How should adults educate children with speech disorders in Japan?

Graduation Thesis

Presented to

the Faculty of the Department of

English Language and Literature

Notre Dame Seishin University

In Partial Fulfillment

of the Requirement for the Degree

Bachelor of Arts

by

Erina Nakada

2014

Contents

Abstract 1

Chapter 1：What are speech disorders

1.1Introduction 2

1.2 Disorders which are related to language 3

1.2.1 Expression Language Development Delay 3

1.2.2 Aphasia 4

1.2.2.1 Total Aphasia 5

1.2.2.2 Broca’s Aphasia 5

1.2.2.3 Wernicke’s Aphasia 5

1.2.2.4 Conductive Aphasia 6

1.2.2.5 Transcortical Motor Aphasia 7

1.2.2.6 Transcortical Sensory Aphasia 7

1.2.2.7 Mixed-transcortical Aphasia 8

1.2.2.8 Pure Word Dumbness 8

1.2.2.9 Amnesic Aphasia (Anomic Aphasia) 8

Table 1：Classification of aphasia 9

1.2.2.10 Summary 10

1.3Disorders which are related to speech 10

1.3.1 The Articulation Disorder 10

1.3.1.1 Functional Articulation Disorder 11

1.3.1.2 Organic

Articulation Disorder 11

1.3.1.3 Dysarth

ria 12

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1.3.2 Dysphonia 13

1.3.3 Stuttering 13

1.3.4 Summary 14

1.4 Disorders which are related to communication 15

1.4.1 Autism 15

1.4.2 Attention-deficit/hyperactivity disorder (ADHD) 16

1.4.3 Language-based Learning Disabilities (LLD) 17

1.4.4 Summary 18

1.5 Phonetically regular and phonetically irregular 19

1.6 Research questions 21

1.7 Summary 21

Chapter 2：Treatment

2.1 Introduction 23

2.2 How to teach children with speech disorders in Japan 23

2.2.1 Language Development Delay 24

2.2.2 Infant Aphasia 27

2.2.3 Dysphonia 29

2.2.4 Articulation Disorder 31

2.2.5 Stuttering 34

2.2.6 Autism 35

2.2.7 Attention-deficit/hyperactivity disorder (ADHD) 37

2.2.8 Asperger’s syndrome 38

2.2.9 Learning Disabilities (LD) 41

2.3 Summary 43

Chapter 3：Discussion

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3.1 Introduction 44

3.2 American treatments 44

3.2.1 Stuttering 44

3.2.2.Dysphonia 45

3.2.3 Speech sound disorders ：Articulation and phonological processes

45

3.2.4 Language-based learning disability(LLD) 45

3.2.5 Attention-deficit/hyperactivity disorder (ADHD) 46

3.2.6 Autism 47

3.3 Comparison with Japan 48

3.4 Answering research questions 48

3.5 Conclusion 50

References 51

Websites 51

iii

Abstract Language is essential tool in life as a member of society. Normal

children can understand what their parents and teachers say and

study. When the children think they want to learn something, they can

do it soon. They also communicate with their friends and parents and

give their opinions, but children with a speech disorder can’t do these

things. Children have delicate hearts, so their friends’ carelessness

may hurt children with speech disorder during their conversation, and

they sometimes become children with a psychological hatred of

attending school or retiring children.Chapter One shows the kinds of speech disorders. We know

symptoms of speech disorder, and study about dyslexia. Dyslexia is

disorder of reading and writing, and the rate that people of English

area have dyslexia is twice or three times than people of Japanese

area. Chapter One finds out the reason. Chapter Two shows treatments of speech disorders, and thinks

better treatments for each speech disorder. One speech disorder has

some treatments but they are different by symptoms, so people need

to cooperate with a medical institution and use the treatment which is

proper to symptoms. Chapter Three studies the treatments of other country and

compare with Japanese treatments. We understand the differences

between two countries, and think about things which adults and

teachers have to do in education of children with speech disorders

1

after this.

2

Chapter 1：What are speech disorders

1.1 Introduction

Language is necessary for human beings. The functions of

language are self-expression, communication, the pleasure of

speaking, getting one’s ideas in shape, sociable gestures, getting rid

of anxiety and hostility, strengthening memory and controlling human

relations and so on. Most people can acquire their first language

naturally without problems but some have speech disorders.Speech disorder is an abnormal way to talk. Sometimes

understanding and expressing language are difficult. A repertoire of

sound expressions which babies have changes from unclear vowel

sounds to clear syllables like ‘dadadada’. Babies can’t utter words

with meaning yet, so this is a pre-speech stage which can reveal

speech disorders but it in normal children it is an important time as a

foundation of speech development. Japan has a system called infants diagnosis whereby each child’s

development is checked when he/she is one and six months. When

words with meaning don’t appear during this time, the parents

worried about their children, but the difference among individuals is

big, and some children speak their first word at about two years old.

Speech delay times are based on arbitrary standards as to whether a

delay might be individual development delay or a disorder. We will

study some cases which have development delay which needs some

3

support on the assumption that drawing a boundary line of speech

and communication disorders is difficult.

1.2 Disorders related to language Language Development Delay (LDD) is the condition in which

words and syntactic skills are delayed, but there is no yardstick for

judging whether it is a disorder or not. A child with LDD is one who

can’t speak words with meaning and can’t understand words even

though they don’t have an auditory disorder when they are over 2

years old. When they are over 3 years old, it shows up if they can

speak only single words like “mama” and “this”. The following cases

can reveal language development. Children with intellectual disorders

and autism which include Down’s syndrome may also have LDD.

Moreover, when children with LLD enter elementary school, the words

which they speak are simple, and they sometimes misuse a

conjunctions and conjunctive particles (れる・られる). In short, a child

with LDD is likely to have a big difference between vocabularies which

is expected at that child’s life age compared to other children.

1.2.1 Expression Language Development Delay

Children with this disorder have only the ability to use gestures

and simple words though they can understand sentences, and

expressive language is much more difficult than understanding

language. This shows a state whereby only language development

has a delay though non-verbal intelligence is normality.

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1.2.2 Aphasia

It is a communication disorder. It’s result of damage or injury

to language parts of the brain. It’s more common in older adults,

particularly those who had a stroke. Aphasia gets in the way of a

person’s ability to use or understand words but doesn’t impair the

person’s intelligence. People with aphasia may have difficulty

speaking and finding the “right” words to complete their thoughts.

They may also have problems like understanding conversation,

reading and comprehending written words, writing words, and

using numbers. Aphasia is usually caused by a stroke or brain

injury with damage to one or more parts of the brain that deal

with language.According to the US National Aphasia Association, about 25%

to 40% of people who survive a stroke get aphasia. Aphasia may

also be caused by a brain tumor, brain infection, or dementia

such as Alzheimer’s disease. In some cases, aphasia is a symptom

of epilepsy or other neurological disorders. Compared with adults

and other speech disorder of infant, it is rare. If children have

aphasia, people have to inspect whether they have a congenital

heart disease or not by ultrasonography of heart. Children often

show aphasia as a function disorder after conversion and the

5

Landau-Kleffner syndrome which is caused by a functional brain

disorder. Immediately after getting it, aphasia’s symptom is most

seriously, but it recovers as time goes by. According to Lenneberg

(1974.), it recovers within 5 months after showing the symptom

but they can’t hope for complete recovery if the aftereffects last

after this point in time. As an exception, it is possible to recover

from aphasia which is caused by non-oxygen brain fever and

carbon monoxide poisoning.

1.2.2.1　Total Aphasia

In total aphasia, all of language functions (hearing, speaking,

reading and writing) are very bad due to damage in a wide area of

fissure of Sylvius. People with total aphasia sometimes utter specific

words automatically. The main examples of disease are problems in

Broca’s area, Wernicke area and the arcuate fasciculus.

1.2.2.2 Broca’s Aphasia

People with Broca’s Aphasia can’t utter words and speech is non-

fluent though they can understand. They are better at Kanji than kana

letters when reading and writing. This model progress shows serious

speech symptoms like total aphasia, but Broca’s aphasia recovers

gradually, and they still have halting utterances. This cause is a

pathological change of the frontal lobe Broca’s area.

1.2.2.3 Wernicke’s Aphasia

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People with Wernicke’s aphasia find it difficult to understand words

and things which are said and written. Their utterances are fluent but

the words don’t have meaning such as “tan”, “nanda” and so on. In

an acute time, they become talkative and, often can’t have subjective

symptoms. The focus is Wernicke area.1

Left brown part is Broca’s area, and right brown part is Wernicke’s

area.

1.2.2.4 Conductive Aphasia

Understanding and expressing words are good but they make

mistakes with the sound of words (they call “ringo” “dengo”), and

remembering words they heard is also difficult. Especially, they make

mistakes when repeating. People with this disorder notice their

mistakes and correct them but they forget words that they should say

because of a decline in their auditory understanding ability. The focus

is arcuate fasciculus. 2

1 http://ja.wikipedia.org/wiki/%E3%83%96%E3%83%AD%E3%83%BC%E3%82%AB%E9%87%8E2 http://ja.wikipedia.org/wiki/%E5%BC%93%E7%8A%B6%E6%9D%9F

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This is arcuate fasciculus (Raf：right arcuate fasciculus, Laf：lefy

arcuate fasciculus). It connects Broca’s area and Wernicke’s area.

1.2.2.5 Transcortical Motor Aphasia

People with Transcortical Motor Aphasia have a decline in voluntary

language and are good at repeating. It is said there is disfluency

formally but they do not try to speak (people with Broca’s Aphasia

can’t speak). In short, the amount of utterances decrease and they

often repeat. The focus is the front of central ditch which surround the

area for uttering words (frontal lobe).

1.2.2.6 Transcortical Sensory Aphasia

People with this disorder can recognize the sounds of words and

can repeat them, but can’t understand the meanings of words.

Repeating another’s words attracts attention. Utterances are fluent

but they have many mistaken words. The focus is the back of central

ditch which surrounds the area for uttering words (frontal lobe).3

3 http://image.search.yahoo.co.jp/search?ei=UTF-8&fr=&p=%E8%A8%80%E8%AA%9E+%E8%84%B3

8

A focus of Transcortical Motor Aphasia is frontal lobe (blue). In the

olden days, it was said the focus of Transcortical Sensory Aphasia is

temporal lobe (green) and parietal lobe (yellow) but it is now said

frontal lobe is also the focus, so people can get Transcortical Motor

Aphasia or Transcortical Sensory Aphasia when frontal lobe is the

focus.

1.2.2.7 Mixed-transcortical Aphasia

This aphasia is like total aphasia but people with Mixed-

transcortical Aphasia often repeat. However, repeating doesn’t

involve meaning’s understanding. When someone gives a suffer the

first word of a proverb, people with this aphasia say a continuation of

it automatically. The focuses are many parts of brain (Broca’s area,

Wernicke area, arcuate fasciculus, the front and the rear of central

ditch which surround the center of uttering words area and angular

gyrus).

1.2.2.8 Pure Word Dumbness

Language expression by sounds is difficult but language

expression by writing is possible because inner speech keeps.

1.2.2.9 Amnesic Aphasia (=Anomic Aphasia)

For this kind of aphasia, utterance and auditory understanding

are normal or good comparatively. This aphasia has features

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whereby suffers can’t remember words and can’t express things in

words. People with this aphasia often speak in a roundabout way,

and sometimes can’t understand nouns. Alzheimer’s type cognitive

impairment often is shown with this aphasia. They often use

pronouns like “this” and “that” in conversations, and repeat topics

which are not connected. The hotbed of disease is angular gyrus.

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Table 1：Classification of aphasia

Kinds of Aphasia

Mixed-Transcortical

Aphasia

Amnesic

Aphasia

Transcortical Sensory Aphasia

Transcortical Motor Aphasia

Total Aphasi

a

Conductive Aphasia

Wernicke

aphasia

Broca’s Aphasi

a

fluency × ○ ○ × × ○ ○ ×

repeat ○ ○ ○ ○ × × × ×

understandinglanguage

× ○ × ○ × ○ × ○

name changing words

× × × × × △ △ △

writing × × × × × × × ×

read aloud × ○ × × × × × ×

Understanding meanings

× × × ○ × △ × △

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1.2.2.10 Summary

Children with Expression Language Development Delays aren’t

delayed intellectually, so they can recover from the delay of language

rapidly from a stage, and often reach normal children’s levels when

they become elementary school students. However, they may have

other disorders like difficulty in hearing when they notice that

intellectual ability and speech ability have a big gap, so they should

get an examination from a medical specialist.Also, there are some kinds of aphasia, and the place where

damage occurs for each disorder is difficult. Features of aphasia are to

have disorders in four language functions (speaking, listening, reading

and writing) and to have disorders in meaning of wards, grammar, a

phoneme and vocabulary. Magazines and newspapers are easier to

understand than a table of the Japanese syllabary for the patients, so

they can write kanji if they can’t write kana.

1.3 Disorders related to speechThere is not only a delay of vocabulary and sentence but also of

speech. When children begin to speak words with meaning, their

pronunciation is unclear but it will be clear gradually.

1.3.1 The Articulation Disorder

Language sounds can be classified into vowels and consonants.

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The vowels add resonance to a sound source which is produced in the

vocal cords, and are produced by strengthening a specific ingredient

of frequency. On the contrary, the consonants are made by disturbing

the flow of expiration, so a distortion and replacement are easy to

occur.

Pronunciation is not so good. It causes a slight distortion of

sound and omission of sound or replacement. When children are

about 6 years old, they utter childlike pronunciation, and have a

replacement of sound which is immature pronunciation. For example,

they call “karasu” “tarasu”.

1.3.1.1 Functional Articulation Disorder

It is most common type in infancy. It causes the omission of

sounds, distortion and replacement though the phonemic organs and

a neurological problem such as paralysis don’t have problems. The

sound of [s] is replaced to [ʃ] and [t], and they call “sakana” “ʃakana”

and “takana” when they are 6 years old.

1.3.1.2 Organic Articulation Disorder

There is a problem with the construction of the phonemic organs

such as lips, tongue and palate. The worst problem is it disturbs

taking in nourishment such as mother’s milk. Children with a cleft

palate have a problem with clearness of articulation. In general, the

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soft palate rises and closes a path to the nasal cavity except

pronouncing a nasal sound such as [m] and [n], so a sound passes

only through the mouth. If children do not only have cleft palate, but

also this height of soft palate is not enough, people hear sounds

which get passed to the nose. Moreover, explosive sounds like [p] and

[t] which need to raise pressure in the mouth and a fricative sound

like [s] are heard like nasal sounds. The pronunciation is not clear

because of it.

1.3.1.3 Dysarthria

Articulation movement isn’t achieved due to neurological

problems such as paralysis of muscles and lack of cooperative

movement. The content of massage is good but they slur their words.

Content of speech and understanding are normal unless have

dementia or aphasia at the same time. When an organ to utter has

nerve illness like a brain blood vessel disease and tumor, this occurs.

Movement disorder of an organ to utter inspects in nervous internal

disease and otolaryngologist. The patients need a medical

examination of brain surgery which includes image diagnosis like CT

(computerizing tomography) to decide diagnosis of a brain’s

pathological change and a treatment plan. Speech-Language-Hearing

Therapist (ST) is in charge of an inspection of speech’s symptom. For

example, the patients become in a dangerous state such as having

breathing disorders when myasthenia gravis is worse. However, the

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symptom that speech gets past to the nose appears early, so it is

often run a diagnostic check by detailed understanding of speech

symptom and a medical close examination. The pronounce disorder of

unknown origin needs to run a diagnostic to check it from different

angles by plural specialists, so they must have inspection in a general

hospital which has a speech therapy department. 1.3.2 Dysphonia

An energy source to produce voice is expiration from the lungs. If

expiration isn’t impeded by anything till it produces from a lip, people

can’t hear the stream as sounds. However, the way of voice has some

places which can be narrow and, the vibration of air occurs and it

changes to useful voice to communicate when the stream of

expiration is impeded.

Children’s voice is hoarse after they continued speaking loudly

because a swelling is gotten by rough treatment of voice and the

vibration of voice. Change of nature of voice is temporary but when

vibration of the vocal cords is irregular and you get a husky voice by

having tubercle and a polyp, it is called dysphonia. However, infants

have hardly it..

1.3.3 Stuttering

Not only utterances are fluent, but also they shows physical

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exercise which involves tension such as gnashing one’s teeth, blinking

and shaking the head. Stuttering often breaks out when children are

from 2 to 6 years old. Boys often experience it more than girls (girls：

boys=1 ： 2.5 ～ 1 ： 3). Also, when children have awareness of

stuttering, they feel anxiety and fear in places to communicate.

Table 2：Non-Fluent Type of Stuttering

Non-Fluent Type Utterance Example (in

Japanese)

Repetition of Syllable 「こ、これちょうだい」

Enlargement of Sound 「どーらえもんがね」

Block 「ｄ…どうぶつえんで見たよ」

Repetition of Word 「たまご、たまご買ってきた」

An interjection 「がっこう、あの、あの、行った

の」

1.3.4 Summary

People record and analyze the state of articulation in free

conversation and name picture cards systematically for children with

pronunciation problems. There is an articulation picture cards

examination that all sound of Japanese is covered and consists of

pictures of language familiar to the children. In an articulation

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examination, examiners recognize children’s pronunciation

receptively, and record omissions, distortion and replacement of

sounds while using a sound letter, so examiners need the this skill. In

addition, examiners look into whether they can form the tongue or not

(movement of articulation organ) and whether they can recognize two

different sounds or not (the sound of a ward distinction).

1.4 Disorders which are related to communication1.4.1 Autism

Usually children start speaking before 1 year old, and they

understand what adults say from a few months later. Parents who have

autistic children encounter a phenomenon that they call their

children’s name but the children don’t turn their faces. The parents

often doubt their difficulty in hearing. However, children react to

television commercials and the sound to open snack bags and sounds

coming from the next room. Thus, autistic babies seem to respond to

noise but respond to voice gradually but they respond to a clue except

voice. For example, when a mother says let’s go outside, a child goes to

the entrance and tries to put on his shoes. You may think he responds

to his mother’s voice, but his mother turns off a light of room and

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switch off television before inventing with words. He sees the series of

movements and judges that he can go outside. It is a stage in their

understanding. Language consists of coding. People remember a

specific voice which corresponds to a thing, and the speech

understanding organizes by understanding that the thing and the

voice are correspondence relation. In autism, we don’t know whether

they stumble on it or not. Children can’t understand the speech, but it

doesn’t mean they lack the ability of communication. When they use

pictures, figure symbols and signs, understanding is easy

comparatively. It is called this communication method ACC

(Augmentative and Alternative Communication). A diagnosis standards of autism like DSM-Ⅳ (Diagnostic Statistical

Manual of Mental Disorders Ⅳ) and ICD-10 (International Classification

of Disease 10) consist of three fields which are the disorder of

personal relations, communication disorder and narrow interest and

activities. The disorder of personal relations and the communicative

disorder are connected to each other because if the relation with

others doesn’t happen, communication itself doesn’t organize, and if

the ability of communication doesn’t grow, children can’t make

relations with others. In their diagnosis, autism is included to the

category of pervasive developmental disorder. Also, Asperger’s

syndrome shows symptoms like autism but language development is

not delayed, and intelligence development is good.

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1.4.2 ADHD (Attention-deficit/hyperactivity disorder)

ADHD is slight development disorder which shows loose

attentiveness and impulsive action as features. The patients can’t

explain even if someone asks reasons of impulsive action. They can’t

imagine the purpose and act, and act whatever comes into their

mind. They can judge right and wrong but they act without a warning

and a plan. Their circuits do a simulated practice in their brain once

but actually don’t act. 3～5% of children who go to school have ADHD.

Concentrating on one thing is difficult, and always is restless. The

causes of ADHD aren’t their parents discipline and mental disease, it

is a disorder of brain function by nature. Children with ADHD are often

misunderstood from people around them and experience troubles, so

they lose their confidence and feel stress incessantly. Symptoms in

daily life are that their rooms are always in a mess, they are often late

and can’t carry out a thing to the end. The treatment of ADHD is done

by combining medication, change of correspondence to patients’

parents and recognition training.

1.4.3 LLD (Language-based Learning Disabilities)

Children with a slight developmental disorder have high natural

abilities but they can’t utilize their abilities well because there is a big

unevenness between things that children can and things that they

can’t do. Recently, 6% children in each grade have a slight

developmental disorder. The children don’t show obvious intellectual

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or a physical disability, so adults around them first notice when

problems in school come up such as children can’t keep up with

school study and suitable for their class.

Figure 1：A trend in children with slight development disorders such

as LLD

This slight developmental disorder has two groups. One is LD

which has learning problems. The other one is high functioning

pervasive developmental disorder and ADHD which display personal

relation and adaptability to society problems. Both types of children

don’t want to go to school or want to stay indoors (truancy). Here,

learning disability (LD) indicates that acquiring skills such as listening,

speaking, reading, writing, reasoning and arithmetic is very difficult.

The cause of LD is a congenital disorder in brain function. In addition,

LD has LLD type and non-verbal LD type. Children with LLD fail in

subject learning such as Japanese and arithmetic because they have a

disorder with the written and spoken language. Children with non-

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A slight development disorder

LD

LLD

dyslexia

High Functioning Pervasive Developmental Disorder(This includes Asprger)

ADHD

Learning problemsPersonal relation and adaptability problems

truancy

verbal LD can’t map space and direction, and a co-ordination of bodily

movement of the whole body is awkward. 75~80% LD is LLD (Paul, R.

2001). After all, children with non-verbal LD often have problems of

communication (Volden, J. 2002), and most LD children have a

developmental disorder of language.

1.4.4 Summary

There are few autistic children who can speak, and if they can get

language, they only speak at the word level and talk to themselves,

and they often speak about their demand, so verbal exchanges as

communication is difficult. However, expressing what they want to

say by using figure symbols and signs is effective because their visual

data processing is good comparatively. Also, both of the

correspondence to word-sound and reading and understanding are

difficult for many LLD children, but there are children with dyslexia

who only can’t change words to sounds in LLD. It is said that Dyslexia

is congenital disorder of brain function, and it is hereditary. Many of

them have high intelligence and can’t read by themselves, but they

can understand the content immediately when someone reads to

them. It is a difference from other LLD children.

1.5 Phonetically regular and phonetically irregular

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Dyslexia is an example of this and is one kind of learning

disability. Reading and writing are very difficult for children with

dyslexia though intelligence and general understanding ability aren’t

abnormal. For example, they can’t understand “7” and “seven” are

the same thing, and words capsize and are memorized. The emergence rate of Dyslexia is 4~5% in Japan and 10~15% in

English areas. Why is the rate in English areas higher? The reason is

that English has more phonemes than Japanese. Japanese phonemes are /a/, /i/, /u/, /e/, /o/; /j/, /w/; /k/, /s/, /c/, /t/,

/n/, /h/, /m/, /r/, /g/, /ŋ/, /z/, /d/, /b/, /p/; /N/, /T/ and /R/ (24). And

English phonemes are /i:/, /ɪ/, /e/, /æ/, /ʌ/, /a:/, /ɒ/, /ɔ:/, /ʊ/,

/u:/, /ɜ:/, /ə/, /eɪ/, /aɪ/, /ɔɪ/, /əʊ/, /aʊ, ɑʊ/, ɪə/,/eə/, /ʊə/, /p/, /b/, /t/, /d/, /k/,

/g/, /ʧ/, /ʤ/, /f/, /v/, /θ/, /s/, /z/, /ʃ/, /ʒ/, /ð/, /h/, /m/, /n/, /ŋ /, /l/, /r/, /w/

and /j/ (44). We combine phonemes, and it which becomes the

smallest unit is syllable. Japanese syllables are organized when they

combine vowels or a vowel and a consonant. “きゃ” and “しゃ” are

“kya” and “sya” but they don’t have more four syllables when a vowel

and a consonant combine. The length of syllables is the same.

Figure 2：Japanese syllables

しゃ　　　　　　　　　　 きゃ a phoneme

　　　　　

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s y a k y a

The same length

The same length

However, English is different. Having vowels in a syllable is the

same as Japanese but the kinds of combination are various, and the

length of syllable is different.

Table 3：The kinds of English syllables

(V=vowel, C=consonant)

Also, letters and sounds are almost the same in Japanese kana.

As an exception, “へ” changes to sound of /he/ or /e/ by the context,

but a sound often changes by words in the same English word. For

example, the sound of “a” is /ei/ in “make (/meik/)”, and is /a/ in “ask

(/ask/)”. Thus, the alphabet of English is phantasmagorical sounds,

and is viewed in combinations of letter and sound, it is very difficult.

1.6 Research questions

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Example of word The kind of syllable (in English)

a Vdo, so V+Cat, an C+Vcut, big C+V+Cbox, sing C+V+C+Ctext, next C+V+C+C+Ctexts C+V+C+C+C+Cblow, tree C+C+Vdream, break, space

C+C+V+C

breast C+C+V+C+Cbreasts C+C+C+V+C+Cstrength C+C+C+V+C+C+C

1. What treatments are available for speech disorders such as

aphasia?2. Which are the most effective?3. What do Japan and America have the differences of treatment

ofspeech disorders?

1.7 Summary

There are various kinds of speech disorders, and one speech

disorder has some kinds. Some disorders can be recovered from soon,

others are caused by having problems in the brain. Also, there is a

disorder in which it is difficult to notice such as LLD. Intelligence tests

like WISC-Ⅲ 　 (Wechsler Intelligence Scale for Children Third Edition)

and K-ABC (Kaufman-Assessment Battery for Children) and language

development test are used to judge whether children have LLD or not.

However, it is dangerous to judge by using only these tests, so people

should get a wide range of information such as their experiences as

growth and scholastic ability, and should judge synthetically. In Chapter Two, we study the treatments for speech disorders and

find better treatment. Also, in Chapter Three, compare Japanese

treatment with treatment of other country, and discover differences

and understand education of the country.

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Chapter 2：Treatment

2.1 Introduction Today, in general education, “the bringing up of children and

students who have ability and attitude which can correspond to the

change of society independently” is demanded strongly from the

point of view of lifelong study. When Japan received the social

request, new guidelines was made, and the ideal method of new

school education was shown. Of course, hard of hearing and speech

disorders education also have to improve. The important thing is

efforts need to be made for the special class which can reward

children’s needs. Guidance which recognizes the actual situation of

disorders and the needs of each child and students is prepared in the

guidelines minutely, and there is security that children always can

receive a needs-based education. In other words, the education for

children’s needs is what we can do and what we must do for the

children and the parents’ needs in educational. Teachers need a clear

aim for parents’ request, and we would like to recognize this as

educational needs.

2.2 How to teach children with speech disorders in Japan

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In the 1950’s, only 20 schools had special class for speech

disorders but it grew rapidly in the 1960’s to 1970’s. According to

special education data for fiscal 1987, there are 1,322 elementary

schools and 88 junior high schools for children with speech disorders.

At present, the class organization movement is stable. (Tani, Komura,

Yoshioka, 1993, p.21)

2.2.1 Language Development Delay

This treatment usually is conducted in a treatment room. Parents

and children have to be in separate rooms because various problems

occur when the parents are in the treatment room. For instance,

special human relations have already been formed between parent

and child, and dependence continues, the first signs of their

independent spirits are delayed, and the feeling to which need to

speak is lost when they bring the relation to the treatment room.

(However, there is an idea that parent and child shouldn’t separate.) For children who are separated from parents, the targets which

they depend on are speech clinicians, so accepting children’s

emotional expressions and actions is important for them. When

treating the child, the speech clinicians have to lead the children

positively.

1) Children should enjoy hearing Speech clinicians speak to children who are playing and let them

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listen to various sounds. When the speech clinicians beat the drum,

the tambourine, the trumpet, the clarinet, the piano and so on, they

observe whether children stop playing and turn their face towards the

direction and how long children pay attention to the sound. They

choose a sound that children are interested in. If it is a drum’s sound,

they beat a drum rhythmically, and raise children’s attentiveness

towards a voice and a sound little by little, and try to give distinction

ability to children.

2) Children should enjoy expressing themselves Uttering as the need arises is more important than uttering

vaguely. For example, speech clinicians say “Now, I beat a drum and

produce interesting sounds. Rub-a dub! It’s Taro’s turn to beat a drum

now. Let’s beat!” and let him beat. This play has two meanings. One is

making children imitate the speech clinicians beat, and another one is

making children experience the joy of producing sounds by beating. Next, speech clinicians let children utter. They do actions that

children are interested in or tickle children. When they record

children’s utterances and play the tape, there are many children who

are strongly interested in their utterances.

3) Children should imitate sounds Speech clinicians lead the children, and imitate the sounds and the

cry of vehicles and animals. When they use the vehicles sounds,

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giving the sounds like “bu-bu-”, “pi-po-pi-po-”and “syuppo syuppo” is

important. Also, involving movement is important. These playgrounds

equipment has a kinetic nature because the children don’t have

actual feelings which give sounds and they loose the joy if the

playground equipment don’t have movement.

4) Children should imitate words and utter them A speech clinician makes the best use of children’s imitation

abilities to promote language development. For example, a speech

clinician opens her arms and runs in a room while saying “bu-n bu-n,

an airplane”. The speech clinician urges children to imitate it while

saying “Taro, now, together”. The child may not utter the word but

the speech clinician continues patiently.

5) Children utter a simple word on their own initiative In this stage, children can say many words, so the children can

answer simple questions. When a speech clinician asks what

something is, the children usually answer. If they don’t answer, they

usually imitate it when the speech clinician says “watch” in a small

voice.

6) Children should talk In this stage, a speech clinician performs plays to raise

conversation ability. First, the speech clinician begins a role play. In

role play shopping, the speech clinician is a buyer and a child is a

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seller. They begin from a simple conversation such as “Hello, please

give me an orange” and “Hello, here you are. Thank you”. After that,

they change their parts. (Sumie, Nishikawa, Tomita, 1985, p.173~175)

The six points of view of teachers’ language and movement1) Teachers imitate what children are doing

Teachers and children understand each other by imitating and

can have an opportunity to be glad together.2) Teachers tell what they are doing

Children can pay attention by showing a model of the way to

use a live language.3) Teachers tell what children are doing

Teachers’ language is common topic with the children, and

show their names and meanings.4) Teachers imitate what children say and correct them

Teachers repeat or correct and repeat.5) Teachers expand what children say

When teachers start from proper express and understanding

level of the children, children’s language development is

better.6) In natural conversation

Teachers adapt themselves to the understanding level of the

children, and follow the passage of story which is primarily

their interests. (Murakami, 1996, p.197~198)

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2.2.2 Aphasia

Children with aphasia are confused with a sudden consciousness

disorder, feel a sense of alienation and loneliness, and are unstable

because of irritation and hastiness, so people around them have to

understand aphasia properly and deal with them warmly.

1) A fundamental way to attend to children with aphasia・ People should speak more clearly, slowly, and speak shorter and

easier than usual to help them understand language.・People should talk about concrete content and should not change

the topic suddenly.・ When the children can’t understand, people should repeat and

devise a different way to say something.・Using characters like kanji is easy for the children to understand.

・When the children can’t understand language, people should speak

while using pictures and gestures.・When the children are slow in understanding, people should show

the real things, and actually go to the place and speak.・ When people speak about something important, they should

confirm whether the children can understand or not.

2) The proper way to attend to symptomsCase 1 ： Children with aphasia can’t find words which they want to

say.

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・ When adults know what the children want to say, the adults

shouldn’t anticipate what they will say and say it.・ When the children don’t say something easily, people should ask

“yes” or “no” questions. Also, people judge an intention which the

children want to tell from their expression and gestures.

Case 2：Children with aphasia say different words from words which

they want to say.・When people can find mistakes from the passage of a story, they

guess words that the children try to tell from the situation and don’t

correct, and keep it just like that.・When people can’t find mistake from the situation, people can show

letters and pictures to confirm understanding.

2.2.3 Dysphonia

Not only speech clinicians treat dysphonia, but also medical,

psychological and educational concern need attention. Especially

medical treatment is necessary.

1) Making good relationship between speech clinicians and children

with dysphonia voice treatment is important. This is sometimes

useful to improve their voice.2) Listening to a model of a good voice (tapes are good)3) Making children with dysphonia imagine their friend who is a

model voice for them in their heads, and utter with a feeling that

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the children are their friends4) Making children with dysphonia relax, and remove their anxiety

・if children are busy, they should take a rest

・children should turn off the light and use a candle at dinner time

・children should join sports and recreation positively

Also, breathing training and breathing utterance’s training are

important. 1) Breathing training

・children should puff their belly while breathing fully

・ children should pull their belly quickly, and continue breathing

out slowly at the same time2) Breathing utterance’s training

Children should・breathe while puffing their belly

・ utter /h/ (glottal sound) for first two seconds, after that,

utter /a/ (vowel) while breathing out (continue it till it is

stable)・utter /ha/ twice or three times in a breath

・practice the above thing with /h/, /i/, /h(F)/ and /u/

・practice /s/ and /z/ (a fricative sound) in the same way

(Sumie, Nishikawa, Tomita, 1985, p.118,123)

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2.2.4 Articulation disorderTable 4：Training of Articulation disorder

Guidance step The content of guidance The way to guidance

The basic training

1. Improvement of the movement function such as lip, tongue and the lower jaw

2. Improvement of the movement function such as the palate and the pharynx

3. C.S.S. (chewing, sucking, swallowing)

4. Breathing and vocalization

・exercises of mouth・ swallowing, internal pressure of the mouth like ta and ka・ chewing gum and sucking with a straw・ adjustment of breathing and connecting expiration and vocalization

Ear training1. The step to separate and confirm2. The step to distinguish3. The step to compare and collate

・distinguish in single syllable・ distinguish in words without meanings・ distinguish in words with meanings・ distinguish in sentences and conversation

Pronunciation training1. The step to imitate sounds2. The step of single syllable3. The step of words without meaning4. The step of words with meaning

・produce sounds as imitation sound of waves・utter voice as whisper・produce sounds with changes・produce sounds to a tune

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Mastering training1. Sentences2. Conversation3. Plays and some like that

・pronounce in short sentences・ pronounce in an improvised play, a puppet play and a story illustrated with picture cards・pronounce in daily conversation

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The basic training Lip：sharpen － pull, open － close Children should suck water, milk and juice with a straw, and

should say /papapa…/. Tongue：stick － pull, move to right and left Children should lick their lips. The lower jaw：children should chew hard food well and chew gum The palate and the pharynx：children should say /a/ continuously,

and close their mouth and swallow air

Ear training Van Riper (1963) distinguishes ear training from separation, stimulus, confirmation and distinguishing.

Separation ：Picking up a sound (disorder sound) from many words ・Giving a signal when there is the sound in a story which is read (e.g.,) the disorder sound of a children is “と(to)”. An adult read “mukashi mukasi arutokoroni…”.

When the child hears “ と (to)”, he/she raises his/her hand.

・Drawing a line beside the sound in sentences which is written　　　　　　(e.g.,) the disorder sound of a child is “な(na)”. The child see a sentence. He/she finds “な(na)”, he/she underlines it. Stimulus：often listening to the right sound of the disorder sound Confirmation ： understanding a feature of the disorder sound

definitely by themselves

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(e.g.,) /s/ is a fricative sound which utter from between teeth but speech clinicians tape, and make children listen and compare the sound with other sounds.

Distinguishing ：Distinguishing the disorder sound and the right sound

(This is a last step.)

Pronunciation training Speech clinicians let children imitate the right sound while giving a strong stimulus, observing their articulation organ’s structure and movement at the same time and teaching the right way to utter.

The first step・/k/ is substituted by /t/. Speech clinicians make children notice that the top of tongue

shouldn’t come up. Feeling a sense of gargling in their body is good.

・/s/ is substituted by /t/. Speech clinicians make children notice breath coming out from

between their teeth. Children should move their tongue lower than the place of /t/, and separate from the gums a little bit to help breath come out.

・/ʃ/ is a phonetic symbol which say /ʃi/.Children should produce it while pulling back their tongue more

than /s/.・/h/ is omitted and becomes /a/ (「ア」).

Speech clinicians make children notice that it is a sound which appears with breath “ha-”. Children breathe on the back of their hand and feel the strength.

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・/ҫ/ is a phonetic symbol which say /ҫi/ (「ヒ」).This is omitted and become /i/ (「イ」). Children should bring their tongue close above while continuing to breathe.

・/F/ is omitted and become /u/ (「ウ」).Speech clinicians make children notice that it is a sound which can blow out a candle “fu-”.

・/ts/ is a phonetic symbol which say /tsu/ (「ツ」).A shift from /tu/ to /tsu/ is good.

The second step Children practice in single syllables.(e.g.,) in case of /s/, children have to say /s-e/ after that they have to

say /se/.

The third step Children practice in syllables without meaning.(e.g.,) children have to say /e-s-a/ after that they have to say /esa/.

The fourth step Children practice in words with meaning.(e.g.,) sakana「サカナ」(the beginning of a word), aisatsu「アイサツ」

(the middle of a word), kasa「カサ」(the end of a word)

Mastering training Mastering training is process that children use words which can use in word’s level correctly in daily life. Speech clinicians make children listen to their wrong articulation, and make them confirm and understand their mistakes. Also, the speech clinicians have to finish articulation guidance patiently while encouraging them. (Sumie, Nishikawa, Tomita, 1985, p.84~87)

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2.2.5 Stuttering It is said that a spontaneous cure rate of stuttering is 40~80%. Stuttering is cured even if the patients leave stuttering, but it sometimes worsens when they leave it.

・the guidance with play・the guidance with stuffed animals and glove puppet・the guidance which has many language activity in plays・counseling (individual and group)・role play・the guidance for mother・ the guidance with diary (children with stuttering or the

mothers)・read in union・individual read aloud guidance・autonomic training・the guidance which has a cooperation with teachers of general

class・language training and distraction

(Sumie, Nishikawa, Tomita, 1985, p.103)

2.2.6 AutismAdults of children with autism should share their experiences

with them while seeing to it that they don’t make them feel anxious or uncomfortable. Also, adults should imitate their children’s actions intensively. It is sometimes effective to notice the existence of others who have a different way from them. Adults need to teach the ways to

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urge other people such as the how to deliver things and the way to imitate positively. When the children experience them actually, they will understand the meaning and what they have to do.

1) The guidance for children without spoken language The guidance of expression uses the communication study which has sign language and letters and pictures. Also, it uses both the treatment for articulation disorder. When speech clinicians give sign language and language to children with autism at the same time, not only the children can use signs, but also they sometimes begin to use language. When guiding the understanding, the children exchange things and fit samples of the same thing or the same picture. After that, they hear words and choose the things. Not only will they understand the signs but also understand language by using both a sign language and language at the same time. If they can’t understand numerals, they sometimes can understand them by number and expressing with fingers.

2) The guidance for children with spoken language Children have adults’ help and they cooperate with adults when they do something. If the children have to experience these scenes, then the adults will demonstrate a proper language model. When the children can speak, adults’ interests shift to an expansion of vocabulary and sentences. However, it develops only the strong part and can’t improve their weak part which has to do with others. Even if the children can communicate with language, the adults prepare activities to enjoy alternate actions with people and heighten an ability to attract others’ attention. Children with autism have to build up conversational ability though asking questions. Questions are repeat another’s words, so the adults give a question and an answer

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(where do you go? A gymnasium) to the children, and urge them to imitate only an answer.

Children often have a problem which practices the rule smoothly even if they begin to talk. Also, as other problem, mutual understanding by conversation and interruptions of conversation often occur because of a difficulty of understanding functional words and abstract words. An ability to read the intention of partner and an ability to express a personal intention exactly need to talk smoothly. This study is possible during the experience to enjoy conversation. Adults around children with autism should have someone to talk to for that purpose. Moreover, they practice conversation scene of high frequency such as the way to call, shopping and a report of incidents in school by using videos and scripts. (Tani, Komura and Yoshioka, 1993, p.160~162)

2.2.7 Attention-deficit/hyperactivity disorder (ADHD)The most important thing in the treatment is adjusting the

environment and correspondence. Adults should understand the children with ADHD and need to secure the situation to spend time comfortably. Children with ADHD have short attention span and concentration, no fixed aim of attention, sudden changes of feeling and action and easily forget. They often are scolded, and repeatedly fail, so they sometimes feel anxiety and refusal when they do something. Also, they sometimes are impulsive and are touchy.

1) The attention has to be concise and clear and lucid If adults preach and give a complicated indication while spending a lot of time, children with ADHD sometimes can’t understand the meaning and get confused. Also, the children sometimes misunderstand the meaning of words and lack knowledge which have already known. Being praised is easier for them to accept than being

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asked to “think!” and “reflect on!” something.

2) Regular fundamental lifestyle Corresponding to the change of situation is difficult for many children with ADHD, so they become composed when the purpose and result of things and opening and completion are clear. Deciding the appropriate subject and frame and removing psychological anxiety are important. Short-term memory is a weak point for them, and they sometimes are forgetting the thing which tried to do. (example ： a child with ADHD tries to play outside but he/she forgets playing outside.)

3) Setting up the environment where stimulation is less Children with ADHD often get confused in an environment with a large number of people, and they are stable comparatively in the small number of people. Treating information is difficult for most of them, and adults have to decrease the number of stimulants. If they are excited, they can be composed and talk when they move to the situation which is quiet and spend a lot of time.

4) Strengthening proper action In amending actions, strengthening proper actions is better than warning improper action. When proper actions are lacking, people should praise them for good things which children are doing, and need to use a table to reflect on.

5) Decreasing failures in friendship Children with ADHD are thought “strange boys (girls)” by children around them. There is the situation which it is easy to stand alone against their intentions, so adults need to teach feelings to their

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friends. Sometimes people around them need to prepare to get praise from other child. (Asai, Arisawa, Anzai and thirty-one others, 2003, p.8~9)

2.2.8 Asperger’s syndrome Teachers should do SST (social skill training). SST is practice to get necessary skills to live in the society. STT has many examples in various scenes, so I will show some examples here.

1) SST which use the sense of game・The quiz to guess a person’s feeling A teacher makes A and B card and cut up each word. She (a teacher) shows a child A card and let them choose the following word from card B. When he (a child) makes a mistake, she corrects it.

Table 5：An example of the quiz to guess person’s feelingA

めいろあそびは

100 てんがもらえて

ころぶと

ちいさい犬は

カレーは

・The quiz to find a common point The following table is questions and answers. A teacher doesn’t show the answers and gives it as a quiz. If he doesn’t say the word at first, he understands the image of the word by repeating it.

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Bかわいい

たのしい

だいすきだ

いたい

うれしい

Table 6：An example of quiz to find a common pointquestions answers

ボールペンと消しゴム 文房具

バラとアサガオ 花

きゅうりと大根 野菜

カラスと犬 動物

赤と黒 色

・The quiz to find an antonym A child finds the opposite word. The following list is quizzes and examples of answers.Table 7：An example of quiz to find an antonym

quiz answer (opposite word)暑い 寒い

広い 狭い

小さい 大きい

白い 黒い

やわらかい かたい

2) SST using picture cards・In case of child who can’t answer The following example uses for children who can’t answer daily conversation like greetings. The children practice many times and can use by remembering as a pattern.

The way to do (T：teacher, C：child) T：What is this picture? Please explain. (a teacher shows and ask) C：…

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T：A children was absent because of a cold, so a teacher ask how you are today. What should you answer in this case?

C：…

T：What do you answer if you feel good? C：Good T：That’s right. You say “thank you, I’m OK” or “I recovered”. Now,

I ask you.

Repeated practice in the rule play T：You were absent yesterday because of a cold but how are you? C：Yes. I recovered.(Tanaka and Iwasa, 2008, p.46, 53, 74)

2.2.9 Learning Disabilities (LD) The treatment of this disorder differs according to the symptoms. I will show two cases here. This is guidance in class.

・When understanding directions is difficult. It is difficult for a child (children with LD) to understand directions of his teacher. When she (his teacher) are told to open your notebook with homework, he just put his notebook on the desk while looking at his friends around him. He can understand the content when she speaks person-to-person even if his surrounding is noisy, but understanding the direction of complicated content is difficult for him even if she speaks person-to-person. She…

1) goes near him, makes eye contact and speaks while attracting his attention

2) prepares pictures which are related3) writes a content of indication step by step on the blackboard

After the guidance, he listens to her, looks at the blackboard and can

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follow her indication. However, problems are left. When he listens to a complicated content of conversation, he asks her again. Also, he fails when he doesn’t make sure. Speaking while going near children and meeting their eyes can make them be conscious they are being talked about. Moreover, choosing a sound which should hear is easier. Also, showing pictures which are related to something said and writing it on a blackboard are easy ways to for children to understand who can’t understand when they just listen.

・When reading aloud is difficultChildren read letters one by one (e.g., きょ・う・は・あ・め・で・

す). The ability to listen and the ability to speak are good. His teacher begins to guide about reading. She…

1) tells which part to read beforehand and lets him practice it2) prepares pictures which are related to the sentence3) writes with a space between words4) writes the pronunciation above kanji5) expands letters of the textbook

After the guidance, he can read with confidence when he reads a textbook in his class. He reads slowly but he can read with unity little by little. However, reading a palatalized syllable and a geminate consonant are not firmly established for long. An effect on the guidance

1) Children develop their will to join classes by urging their understanding of the content beforehand

2) Children are possible to suppose and read by having visual supports.

3) Taking apart sentences with unity by themselves is difficult for

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the children, so teachers make unity of meanings visually beforehand.

4) Writing the pronunciation above kanji lightens a burden on reading.

5) There is letter size to read for each child, so teachers have to find a suitable size while consulting them.

(A society for the study of national special education, 2008, p.14~15, 18~19)

2.3 SummaryThese treatments are of various kinds. One disorder has some

treatments, so we have to choose the way which is appropriate to the symptoms or disorders.

The treatments shown in Asperger’s syndrome are used for children with LD, children with autism and children with ADHD, so we should know the disorders well and choose the way which is suitable for each child.

We studied the treatment for elementary school students but there are treatments for children attending kindergarten and junior high school students. There is no great difference between the treatments for elementary school students and the treatments for children attending kindergarten and junior high school students. However, the treatment for junior high school students has different aims from the treatment for elementary school students, and the aims are the treatment which developed for junior high school students. In the next chapter I will compare Japanese treatment for children with speech disorders with the treatment of other countries, and think of better treatments for the children.

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Chapter 3：Discussion

3.1 Introduction Chapter One showed that there are many ways to treat speech disorders. One speech disorder has some kinds and they appear different symptoms. Chapter Two shows the treatments. They are different by kinds and symptoms. One speech disorder has some treatments, so people have to choose proper treatment for children with speech disorders. Also, people around children with speech disorders need to understand speech disorders, the children themselves, the ways to treat them and the most appropriate ways to communicate with them. There are often differences between countries so in this chapter. I will compare Japan with other countries to discover the differences of treatment.

3.2 American treatmentsThis section shows the available treatments of some American

speech disorder. Treatment depends on the cause, type, and severity of the symptoms. At the end of the section we will compare them the Japanese treatments.

3.2.1 Stuttering Most American treatment programs for people who stutter are "behavioral." They aim to teach the person specific skills or behaviors that lead to improved oral communication. For example, many SLPs (speech-language pathologists) teach people who stutter to control the speed at which they speak. Moreover, people will learn to start saying words in a slightly slower and less physically tense manner. They will also learn to control or check their breathing. When learning to control speech speed, people often begin by practicing smooth,

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fluent speech at speeds that are much slower than typical speech, using short phrases and sentences. Over time, people learn to produce smooth speech at faster speeds, in longer sentences, and in more challenging situations until speech sounds are both fluent and natural. "Follow-up" or "maintenance" sessions are often necessary after completion of formal intervention to prevent relapse.

3.2.2. DysphoniaAt present, there is no cure for spasmodic dysphonia. However,

several treatment options exist for voice improvement. Repeat injections of small doses of botulinum toxin (Botox) into one or both vocal cords are frequently recommended and performed by doctors. Botox weakens the laryngeal muscles and results in a smoother and less forceful voice because of less forceful closing of the vocal cords. Temporary difficulty of breathing or difficulty of swallowing sometimes occurs for a short time after injection.

3.2.3 Speech sound disorders ： Articulation and phonological processes SLPs (speech-language pathologists) provide treatment to improve the articulation of individual sounds or reduce errors in production of sound patterns.

Articulation treatment may involve demonstrating how to produce the sound correctly, learning to recognize which sounds are correct and incorrect, and practicing sounds in different words. Phonological process treatment may involve teaching the rules of speech to individuals to help them say words correctly.

3.2.4 Language-based learning disability (LLD) The goals of speech and language treatment for the child with a reading problem target the specific aspects of reading and writing

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that the student is missing. For example, if a younger student has difficulty distinguishing the different sounds that construct words, treatment will focus on activities that support growth in this skill area (rhyming, tapping out syllables, etc.). Individualized programs always relate to school work. Therefore, materials for treatment are taken from, or are directly related to, content from classes (example; textbooks for reading activities, assigned papers for writing activities, practice of oral reports for English class). The student is taught to apply newly learned language strategies to classroom activities and assignments. The SLP (speech-language pathologist) may work side-by-side with the child in his/her classrooms to assist the child. Intervention with spoken language (speaking and listening) can also be designed to support the development of written language. For example, after listening to a story, the student may be asked to state and write answers to questions. He/she may be asked to give a verbal and then a written summary of the story.

Articulation (pronunciation) needs are also treated in a way that supports written language. For example, if the child is practicing saying words to improve pronunciation of a certain sound, he /she may be asked to read these words from a printed list. The SLP consults and collaborates with teachers to develop the use of strategies and techniques in the classroom. For example, the SLP may help the teacher modify how new material is presented in lessons to adapt to the child's comprehension needs. The SLP may also demonstrate what planning strategies the student uses to organize and focus on written assignments.

3.2.5 ADHD Specific speech and language patterns vary from child to child with ADHD. For example, some children with ADHD also have learning disabilities that affect their speech and language. Evaluation of each

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child's individual speech and language ability is critical to developing an appropriate treatment plan. Speech and language intervention for the person with ADHD is always individualized. Each person has different needs.1) A physician will work with the family and student to instruct

medication, if needed, to help with attention. If medication is instructed, the SLP will work with other educational professionals to observe the student's pre- and post-medication behavior. As part of the educational team, the SLP will communicate with the family and physician about any post-medication behavioral changes. Is the student drowsy? Is sustained attention better or worse? How long does it take for the medication to take effect? The physician will use these observations to adjust dosage, the time medications are administered, and which medication is used.

2) The SLP along with other team members, will work with the teacher to change the classroom environment as needed (example; sitting the student in the front of the classroom, having the student repeat directions before following them, using checklists and other visual organizers to help with planning and follow-through).

3) Speech-language treatment will focus on individualized language goals such as teaching better communication in specific social situations, and study skills (planning/organizing/attention to detail). Again, language goals will differ depending on the needs of the individual student.

3.2.6 Autism There is no known cure for autism. In some cases, medications and

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dietary restrictions may help control symptoms. Intervention should begin when the child is young. Early intervention and preschool programs are very important. An evaluation by an SLP should be completed to determine social skill and communication needs. An appropriate treatment plan that meets the needs of the child and family can then be established. Treatment may include any combination of traditional speech and language approaches, augmentative and alternative communication, and behavioral interventions. It is also important to have the child's hearing evaluated to rule out hearing loss.

3.3 Comparison with Japan Japanese treatment and American treatment are almost the same. For instance, both America and Japan show that the treatments of stuttering use the ways to remove their anxieties and to read smoothly such as reading all together, shadowing and masking. As a big difference, America says available treatments but Japan doesn’t say that. Of course, giving proper treatment to each child with speech disorders is important.

3.4 Answering the research questions The above comments suggest there are still some things we don’t know about. These are the research questions for this thesis as shown in Chapter One.

1. What treatments are available for speech disorders such as aphasia?

2. Which are the most effective?3. What do Japan and America have the differences of treatment

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of speech disorders?

1. The treatment of language development delay starts from enjoying listening and expressing themselves, and imitating sounds and words. Finally, the treatment connects to conversation. Using things that children are interested in is important. The treatment of infant aphasia includes asking easy “yes” and “no” questions and predicting what children want to say. When children can’t understand, teachers or speech clinicians use pictures and gestures. In the treatment of dysphonia, the environment around children is important. Teachers or speech clinicians have to make an environment which is easy for the children to speak. After that, children can do breathing training and breathing utterance training. The treatment of articulation disorders does the basic training such as exercises of mouth, ear training such as distinguishing single syllables, pronunciation training such as uttering voices as whisper and mastering training such as pronouncing in daily conversation. The treatment of stuttering centers round play with stuffed animals and glove puppets. The treatment of autism, ADHD, Asperger’s syndrome and LD have SST (social skill training) which have the sense of game and which use picture cards. They are different according to the symptoms.

2. Some scholars showed the main treatment but the way to treat them is different depending on the symptoms, so we can’t say which are the most effective. We have to change the treatment to suit the symptoms.

3. Both countries have some differences but they are small. For instance, both America and Japan treat speech sound disorders (articulation) by the movement function such as lips and tongue to

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improve, demonstrating how to produce the sound correctly and using practically the sound in conversation. Also, the treatment of stuttering, learning disabilities (Language-based learning disability) and ADHD are almost the same. However, in dysphonia and autism, treatments are a little different. In dysphonia, America recommends medication (Botox) but Japan recommended preparing the environment to make good relations and get them to be relaxed. In autism, America shows medication and dietary restrictions but Japan shows using both the guidance to express like sign language, letters and pictures and the treatment for articulation.

3.5 Conclusion Some speech disorders are difficult to notice, so adults around children with speech disorders have to know speech disorders, and take the children to the hospital which can treat them. There are some tests to take. For example, there are case-detection screening test (This test is to find a person with articulation problems. The person has to see a picture of daily things and say the name), predictive screening test (This test is to predict. When a person doesn’t treat abnormal articulation, it is the test to predict whether the person has a disorder or develop to a right articulation naturally), infants analytic development test (It can evaluate six fields such as a moving exercise, hands exercise, basic habit, personal relations, utterance and language understanding analytically) and so on. Needs for each child is different. Parents who have children with speech disorders have to consult with a medical institution and teachers, and they need to give the best treatment and education to the children.

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