Causation in Child Language DisordersDES 320

Syndrome

“the presence of multiple anolalies in the same individual with all of thoses anomalies having a signle cause” (Sprintzen, 1997)

Examples: facial features, structural abnormalities, hearing/speech problems

Etiologies of language disorders

Impoverished language inputHearing impairmentsDeprivation

Conditions where neural development is affectedSyndromes

Congenital syndromes– Chromosomal abnormalities– Genetic syndromes– Teratorgenic: in utero diseases and toxins

Diseases and toxins after birth

Acquired aphasia in childhood

Unknown causes (presumably neural development is afffected)

Impoverished language input…Hearing Impairment

Middle Ear: transmission of sound from the auditory canal into middle ear

(conductive hearing loss)

Inner Ear: transmission of sound into neuronal firing

(sensorineural hearing loss)

Spoken language development in hearing losses depends on:

Degree of hearing loss (profound, severe, moderate, mild)Unilateral or bilateralAge of onsetAudiometric slope of the loss (for ex. High frequency vs. low frequency affects perception of different phonemes)Age of identificationAmplification (functional or not)Amount and type of habilitation (ASL, auditory-oral, total communication)Educational environmentFamily support or lack thereof…

Otitis Media: impact on language development

Does fluctuating conductive hearing loss due to otitis media effusion (OME) cause language disorders?

Possible phonological disorders…1/3 of kids receiving Speech or language intervention have a hx of OMEPontentially problems in other areas of langauge…evidence is contradictory…

OME usually associated with phonological impairmentOME may be a risk factor that must occur with something else in order to cause a language disorder

Impoverished Language Input…Language Deprivation

NeglectHard to show causality because these are often children with multiple problems

Physical abuse, emotional abuse, sexual abuse, parental alcohol & drug abuseDisabilities

Language gains depend on age of child

Nervous System

The rest of the causes we will discuss affect development of the nervous system…often times in ways in which we don’t understandMore plasticity & less cerebral localization in children

Effects on language seen in focal damage in adults not seen in childrenDamage limited to left hemisphere Broca’s or Wernicke’s areas doesn’t explain language problems in developmental disorders

Syndromes involving genes…

Chromosomal abnormalitiesAddition or deletion of whole chromosomes

Addition or deletion of parts of chromosomes

Restructuring or rearranged chromosomes

Genetic syndromesRun in families

Affected gene(s) may or may not be discovered yet (ex. Chromosome 19 in my family)

Chromosomal abnormalities

Run in family or randomn genetic mutationDisorders: Hearing loss

Autosomal chromosomes (1-22)Disorders: Down syndrome, Cri du chat, Williams Syndrome

Sex chromosomes: #46Female – XX & Male – XY: a parent can be normal, a carrier or affected…the combination of sex chromosomes that the parents pass onto a child impact whether the child is normal, a carrier or affected….Disorders: Fragile X, Kleinfelter syndrome, Turner Syndrome

In utero origins of syndromes

Maternal diseasesRubella, Cytomegal Virus (CMV), Herpes simplex, Syphilis, Toxoplasmosis

ToxinsX-radiation, smoking, cocaine & other illegal drugsLegal drugs (prescriptions, etc.)Fetal alcohol syndrome

Mental retardation, small size, cleft palate, abnormalities of face and ear

During or after birth origins of syndromes

Complications during birth…premature birth

Intraventricular hemorrhage

Respiratory disorders: anoxia – oxygen deprivation to the brain

Infections & toxins measles, mumps

Meningitis

Lead (in paint in older houses, older toys)

Acquired Aphasia in childhood

Head injury

Brain tumors

Rare instances of stroke

RecoveryThe site of damage is less influential than in adults

The extent of damage is more important

Case

When I met Emma, she was 5 years old and living in a foster home. She (along with her older brother) had lived with biological mom for the first four yrs. Of her life. In Emma’s past was evidence of a head injury due to physical violence, maternal alcohol abuse and being locked in her room for extended periods of time. Emma’s main difficulty in the area of language was lexical and phonological processes. She was substituting and deleting sounds. She also had small vocabulary and word finding difficulties. When she learned new words, she had difficulty retaining them over time. What was the cause or etiology of Emma’s phonological and lexical difficulties? Why is causality a slippery slope in language disorders?

Disorders with unknown etiologies

Presumably disorders of central nervous system development

Landau-kleffner syndrome

Autism

SLI

Dyslexia

Thought Question…

What do we know about causation in language disorders? Think about today’s lecture notes and also our previous discussion about the relationship between cognition and language development…

What do we not know?

Thought Question…

If language disorders are impacted by genetic and/or neurological factors, how much of an impact do you think environmental influences have on the prognosis for remediation? What can we do as SLPs to prevent language disorders or lessen their severity?