Communication disorders

1. Communication disorders Melissa Sims

2. Defining Communication Disorders • Legal Definition: The Individuals with Disabilities Education Act, or IDEA, defines the term “speech or language impairment” as follows: “(11) Speech or language impairment means a communication disorder, such as stuttering, impaired articulation, a language impairment, or a voice impairment, that adversely affects a child’s educational performance.” [34 CFR §300.8(c)(11] • American Speech-Language-Hearing Association Definition: “An impairment in the ability to receive, send, process, and comprehend concepts or verbal, nonverbal and graphic symbol systems. A communication disorder may be evident in the processes of hearing, language, and/or speech. A communication disorder may range in severity from mild to profound. It may be developmental or acquired. Individuals may demonstrate one or any combination of the three aspects of communication disorders. A communication disorder may result in a primary disability or it may be secondary to other disabilities.” Smith, T. E., Polloway, E. A., Patton, J. R., & Dowdy, C. A. (2012)

3. Definitions (cont.) • Laymen’s Terms: Simply put, communication or speech and language impairments involve difficulty in exchanging knowledge, ideas, opinions, desires, and feelings. Vaughn, S.R., Bos. C.S., Schumm, J.S. (2011) • Types of Speech and Language Impairments: • Articulation: speech impairments where the child produces sounds incorrectly (e.g., lisp, difficulty articulating certain sounds, such as “l” or “r”) • Fluency: speech impairments where a child’s flow of speech is disrupted by sounds, syllables, and words that are repeated, prolonged, or avoided and where there may be silent blocks or inappropriate inhalation, exhalation, or phonation patterns • Voice: speech impairments where the child’s voice has an abnormal quality to its pitch, resonance, or loudness • Language: language impairments where the child has problems expressing needs, ideas, or information, and/or in understanding what others say. NICHCY Disability Fact Sheet #11 (2011)

4. Breaking It down • Articulation Errors: A child can make the following articulation errors when producing speech sounds: Substitutions, Omissions, Distortions, and/or Additions. An easy way to remember these is to use the acronym SODA! • S – Substitutions: Definition: Replace one sound with another sound. Examples: “wed” for “red,” “thoap” for “soap,” “dut,” for “duck” • O – Omissions (also known as deletions): Definition: Omit a sound in a word. Note: This error affects intelligibility the most, making speech more difficult for the listener(s) to understand. Examples: “p ay the piano” for “play the piano”, “g eennake” for “green snake” • D – Distortions: Definition: Produce a sound in an unfamiliar manner. Examples: “pencil” (nasalized—sounds more like an “m”) for “pencil,” “sun” (lisped—sounds “slushy”) for “sun” • A – Additions: Definition: Insert an extra sound within a word. Examples: “buhlack horse” for “black horse,” “doguh,” for “dog” Super Duper Inc. Handout

5. Breaking it down • Fluency disorders: The rate and flow of a person’s speech. • Fluency is often affected by stressful or demanding experiences. While anyone can experience interruptions in fluency there are factors that help determine normal from abnormal dysfluency: Frequency of occurrence Duration of individual moments of dysfluency Amount of tension present Awareness and attitude towards dysfluency • The most common type of fluency disorder is stuttering. Smith, T. E., Polloway, E. A., Patton, J. R., & Dowdy, C. A. (2012)

6. Breaking it down • Voice disorders: • Phonation: “[Refers] to the production of sounds by the vocal folds. Humans have two vocal folds, which are located in the larynx and lie side by side…[Healthy] vocal folds vibrate, coming together smoothly…If the vocal folds do not meet and come together smoothly, the voice is likely to sound breathy, hoarse, husky, or strained.” May include pitch disorders. • Resonance: Involves too little (hyponasality) or too much (hypernasality) sound (resonance) coming out through the nasal passages. Smith, T. E., Polloway, E. A., Patton, J. R., & Dowdy, C. A. (2012)

7. Breaking it down • Language disorders: Receptive (understanding language) and Expressive (conveying message) • Types of deficit: Morphological: Dealing with the rule system related to construction of words Syntactic: Dealing with the ordering of words so they can be understood Semantic: Dealing with the meaning or content of words and word combinations Pragmatic: Dealing with the purpose or function of communication Metalinguistic: Dealing with thinking about, reflecting on, and analyzing language Smith, T. E., Polloway, E. A., Patton, J. R., & Dowdy, C. A. (2012) Vaughn, S.R., Bos. C.S., Schumm, J.S. (2011)

8. Breaking it down • Language disorders cont.: • Types of Language disorders: No Verbal Language: No indication of understanding or spontaneously using language by age 3 Quantitatively Different Language: Language is different from that of nondisabled Delayed Language Development: Language follows normal course of development but is seriously behind others of same age Interrupted Language Development: Normal language development begins but is interrupted by some trauma, injury, or illness Smith, T. E., Polloway, E. A., Patton, J. R., & Dowdy, C. A. (2012)

9. Signs and Symptoms Speech and Language Delays Developmental Sequence for the Production of Speech Sounds: ASHA speech development chart Image source

10. Signs and symptoms • Risk factors: “The most consistently reported risk factors for speech and language difficulties include a family history of speech and language delay, male gender, premature delivery, and low birth weight. Early identification of children with developmental delay or developmental disabilities, such as marked hearing deficits or craniofacial abnormalities, will lead to intervention at a young age when chances for improvement may be best.” Wankoff, L. S. (2011) • Warning signs: “Warning signs for referral to an SLP may be subtle and may present in developmental, academic, behavioral, or social–emotional realms.” Wankoff, L. S. (2011)

11. Warning signs • 3–4 year olds • Typically not intelligible to strangers. • Little or no conversational competence, i.e., lack of topic initiation, maintenance, or change; little turn-taking. • Little or no vocabulary growth. • Minimal use of grammatical markers for tense, person, and number. • Does not discuss non-present events; has not begun to tell narratives. • Apparent noncompliance, inattentiveness, anxiety, or oppositionality, which can be comorbid with language comprehension deficits. • Kindergarten children • Very poor intelligibility. • Poor expressive language. • Deficient listening comprehension. • Resistance to learning concepts about print, phonological awareness games (e.g., sound games), or letter-sound correspondence. • Numbers 2–6 above. Wankoff, L. S. (2011)

12. Warning signs Cont. • First and second graders • Difficulty learning to read. • Poor expressive language skills (e.g., weaknesses in vocabulary, word retrieval, making inferences or ambiguity detection, and conversational skills). • Challenges in listening comprehension skills for conversation, television shows, movies, or jokes. • Apparent noncompliance, inattentiveness, anxiety, or oppositionality, which can be comorbid with language comprehension deficits. • Third and fourth graders • Poor expressive language (i.e., difficulty answering questions or formulating verbal messages or managing conversations). • Deficits in listening and/or reading comprehension. • Challenges in decoding unfamiliar words. • Apparent noncompliance, inattentiveness, anxiety, or oppositionality, which can be comorbid with language comprehension deficits. Wankoff, L. S. (2011)

13. Signs and symptoms • Characteristics: Check out this National Dissemination Center for Children with Disabilities Fact Sheet for Characteristics of Speech and Language impaired children • Social/Emotional/Behavioral characteristics: • Desire not to draw attention to self • Lack of peer acceptance • Poor self-concept • Easily frustrated • Inappropriate classroom behavior Smith, T. E., Polloway, E. A., Patton, J. R., & Dowdy, C. A. (2012)

14. Prevalence • “The second most common disability of students ages 6 through 21 served under IDEA is speech and language impairment.” Smith, T. E., Polloway, E. A., Patton, J. R., & Dowdy, C. A. (2012) • The actual number of students receiving services for speech and langugage disorders in 2005 is reported at 18.7%. Vaughn, S.R., Bos. C.S., Schumm, J.S. (2011) • 90% of students receiving services are 6-11 years of age. Smith, T. E., Polloway, E. A., Patton, J. R., & Dowdy, C. A. (2012) • 5% of all students are served by speech-language pathologists and two-thirds of this 5% are boys. Smith, T. E., Polloway, E. A., Patton, J. R., & Dowdy, C. A. (2012)

15. Teaching strategies While referring students the speech-language pathologist is the most common strategy for speech and language impairment there are some things that teacher’s can do in the inclusion classroom SPEECH DISORDERS: • Establish and maintain a positive classroom climate • Help students learn to monitor their own speech • Pair students for practice • Teach students affirmations and positive self-talk • Differentiate instruction and materials • Encourage parents to work with their children • Teach student their own strategies Smith, T. E., Polloway, E. A., Patton, J. R., & Dowdy, C. A. (2012)

16. Teaching strategies LANGUAGE DISORDERS: • Teach some prerequisite imitation skills • Give students opportunities for facilitative play • Improve comprehension in the classroom • Practice following directions • Pairing and practice descriptions • Work on categorizing • Encourage students to talk with their teachers and peers • Develop pragmatic language skills • Classroom interactions • Social interactions • Personal interactions • Use naturalistic techniques and simulated real-life activities to increase language use • Encourage students’ conversational skills through story reading • Use music and play games to improve language • Use challenging games with older students • Adapt strategies to develop students’ learning tools Smith, T. E., Polloway, E. A., Patton, J. R., & Dowdy, C. A. (2012)

17. Resources • National Dissemination Center for Children with Disabilities • American Speech-Language-Hearing Association • ASHA: Responsiveness to Intervention: New Roles for Speech-Language Pathologists • Categories of Disability Under IDEA

18. Works cited • Daymut, J.A. Types of Articulation Errors – A Simple Guide (2009). http://www.superduperinc.com/handouts/pdf/201_TypesofArticulationErrors.pdf . Retrieved 14 September, 2012. • National Dissemination Center for Children with Disabilities (NICHCY). Categories of Disability Under IDEA. http://nichcy.org/disability/categories . Retrieved 14. September, 2012. • National Dissemination Center for Children with Disabilities (NICHCY) (2011). Speech-Language Impairment. http://nichcy.org/wp-content/uploads/docs/fs11.pdf. Retrieved 14 September, 2012. • Smith, T. E., Polloway, E. A., Patton, J. R., & Dowdy, C. A. (2012). Teaching students with special needs in inclusive settings, sixth edition.  Upper Saddle River, NJ: Pearson • Vaughn, S.R., Bos, C.S., Schumm, J.S. (2011). Teaching Students Who Are Exceptional, Diverse, and At Risk in the General Education Classroom (5th ed.). Upper Saddle River, NJ: Pearson. • Wankoff, L. S. (2011), Warning Signs in the Development of Speech, Language, and Communication: When to Refer to a Speech-Language Pathologist. Journal of Child and Adolescent Psychiatric Nursing, 24: 175–184.