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Navigating Speech and Language
Through Preschool Years
Delay vs. Disorder?
OBJECTIVES
Participants will be able to:
• Identify hallmarks of normal speech and
language development
• Define speech/language delay versus disorder
• Identify characteristics that differentiate
Autism vs. Language Disorder
• Connect speech and language development to
literacy
FOUNDATIONS
COMMUNICATION
COMMUNICATION
VERBAL NONVERBAL
Linguistic Paralinguistic Nonlinguistic
6 BASES OF COMMUNICATIVE
DEVELOPMENT
1. Neurological- development of structures and
landmarks in the brain used for processing language
2. Cognitive-mental activities involved in comprehension
of received information; development of symbolism
3. Perceptual-use of sensory information and previous
experience to make sense of new sensory information
4. Motor-muscle movement and associated neuro-
feedback
5. Social –interactive processes that drive learning
6. Communicative- development of communicative
intentions evident through goal directed behavior
NEUROLOGICAL FOUNDATIONS
Brain weight is associated with neural
development
Early sensation and perception provide the
input to increase the number and
complexities of neural connections
Brain weight is tripled by 2 years of age
EARLY EXPERIENCES ARE CRITICAL!
Physiological change serves in the
development of speech and language
COGNITIVE FOUNDATIONS
• Sensation • perception
Cognitive Cognitive
development development
Cognitive Cognitive
development development
• cognition • Motor
control
Cognitive growth sets the pace for linguistic growth.
MOTOR FOUNDATIONS
•Stability develops in an upward progression, motor control develops in a downward
progression.
•Motor sequences in the body will be mirrored in the mouth.
SOCIAL AND COMMUNICATIVE
FOUNDATIONS
Used to expand an individuals understanding of
entities and relationships
Language is used as a social tool, motivated by
improving communication and social connections
Symbolic communication is developed by
associating real things to cognitive
representations.
IF YOU ARE TREATED AS A COMMUNICATOR, YOU
BECOME A COMMUNICATOR!
EARLY DEVELOPMENTAL TRENDS
• Typical development happens without our
efforts to make it progress
• Motor skills development allows for
freedom of movement
• Freedom of movement allows for
exploration
• Exploration, in turn, drives development
• Changes in development lead to cognitive
and psychosocial development
EXPERIENCE DRIVES DEVELOPMENT
• Experience and interaction help organize the
brain and mind for cognitive growth.
• Based on commonly accepted learning theories,
we know cognitive growth sets the pace for
linguistic growth.
• Parallel development between cognition and
language. Play is a vehicle for learning. Language
and play are interdependent. Play sequences
should be mirrored in a child’s language.
STEPS IN LINGUISTIC PROCESSING
4 steps in linguistic processing:
1. Attention- awareness to a learning situation
2. Discrimination-identification of relevant
characteristics of different inputs
3. Organization- chunking related bits of
information
4. Memory-recall of previously learned
information (rehearsal is required for long
term storage)
LANGUAGE
Language is an accepted system of arbitrary
codes and signals/symbols used to
communicate ideas.
Used as a tool
Has specific rules
Productive and creative
COMPONENTS OF LANGUAGE
Form Content Use
Sounds
Combined Vocabulary Attitude
sounds Word choice Emotion
Word order
Txt msgng…………………. OMG! …………………. :-P
SPEECH
Expression of language with sounds
Humans understand speech by~ 7 months of
age
Humans use speech productively (goal
directed behavior) by ~ 12 months of age
Overlaid onto a biological system that has its
roots in a primary survival function (feeding).
THE SPEECH CHAIN
1. Speaker formulates a
message
2. Motor nerves send impulses
to lungs larynx and
articulators
3. Sound waves are
transmitted to listener’s ear
(enter feedback link)
4. Listener’s ear transforms
message
5. Listener’s brain decodes
message
SPEECH SOUND DEVELOPMENT
Sound classes, in order of emergence, based on
*norms:
vegetative sounds, cooing, vowels, babbling
Earliest sounds: /p, b, m, n, h, w/
Followed by: /k, ɡ, d, t, ŋ, f, /
Then:/j, r, l/
Finally: /s, ʃ , ʧ , z , v, Ө, ʤ/
*hypothetical children do not exist. A wide range of
variability can be seen up to 36 months of age.
WHAT IS NORMAL SPEECH AND
LANGUAGE?
Development in feeding, speech, language,
voice and fluency that follows predictable
developmental stages at expected age ranges
Goal directed- used to “get things done”
Symbolic
Social and interactive
Progression is based on refinement of sensori-
motor and cognitive skills laid down in the first
24 months.
COMMUNICATIVE TIMELINE:
0-6 months
6 months
Birth Mutual gaze, play routines
sensory and motor Co-action patterns, and
perception drives learning. “proto-conversations”
Oral reflexes, vegetative Pleasure sounds,
sounds reduplicated babbling,
vocal play
3 months
Parent infers communicative
intent
Vocalizations through
reflexive crying, hunger,
tension and pain.
Oral reflexes have
disappeared
Circular reactions
COMMUNICATIVE TIMELINE:
7 -12 months
7-9 months
• ↑ᵈ goal directed behavior 12 months
• “Early intentional ↑ᵈ cognitive growth
communication”
• Functional gesture and Shift from pre-symbolic to
vocalization symbolic communication
• more frequent and effective First TRUE words appear
exchanges early phonological productions
and simplification processes
9-12 months
↑ᵈ information processing and
storage
Joint reference, joint action, turn-
taking
Non-reduplicated (canonical)
babbling, jargon and proto-words
COMMUNICATIVE TIMELINE:
Form
TODDLER ADVANCEMENTS
• SOUNDS-predictable Use
patterns and Ø presupposition
processing
/p,b,t,d,k,g,h,m,w,n/ →Making demands
• SOUND
COMBINATIONS-one →Expressing
word relationships wishes/displeasure
• 50% intelligible to
unfamiliar listener →Attitudes/states
Content Developments
WORD CHOICE •They rely on emphasis
- Two broad categories of •Use what they know to
words: agents and objects help them figure out what
they don’t
- Nouns and proper names
predominate •Appearance of plurals,
action verb endings,
- Vocab. growth spurt 18-24 prepositions, attributes
months (150-300 words by •Toddler “word recipes” for
24 months) making 2-4 word
combinations
TODDLER’S RULES
Author: Unknown
1. If I want it, it's mine
2. If it's in my hand, it's mine
3. If I can take it away from
you, it's mine
4. If I had it a little while ago, it's mine
5. If it's mine, it must never appear
to be yours in any way
6. If we are building something together,
all the pieces are mine
7. If it just looks like mine, it's mine
8. If I think it's mine, it's mine
9. If I give it to you and change
my mind later, it's mine
10. Once it's mine it will never belong
to anyone else, no matter what
PRESCHOOL ADVANCEMENTS
Form Use-situation
SOUNDS-↑ᵈ consonant dependent!
development, processes
dropped or dissolving by age 4 Early presupposition
SOUND COMBINATIONS- Participation in
syntactic agreements made to
sentence elements and word organized discourse
order
Limited conversational
WORD ORDER- basic forms of
English (s-v-o) and
repair and topic
modifications to this pattern maintenance
Content Developments-
Moves from
WORD CHOICE modification of
↑ᵈ concept sentence elements to
manipulation of word
development ordering, use of
↑ᵈverb forms conjoining and
embedding, and verb
↑ᵈ pronouns phrase development
PRE-LITERACY FACTS
Children between ages 2-3 years should be able to
tell about plans, use scripts and descriptions to
describe routines.
At around 4 years of age children add physical and
mental states to their descriptions.
Emergent reading phases precede reading, and at
around 4 years of age children begin to recognize
and identify environmental print, and know the
direction of reading.
Narratives have roots in early social language skills.
EARLY SCHOOL AGE ADVANCEMENTS
Form-
SOUNDS-by age 8 all sounds Use-
competently produced ↑ᵈresources available to
COMBINED SOUNDS/WORDS- adapt language and adjust to
↑ᵈ noun and verb phrase needs of listener
development, ↑ᵈ markings of Presupposition/alternation
comparisons, action, and
reversals (addition of prefixes Topic introduction and closure
and suffixes) Conversational repair with ↑ᵈ
↑ᵈ conjoining, embedding, skill
and passive sentence types Use of deictic terms
Content- Developments
↑ᵈ specificity of
definitional skills Literacy
↑ᵈ quantifiers -reading
↑ᵈpronouns
-writing
↑ᵈ adjective development
↑ᵈ use of figurative
-narratives
language
EXPECTED SKILLS
Up to 4 years Up to 5 years Up to 6 years
SPEECH /p,b,m,n,h,k,g,t,d/ /f, v, ʃ, ʤ,ȝ, j, w, l, s/ /Ө, r, r+vowels/
RECEPTIVE Basic concepts, pronouns, Qualitative ,spatial concepts, Time /sequence,
Negatives, categories, time concepts, noun +2 early math,
LANGUAGE Analogies modifiers inclusion/exclusion
passive voice
EXPRESSIVE Object ID, asks ?’s, varied word Gives location, reason, Similarities, 1:1
combinations, 4-5 word categorizes, adjectives, divergent naming,
LANGUAGE sentences, categorizes, past tense, convergent repairs absurdities
object use, possessives, naming
descriptors,
Hypothesizes, gives analogies
FLUENCY Partial/whole word repetition,
reformulations, phonemic Reformulated phrases
Repetitions with ↑ᵈ
production accuracy
ATYPICAL DEVELOPMENT
Dyspraxia Language Disorder Autism
WHAT COULD GO WRONG?
Children quickly compensate for their own missing links.
What initially may have appeared to be a delay may
actually be a disorder hiding under the “wide range of
variability in early childhood development.
Language Disorder: receptive/expressive or both
Articulation Disorders :dyspraxia, dysarthria,
phonological processing disorder
Autism or Spectrum Disorders
Congenital Disorders:
Acquired or Degenerative Disorders
BROKEN LINKS
When skill sets do not appear when
expected, we must define a delay or a
disorder.
Developmental delay implies “…an
impairment… in the meeting of
milestones that a child should achieve by
a specific chronological age.” (Taber’s
Cyclopedic Medical Dictionary, 2001)
The term “disorder” implies a pathologic
or abnormal condition. In other words,
absence or atypical acquisition and/or
presentation of a skill.
RISKS
As high as 70% of children exhibiting oral language
impairments will later exhibit difficulties with literacy.
Toddler and preschool language development is critical
for school success.
Autism is the fastest growing childhood disorder, and is
primarily a disorder of verbal and non-verbal language.
A labeling of “delay” does not necessarily mean an
absence of disorder.
Excellent memory for rehearsed or rote learned skills
(colors, letters, numbers) is not the same as symbolic
learning.
RED FLAGS
for AUDITORY PROCESSING
• Difficulty with phonemic awareness
• Asking “what” repeatedly after directions are given, or
“I don’t know” to avoid responding
• Answering wh- questions incorrectly
• Using semantic substitutions (word for word)in
expressive language that cannot be explained by
articulation concerns
• Evidence of increased distraction or fatigue after
periods of listening
• Body language indicating “shutting out” of active or
potential communicative partners
RED FLAGS for
RECEPTIVE LANGUAGE
• Need for frequent repetition
• Need for extra explaining before following through with
directions
• Difficulty answering questions
• Difficulty understanding time concepts
• Difficulty understanding prepositions or spatial concepts
• Difficulty with 1:1 correspondence
• Difficulty organizing or categorizing
• Poor eye contact during listening tasks
RED FLAGS
for EXPRESSIVE LANGUAGE
• Switching or omission of pronouns (sometimes I am you and
you are me and me is you)
• Omission or difficulty using spatial or time concepts
• Difficulty retelling actions or events
• Omission of connector or functor words (telegraphic speech)
• Verb irregularity
• Frequently switching topics in conversation
• Overuse of rote phrases and communicative exchanges
• Inability to tell about something
RED FLAGS
for ARTICULATION
• Inconsistent speech sound substitutions
• Immature sounding speech toward later preschool years
• Irregular airflow during speech
• “wet” speech
• Hypernasal/hyponasal
• Jaw sliding during speaking
• Parent difficulty understanding speech
• A child should be 80% intelligible to their primary caregiver by 3
years of age, to other listeners by 4 years of age
• Messy eating, drooling, or restricted food preferences
• Poor stability; open mouth posture, uncoordinated gate + immature
or disorganized speech or feeding.
RED FLAGS for VOICE
• Hoarseness or raspiness in the absence of
chronic allergies or recent illness
• Loss of voice within an utterance or
conversation
• Breathiness during speech
• Difficulty changing pitch during speaking
RED FLAGS for FLUENCY
• Repetitions of phoneme at the beginning of a
word, thought or phrase
• Episodes of stopped airflow and/or sound
during speech
• Very rapid speech
• Variable rate of speech
• Avoidance of conversational interaction
IS IT AUTISM?
• DSM-IV (1994)Criteria for Autism requires specific
characteristics that include a total of at least 6 variations
and manifestations from the following categories:
• “qualitative impairment in social interaction…, qualitative
impairments in communication…, restricted repetitive and
stereotyped patterns of behavior, interests and activities…”
• “Delays or abnormal functioning in at least one of the
following areas, with onset prior to age 3 years: (1) social
interaction, (2) language as used in social communication,
or (3) symbolic or imaginative play”
• “The disturbance is not better accounted for by Rett's
Disorder or Childhood Disintegrative Disorder”
AUTISM vs. LANGUAGE DELAY?
Based on DSM-IV criterion, the primary
difference between a language
delayed/disordered child and an autistic child
is that the child with Autism will demonstrate
impairment in areas of social interaction and
symbolic play, as well as language form,
content, and/or use. A child without spectrum
characteristics will still initiate and/or engage
in social interactions and play routines.
AUTISM FACTS
• According to Pathfinders for Autism, Maryland estimates indicate 1:142 children
are diagnosed with Autism, a complex neurological disorder. Boys are 3-4 times
more likely to be diagnosed with Autism than girls.
http://www.pathfindersforautism.org/aboutAutism.aspx
• According o the National Institute of Mental Health, causes of Autism have been
investigated with the following results: “The Institute of Medicine (IOM)
conducted a thorough review on the issue of a link between thimerosal (a mercury
based preservative that is no longer used in vaccinations) and autism. The final
report from IOM, Immunization Safety Review: Vaccines and Autism, released in
May 2004, stated that the committee did not find a link. ..All these disorders are
characterized by varying degrees of impairment in communication skills, social
interactions, and restricted, repetitive and stereotyped patterns of
behavior…Evidence points to genetic factors playing a prominent role in the causes
for ASD. A U.S. study looking at environmental factors including exposure to
mercury, lead and other heavy metals is ongoing.”
http://www.nimh.nih.gov/health/publications/autism/complete-index.shtml
WHAT TO DO?
1. Educate yourself. Find out what is “typical”.
2. Be the “eyes” of the community. Be observant for
early warning signs.
3. Document your concerns. It is hard to remember
details as time goes by.
4. Interview the child in a non-threatening way. Many
children are aware of their own weaknesses.
5. Come alongside parents who suspect their child has a
problem and direct them to community resources.
6. Use community resources. Pediatricians, Child Find,
and private practice specialists can help.
ADDRESSING CONCERNS WITH
PARENTS
Be prepared. Have all of your observations, papers, and
examples ready. Plan how you want the meeting to go.
Educate yourself. Consult a speech-language pathologist
about concerns you may have.
Make an approach. Ask the parent when would be a good
time to talk about some observations your have noticed in
your setting.
Use sensitivity. No-one wants to be told their child is different
or irregular. Chose words like “I noticed”, or “based on
classroom performance/behavior”, or “lets err on the side
of caution and have *concern+ ruled out”.
Emphasize the importance of early intervention! Labels can
drop off with early and appropriate intervention.
