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(c) Allyn & Bacon 2004Copyright © Allyn and Bacon 2004 Chapter Eleven Teaching Students with Communication Disorders This multimedia product and its contents are protected under copyright law. The following are prohibited by law: any public performance or display, including transmission of any image over a network; preparation of any derivative work, including the extraction, in whole or in part, of any images; any rental, lease, or lending of the program.
(c) Allyn & Bacon 2004Copyright © Allyn and Bacon 2004 Introduction Most of us take our ability to communicate for granted. When communication is impaired, absent, or qualitatively different, the simplest interactions become different or even impossible. Disorders in communication may result in social problems in school. Communication problems are often complex. There are many different types of communication disorders, involving both speech and language.
(c) Allyn & Bacon 2004Copyright © Allyn and Bacon 2004 Definitions of Communication & Language COMMUNICATION is the exchange of information and ideas. Communication involves encoding, transmitting, and decoding messages. It is an interactive process requiring at least two parties to play the roles of both sender and receiver. LANGUAGE is a system used by a group of people for giving meaning to sounds, words, gestures, and other symbols to enable communication with one another.
(c) Allyn & Bacon 2004Copyright © Allyn and Bacon 2004 Definition of Speech (Heward, 1995) Although it is not the only possible vehicle for expressing language (gestures, manual signing, patterns, and written symbols can also be used to convey ideas and intentions), speech is a most effective and efficient endeavor. Speech is one of the most complex and difficult human endeavors. SPEECH is the actual behavior of producing a language code by making appropriate vocal sound patterns.
(c) Allyn & Bacon 2004Copyright © Allyn and Bacon 2004 Important Language Considerations (American Speech-Language-Hearing Association, 1982) Effective use of language for communication requires a broad understanding of human interactions, including associated factors such as nonverbal cues, motivation, and sociocultural roles. Language learning and use are determined by the interaction of biological, cognitive, psychosocial, and environmental factors. Language is rule-governed behavior. Language evolves within specific historical, social, and cultural contexts.
(c) Allyn & Bacon 2004Copyright © Allyn and Bacon 2004 Normal and Disordered Communication According to Emerick and Haynes (1986), a communication difference is considered a disability when: the transmission or perception of messages is faulty. the person is placed at an economic disadvantage. the person is placed at a learning disadvantage. the person is placed at a social disadvantage. there is a negative impact upon the person’s emotional growth. the problem causes physical damage or endangers the health of the person.
(c) Allyn & Bacon 2004Copyright © Allyn and Bacon 2004 Types of Communication Disorders SPEECH DISORDERS LANGUAGE DISORDERS
(c) Allyn & Bacon 2004Copyright © Allyn and Bacon 2004 Speech Disorders SPEECH DISORDERS include impairments of: Voice Articulation Fluency
(c) Allyn & Bacon 2004Copyright © Allyn and Bacon 2004 Prevalence About 2% of the school-age population were classified as having speech or language impairments during the school year. Because many other students have other conditions as their primary disability but still receive speech-language services, the total number of students served by speech- language pathologists is about 5% of all school-age children (2/3s of these students are boys) Students with communication disorders constitute about 20% of all students with disabilities. Of the estimated one million students identified as speech- language impaired, over 90% are 6 to 12 years old.
(c) Allyn & Bacon 2004Copyright © Allyn and Bacon 2004 Identification, Assessment, and Eligibility Students with speech or language impairments are the most highly integrated of all students with disabilities. During the school year, 88.5% of students with communication disorders were served in general education classrooms, and 6.5% were served in resource rooms. The small proportion served in separate classes most likely represents students with severe language delays and disabilities.
(c) Allyn & Bacon 2004Copyright © Allyn and Bacon 2004 Types of Speech Disorders Articulatory & Phonological Disorders Voice Disorders Fluency Disorders
(c) Allyn & Bacon 2004Copyright © Allyn and Bacon 2004 Articulatory and Phonological Disorders Articulation and phonological disorders are the most common speech disorder affecting about 10% of preschool and school age children. The ability to articulate clearly and use the phonological code correctly is a function of many variables, including: Age Developmental History Oral-Motor Skills Culture
(c) Allyn & Bacon 2004Copyright © Allyn and Bacon 2004 Most Common Types of Articulation Efforts Distortions Substitutions Omissions Additions
(c) Allyn & Bacon 2004Copyright © Allyn and Bacon 2004 Organic & Functional Causes of Articulatory & Phonological Disorders FUNCTIONAL CAUSES: lack of opportunities to practice appropriate/ inappropriate speech transient hearing loss during early development absence of good speech models differences in speech related to culture (often do not constitute a speech disorder) ORGANIC CAUSES: Cleft palate Dental malformations Tumors Hearing loss Brain damage Other related neurological problems The severity of articulation disorders can vary widely, depending in part on the causes of the disorder.
(c) Allyn & Bacon 2004Copyright © Allyn and Bacon 2004 Teaching Suggestions Take note of how understandable or intelligible the student’s speech is. Consider how many different errors the student makes. Consider whether the errors could be due to physical problems. Evaluate whether the speech errors may have an impact of the student’s ability to read and write. Observe whether the articulation errors cause the student problems in socialization or adjustment.
(c) Allyn & Bacon 2004Copyright © Allyn and Bacon 2004 Voice Disorders Defined VOICE DISORDERS are abnormalities of speech related to volume, quality, or pitch. Voice disorders are not very common in children. It is difficult to distinguish an unpleasant voice from one that would be considered disordered. Two basic types of voice disorders: Phonation - production of sounds by the vocal folds EXAMPLE: Hoarseness Resonance - hypernasality or hyponasality
(c) Allyn & Bacon 2004Copyright © Allyn and Bacon 2004 Causes of Voice Disorders Vocal Abuse and Misuse Trauma to the Larynx, Nodules, or Tumors Learned Speech Patterns Medical Conditions or Trauma Reye’s syndrome Juvenile arthritis Psychiatric problems Tourette syndrome When voice disorders are related to a medical condition, the child may be referred to an otolaryngologist (ear, nose, and throat doctor). Most voice disorders are due to functional problems, resulting from learned speech patterns.
(c) Allyn & Bacon 2004Copyright © Allyn and Bacon 2004 Questions to Ask Before Referring a Student for a Possible Voice Disorder Might the voice quality be related to a hearing loss? Is there a possibility that the voice disorder is related to another medical condition? Has there been a recent, noticeable change in the student’s vocal quality? Does the student habitually abuse or misuse his voice? Does the student’s voice problem make him difficult for others to understand? Is the student’s voice having such an unpleasant effect on others that the student is teased or excluded from activities?
(c) Allyn & Bacon 2004Copyright © Allyn and Bacon 2004 Fluency Disorders Defined FLUENCY refers to the pattern of the rate and flow of a person’s speech. Normal speech patterns include some interruptions in speech flow. When the interruptions in speech flow are so frequent or pervasive that a speaker cannot be understood, when efforts at speech are so intense that they are uncomfortable, or when they draw undue attention, then the dysfluencies are considered a problem. Many young children exhibit dysfluencies; these typically disappear by age 5.
(c) Allyn & Bacon 2004Copyright © Allyn and Bacon 2004 Fluency Disorders Fluency problems consist of blocking, repeating, or prolonging sounds, syllables, words, or phrases. The most frequent type of fluency disorder is stuttering, which affects about 2% of the school-age children. More boys than girls are affected.
(c) Allyn & Bacon 2004Copyright © Allyn and Bacon 2004 Stuttering In stuttering, interruptions in speech are frequently obvious to both the speaker and the listener. Stuttering has received much attention, even though it is not as prevalent as other communication disorders.
(c) Allyn & Bacon 2004Copyright © Allyn and Bacon 2004 Causes of Stuttering There are many causes of stuttering. There is growing evidence supporting a genetic and physiologic basic of stuttering.
(c) Allyn & Bacon 2004Copyright © Allyn and Bacon 2004 Is the student concerned about his dysfluencies? Is there a pattern to situations in which the student stutters? Is the student experiencing social problems? Are the dysfluencies beginning to occur more often in the student’s speech or beginning to sound more effortful or strained? When Fluency Disorders are Considered a Serious Problem
(c) Allyn & Bacon 2004Copyright © Allyn and Bacon 2004 Classroom Accommodations for Students with Speech Disorders Build a Positive Classroom Climate Help Students Learn to Monitor Their Own Speech Pair Students for Practice Teach Students Affirmations and Positive Self-Talk Modify Instruction and Materials Encourage Parents to Work with Their Children Teach Students Their Own Strategies
(c) Allyn & Bacon 2004Copyright © Allyn and Bacon 2004 Build a Positive Classroom Climate Reward the student.Accept the child. Be a good listener.Be positive. Don’t interrupt or finish the student’s sentence for him or her. Encourage the student. Educate other students in the class about speech disorders, when appropriate. Don’t refer to students in terms of their behaviors (“students” not “stutters” Maintain eye contact when the student speaks. Work closely with the speech-language pathologist. Provide lots of opportunities for student to participate in oral activities. Encourage the student’s family to actively support the educational and communication program. Give student chances to model and practice appropriate speech. Talk with the student privately about his speech problems.
(c) Allyn & Bacon 2004Copyright © Allyn and Bacon 2004 Pair Students for Practice To master speech skills, students will need to practice the skills taught by the speech-language pathologist (S/LP). Students can practice specific sounds using practice exercises with a partner using a program such as Loehr’s Read the Picture Stories for Articulation (Loehr, 2002).
(c) Allyn & Bacon 2004Copyright © Allyn and Bacon 2004 Teach Students Affirmations and Positive Self-Talk Low self-confidence and a positive attitude are important for students with speech disorders, especially stuttering. Negative self-talk is common among individuals with speech disorders. The goal of positive self-talk is to replace negative thought patterns. Encourage students to mentally erase negative ideas and immediately think of something positive.
(c) Allyn & Bacon 2004Copyright © Allyn and Bacon 2004 Modify Instruction and Materials Suggestions from Pre-Referral Intervention Manual (McCarney & Wunderlich, 1988): Set up a system of motivators to encourage student’s effort. Highlight material to identify key syllables and words in a passage. Give student practice listening so that they can learn to discriminate among sounds, fluent speech patterns, and good vocal habits. Tape the student’s reading so that he/she can evaluate self related to communication goals. Reduce the emphasis on competition.
(c) Allyn & Bacon 2004Copyright © Allyn and Bacon 2004 Encourage Parents to Work with Their Children There are many ways to structure practice activities so that students can work at home with their parents. One program is the book. Oral-Motor Activities for School-Aged Children. This program is a series of homework activities designed to build speech skills.
(c) Allyn & Bacon 2004Copyright © Allyn and Bacon 2004 Teach Students Their Own Strategies Help student come up with strategies for dealing with specific people or situations that make them nervous. Teach student to self- reinforce by recognizing when they are doing well. Allow student to record his/her own speech and listen carefully for errors. Encourage student to participate in groups in which responses do not have to be individually generated. Let student practice skills with a friend in real situations. Teach student to relax with breathing exercises or mental energy.
(c) Allyn & Bacon 2004Copyright © Allyn and Bacon 2004 Language Disorders LANGUAGE is the system we use to communicate our thoughts and ideas to other. Language is an integral component of students’ abilities in reading, writing, and listening. Disorders of language may have a serious impact on academic performance. In recent years, the emphasis in the field of communication disorders has shifted away from the remediation of speech problems to an increased focus on language disorders. Approximately 50% to 80% of children seen by speech- language pathologists have language disorders.
(c) Allyn & Bacon 2004Copyright © Allyn and Bacon 2004 There are two modes of communication: Receptive Language - involves receiving and and decoding and interpreting language EXAMPLE: reading and listening Expressive Language - involves encoding or production of a message EXAMPLE: writing and speaking There is a sequence of normal language development. Language Disorders
(c) Allyn & Bacon 2004Copyright © Allyn and Bacon 2004 Three Dimensions of Language FORM describes the rule systems used in oral language. CONTENT refers to the intent and meaning of language and its rule system. Semantics deals with the meaning of words and word combinations. FUNCTION refers to the use of language in social contexts. Pragmatics are the rules of social language.
(c) Allyn & Bacon 2004Copyright © Allyn and Bacon 2004 Language Form Involves three different rule systems: Phonology - rule system that governs the individual and combined sounds of a language (e.g., vowel sounds) Morphology - rule system controlling the structure of words (e.g., prefixes and suffixes) Syntax - rule system that governs the ordering of words (e.g., verb tense, questions)
(c) Allyn & Bacon 2004Copyright © Allyn and Bacon 2004 Content Of Language Semantics - deals with the meaning of words and word combinations. When students fail to comprehend concrete and abstract meanings of words, inferences, or figurative expressions, it is difficult for them to understand the more subtle uses of language such as jokes, puns, similes, proverbs, or sarcasm.
(c) Allyn & Bacon 2004Copyright © Allyn and Bacon 2004 Function Of Language Pragmatics - language that is used in various social contexts. If children are to build and maintain successful relationships with others, they need to understand and effectively use language skills that are appropriate to the context. Students from different cultural backgrounds may be particularly challenged in this area.
(c) Allyn & Bacon 2004Copyright © Allyn and Bacon 2004 Types of Language Disorders Absence of Verbal Language Qualitatively Different Language Delayed Language Development Interrupted Language Development
(c) Allyn & Bacon 2004Copyright © Allyn and Bacon 2004 Indicators of Language Impairment PRIMARY GRADES Problems in Following Verbal Directions Difficulty with Preacademic Skills Phonics Problems Poor Word Attack Skills Difficulties with Structural Analysis Problems Learning New Material INTERMEDIATE GRADES Word Substitutions Inadequate Language Processing and Production that Affects Reading Comprehension and Academic Achievement MIDDLE AND HIGH SCHOOL GRADES Inability to Understand Abstract Concepts Problems Understanding Multiple Word Meanings Difficulties Connecting Previously Learned Information to New Material that Must Be Learned Independently Widening Gap in Achievement When Compared to Peers
(c) Allyn & Bacon 2004Copyright © Allyn and Bacon 2004 Classroom Adaptations for Students with Language Disorders Teach Some Prerequisite Imitation Skills Increase Comprehension in the Classroom Give Students Opportunities for Facilitative Play Encourage Students to Talk with Their Teachers and Peers Use Naturalistic Techniques and Simulated Real-Life Activities to Increase Language Use Encourage Students’ Conversational Skills Through Story Telling
(c) Allyn & Bacon 2004Copyright © Allyn and Bacon 2004 Classroom Adaptations for Students with Language Disorders Use Music and Play Games to Improve Language Arrange Your Classroom for Effective Interactions Use Challenging Games with Older Students Modify Strategies to Develop Students’ Learning Tools Work Collaboratively with the Speech-Language Pathologist Use Storytelling and Process Writing
(c) Allyn & Bacon 2004Copyright © Allyn and Bacon 2004 Children’s patterns of speech and language reflect their culture and may be different from that of some of their peers. It is important not to mistake a language difference for a language disorder. Cultural variations in family structure, childrearing practices, family perceptions and attitudes, and communication style can each influence students’ communication. Language Differences
(c) Allyn & Bacon 2004Copyright © Allyn and Bacon 2004 Relationship Between Communication Style and Culture Culture has a strong influence on the style of communication. Communication style can be affected by factors such as: Gender Age Status Communication differences in style can be manifested through nonverbal means such as: Gestures Facial expressions Physical space Use of silence
(c) Allyn & Bacon 2004Copyright © Allyn and Bacon 2004 Multicultural Considerations in Assessment Observation is an important form of assessment, particularly when students are linguistically diverse. Considerations for assessment personnel who work with students having cultural and linguistic differences include: Selection of tests that have valid items Using procedural modifications (e.g., lengthening time limit) Assess whether the linguistically or diverse child has had access to the information Consider scoring the test in two ways, first as the manual indicates, then allowing credit for items considered correct in the child’s language system. Focus on what the child does well rather than what he or she cannot do.
(c) Allyn & Bacon 2004Copyright © Allyn and Bacon 2004 Augmentative and Alternative Communication (AAC) AUGMENTATIVE COMMUNICATION denotes techniques that supplement or enhance communication by complementing whatever vocal skills the individual already has. ALTERNATIVE COMMUNICATION are techniques used by individuals who must employ techniques that serve in place of speech. AAC is a multimodal system consisting of four components: symbols aids techniques strategies
(c) Allyn & Bacon 2004Copyright © Allyn and Bacon 2004 Aided and Unaided Communication Techniques AIDED communication techniques require a physical object or device to enable the individual to communicate (e.g., charts, communication boards). UNAIDED communication techniques do not require any physical object or device to enable the individual to communicate (e.g., speech, manual signs or gestures, facial communication).
(c) Allyn & Bacon 2004Copyright © Allyn and Bacon 2004 Examples of Communication Aids Non-Electronic Aids Communication Boards Charts, Frames or Books Electronic Aids Voice Output Communication Aids
(c) Allyn & Bacon 2004Copyright © Allyn and Bacon 2004 Facilitated Communication Facilitated communication is a process involving having someone (a facilitator) support the arm or wrist of the student with autism, who then points to letters on a keyboard. The keyboard is often connected to a computer so that the student’s words can be displayed or printed. Efficacy research on facilitated communication has yielded mixed results.
(c) Allyn & Bacon 2004Copyright © Allyn and Bacon 2004 Promoting Inclusive Practices for Students with Communication Disorders In years past, pullout models were used for students requiring speech-language services. Today, the trend is toward the provision of speech-language services in the general education classroom. Collaboration between classroom teachers and speech-language pathologists is essential.
(c) Allyn & Bacon 2004Copyright © Allyn and Bacon 2004 Future Trends In addition to providing services in the more traditional area of oral communication skills, speech-language pathologies now are called upon to have expertise in areas such as: Addressing swallowing disorders Medicaid billing Selecting AAC systems Providing interventions for children with TBI Promoting and enhancing literacy skills
(c) Allyn & Bacon 2004Copyright © Allyn and Bacon 2004 Future Trends There is an increasing demand for services, especially in the area of language disorders. The traditional “pull-out” model will still be offered, but the trend is toward a more collaborative and consultative framework. To address personnel shortages, alternate methods might include: Employment of SLP assistants Flexible scheduling Cross-disciplinary service provision Increased use of natural supports
(c) Allyn & Bacon 2004Copyright © Allyn and Bacon 2004 Future Trends Another area of change is the expected continuation of technological advances. This means that students with severe communication disorders will have increased opportunities to participate in ways that seemed impossible several years ago. Distance learning and telehealth services will become more commonplace.
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