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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.

				
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