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MSFP
SPEECH, LANGUAGE, AND COMMUNICATION DISORDERS
| Term | Definition 1 | Definition 2 |
|---|---|---|
| COMMUNICATION | Broad umbrella term that encompasses understanding and producing language, speech, nonverbal communication gestures, and written language. | |
| LANGUAGE | includes the form, function, and use of a conventional system (i.e. spoken words, sign language, written words, pictures) in a rule-governed manner for communication. | |
| SPEECH | Speech is the expressive production of sounds and includes an individual’s articulation, fluency, and voice resonance quality. | |
| DSM-5 COMMUNICATION DISORDERS • LANGUAGE DISORDER | • Developmental language disorder is the most common developmental disability of childhood (5 to 10%) • By age 5, approximately 8% have language impairment alone • M > F | |
| DSM-5 COMMUNICATION DISORDERS • SPEECH DISORDER | • By age 5, approximately 6% of children are identified as having a speech impairment alone • M > F | |
| DSM-5 COMMUNICATION DISORDERS • CHILDHOOD-ONSET FLUENCY DISORDER (STUTTERING) | • Highest rates among young children • Mean age of onset is 2-4 years old •More common in males (M > F) | |
| DSM-5 COMMUNICATION DISORDERS • SOCIAL (PRAGMATIC) COMMUNICATION DISORDER | Very few children have isolated social-communication difficulties (0-1.3%). | |
| GENETIC CAUSES | • Multiple genetic regions and epigenetic changes • Chromosomal copy number variants have also been associated with abnormalities of language and speech • Gene mutations underlie some cases of stuttering | |
| PERINATAL FACTORS • Prematurity | • Altered brain maturation and vulnerability due to prematurity is associated with changes in brain structure and subsequent language impairments. • Premature = structure of the brain is immature | |
| PERINATAL FACTORS • Low birth weight (LBW) | Associated w/ poor language abilities | |
| ENVIRONMENTAL CAUSES | • Language problems are significantly affected by the quality of the child-caregiver interaction • Neglect and abuse (physical and emotional) | • High-Stress, Low-Verbal Environments • Multilingual family environment • Low paternal and maternal education |
| NEURAL NETWORKS | • Frank neurologic injury is typically absent. • Fundamental difficulty in the brain's capacity to process complex information rapidly. | |
| Electrophysiologic studies: | Abnormal latency in the early phase of auditory processing. | |
| WHITE MATTER ABNORMALITIES | White matter organization in infancy sets a foundation for long-term language development. | |
| Link between white matter and language: • Arcuate fasciculus | • Neural pathway that passes through white matter and connects the inferior frontal and superior temporal regions. • one that connect the 2 areas ( Broca’s area and Wernicke’s area) • It plays a crucial role in language processing and production. | |
| fluency | Inferior frontal area - Broca’s area = | |
| comprehension | Superior temporal area - Wernicke’s area = | |
| Link between white matter and language: • Inferior frontal gyrus | • May have more gray matter or may be smaller compared to typically developing individuals. • Broca's area (pars opercularis and pars triangularis • Motor speech area • Controls the movements employed in speech | |
| Pars orbitalis | Covert articulation and semantic processing | |
| Semantics | - meaning, logic, sense of word | |
| Link between white matter and language: • Planum temporale (atypical symmetry) | • Normally shows a leftward asymmetry • Important for speech and complex sound processing and auditory-motor integration | |
| Planum Temporale: Wernicke's area | • Sensory speech area • Permits understanding of written and spoken language and enables a person to read a sentence, understand it, and say it out loud | |
| LANGUAGE DISORDERS | • Word-finding problems, impoverished verbal definitions, or poor understanding of synonyms, multiple meanings, or word play • Problems with remembering new words and sentences | • Reduced ability to provide adequate information about the key events and to narrate a coherent story |
| DSM-5 LANGUAGE DISORDERS: A. | Persistent difficulties in the acquisition and use of language across modalities due to deficits in comprehension or production that include the following: 1. Reduced vocabulary 2. Limited sentence structure 3. Impairments in discourse | |
| DSM-5 LANGUAGE DISORDERS: B. | Language abilities are substantially and quantifiably below those expected for age | |
| DSM-5 LANGUAGE DISORDER: C. (ONSET) | Onset of symptoms is in the early developmental period. | |
| DSM-5 LANGUAGE DISORDER CONSIDERATIONS BEFORE MAKING DIAGNOSTIC: D. | The difficulties are not attributable to hearing or other sensory impairment, motor dysfunction, or another medical or neurological condition and are not better explained by intellectual developmental disorder or global developmental delay. | |
| SPEECH SOUND DISORDERS | • Difficulty w/ phonological knowledge of speech sounds • Lisping is particularly common (distortion) | |
| Speech sound production | • Describes the clear articulation of the phonemes that in combination make up spoken words. | • The phonological knowledge of speech sounds and the ability to coordinate the movements of the articulators |
| Articulators of speech: | tongue, lingual muscles, labial muscles, lips, buccal muscles, jaw, mandible, voice box, pharynx, larynx, orbicularis oris, etc. | |
| Articulation disorders | are characterized by substitutions, omissions, additions, or distortions of speech sounds that interfere with intelligibility. | |
| DSM-5 SPEECH SOUND DISORDERS: A. | Persistent difficulty with speech sound production | |
| DSM-5 SPEECH SOUND DISORDERS: B. | The disturbance causes limitations in effective communication that interfere with social participation, academic achievement, or occupational performance, individually or in any combination. | |
| DSM-5 SPEECH SOUND DISORDERS: C. (ONSET) | Onset of symptoms is in the early developmental period. | |
| DSM-5 SPEECH SOUND DISORDERS CONSIDERATIONS BEFORE MAKING DIAGNOSTIC: D. | The difficulties are not attributable to congenital or acquired conditions, such as cerebral palsy, cleft palate, deafness or hearing loss, traumatic brain injury, or other medical or neurological conditions. | |
| In cerebral palsy, | articulators can be affected d/t spasticity which can result in difficulty in speaking (larynx muscles, smth.) | |
| In cleft palate, | there is no pressure build up, the air escapes, not effectively produce sound = hypernasal | |
| CHILDHOOD-ONSET FLUENCY DISORDER (STUTTERING) | • Starts gradually with repetition of initial consonants, first words of a phrase, or long words. • As the disorder progresses, the dysfluencies become more frequent and interfering • Occurring on the most meaningful words or phrases in the utterance. | • Often is more severe when there is special pressure to communicate |
| Speech dysfluencies: | • Broken words • Audible or silent blocking • Circumlocutions • Words produced with an excess of physical tension • Monosyllabic whole-word repetitions | |
| DSM-5 CHILDHOOD-ONSET FLUENCY DISORDER (STUTTERING): A. | Disturbances in the normal fluency and time patterning of speech that are inappropriate for the individual's age and language skills, persist over time, and are characterized by frequent and marked occurrences of one (or more) of the following: | 1. Sound and syllable repetitions 2. Sound prolongations of consonants as well as vowels 3. Broken words 4. Audible or silent blocking 5. Circumlocutions 5. Words produced with an excess of physical tension 6. Monosyllabic whole-word repetitions |
| Audible or silent blocking | filled or unfilled pauses in speech | |
| Circumlocutions | word substitutions to avoid problematic words | |
| DSM-5 CHILDHOOD-ONSET FLUENCY DISORDER (STUTTERING): B. | The disturbance causes anxiety about speaking or limitations in effective communication, social participation, or academic or occupational performance, individually or in any combination. | |
| DSM-5 CHILDHOOD-ONSET FLUENCY DISORDER (STUTTERING) ONSET: C. | The onset of symptoms is in the early developmental period. | |
| DSM-5 CHILDHOOD-ONSET FLUENCY DISORDER (STUTTERING): D. | The disturbance is not attributable to a speech-motor or sensory deficit, dysfluency associated with neurological insult (e.g., stroke, tumor, trauma), or another medical condition and is not better explained by another mental disorder. | |
| aphasia | blurting out random words and says random words | |
| SOCIAL (PRAGMATIC) COMMUNICATION DISORDER | Difficulty with pragmatics | |
| SOCIAL (PRAGMATIC) COMMUNICATION DISORDER deficits | • Understanding and following social rules of both verbal and nonverbal communication • Changing language according to the needs of the listener or situation • Following rules for conversations and storytelling | |
| SOCIAL (PRAGMATIC) COMMUNICATION DISORDER functional limitations | effective communication, social participation, development of social relationships, academic achievement, or occupational performance | |
| DSM-5 SOCIAL (PRAGMATIC) COMMUNICATION DISORDER: A. | Persistent difficulties in the social use of verbal and nonverbal communication as manifested by all of the following: 1. Deficits in using communication for social purposes | 2. Impairment of the ability to change communication to match context 3. Difficulties following rules for conversation and storytelling 4. Difficulties understanding what is not explicitly stated and nonliteral or ambiguous meanings of language |
| DSM-5 SOCIAL (PRAGMATIC) COMMUNICATION DISORDER: B. | The deficits result in functional limitations in effective communication, social participation, social relationships, academic achievement, or occupational performance, individually or in combination. | |
| DSM-5 SOCIAL (PRAGMATIC) COMMUNICATION DISORDER onset: C. | The onset of the symptoms is in the early developmental period (but deficits may not become fully manifest until social communication demands exceed limited capacities). • Early developmental period = 2-3 years old • School age = 5-6 years old | |
| DSM-5 SOCIAL (PRAGMATIC) COMMUNICATION DISORDER considerations before making diagnostic: D. | Symptoms are not attributable to another medical or neurological condition or to low abilities in the domains of word structure and grammar, and are not better explained by ASD, IDD, global developmental delay, or another mental disorder | |
| In children who are verbal ASD, | they tend to have no tone (monotonic), don’t show a lot of emotions (you don’t know if they are enjoying/angry), limited words, and would resort to gestures. | |
| ASD presents repetitive movements | the difference from communication problems with ASD | |
| UNSPECIFIED COMMUNICATION DISORDER | • Symptoms characteristic of communication disorder do not meet the full criteria for communication disorder or for any of the disorders in the neurodevelopmental disorders diagnostic class. | • The clinician chooses not to specify the reason that the criteria are not met for communication disorder or for a specific neurodevelopmental disorder, and includes presentations in which there is insufficient info to make a more specific diagnosis. |
| HEAD AND NECK ANOMALIES | Associated with hearing/ speech abnormalities | |
| WAARDENBURG SYNDROME | • Ocular, skin, and hair hypopigmentation (white forelock of hair) • Hearing loss → Speech and language deficits | |
| GOLDENHAR SYNDROME | Facial asymmetry, ear malformation | |
| WILLIAMS SYNDROME | • Dysmorphic facial features: elfin-like features, with a broad forehead, full cheeks, an under-developed chin, and a shortened nose. • They are hyperfriendly and when you study their DNA, they have similarities with a dog. | |
| VELO-CARDIO-FACIAL SYNDROME / 22Q11.2 DELETION | Dysmorphic facial features: long, narrow face, tubular nose with a bulbous tip, narrow palpebral fissures, small mouth, and ears | |
| PIERRE ROBIN SYNDROME | Retrognathism of chin | |
| STRUCTURAL ANOMALIES AFFECTING SPEECH • CLEFT LIP | • Hypernasality • Difficulty with specific sounds | |
| STRUCTURAL ANOMALIES AFFECTING SPEECH • CLEFT PALATE | • Speech difficulties, including hypernasal speech • May have severe and persistent serous otitis media | |
| STRUCTURAL ANOMALIES AFFECTING SPEECH • VELOPHARYNGEAL INSUFFICIENCY (VPI) | Hypernasal speech with weak production of consonants | |
| HEARING IMPAIRMENT | • Eval: Na-hearing screening na po ba? • Sensorineural hearing loss • Acute or chronic serous otitis media (conductive hearing loss) | |
| Otitis media with effusion | is of particular concern to the language development of young children | |
| Otitis media | • is typically transient and may increase the sound threshold at which children can detect tones or understand language. • Eval: Na-hearing screening na po ba? | |
| Generalized muscular hypotonia with increased range of motion of the joints | • Frequently seen in children with language impairment • The reason for this association is not clear, but it might account for the fine and gross motor clumsiness often seen in these children. | |
| Dysarthria | • Originates from neuromotor disorders (e.g., Cerebral palsy) • Weakening of muscles used for speech resulting in abnormalities in articulation, speed, and pitch.. | |
| Communication disorders have high rates of comorbidity with other neurodevelopmental disorders and some medical conditions: | • Autism spectrum disorder • Attention-deficit/hyperactivity disorder (ADHD) • Specific learning disorder • Intellectual developmental disorder (intellectual disability) • Mental disorders (e.g., anxiety disorders) • Seizure disorders | |
| AUTISM SPECTRUM DISORDER | • A disordered pattern of language, speech, and communication development. • Children show a wide range of language and communication abilities | • At the severe end, language and speech may be extremely limited (nonverbal). • 30-50% of children with ASD also meet criteria for intellectual disability, which contributes to the challenges of developing communication skills. |
| EPILEPSY SYNDROMES | Children with Landau-Kleffner syndrome (acquired epileptic aphasia) have a history of typical language development until they experience a regression in language ability. | |
| METABOLIC AND NEURODEGENERATIVE DISORDERS | Regression of language development may alongside the loss of neuromotor function in various metabolic disorders: • Lysosomal storage disorders • Peroxisomal disorders • Ceroid lipofuscinosis • Mucopolysaccharidosis (Hunter disease, Hurler disease) | |
| INTELLECTUAL DISABILITY • Most children with a mild intellectual disability | are likely to encounter difficulties with higher-level language skills • Children with an IQ as low as 25 | |
| INTELLECTUAL DISABILITY • Children with an IQ as low as 25 | may eventually acquire a small lexicon and ability to combine words. | |
| Down syndrome: | verbal skills are more impaired than nonverbal skills | |
| William syndrome: | language skills may be relatively preserved compared to nonverbal skills | |
| Fragile X syndrome: | unusual word or sound repetition may be present. | |
| LEARNING DISABILITY | Children with articulation or other speech sound disorders are at risk for later reading and learning disability. | |
| TREATMENT - SPEECH-LANGUAGE THERAPY (SLT) | • Effective for the developmental speech and language impairments that involve expressive, phonological and vocabulary difficulties. • Disorders of language and speech are often treated by SLPs alone or as part of a multidisciplinary team. | |
| TREATMENT - AUGMENTATIC AND ALTERNATIVE COMMUNICATION (AAC) | An area of clinical practice that addresses the needs of individuals with significant and complex communication disorders | |
| Functions of AAC • Augmentative: | supplements existing speech | |
| Functions of AAC • Alternative: | replaces speech that is absent or nonfunctional | |
| AAC uses a wide variety of electronic and non-electronic techniques: | Includes sign language, gestures, tangible objects, line drawings, picture communication boards and letter boards, and speech-generating devices. | |
| TYPES OF AAC • Unaided | Low-Tech: • Sign language • Gestures | Mid-High Tech: |
| TYPES OF AAC • Aided | Low-Tech: • Communication boards/books • Picture exchange systems • Visual schedules • Eye-gaze picture boards • Simple single-message speech output devices | Mid-High Tech: • VOCAs/SGDs w/ prestored recordings of natural speech or computer- generated speech • Specialized software on electronic devices • Simple single-message speech output devices • Spelling and/or symbol systems to represent language |
| Unaided system: | Do not require special materials or equipment, rely on the user's body to convey messages. | |
| Aided systems: | Require the use of tools or equipment can require power or no power | |
| EDUCATION | • Interactions between young children and their caregivers that are positive, responsive, and warm allow children to practice their early word learning. • Living in stable home environments is better for language development. | • Parents are key to the success of a child's progress in speech or language therapy. • Kids who finish the program quickest and with the longest-lasting results are those whose parents were involved. |
| Individualized Education Programs (IEPs) | • Developed for every student who receives special education services. • Designed to ensure that children who are eligible for special education services have individualized and well-defined objectives for meeting educational and functional goals. | |
| PARENTAL SUPPORT | • Interactions between young children and their caregivers that are positive, responsive, and warm allow children to practice their early word learning. • Living in stable home environments is better for language development. | • Parents are key to the success of a child's progress in speech or language therapy. |
| PSYCHOLOGICAL AND NEURODEVELOPMENTAL EVALUATION | • Assess cognitive ability and social skills • Assess social behaviors to determine whether the child meets diagnostic criteria for ASD | |
| PSYCHOLOGICAL AND NEURODEVELOPMENTAL EVALUATION • Evaluate for coexisting conditions: | • Anxiety • Mood disorder • Attention-deficit/ hyperactivity disorder (ADHD) • Autism spectrum disorder (ASD) • Learning challenges | |
| AUDIOLOGIC EVALUATION | • Any child who shows a speech or language problem should have a hearing assessment by an audiologist. • Early identification of hearing loss will prevent speech deficits and promote language acquisition. | |
| PEDIATRIC EVALUATION | Identification of potential contributors to the child's language and . communication difficulties | |
| PEDIATRIC EVALUATION • Family history (can suggest genetic predisposition) | • Delay in talking • Need for speech/language therapy • Academic difficulty | |
| PEDIATRIC EVALUATION • Pregnancy history | Risk factors for prenatal developmental anomalies (e.g., polyhydramnios or decreased fetal movement patterns) | |
| PEDIATRIC EVALUATION • Diagnostic Studies | • No routine diagnostic studies are indicated for isolated language disorders with the exception of the hearing assessment. • If language delay is a part of a generalized cognitive or physical disorder: Genetic evaluation Neuroimaging EEG |
Created by:
avemaria