactive exchange of information, ideas, feelings, needs, and desires • Communication includes: • A message • A sender who expresses the message • A receiver who responds to the message (Heward, 2013)

3. Functions of Communication • Narrating – The ability to tell a sequence of related events • Explaining/Informing – The ability to put what they learn into words • Requesting – The ability to express their wishes and desires to others • Expressing – The ability to express their personal feelings and opinions & respond to the feelings of others (Heward, 2013)

4. Definition: • An impairment in the ability to receive, send , process, and comprehend concepts or verbal, nonverbal and graphic symbols systems • May be evident in the processes of hearing, language, and/or speech • To be eligible for services: • Must adversely affect educational performance (American Psychiatric Association, 2013)

5. Prevalence • In the 2009-10 school year, 1,107,029 children ages 6 to 21 received special education services under the IDEA category of “speech or language impairments” • This number represents about 2.5% of the school-age population and 19% of all students receiving special education services • Speech or language impairments is the second-largest category after learning disabilities

6. Prevalence cont’d. • The actual number of children with speech and language impairments is much higher than the statistics show. Approximately 50% of children who receive special education services because of another primary disability also have communication disorders • School-based speech-language pathologists (SLPs) work with a median caseload of 50 students each month

7. Characteristics: • Four basic kinds of speech-sound errors exist: • Distortions (may sound like a lisp) • Substitutions • Omissions (dropping consonants) • Additions

8. Characteristics Cont’d • Articulation Disorder: • Child cannot produce a given sound physically • Phonological Disorder: • Child produces a given sound correctly in some instances, but not all • Fluency Disorder: Stuttering (MOST COMMON!!!) • Repetition of consonants or vowel sounds, usually at the beginning of words, prolongations, hesitations, interjections, and complete verbal blocks

9. Characteristics Cont’d • Voice Disorder: • Abnormal vocal quality, pitch, loudness, resonance, and/or duration for the speaker’s age & sex • Language Impairments: • Problems with phonology, morphology, syntax, semantics, and/or pragmatics; they are usually classified as either receptive or expressive

10. Workshop Activity ONE! • YOUTUBE VIDEO

11. Identification and Assessment • Screening and Teacher Observation • In some school districts, Speech Language Pathologists screen the spoken language abilities of all kindergarten children • Classroom teachers also play an important role in identifying children who may have speech and language impairments

12. Identification and Assessment cont’d. • Evaluation Components • Case history and physical examination • Articulation • Hearing • Phonological awareness and processing • Overall language development and vocabulary • Assessment of language function • Language samples • Observation in natural settings

13. Assessment of ELL/ Nonstandard English learners • Only a few standardized language proficiency tests are available in languages other than English. Translation or adaption of tests into other languages poses certain problems • Best practices in assessing speech and language competence of children who not speak standard English as their first language include assessments of basic interpersonal communication skills (BICS) and cognitive academic language proficiency (CALP) • Must take into account the individual's cultural and language context, particularly for individuals growing up in bilingual environments

14. Etiology • A speech or language impairment may be organic—that is, attributable to damage, dysfunction, or malformation of a specific organ or part of the body • A functional communication disorder cannot be ascribed to a specific physical condition, and its origin is not clearly known

15. Causes of Speech Impairments • Cleft palate, paralysis of the speech muscles, absence of teeth, craniofacial abnormalities, enlarged adenoids, and traumatic brain injury • Dysarthria - refers to a group of speech disorders caused by neuromuscular impairments in respiration, phonation, resonation, and articulation

16. Causes of Language Disorders • Factors that can contribute to language disorders in children include developmental and intellectual disabilities, autism, traumatic brain injury, child abuse and neglect, hearing loss, and structural abnormalities of the speech mechanism • Aphasia describes a loss of the ability to process and use language. Aphasia most often occurs after a cardiovascular event (stroke). • Research indicates that genetics may contribute to communication disorders • Environmental influences also play an important part in delayed, disordered, or absent language

17. Educational Placement Alternatives • Monitoring • The SLP monitors or checks on the student’s speech and language performance in the general education classroom. This option is often used just before a student is dismissed from therapy • Pull-Out (intermittent direct service) • An isolated approach in a separate room • Collaborative Consultation • The SLP often provides training and consultation for the general education classroom teacher, who may do much of the direct work with a child with communication disorders • The specialist concentrates on assessing communication disorders, evaluating progress, and providing materials and techniques

18. Educational Placement Alternatives cont’d. • Classroom or Curriculum Based • SLPs are working as educational partners in the classroom, mediating between student’s communication needs and the communication demands of the academic curriculum • The SLP trains classroom teachers and parents to promote children’s speech and language development • Separate classroom • Students with the most severe communication disorders are served in special classrooms for children with speech or language impairments

19. Educational Placement Alternatives cont’d. • Community based • Language therapy is provided outside the school, usually in the home • Combination • Variations of all these models exist, and many schools and SLPs serve children using combinations of two or more models

20. QUICK CHECK! • What abilities do speech or language impairments interfere with? • Receiving information • Sending Information • Processing Information • Comprehending Information • All of the above

21. QUICK CHECK CONT’D • What is the most common type of fluency disorder? • Phonological • Stuttering • Dysphonia • Production • Expressive

22. QUICK CHECK CONT’D • A child that has problems in areas of phonology, morphology, syntax, semantics, and or/pragmatics would most likely be classified as: • Phonological Disorder • Articulation Disorder • Language Impairment • Voice Disorder

23. Related Services • Speech-language pathologist (SLP) is the school-based professional with primary responsibility for identifying, evaluating, and providing therapeutic services to children with communication disorders • Terms such as speech therapist, speech clinician, and speech teacher are used in some schools as well

24. Related Services cont’d. • The SLP is a key member of the IEP team • The SLP’s goal is to correct the child’s speech and/or language problems or to help the child achieve the maximum communication potential, which may involve compensatory techniques and/or augmentative and alternative means of communication

25. Related Services cont’d. • Speech-language pathology addresses both organic and functional causes and encompasses practitioners with numerous points of view who use a wide range of accepted intervention techniques • Some SLPs employ structured exercises and drills to correct speech sounds; others emphasize speech production in natural language contexts. • Some prefer to work with children individual therapy sessions; others believe that group sessions are advantageous for language modeling and peer support.

26. Accommodations/Modifications • Minimize unnecessary classroom noise/distractions as much as possible • Provide verbal cues • Give simple directions (break down complex tasks) • Increased wait-time • Visual cues • Positive learning environment • Spelling/Vocabulary list • Alternative placement

27. Workshop Activity TWO! • Blowing Bubbles – Helps children control breath and purse lips as well

28. AAC • Augmentative and Alternative Communication • 3 Components • Representational symbol set or vocabulary • Means for selecting the symbols • Means for transmitting the symbols

29. ACC MODEL

30. ACCMay be: Unaided/Aided • Unaided • Techniques that do not require physical aid/device • Oral Speech, gestures, facial expressions, body posture, and manual signs • Aided • Techniques that involve an external device • No Tech – Pencil/Paper • Low Tech - Switch that transmits one word/phrase • High-Tech – Computerized voice-output device

31. Materials/Equipment • Communication Buttons • PECS • Basic Communication Device • Advanced Comm. Device Springboard • IPad/IPhone Apps

32. Curriculum • What will the child need to communicate on a daily basis? • Focus on vocabulary that peers in similar situation and settings use • What are the child’s annual goals? • Curricula should reflect student’s progress towards a long-term objective • What is the child interested in? • Engage the student with authentic activities and teach to their interests

33. Curriculum Cont’d • Adapted to child’s unique needs! • Low-risk interpersonal opportunities! • Articulation Errors • Discrimination/Production Activities (e.g. - /t/ tape vs. /k/ cape) • Phonological Errors • Card activities where they differentiate between similar words with different final consonants (e.g. – sea, seed, seal, seam, and seat)

34. Curriculum Cont’d • Voice Errors • Guidelines or a checklist of tips to help student relax before speaking and be aware of controlling aspects of his/her voice • Fluency Errors • Model proper speech • Teach behavioral/coping principles when child faces verbal block • Ignore child’s stutters, praise fluent utterances frequently

35. Workshop Activity THREE! • Oral Motor Exercises • Making Silly Faces- Helps stretch muscles in the children’s face

36. Naturalistic Strategies • Also called: Milieu/incidental teaching • Takes advantage of naturally occurring activities throughout the day to provide motivation and opportunities for a child to use language skills • Involves structuring environment to create opportunities for desired student response and structured adult response

37. 6 Naturalistic Strategies • Interesting Materials • Out of reach • Inadequate portions • Choice-making • Assistance • Unexpected Situations

38. Instructional Methodologies • Thoroughly Explain New Vocabulary – Students with language impairments often have problems learning and retaining new words • Embed New Vocabulary Across the Curriculum – Students will need a lot of practice and repetition with new vocabulary • Provide Longer Wait Time– Students with language impairments sometimes need a little longer to formulate and express responses to questions • Break Multistep Directions into Smaller Components– Do not move on to a new direction until the student completes each task successfully

39. Post-Secondary/Vocational • The needs of an Exceptional Student at post-secondary level that should be to taken into consideration: • Secondary school credit substitutions/curriculum modifications on post secondary course prerequisites • Alternate assessments/documentation • Human/other resources (e.g. tutoring/note takers/readers/audio or visual tape recordings of course materials and lectures/alternative formats for tests and exams) • Student/parent preferences/professional recommendations

40. Post-Secondary/Vocational Cont’d • Additional Considerations: • Consider the student’s strengths and needs and identify necessary program/workplace modifications and accommodations • provide guidance with career choices and opportunities to increase knowledge and familiarity with employment • Specialized supports (mentors, job coaches, reader) • Make student and family aware of how to access services in the future, link up with advocacy groups

41. Organizations/Agencies • CEC (Council For Exceptional Children) • CASANA (Childhood Apraxia of Speech Association of North America) • NASET (National Association of Special Educators) • ASHA (American Hearing-Speech Language Association)

42. Workshop Activity Three!!! • Please turn your attention to the case study on stuttering!!

43. Recreational Programs/Facilities • http://www.oafccd.com/summer-camps-communication-disorders/ (Summer Camps) • http://www.seattlechildrens.org/clinics-programs/childhood-communication-center/ (Hospital Clinic Program) • http://www.uri.edu/hss/cmd/centers.html (University Center)

44. Webliography • http://www.csu.edu.au/__data/assets/pdf_file/0008/227654/Books-and-moviesaboutcommunicationimpairments.pdf (Books/Movies) • http://www.mnsu.edu/comdis/kuster4/part106.html (Books) • http://www.ohioslha.org/pdf/Convention/2010%20Handouts/Fluency%20SC22%20Kuster.pdf (Stuttering Resources)

45. Webliography Cont’d • http://www.journals.elsevier.com/journal-of-communication-disorders/ (Professional Resources) • http://journals.pubs.asha.org/journals.aspx (Professional Resources) • https://sites.google.com/site/communicationdisordersproject/resources (Teacher Resources) • http://www.supportforfamilies.org/internetguide/specdisab.html (Parent Resources)

46. Bibliography • Stuttering (Fluency Disorder) • http://www.stutteringhelp.org/content/stuttering-kids-kids (Video) • Articulation Disorder • http://www.mnsu.edu/comdis/kuster2/disorderbooks/charlie.pdf (Children’s) • Phonological Disorder • http://www.youtube.com/watch?v=CzE7Wm9dz14 (Video) • http://web.shs.ohio-state.edu/Faculty/Fox/Fox_Publications/Edwards_Fox_Rogers_2002.pdf (Professional) • http://www.youtube.com/watch?v=g4XdGZupV_4 (Childrens)

47. Bibliography Cont’d • Voice Disorders • http://www.youtube.com/watch?v=VTUiId-4VcE (Video) • Language Impairments • http://eprints.gold.ac.uk/2592/1/hill_ijlcd_2001.pdf (Professional) • http://www.youtube.com/watch?v=BnRNeDtme0g (Video)

48. References • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing. • Heward, William L. Exceptional Children An Introduction to Special Education (10thEdition). Upper Saddle River: Pearson Education, 2013. Print. • Shriberg LD, Tomblin JB, McSweeny JL: Prevalence of speech delay in 6-year-old children and comorbidity with language impairment. J Speech Lang Hear Res 42(6): 1461–1481, 1999