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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