Communication Disorders across the Age Span: Children and Behaviour Genese Warr-Leeper, Ph.D.

1. Communication Disorders across the Age Span: Children and Behaviour Genese Warr-Leeper, Ph.D. Communication Sciences and Disorders University of Western Ontario

2. Objectives: CDescribe communication disorders C Describe the role of effective communication C Describe the problems that may result from communication disorders C Describe referral and treatment options

3. DISORDERS OF SPEECH AND LANGUAGE Speech Disorder • Articulation / Phonological Disorders (3-10%) • Fluency (2-3%) • Voice (2-3%)

6. Important Milestone for Articulation • The average 3-year-old says 50% of the sounds in English correctly and is 90% intelligible.

7. Important Milestone for Fluency (stuttering and stammering) • A developmental trend in fluency that you should be aware of is normal dysfluency of a specific type, whole word and easy repetition, does occur in children as they develop and will spontaneously disappear. • Usual age for females is between 2 and 3 years and for males is between 3 and 4 years of age. • Other communication partners (e.g., parents, siblings, teachers) should not react or interfere but should listen attentively, speak slowly, and remain calm.

8. Important Indicator of Fluency Disruption • If a child exhibits struggle behaviour, e.g., eye blinking, fist clinching, breath holding or begins to complain that s/he can not say particular words, an assessment by a speech-language pathology is warranted.

9. Voice Disorders • Laryngeal – problems with quality of voice • Rough, harsh, hoarse, breathy • Resonance – problems with balance between resonance in the oral and nasal cavities • Hypernasal • Hyponasal

10. Speech skills are different from • Language skills • Speech is the production of sounds that make up words and sentences. • Language refers to the use of words and sentence to convey ideas and understanding the ideas from words and sentenced used by others.. Language Disorders/Impairment (6-10%). Also know as Language Learning Disorders (LLD) and Specific Language Impairment (SLI)

11. PLACE THESE ADJECTIVES IN ORDER IN FRONT OF THE NOUN: • RED • EIGHT • CANADIAN CUPS • SMALL • PLASTIC • PUT THE FOLLOWING NONSENSE VERBS INTO PAST TENSE ADDING “ED” • WEG • WEK • LAT

13. CN SH RD THS? I EE A I O!

14. 1. The baby kicked the ball. 2. The punter kicked the ball. 3. The golfer kicked the ball.

15. The boys hid until the caretaker tossed some meat into the lion cage and went to the other end of the tent. • The lion was sound asleep and seemed unaware of the boy’s presence. • One of them opened the cage door and they stood there staring for several moments. • Suddenly the lion stirred in his sleep and the boys ran from the tent, leaving the door open. • The caretaker was busy hauling a large bunch of bananas to the monkey cages. • The huge circus tent was deserted the morning after the big show, except for an animal caretaker and two mischievous boys. • When they saw him coming, the monkeys were screeching nervously and climbing all over each other.

16. “Goin’s Swimming.” Part 1. • John swallowed the last drops of orange juice and looked at the sky. He turned to his Dad and said “Dad, will you take Sue and me swimming today?” • Mr. Singer started to answer, then paused. After a moment, he replied “I’d find that enjoyable myself. But first, I better keep my promise about today’s yard work.” • John bounded up from the table with such enthusiasm that he nearly upset it. Starting towards the garage he shouted “I’ll begin collecting the tools now so we can get started.”

17. “Goin’ Swimming.” Part 2. John loaded the rake, clippers, lawn mower and sacks into the back of the truck. Mr. Singer emerged with him appointment book, found the entry that said “Smiths, 101 Cleveland, 1:00 pm, Wednesday.” Climbing in next to John, Mr. Singer said, “It’s just over a couple of blocks. If we hurry, we can be there on time.” John turned the key and checked the rear view mirror. Just then, Mr. Singer shouted “Wait, we forgot Sue.” He jumped out and gave a loud whistle. In a moment, there was Sue, tearing around the corner of the house. She leapt into the back of the truck and began licking the rear window. Mr. Singer looked at John and chuckled. “I hope Sue won’t mind waiting for her swim until we finish the job.”

18. It was the larky samquist when I gluzzed for gymloc. My fistum was clavving like a porstal dibbit, and the wapstor chubbed kippily as the jab vopped in histers. “The icobostabs are lipsy and savmotobic,” said the glived wapstor stibbing by the bink. “Why can’t you reth and estel it?” I asked. “Because you don’t nobble and ubber enough, and anyway you are an ostimacious zoppit.” So I spivvaled him, and zoved in my fistum, tutting the jab vop. 1. What is the story about? 2 When did the speaker gluzz for gymloc? 3. Who chubbed as the jab vopped in histers? 4. What is the condition of the fistum? 5. Where was the wapstor stibbing? 6. Why couldn’t the wapstor reth and estel it? 7. List the verbs in this passage. 8. List the adjectives.

19. Social Communication Skills • Taking Turns • Topic Specification, Maintenance, and Change • Structuring Conversation  sequence, giving right amount of information • Clarification  requesting and responding to requests for clarification

20. Level of language skill impacts on social development with potential collateral effects on cognitive growth. It is known that communicative competency is strongly linked to social acceptability and popularity in preschool and school‑age children (Hazen & Black, 89; Black & Hazen, 90). Studies have found that preschool children who were well liked demonstrate more coherent conversation and are more inclined to direct initiations clearly to conversational partners than children identified as disliked. Liked children compared to disliked children are less skilled at initiating, contingent responding, acknowledging and speaking to more than one partner simultaneously (Hazen & Black, 89). Disliked children compared to liked children are less skilled at requesting using polite forms, less responsive in interactions, and more likely to produce irrelevant remarks (Black & Hazen, 1990). Further, research examining social interaction/social status of children with language impairments in preschool classrooms has shown that children with communication impairments are more frequently ignored by peers (Rice, Sell, & Hadley, 91) and are not as popular as their normally developing classmates (Gertner, Rice, & Hadley, 94).

21. Children with limited communication skills are at a distinct social disadvantage relative to peers with age-appropriate communication skills (Rice & Wilcox, 95). Children with weak language skills can be entrapped in a cascade of negative consequences. Children may become sensitive to communication failure and withdraw from peer interactions which in turn decreases opportunities to develop of social communication. For children with limited social communication, play can be difficult to initiate and sustain, leading to reduced opportunities for developing play schema, language skills, and the associated cognitions. This spiral of negative consequences may result in behavioural difficulties, further compounding the situation and leading to rejection or isolation from others.

22. METALINGUISTICS There is a difference between practical knowledge (know how) and conscious knowledge (reflecting on language itself. Meta develops over a long period of time and is on a continuum from vague awareness to playful manipulations of language meaning invented by poets and novelists. Metalinguistics reflects awareness that language is: 1. An arbitrary, conventional code 2. System of elements & rules for combination of these elements 3. Used for communication Metalinguistic language awareness can have several very important functions: 1. Appropriate use of language in context ----> know what is appropriate and adjust to listeners and situations 2. Further development of language knowledge- learn new words 3. Acquisition of literacy ----> segmentation and cracking of the print code 4. Social growth & appreciation of language -----> word play such as chants, idioms, ritual insults . . .

23. Identification of a Language Problem • 3 indicators • Report of slow development of language • Social problems • Difficulty in reading and writing • Use developmental checklists/schedules • See Warning Signals for School Age Children

26. Language & Behaviour • Weak language predicts a later behaviour disorder • Co-occurrence • Prevalence of LI among BD is 10 times higher than in general population • 52% LI are RD (9% controls) • 29% LI are BD (19% controls)

27. Language & Literacy • Level of oral language is highly predictive of reading level • Over 70% of poor readers in grade 2 have a history of language deficits in kindergarten • Relationship between language disorders and behavior disorders are mediated by reading disorders

28. Good News • Language intervention has been empirically proven to improve social and learning outcomes for children with weak and disordered language skills.

29. Common Language Problems in BD & ED • Consistent difficulties in listening, particularly for decontextualized material which must be processed quickly (e.g., the classroom). • Difficulties in understanding multiple meanings of words and figures of speech (Fact: 1 in 3 to 1 in 10 utterances have multiple meaning phrases in them). • Difficulties in inferencing (filling-in) for missing information (e.g., may not follow the logical connections between cause and effect that can influence understanding behavioural consequences). • Difficulties in producing syntactically complex sentences (Fact: 70% of the sentences we use and process are complex).

30. Social Communication Problems • Language output not adapted to listener needs (e.g., the child does not give you all of the information needed to understand) • Difficulties introducing, maintaining, and changing topics • Fewer socially positive utterances produced within interactions • Insufficient verbalization during tasks that require talking

31. Common Behaviour Difficulties in LI • Problems with self-regulation - Difficulty controlling emotional reactions • Immature play - Immature themes in play • Social skills deficits - Poor social skills • Reading and other learning disabilities • Difficulty reading facial cues

32. Implications for Management • Children with emotional and behavioural problems should be routinely screened for language problems and vice versa • Language component of emotional and behavioural intervention programs for children with co-occurring language problems should be fully recognized and incorporated into team treatment plans • Children, parents, teachers, and other professionals need to be adequately counselled regarding the language issues relevant to children's emotional and behavioural functioning (e.g., the difference between not comprehending instructions or directions and non-compliance; how to help the child comprehend and express, etc.)

33. Other Factoids • Individuals with language impairments do not outgrow the problem • Manifestations of the problem change as demands of life change • Language difficulties needs to be identified and managed throughout the life span

34. Ontario Association for Families of Children with Communication Disorders <www.oafccd.com> Canadian Language and Literacy Research Network <www.cllrnet.ca>