Queens College, City University of New York Department of Linguistics and Communication Disorders

1. Queens College, City University of New York Department of Linguistics and Communication Disorders Division of Arts & Humanities LCD 323: Disorders of Language Fall 2014 Leslie Grubler MA, CCC-SLP, TSHH Queens Hall 315D: Office Hours, Monday 430-530; Friday 8-9 & 12-1 By Appointment

2. CLASSROOM OPERATIONS Review of Syllabus

3. Instructor Description As a 300-level course, Disorders of Language will provide a succinct and in depth understanding of language disorders in both children and adult and an introductory analysis of treatment, assessment, and reporting. Also provided is a relevant understanding of evidence-based practice, and the preparation of meaningful goals to yield desirable outcomes. During this semester, you become an observer in the process of change to yield a keener understanding of the scope of practice of a speech-language pathologist as well as a keener understanding of the many language disorders you have studied thus far. As an observer in real time, you will be privy to the confidential nature of the formation of relationships between clinician/student clinician, patient, and family and the therapeutic necessity and meaningfulness of the development of rapport. In this role, you will become aware of the role of each of the participants -- the team members -- inclusive of the clinician, student-clinician, family member(s), and Clinical Supervisor. Together, we will discuss each of these roles as well as our own expectations for these participants. Readings of journal articles, publications, case studies, and videos will now come-to-life in not only unanticipated and unpredictable ways but in ways in which the unique manifestations of a communication disorder and the unique wants and needs of the patient, result in demonstrated unique treatment approaches. Throughout this semester, we will think on and remind ourselves of issues in quality of life; and we will discuss how quality of life is impacted by disorder. This course will ground you in an understanding of language disorders in children, adolescents, and adults and enable you to consider infinite “how-to” possibilities as you embark on further developing your own potential in the field of speech-language pathology as well as readying you holistically to embark on your profession of choice.

4. To understand the components and relatedness of cognition, speech, and language (ASHA Standard III BCD) To identify and differentiate the various symptoms and classifications of language and cognitive disorders studied this semester (ASHA Standard III BCD). To recognize and relate the etiologies of language and cognitive disorders with their symptoms and classifications (ASHA Standard III BCD). To describe and demonstrate the specific diagnostic exams used with language and cognitive disorders studied(ASHA Standard III BCD). To outline and compare the treatment plans used for each of the language and cognitive disorders studied (ASHA Standard III BCD) - To engage in 13 hours of observation of individuals with a variety of communication disorders and prepare observation logs according to distributed guidelines· (ASHA Standard III BCD). To understand the concepts of evidence-based practice, the preparation of meaningful goals and the achievement of desirable outcomes To demonstrate an understanding of the necessity of the human applications of six requisite therapeutic skills inclusive of rapport-building, listening, interpreting body language, teaming, empathy, and informed intuition throughout all observations. Learning Outcomes

5. To increase your readiness for graduate school and assist you in further enhancing your application via the acquisition of knowledge, current data, and meaningful experiences • To develop a more holistic understanding of the profession of speech-language pathology • To assist in the development of self-confidence particularly in ensuring that you gain confidence in the foundation that you have established • To further develop students who recognize, acknowledge and seek to explore and experience the grandiosity of the profession ie. develop an appreciation for the value of this field and the more certain potential of your contribution • To develop within you an integration of the basic principals underlying intervention and assessment with concepts of informed intuition, the necessity for the development of rapport, and an acute awareness of body language, • To more intimately understand the contribution of speech-language pathologists to improvements in quality of life and to recognize both the power and choice that we have as clinicians. Teaching Outcomes

7. Page-Building….

9. 10 Memes of Mindfullness…

10. I. Iceberg Theory

11. II. Kubler-Ross

12. III. Meaningful PRACTICE

13. and More PRACTICE . . .

14. and More PRACTICE. . .

15. Until…ahhhhhhhhhhhh

16. IV. Hierarchy of Needs Maslow's

17. V. PRACTICE CREATIVITY RECEPTIVITY INFORMED INTUITION EMPATHY KNOWLEDGE

18. VI.On Developing Expertise What is experienced by an expert as direct perception is dependent on long training. Experts chunk information into larger meaningful units, they filter out irrelevant information, and they rely on a large set of mental models. This processing of sensory information by the expert is done implicitly (unconsciously) and for the expert it seems like “direct perception of truth, fact, etc, independent of any reasoning process.”(Mayer 1992)

19. VII.Ongoing Reflections THE FIVE QUESTIONS: • What am I doing? • What am I missing? • Is it working? • What else can I do? • What can I do better?

20. VIII. • PatienceVisionary The Patience Monger

21. On Relationships

22. IX. FIRST:Understand the learning profile THEN:proceed to intervention…

23. X.Thinking/Stepping Out of the Box

24. ? “Can I open other people’s boxes and allow them to step out?” “What do I need to do to step out of the box?” "When I step out of the box, am I stepping into another one?” “Am I aware that I am in a box?” “Can I step out of the box and stay out of the box?” “Am I in a box?” "Who created the box?” "What box am I stepping out of?”

25. It Can Feel Like RU LES

26. Review of Language Development

27. Laying the Foundation

28. Becoming a Clinical Decision-Maker: • A fourth grade student is having difficulty comprehending his reading especially in science and geography. He is very social and gets along well with his peers. • A sixth grade student who has been diagnosed with a learning disability does not appear to understand when other students are using sarcasm; he takes their statements literally. This situation is causing problems at school. • A two-year-old has 50+ words but almost all of the words are nouns. He is not combining words into two-word combinations. • An eighth grade student is getting poor grades in writing composition. His teacher says his writing is “immature” and that he does not write with enough complexity.

29. DEFINITIONS • Language is a complex and dynamic system of conventional symbols used for thought and communication. • Speech is the articulation and the rate of speech sounds and quality of an individual’s voice. • Communication, includes symbolic and non-symbolic information (i.e., facial expressions, body language, gestures, etc.).

30. A language disorder… • may be evident in the process of hearing, language, speech, or in a combination of all three processes. • is impaired comprehension and/or use of spoken, written, and/or other symbol systems. • can represent a deficit in receptive language, expressive language, or a combined expressive-receptive deficit

31. Background Information • Children with speech and language disorders make up 1.79% of the total school population. • Late Talker • NOT a language difference

32. The Domains of Language • Form • Syntax • Morphology • Phonology • Content • Semantics • Use • Pragmatics

33. Components of Language • Morphology • The structure of words and the construction of word forms. • Syntax • The order and combination of words to form sentences • Relationships among the elements within a sentence. • Phonology • The sound system of a language • Rules that govern the sound combinations. • Semantics • The system that governs the meanings of words and sentences.

34. Pragmatics • The system that combines the above language components in functional and socially appropriate communication.

35. The Five Communication Subdomains • Early Pragmatics • Vocabulary • Early Word Combinations • Morpho-syntax • Discourse

36. Subdomain 1:Early Pragmatic Skills • Prelinguistic communication • Joint visual attention (JVA) - between 10 and 12 months • One of the first interactive communication acts • Early Development • 8 and 15 months - Request objects or activities, refusal, comments • 16 and 23 months - Requesting information, answering questions, acknowledging a response. • Early Discourse Skills – begins in preschool and continues • Initiating a conversation • Taking turns during a conversational exchange • Maintaining ongoing topic • Conversational topic switching • Making conversational repairs • Code switching

37. Clinical Implications for Communication Subdomain 1 • Underlie all later communication • First aspect of communication that is considered during observational process • If the clinician identifies a weakness in the individual’s ability in early pragmatic functions; Communication Subdomain 1 becomes the focus of intervention.

38. Subdomain 2:Vocabulary Development • Vocabulary development • Begins towards the end of the first year of life and continues to develop throughout one’s life. • First words typically produced between 10 and 16 months. • By two years, children typically produce 200-500 words and understand many more words than they produce • Semantics deficits are characteristic of many language disorders including: • developmental delay • autism spectrum disorder • hearing impairment • specific language impairment.

39. Clinical Implications for Communication Subdomain 2 • At early stages in vocabulary development, practitioners consider whether children’s word usage reflects a variety of semantic categories. • The interventionist may train caregivers to facilitate a variety of semantic forms. • Successful vocabulary interventions should • integrate new word meaning with familiar words, • provide repeated, meaningful, and contextual opportunities to learn new words, • provide explicit and implicit learning opportunities, • aim for fluent and automatic understanding and use of new words, and • teach students to be more independent word learners.

40. Subdomain 3:Multiple Word Combinations • Once an individual produces approximately 50 individual words, word combinations begin to emerge. • At this early word combination level, children are not governed by adult syntax rules and do not use morphological forms. • Children create combinations of words by: • naming objects or people of interest • stating the actions objects or people perform • describing the object’s or person’s characteristics • describing who owns or possesses the object.

41. Clinical Implications for Communication Subdomain 3 • Once a child is able to demonstrate early pragmatic skills and has more than 50 single words practitioners engage children in early play activities to facilitate multiple word combinations. • A child’s parents and/or caretakers are trained to facilitate semantic combinations. • For older individuals with significant communication impairments, practitioners may incorporate an alternative communication approach (AAC).

42. Subdomain 4:Morphosyntax Development • Children’s utterances begin to demonstrate characteristics of syntax and morphological development (i.e., language form). • Occurs between 24 and 36 months for children developing typically. • Examples: • present progressive ing verb • plural s • By age 5, children’s sentences evidence complex syntax including the use of embedded phrases and clauses.

44. Clinical Implications for Communication Subdomain 4 • Once an individual demonstrates the ability to use foundational pragmatic functions and produces multiword combinations using a variety of semantic categories practitioners typically evaluate a speaker’s use of morphosyntax using the framework developed by Brown (1973). • Used in language analysis • Demonstrated in students’ ability to read difficult texts and write at the level required for school success.

45. SUBDOMAIN 5: Advanced Pragmatic & Discourse Development • Between the ages of 3 and 7 children’s developing pragmatic/discourse skills include the ability to use language to: • reason and to reflect on past experiences • predict events, express empathy • maintain status and interactions with peers • use and understand sarcasm and politeness forms • code switch in order • Students also have to learn to modify discourse styles for different situations. Some forms of discourse are called narratives. • Narrative forms

46. Clinical Implications for Communication Subdomain 5 • Skilled practitioners track children’s abilities to use vocabulary, produce sentences, and use advanced language within sophisticated discourse genres. • Observe student: • in the classroom • with peers • producing narratives • Discourse analysis • Focus on intervention for students in peer-groups, etc.

47. Becoming a Clinical Decision-Maker: • A fourth grade student is having difficulty comprehending his reading especially in science and geography. He is very social and gets along well with his peers. • A sixth grade student who has been diagnosed with a learning disability does not appear to understand when other students are using sarcasm; he takes their statements literally. This situation is causing problems at school. • A two-year-old has 50+ words but almost all of the words are nouns. He is not combining words into two-word combinations. • An eighth grade student is getting poor grades in writing composition. His teacher says his writing is “immature” and that he does not write with enough complexity.

48. On Facilitation of Language And … Power or Empowerment

49. Interesting Facts… • Communicatively Useful Language:Research indicates that children select and acquire the utterances that are communicatively most useful. This is why children typically acquire request forms, greetings that will initiate social interaction, and words that mark initiation or completion of favorite activities as their first utterances. Labels and other descriptive terms are usually not acquired very early in the course of language acquisition and when best acquired are almost always learned more for the sake of the “game” of naming than being because of intrinsic interest of the child in such forms. Snow et al. 1984

50. More Interesting Facts • Imitation:Children use imitation as a technique to keep conversations going, to practice unfamiliar forms, and to learn new forms which suggests that it should work in therapy and direct teaching. But imitation as used by normally developing children is highly selective, and subject to the principle of communicative usefulness. Children use communicatively useful forms when they note others using them, or sometimes by producing delayed imitations when the need arises. Snow et al. 1984