Common speech language disorders in pediatrics and their treatments

1. Common speech language disorders in pediatrics and their treatments

2. Objectives Increase knowledge of: Pediatric speech language development Common disorder related to speech delays Common evaluation and treatment procedures

3. 8 to 12 months milestones Movement Gets to sitting positions Crawls forward on belly Assumes hand knee position Creeps on hands and knees Gets from sitting to crawling or prone position Pulls self up to stand Walks holding on to furniture. Uses pincer grasp Bangs tow cubes together Puts objects in and out of container Lets objects go voluntarily. Language Pays increasing attention to speech Responds to simple verbal request Responds to “no” Uses simple gestures, such as shaking head “no” Babbles with inflection. Says “dada” and “mama” Uses exclamation such as OH-oh! Tries to imitate words. First words often are not proper English. For most children a word is any sound that consistently refers to same person , object or event. First words often are not proper English. For most children a word is any sound that consistently refers to same person , object or event.

4. 15 months milestones Motor Walks with run like gait. Walks few steps backward and sideways. Carries objects in both hands. Takes of shoes and socks Language Points to clothes, persons, toys, animals named. Uses jargon and words in conversation. Has four to six words in vocabulary.

5. 18-24 month Milestones and Warning signs. Says some two word sentences such as “more milk”, “all gone” and “me go”. Asks for cookie or toys Understands were is mommy and daddy. Understands simple directions Understands more words that they can speak Has 20 words in vocabulary Uses more gestures than words. Are you concerned about child’s ability to talk and understand.

6. 18-24 month Milestones and Warning signs. Identifies some body parts. Refers to self by name. Sings and hums

7. Terrible Two’s Movement Walks smoothly Runs rhythmically Walks up and down stairs alone without alternating feet. Tiptoes for a few steps. Pushes tricycle Eats with fork. Language Has 200-300 word vocabulary Names most common everyday objects. Uses short incomplete sentences. Uses some prepositions (in, on) Pronouns (I, Me, you) Uses some regular verb ending.

8. Terrible Two’s Cognitive Milestones Finds Objects even when hidden under two or three covers. Begins to sort by shapes and colors Begins making-believe play.

9. Terrible Two’s Cognitive Milestones By the End of this period. Makes mechanical toys work Matches an object in her hand or room to a picture in a book. Sorts objects by shape and color. Completes puzzles with three or four pieces. Understands concepts of “two”

10. Age Three to Five Movement 3 years old Hops and stands on one foot up to five seconds. Goes upstairs and downstairs without support. Kicks ball forward Throws ball overhand Catches bounced ball most of time. Moves forward and backward with agility. Language 3 years old Active vocabulary of 300 or more words. Can talk in sentences of five or six words and imitate most adult sounds.

11. Age Three to Five Language Milestones By the End of this period. Understands the concepts of “same” and “different” Speaks in sentences of five or six words. Speaks clearly enough for strangers to understand Tells stories.

12. Developing Sounds Age Level Phonemes 2 yrs – 4yrs p,m,h,n,w,b,k,g,d,t 4yrs – 5 yrs f,y, ng,l 6 yrs – 8yrs r, ch, s sh, z, j, v, th, zh

13. Four years old Language Has 1,500-1,600 word vocabulary Asks many, many questions Uses increasingly complex sentences Recounts stories and the resent past Understands most questions about immediate environment Has some difficulty with answering how and why Relies on word order for interpretation

14. Four Years Old Cognition Categorizes Counts to five Can show three objects Understands concepts of three Knows primary colors Labels some coins

15. Medical Disorders and Syndromes associated with speech/language disorders Down syndrome Fragile X Cerebral Palsy (CP) Cleft Lip or Palate Pierre Robin PDD/Autism Spectrum Autism Failure to Thrive (FTT) Fetal Alcohol syndrome

16. Down Syndrome speech/language delays Oral abnormalities Articulation Feeding Hyper nasal Conductive hearing loss Some cases sensorineural hearing loss. Delayed language related to syntactic and morphologic features

17. Fragile X Hearing loss Jargon Perseveration Echolalia Inappropriate language Talking to ones self Voice problems Articulation Disorders

18. Cerebral Palsy Leading cause of dysphasia in children 60-70% of individuals have mental retardation

19. Cleft Lip or Palate Feeding issues Watch speech development

20. Pierre Robin Unilateral or bilateral conductive hearing loss associated with otitis media and cleft palate. Delayed language Hypernasality and nasal emission Articulation disorders

21. PDD/Autism Spectrum and Asperger’s Syndrome High functioning autism Characteristic of right hemisphere deficits Poor nonverbal communication Echolalic repetitive speech Problems with figurative language.

22. Autism Poor social interaction Difficulty establishing relationships Expressive language often has very little meaningful output. Poor pragmatic skills. Doesn’t make eye contact or facial expressions.

23. Failure to Thrive (FTT) Language learning issues Feeding issues.

24. Fetal Alcohol syndrome Severe growth retardation Cleft palate Disorders of articulation Language disorders (syntactic, semantic, and pragmatic aspects of language)

25. Environmental Disorders Otitis Media – Inflammation of the middle ear. Otitis Media is often caused by frequent upper respiratory infection. Impacts hearing which causes delays in speech development.

26. Hearing Impairment Conductive- Loss resulting in dysfunction in the outer or middle ear Sensorineural loss- result of damage to inner ear or auditory nerve

27. Differences between Speech/Language disorders Speech disorders are associated with how well the child is producing the sounds. Speech problems Omissions Substitutions Consonant deletions Imprecise vowel production Addition of sounds Breathiness before productions of vowels Fluency problems

28. Differences between Speech/Language disorders Continued Receptive Language problems: Can the child understand what is being said. Expressive Language problems: How well the child is able to use language to make their wants and needs known.

29. Language Problems Limited vocabulary Poor comprehension of word meaning Slower acquisition of grammar Slower acquisition of verb forms Difficulty understanding and producing complex sentences. Shorter sentences. Pragmatic problems Limited oral communication (child says very little) Reading and writing problems.

30. Treatment of children with expressive and Receptive language delays. Develop prelinguistic skills. (problem solving, attention, interaction, cognitive, and play)

31. Receptive Language Skills Receptive Language is closely related to development of cognitive abilities. Children who have delays with receptive language have difficulty understanding concepts such as (time, cause and effect, wh questions, and y/n questions)

32. Strategies for developing Receptive language skills. Labeling Imitation Focused Stimulation Modeling Self-Talk Parallel talk Supplementing verbal speech with gestures Supplementing verbal speech with picture stimuli Guided Learning Paraphrasing Scaffolding

33. Labeling Name object with in the child’s environment

34. Imitation Model for the child the action the adult would like the child to do.

35. Focused stimulation While the child is getting dressed, the caregiver can find many opportunities to expand the child’s language.

36. Modeling Show or say what you want the child to do before you expect her to do it.

37. Self Talk An audible commentary by a person describing action, perception, or feelings. While doing daily activity at home describe what you are doing.

38. Parallel Talk A technique in which the therapist provides a running commentary on what the client is doing

39. Guided Learning This strategy involves arranging the environment so something will attract the child’s attention and make it somewhat challenging.

40. Paraphrasing If the child seem to not understand what is being asked try to make the request in a simple way.

41. Scaffolding Building on or adding to the child’s communication attempt.

42. Expressive Language Communicative intent Communicative Function types Semantic-syntactic relations Morpheme types Sentence Structure

43. Communicative intent Repeating Calling attention Protesting Greeting Answering acknowledging

44. Communicative Function Naming Possession Social Interaction

45. Semantic Relation Meaning; the relationship of symbols to objects and events.

46. Morpheme Types -ing In On Regular plural –s Irregular past tense Regular past tense

47. Sentence Structure Declarative Negative Interrogative

48. Dysphagia Disorder of swallowing

49. Feeding Tips and Techniques Positioning- feed in upright position with support given to the trunk, neck, and head. Nipple- A nipple with a soft, thin wall that the child most helpful Burping- Infants with cleft palates need frequent burping Oral Motor treatment Food Presentation

50. References Nancy B. Swigert The Source for Pediatric Dysphagia, Linguisystems, Inc. 1998 Charles Van Riper/Robert L. Erickson Speech Correction An introduction to Speech Pathology and Audiology Nance Swigert The Early Intervention Kit 2004 Hegde M.N. Pocket Guide to Treatment in Speech Language Pathology