Causes: Language Disorders Developmental and Intellectual Disabilities Autism Traumatic Brain Injury Child Abuse and Neglect Hearing Loss Structural Abnormalities of the Speech Mechanism Aphasia Genetics Environmental Influences

Identification and Assessment Screening and Teacher Observation Evaluation components Case history and physical examination Articulation Hearing Phonological awareness and processing Vocabulary and overall language development Assessment of language function Language samples Observation in natural settings

Assessment of Children Who Are Culturally Diverse Assess language proficiency in both the first and second languages when determining a culturally and linguistically different child’s communication competence. Do not diagnose with a speech-language disorder if problems are observed only in English and not in their first language (or dialect). Include assessment of basic interpersonal communication skills and cognitive academic language proficiency. Assessment for the purpose of identifying children with disabilities are required, by IDEA, to be conducted in the child’s native language

Educational Approaches Articulation and phonological errors: Discrimination and production activities Fluency disorders: Behavioral principles and self-monitoring Voice disorders: Medical Examination and Direct vocal rehabilitation Language disorders: Vocabulary building, naturalistic interventions

Augmentative and Alternative Communication (ACC) ACC refers to a diverse set of strategies and methods to assist individuals who cannot meet their communication needs through speech or writing. ACC entails three aided or unaided components A representational symbol set or vocabulary A means for selecting the symbols A means for transmitting the symbols Symbol sets and symbol systems for ACC Selecting the symbols Transmitting the symbols

Placement Options In 2011 to 2012, 87% of children with speech or language impairments were served in the general education classroom, 6% in resource rooms, and 4% in separate classrooms. Some examples of service delivery models: Monitoring Pullout Collaborative Consultation Classroom or Curriculum Based Separate Classroom Community Based Combination

Autism Spectrum Disorder Autism is a developmental disability affecting verbal and nonverbal communication and social interaction, generally evident before age 3, that adversely affects a child’s educational performance. Other characteristics are engagement in repetitive activities and stereotyped movements, resistance to environmental change or change in daily routines, and unusual response to sensory experiences. Autism does not apply if the child has a serious emotional disturbance.

DSM Definition Subsumes all four related disorders into a single diagnostic category, autism spectrum disorder with the following characteristics: Persistent deficits in social communication and social interaction across context Restricted, repetitive patterns of behavior, interests, or activities

DSM Definition Symptoms must be present in early childhood Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning Symptoms are not explained by intellectual disability or developmental delay

Characteristics Impaired Social Relationships Extreme aloofness Social situation difficulties attributed to deficits in theory of mind Deficits in joint attention Communication and Language Deficits Some children with autism do not speak Echolalia is common among those who do talk Concrete or literal processing of verbal information is common

Characteristics Repetitive, Ritualistic, and Unusual Behavior Patterns Some children exhibit stereotypy which is a pattern of persistent and repetitive behaviors Insistence on Sameness Children with autism are inflexible with routines Unusual Responsiveness to Sensory Stimuli 70% to 80% of individuals with autism react atypically to sensory stimulation Over and underresponsiveness Hyposensitive and hypersensitive

Characteristics: Cognitive Functioning ASD occurs across the full range of intellectual abilities There are deficits in executive functioning About 10% to 15% exhibit “splinter skills” About 1 in 10 have savant syndrome Many exhibit overselectivity Theory called weak central coherence Obsessive attention on a specific object or content Some possess a strong aptitude for rote memory of certain things

Characteristics: Challenging Behavior Some students with autism exhibit property destruction, aggression toward others, and even self-injury Many experience a variety of sleep problems Some have extremely narrow food preferences Some engage in pica which is the compulsive, recurrent consumption of nonfood items

Characteristics: Asperger Syndrome Asperger syndrome is at the mild end of the ASD Asperger is no longer a separate category in DSM Impairment in the social areas Deficits in the use of nonverbal behaviors related to social interaction No general language delay Most have average or above-average intelligence Their peculiarities and social skills deficits make it difficult to develop and maintain friendships

Prevalence Autism occurs in as many as 1 in 68 children Rise in autism prevalence is an international phenomenon Autism is the fourth largest and fastest growing disability category in special education Boys are affected nearly 5 times more often than girls ASD appears in all racial, ethnic, and socioeconomic groups In the 2012 to 2013 school year, 498,000 students ages 3 to 21 years received special education services under the IDEA category of autism

Causes Autism is a neurodevelopmental disorder with no medical or physiological marker. In 85% of cases, the cause of autism is unknown There is a clear biological origin of autism in the form of abnormal prenatal and postnatal brain development, structure, or neurochemistry. Autism clearly has a genetic component. Combination of autism-related genes, exposure to certain environmental factors may lead to the development of autism in some children.

Identification and Assessment Early diagnosis is highly correlated with dramatically better outcomes Autism can be reliably diagnosed at 18 months of age Screening Tools Modified Checklist for Autism in Toddlers (M-CHAT) Social Communication Questionnaire (SCQ) Autism Spectrum Screening Questionnaire (ASSQ)

Identification and Assessment Diagnosis, for those who fail screening tests or whose parents or caregivers have reasons for concern undergo a complete diagnostic evaluation. Diagnostic Tools Childhood Autism Rating Scale (CARS-2) Autism Diagnostic Interview-Revised (ADI-R) Autism Diagnostic Observation Schedule (ADOS) Asperger Syndrome Diagnostic Scale (ASDS)

Educational Approaches Children with autism are among the most difficult students to teach Early Intensive Behavioral Intervention The work of Ivar Lovass Applied Behavior Analysis (ABA) Discrete Trial Training Visual Supports Visual Activity Schedule Social Stories

Social Stories Written at the student’s level of comprehension and usually contain four basic types of sentences written from the perspective of the student. Descriptive Sentences Perspective Sentences Directive Sentences Affirmative Sentences Constructed with one sentence per page and with photographs or line drawings depicting key information sometimes added. Not considered an evidence-based practice

Unproven Treatment An Example Facilitated Communication is a process by which a communication partner, called a facilitator, provides physical support to assist an individual who cannot speak or whose speech is limited to type on a keyboard or point at pictures, words, or other symbols on a communication board. There is no rigorous scientific evidence to support claims of success in the use of this intervention.

Unproven Treatment Parents and teachers are easy targets for interventions that promise cures. Concerning a particular practice, teachers should collect direct and frequent measures of student learning to evaluate effects on students.

Placement Options Students with autism are increasingly placed in general education classrooms for the purpose of improved social integration During the 2012 to 2013 school year: approximately 40% of students with autism were educated in the general education classrooms 18% served in resource room programs 33% in separate classes About 9% of students with autism attended special schools or residential facilities

General Education Classroom Success in the general education classroom for a student with ASD depends on the child’s ability to reliably do the following: Display near-zero levels of problem behavior Participate and learn in group lessons Complete assigned tasks independently Interact with peers appropriately Comply with classroom rules/follow the teacher’s directions Get the teacher’s attention/assistance appropriately

Resource and Special Classrooms The general education classroom is not the least restrictive environment for all students with ASD. Instruction in the resource room or special class typically features High frequency of instructional time per minute; careful specification of and planning for transferring the control of students’ responses from teacher- contrived antecedent and consequent stimuli to naturally occurring events; specific strategies for promoting generalization of newly learned skills to the regular classroom, the community, and the home; continuous recording of data on performance of targeted skills; and the daily review of data for decision making