1. Causation in Child Language Disorders DES 320

2. Syndrome “the presence of multiple anolalies in the same individual with all of thoses anomalies having a signle cause” (Sprintzen, 1997) Examples: facial features, structural abnormalities, hearing/speech problems

3. Etiologies of language disorders Impoverished language input Hearing impairments Deprivation Conditions where neural development is affected Syndromes Congenital syndromes –Chromosomal abnormalities –Genetic syndromes –Teratorgenic: in utero diseases and toxins Diseases and toxins after birth Acquired aphasia in childhood Unknown causes (presumably neural development is afffected)

4. Impoverished language input…Hearing Impairment Middle Ear: transmission of sound from the auditory canal into middle ear (conductive hearing loss) Inner Ear: transmission of sound into neuronal firing (sensorineural hearing loss)

5. Spoken language development in hearing losses depends on: Degree of hearing loss (profound, severe, moderate, mild) Unilateral or bilateral Age of onset Audiometric slope of the loss (for ex. High frequency vs. low frequency affects perception of different phonemes) Age of identification Amplification (functional or not) Amount and type of habilitation (ASL, auditory- oral, total communication) Educational environment Family support or lack thereof…

6. Otitis Media: impact on language development Does fluctuating conductive hearing loss due to otitis media effusion (OME) cause language disorders? Possible phonological disorders…1/3 of kids receiving Speech or language intervention have a hx of OME Pontentially problems in other areas of langauge…evidence is contradictory… OME usually associated with phonological impairment OME may be a risk factor that must occur with something else in order to cause a language disorder

7. Impoverished Language Input…Language Deprivation Neglect Hard to show causality because these are often children with multiple problems Physical abuse, emotional abuse, sexual abuse, parental alcohol & drug abuse Disabilities Language gains depend on age of child

8. Nervous System The rest of the causes we will discuss affect development of the nervous system…often times in ways in which we don’t understand More plasticity & less cerebral localization in children Effects on language seen in focal damage in adults not seen in children Damage limited to left hemisphere Broca’s or Wernicke’s areas doesn’t explain language problems in developmental disorders

9. Syndromes involving genes… Chromosomal abnormalities Addition or deletion of whole chromosomes Addition or deletion of parts of chromosomes Restructuring or rearranged chromosomes Genetic syndromes Run in families Affected gene(s) may or may not be discovered yet (ex. Chromosome 19 in my family)

10. Chromosomal abnormalities Run in family or randomn genetic mutation Disorders: Hearing loss Autosomal chromosomes (1-22) Disorders: Down syndrome, Cri du chat, Williams Syndrome Sex chromosomes: #46 Female – XX & Male – XY: a parent can be normal, a carrier or affected…the combination of sex chromosomes that the parents pass onto a child impact whether the child is normal, a carrier or affected…. Disorders: Fragile X, Kleinfelter syndrome, Turner Syndrome

11. In utero origins of syndromes Maternal diseases Rubella, Cytomegal Virus (CMV), Herpes simplex, Syphilis, Toxoplasmosis Toxins X-radiation, smoking, cocaine & other illegal drugs Legal drugs (prescriptions, etc.) Fetal alcohol syndrome Mental retardation, small size, cleft palate, abnormalities of face and ear

12. During or after birth origins of syndromes Complications during birth…premature birth Intraventricular hemorrhage Respiratory disorders: anoxia – oxygen deprivation to the brain Infections & toxins measles, mumps Meningitis Lead (in paint in older houses, older toys)

13. Acquired Aphasia in childhood Head injury Brain tumors Rare instances of stroke Recovery The site of damage is less influential than in adults The extent of damage is more important

14. Case When I met Emma, she was 5 years old and living in a foster home. She (along with her older brother) had lived with biological mom for the first four yrs. Of her life. In Emma’s past was evidence of a head injury due to physical violence, maternal alcohol abuse and being locked in her room for extended periods of time. Emma’s main difficulty in the area of language was lexical and phonological processes. She was substituting and deleting sounds. She also had small vocabulary and word finding difficulties. When she learned new words, she had difficulty retaining them over time. What was the cause or etiology of Emma’s phonological and lexical difficulties? Why is causality a slippery slope in language disorders?

15. Disorders with unknown etiologies Presumably disorders of central nervous system development Landau-kleffner syndrome Autism SLI Dyslexia

16. Thought Question… What do we know about causation in language disorders? Think about today’s lecture notes and also our previous discussion about the relationship between cognition and language development… What do we not know?

17. Thought Question… If language disorders are impacted by genetic and/or neurological factors, how much of an impact do you think environmental influences have on the prognosis for remediation? What can we do as SLPs to prevent language disorders or lessen their severity?