PEDIATRIC COMMUNICATION DISORDERS PRE-K - 12

TYPES OF COMMUNICATION DISORDERS Primary Secondary - Associated with autism, Intellectual disabilities, hearing loss etc. Acquired – Pediatric Brain Injury, Meningitis, encephalitis

PRIMARY COMMUNICATION DISORDERS Language SLI Speech Sound Disorders Articulation Phonological Childhood apraxia of speech *

SECONDARY AND ACQUIRED COMMUNICATION DISORDERS Autism Social Communication Disorder Intellectual Disabilities Pediatric Brain Injury

DIFFERENCES NOT DISORDERS Dialect  Regional  AAEV Language Interference in English Language Learners  Phonology  Grammar or Syntax Code Switching

COMMON LANGUAGE DISORDERS

LANGUAGE DISORDERS About 15% of toddlers are Late Talkers About 7-10% of school age children manifest SLI Many will continue to have some language difficulty throughout life. [but can succeed with accommodations] May be reclassified as Language Learning Disorder as they get older Can manifest in semantics, phonology, morphology, syntax and pragmatics [any or all] Vary in severity

SEMANTIC PROBLEMS First words late to develop Vocabulary may be limited Take longer to learn new words [curriculum words too] Trouble with abstract words (remain literal longer)- Can affect academic achievement [“pioneers pushed westward” Word finding difficulty (like anomia)

SEMANTIC (CONT.) Trouble with words with multiple meanings [affects humor too] Run Can affect reading (oral and comprehension) Homographs - invalid/invalid; conduct/conduct Homophones – read/reed; read/red; record/record

MORPHOLOGY ERRORS Grammatical endings on nouns and verbs Most of these are developed by 5 or 6 Past –ed Verb “to be” Plural “s” Be + verb + -ing(I’m going, He’s dancing) Common to overgeneralize (I goed, He ated, I heared)

SYNTACTIC ERRORS Trouble forming correct question form Trouble acquiring correct negative form Trouble learning a variety of conjunctions to expand length Remember there is a developmental pattern

PRAGMATIC PROBLEMS Learning to use language for a variety of reasons called “intents”[ starts out before language with gesture and vocalizations] Request actions and objects Comment on objects and actions Inform Protest Deny

PRAGMATIC PROBLEMS (CONT.) Trouble having a conversation -taking turns -maintaining topic -later, able to change topic smoothly - later learning not to interrupt Trouble producing narratives

WHAT ARE NARRATIVES? Recount Account Procedural Event Casts Stories Expository

CHILD NEEDS TO: Take the listener’s perspective Organize in a logical manner Link ideas using conjunctions Include essential information Pronoun referents must be clear

LANGUAGE DISORDER CHANGES WITH AGE 2 years old check-up: fewer than 35 words and/or no two word combinations : refer for evaluation 4 years old: may have lingering semantic and phonological problems May have problems with phonological awareness: rhymes, identifying words with first sound, connecting sound to letter[Virginia PALS]

CHANGES WITH AGE: RELATED TO READING [VA PALS] Phonological Awareness: Preschool: Identifying rhymes words that start with the same sound count words or syllables Kindergarten Name printed letters Say sound letter makes Older students Count number of sounds in a word Elision tasks

LATER PA 6-7 year olds: difficulty learning to decode (read) More advanced phonological awareness Letter-sound, phonics, spelling Virginia PALS includes these too Older Children reading comprehension problems. Generally related to oral language comprehension Not just reading or memory

SPEECH SOUND DISORDERS

Articulation: continue with common sound substitutions that are normal in typically developing children: f/th, p/f, t/k, w/r Sounds develop at different ages [most develop all sounds by 6 or 7] Parents and those close to child understand more easily than others

WHAT IS EXPECTED? Age when most can understand the child (may still make errors) 1;0 25% 2;0 50% 3;0 75% 4;0 100%

PHONOLOGICAL DISORDERS Patterns rather than straight substitutions or distortions Toddlers and preschool may drop final sound boo/book or boot May show patterns of sound errors – substituting front sounds for back sounds [ t/k, or d/g] or back sounds for front sounds [ g/d, ] or stops for continuants [t/s, p/f ] Drop unstressed syllables e.g. ‘puter/computer

CHILDHOOD APRAXIA OF SPEECH-SLP “ Childhood apraxia of speech is a neurological childhood (pediatric) speech sound disorder in which the precision and consistency of movements underlying speech are impaired in the absence of neuromuscular deficits (abnormal reflexes, abnormal tone), CAS may occur as a result of known neurological impairment, in association with complex neurobehavioral disorders of known or unknown origin, or as an idiopathic neurogenic speech sound disorder. The core impairment in planning and/or programing spatiotemporal parameters of movement sequences results in errors in speech sound production and prosody”. ASHA

CHILDHOOD APRAXIA OF SPEECH - PUBLIC “Childhood apraxia of speech (CAS) is a motor speech disorder. Children with CAS have problems saying sounds, syllables and words. This is not because of muscle weakness or paralysis. The brain has problems (e.g. lips, jaw, tongue) needed for speech. The child knows what he or she wants to say, but his/her brain has difficulty coordinating the muscle movements necessary to say those words.” ASHA

CHILDHOOD APRAXIA OF SPEECH Recent dramatic increase in diagnosis Currently no behaviorally defined diagnostic criteria to distinguish it from severe speech sound disorders Even diagnosed in preverbal or nonverbal very young children May be associated with oral apraxia, verbal apraxia or limb apraxia Require more intense therapy

INCREASE IN DIAGNOSIS DUE TO: Increased Awareness Emphasis on Early Intervention Insurance Coverage: Medical vs. Developmental

SOME EXAMPLES Lily:oral apraxia Joey:verbal apraxia Ben: possible verbal

WHAT WE MAY SEE Inconsistent errors even on repeated attempts of the same word Groping behaviors Automatic production of words may be better than volitional

WHAT WE KNOW Requires more frequent and intensive treatment Takes longer to remediate Often have language impairment as well

QUESTIONS?