Late talkers and specific language impairment: inservice presentation

Late talkers and specific language impairment: inservice presentationAlyssa Heba, University of North Carolina at Greensboro

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Pre-Presentation Survey1. A 2-year-olds vocabulary is about: 50 words, 100 words, 200 words, more than 300 words

2. A babys first words are generally produced around: 6 months, 9 months, 12 months, after 15 months

3. Most children who a slow to begin talking turn out fine. Strongly Agree/Agree/Disagree/Strongly Disagree

4. Most children with a preschool language disorder have difficulty learning to read. Strongly Agree/Agree/Disagree/Strongly Disagree

5. About _________3%, 5% 7% > 10% of preschool children have developmental language delays (i.e., SLI)

6. Children who have families with a history of developmental language disorders are at greater risk for having a developmental language disorder.Strongly Agree/Agree/Disagree/Strongly Disagree

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Language DisordersChildren can be described as having a language disorder if they have a significant deficit in learning to talk, understand, or use any aspect of language appropriately, relative to both environmental and norm-referenced expectations for children of similar developmental level. Lets break apart this definition so its easier to understand.

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Language DisordersSIGNIFICANT DEFICIT: A deficit that is big enough to be noticed by ordinary people such as parents as teachers, not just language-development experts. The deficits must also affect how the child functions socially in the world he/she lives in.

ASPECTS OF LANGUAGE: Comprehension: The language that your child understandsProduction: The language that your child uses to communicate

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NORM-REFERENCED EXPECTATIONS: In addition to it affecting the child's everyday life, the child with the language disorder must also score below expectations on some standardized or norm-referenced test. Norm referenced tests are standardized tests that are designed to report whether test takers performed better or worse than an average student, which is determined by comparing scores against the performance results of a statistically selected group of test takers, typically of the same age or grade level, who have already taken the exam.

Language Disorders

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Language DisordersDEVELOPMENTAL LEVEL: One way to do this is to say their developmental level is lower than their chronological age, but it is better to use mental age rather than chronological age for a reference point. Chronological Age: is a measure of an individual's age based on the calendar date on which he or she was born. Chronological age is calculated on most psychological tests. It is measured in days, months and years.Mental Age: is a measure of an individual's mental attainment based on the chronological age at which an average individual reaches that same level of attainment. Simply put, mental age is based on intellectual development, where as chronological age is based on the calendar date on which you were born.

We do not expect a child's language skills to be better than their general level of development, for example: we do not expect a 4 year old functioning at a 2 year old level to achieve language skills on par with his chronological age of 4.

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Late Talking

Intro about how parents often use the wait and see approach or use anecdotal evidence about other children who were late and now they wont be quiet to guide their judgement on how to deal with their own child who seems to not be meeting developmental milestones appropriately. While parents are often told not to worry, when a child isnt meeting developmental milestones it is a cause for concern. It is true that some children will catch up on their own, but others will not. 7

What is late talking?Late talkers are part of the toddler population and are identified at approximately two years of age when children produce fewer than 50 words and do not combine words. These children typically have a good understanding of language. Normal sensory, cognitive, hearing and motor development.A typical two year old would be putting together 2-4 word phrases with a vocabulary size of 200-300 words. Late talkers represent a very diverse group, but there are a few characteristics that research has found they share with each other.

Communication Variables:Lexical Acquisition: LT do not understand and learn new words at the same rate as their peers. They seem to have limitations in their fast mapping ability; this requires that they have more time to learn words than typically developing peers. Communicative Intent: LT use less communicative tasks than typically developing children.Personal and Social Variables:Development of Social Skills: LT typically present with limited social skills, but what is the cause of the limited social skills? Are theyless motivated to socialize, and thus less motivated to use expressive language, or do the low social skills cause the language difficulty?Family Characteristics:Language Stimulation: Parents of children with a language delay use longer-than-optimal sentences when speaking to their children, which may reduce the efficacy of the stimulation. Parents of LT also respond less when their child initiates communication.Family History of Language Delay: A family history of language disorders is seen in LTs. Mothers Education: If the mother has a low level of education, she uses fewer utterances and poorer vocabulary than mothers with a higher level of education and this is seen with LTs.

Limitations:2.2.1. The two instruments used to measure expressive vocabulary were based on non-equivalent thresholds, the Language Development Survey and the MacArthur Communicative Development Inventories. 2.2.2. Some researchers explicitly took into account the absence of combinations of words in the inclusion criteria for their studies, others did not mention it.

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Normal Speech Development (0-2 years)Social cooing/babbling in response to you at 2 monthsSome syllables around 6 monthsOne word utterances by age 1 (mama, dada)Two word sentences by age 2 (more milk, cookie gone!)

Children reach these milestones at varied rates. Some talk at 10 months, others may wait another six. 9

Why is the identification of late talking important?Studies show that there are long term effects for children who are late talkers.Later in academic careers, late talkers typically perform within the same range as typically developing peers, but in the lower end. Growing up, late talkers have the most difficulty with narratives, grammar and vocabulary.

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Factors that increase the risk of continuing language problemsReceptive LanguageUse of GesturesAge of DiagnosisProgress in Language Development

As per ASHA, negative aspects of these factors increase the risk of a true language problem but do NOT mandate its presence.

Receptive language: Understanding language generally precedes expression and use. Some studies that have followed-up late-talking children in this age range have found, after a year, that age-appropriate receptive language discriminated late bloomers from children who had true language delays. Other researchers doing follow-up studies included only children whose receptive language was within normal limits because they believed that delay in this area was likely to produce worse outcomes.Use of gestures: One study has found that the number of gestures used by late-talking children with comparably low expressive language can indicate later language abilities. Children with a greater number of gestures used for different communication purposes are more likely to catch up with peers. Such a result is supported by findings that some older children who are taught non-verbal communication systems show a spontaneous increase in oral communication.Age of diagnosis: More than one study has indicated that the older the child at time of diagnosis, the less positive the outcome. Obviously, older children in a study have had a longer time to bloom than younger children but have not done so, indicating that the language delay may be more serious. Also, if a child is only developing slowly during an age range when other children are rapidly progressing (e.g. 24-30 months) that child will be falling farther behind.Progress in language development: Although a child may be slow in language development, he or she should still be doing new things with language at least every month. New words may be added. The same words may be used for different purposes. For example, "bottle" may one day mean "That is my bottle," the next, "I want my bottle," and the next week, "Where is my bottle? I don't see it." Words may be combined into longer utterances ("want bottle" "no bottle"), or such longer utterances may occur more often.

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How can you help a late talker?SELF TALKTalk about what youre doing.The key: key your phrases short. You should speak in phrases that are the same length as your childs or slightly longer. Dont be afraid to repeat!

Describe what you are holding, the actions you are performing, what you see, how you feel, and what you hear, smell, or taste.

If your child is speaking in one word phrases, you should be using one and two word phrases like, ball. Kick ball.12

How can you help a late talker?PARALLEL TALKTalk about what your child is doing. Label objects, describe actionsContinue to use phrases that are right at or slightly above the length your child is using.

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Build on your childs speech or gestures.Take whatever your child says and add one word onto it.EXPANSIONHow can you help a late talker?

If your child says ball, you could say want ball, my ball, yellow ball, throw ball, or anything else that contains the word ball with one other word. If your child is not saying anything yet, you can build on his gestures. Whenever he points at something or makes a gesture to try to communicate something with you, say the word that goes along with that gesture. You can name the thing hes pointing at or reaching for, label the emotion hes feeling, or anything else you feel like your child is trying to communicate.

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VOCABULARY BUILDINGIncrease your childs receptive vocabulary (the words they understand).You can increase your childs receptive vocabulary by having him point to pictures, objects, or people when you label them for her. How can you help a late talker?

Children must first understand words before they can use them.15

Specific Language Impairment (SLI)

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What is Specific Language Impairment?A language impairment in the absence of significant sensory, neurological, intellectual, and emotional impairment/disorder. Nonverbal cognitive abilities should be within the normal range. It has a prevalence rate of about 7% and is more common in males than females. SLI persists into adulthood.Research shows there is a severe impairment in phonological short term memory (non-word repetition)

Profile of linguistic abilities (in grammar, semantics, phonology and pragmatics) varies across children and across time. However, English-speaking children with SLI generally have issues with grammatical morphology. In the preschool years a low MLU is apparent, and that can continue up until age 9. They also have trouble marking finiteness in sentences and making grammatical judgments.

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Symptoms of SLIOften late to talk (may not be talking by 2 and at 3 may be hard to understand)Struggle to learn new words and make conversationDifficulty with verbsSome common errors include:Dropping he s from the present tense verbs (She ride her bike vs. She rides her bike)Dropping the past tense Asking questions without the be or do verbs (Why he like me vs. Why does he like me?)

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How do we predict SLI?There are several factors that go into predicting whether or not a child will have SLI as they grow up.Late emergence of expressive languageLanguage comprehensionFamily history of language delay/impairmentDelay in receptive and expressive vocabularyLack of communicative gestures

SLI, like LTs is heterogeneous disorder, with various subgroups and a changing profile for each individual across development. This heterogeneity is one of the reasons it is so difficult to ID accurate predictors of development from LT status to SLI status.

Predictive Factors of SLI: Genetic Factors: Family history of language or learning disorders should be considered as a risk factor when predicting future language recovery from an early language delay but it is not a sufficient predictor on its own. Environmental Factors: Conversational styles of parent-child input and variations in linguistic input. Neurobiology: Brain structures in children with SLI have been found to differ in volume and symmetry from those of TD children. Smaller Brocas area, reduced surface area in the primary auditory cortex and increased gray matter in the right perisylvian region and the occipital petalia. Typically, the dominant, left hemisphere language areas are larger in volume compared with the corresponding regions of the right hemisphere. However, for children with SLI, the hemispheres may not differ in volume, or may show a rightward dominance. Currently, there are few studies of how these physiological differences relate to language function, but it does point researchers to areas of the brain where neurolinguistic processing may be different for children with SLI.

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Predicting SLIGenetic factorsFamily history of language or learning disorders should be considered as a risk factor when predicting future language recovery from an early language delay.

Environmental Factors: Conversational styles of parent-child input and variations in linguistic input. Neurobiology:Brain structures in children with SLI have been found to differ in volume and symmetry from those of typical children.

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Diagnosing SLIA parent or preschool teacher may be the first to suspect a child has SLI. A speech language pathologist is often involved in the diagnosisLanguage skills are tested w/ assessment tools that evaluate a number of things. Tests are used on children 3-8 years of age once they enter school

How well a child constructs a sentence and keeps words in orderVocabulary sizeQuality of speech

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Post Presentation Survey1. A 2-year-olds vocabulary is about: 50 words, 100 words, 200 words, more than 300 words

2. A babys first words are generally produced around: 6 months, 9 months, 12 months, after 15 months

3. Most children who a slow to begin talking turn out fine. Strongly Agree/Agree/Disagree/Strongly Disagree

4. Most children with a preschool language disorder have difficulty learning to read. Strongly Agree/Agree/Disagree/Strongly Disagree

5. About _________3%, 5% 7% > 10% of preschool children have developmental language delays (i.e., SLI)

6. Children who have families with a history of developmental language disorders are at greater risk for having a developmental language disorder.Strongly Agree/Agree/Disagree/Strongly Disagree

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