Language Disorders
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Transcript Language Disorders
Development of Language and
Literacy: Typical Milestones and
Childhood Language Disorders
Krista Stangel
Graduate Student Clinician - MS SLP
Lucas Steuber
MA Applied Linguistics
Graduate Student Clinician - MS SLP
What is Speech-Language Pathology?
Responsible for “diagnosis, prognosis, prescription and
remediation” for children and adults with difficulty
speaking, listening, reading, writing, or swallowing.
Speech, literacy, nonverbal communication,
assistive/augmentative communication, craniofacial
disorders (cleft palate), etc …
Minimum of three years of graduate education
(including clinical fellowship)
The agenda for today
Developmental Milestones in Normal Language
Acquisition – Lucas
Signs of Childhood Language Disorders & Strategies
for Enhancing Language
Q&A
Development – Krista
What is language?
More than just speech
More than just speech and writing
Actually, more than just words
Language is communication in all of its forms
Language is how we interact with others and share
our ideas
What is language?
Language learning and use is an interaction of
biological, cognitive, psychological, social, and
environmental factors
Language must be seen in historical, cultural, and
social context
Effective use of language requires a lot more than just
knowing the meaning of words
Example of amelioration/pejorating
Domains of Language
Syntax
Semantics
Phonology
Morphology
Pragmatics
Syntax
“Grammar”
The rules about how we combine words and
phrases to create sentences
Different across languages
English syntax is Subject-Verb-Object
“I told him”
French syntax can be Subject-Object-Verb
“Je lui ai dit” (“I him have told”)
Semantics
Generally: Meaning
Specifically: Vocabulary
Our mental dictionary that we use to interpret
language and the world
Contextual! “How many words do Eskimos have for
snow?”
OED has 171,476 English words in use; 47,156
obsolete words (some obsolete)
George Washington
Having thus imparted to you my sentiments as they have been
awakened by the occasion which brings us together, I shall
take my present leave; but not without resorting once more to
the benign Parent of the Human Race in humble supplication
that, since He has been pleased to favor the American people
with opportunities for deliberating in perfect tranquility, and
dispositions for deciding with unparalleled unanimity on a form
of government for the security of their union and the
advancement of their happiness, so His divine blessing may be
equally conspicuous in the enlarged views, the temperate
consultations, and the wise measures on which the success of
this Government must depend.
George Bush
God bless you and God bless the United States of
America.
Phonology
The sounds of language
Also the rules that we use to determine what sounds
can go together in each language
Ghoti = FISH (enough, women, nation)
Sometimes has very little connection to orthography –
the way we spell in English
Two main reasons for this:
First, blame the French! (Norman invasion – 1066)
Next, blame the “Great Vowel Shift” – 1350-1700
Morphology
The system we use to change the form and
meaning of words
Think “conjugation”
Watch (N/V), Watches (N/V), Watched (V) …
Some languages are agglutinative; syntax is
morphology
Swahili: Nilimwambia “I told him”
Ni – li – mwambi - a “I him tell (past tense)”
Pragmatics
Language in use
Specifically, appropriate use
We all suffer from lapses in pragmatics
I’m too loud and I talk too fast
Children often learn some elements of pragmatics
before other parts of language
Turn taking, reference (“deixis”), reciprocity of
smiling
Other Concerns
Register: Talking to parent vs talking to friend
Genre: Academic writing vs Facebook
Dialect: Everyone has a dialect (and an accent)
English as a Second Language
DIFFERENCE VS. DISORDER
Stages of Language
Acquisition
Many people think about language and literacy
happening at school
“Critical Period”
In fact language learning starts much earlier and
continues much later
Let’s look at phases of normal development in all
of the domains of language we just covered
Birth to Eight Months
Phonology
0-2mos: “Vegetative” noises
2-4mos: Laughing, cooing, pleasure and displeasure
noises. May begin to cry differently for different
needs
4-6mos: Some clear vowels; “vocal play”
6-8mos: Babbling short repeating groups like
“mamamama bibibibi”
Birth to Eight Months
Everything else
Not much to point to in terms of production with
syntax, pragmatics, morphology, etc…
Much “intentionality” on the part of young babies is
actually really attributed by caregivers
However, the foundation of structure and meaning is
being laid
Eight Months to a Year
Pragmatics
Okay, NOW they start to mean it
Intent shown by gesturing, refusing, games like
“peekaboo” understood
Semantics
Understanding of 3-50 words
First words! Usually a name of a familiar person or object
First words almost always have consonant-vowel shape
Eight Months to a Year
Phonology
Start to see babble that’s not just duplicated
Contains “intonation contours” like normal speech
http://www.youtube.com/watch?v=_JmA2ClUvUY
12-18 Months
Pragmatics
Starts to use words to communicate things that
before were maybe communicated via gesture
On average, five communicative actions per minute
during play
Semantics
Expressive vocabulary of 50-100 words
Words communicate identity of people and objects,
rejection (no!), possession (mine)
18 months to 2 years
Pragmatics
New communicative intents include requesting
information (rather than just objects/activities) and
answering questions
On average, 7-8 communicative actions during free
play
Semantics
Understanding of so-called “WH-” questions
Who, what, where, when, how (but not yet why)
18 months to 2 years
Syntax/Morphology
“Brown’s Stage 1”
Two-word utterances with consistent word order.
Few grammatical markers (-s, -ed, etc)
Phonology
Speech is 50% intelligible to familiar listeners
Two-syllable words emerge, along with CVC
(consonant-vowel-consonant) words. “dog”
Literacy Check In!
Before two years…
Phonological awareness
“Meta-textual” skills like orientation and page turning
Scribbling with crayons etc
May pretend to read when others are reading
Two to Two and a Half Years
Pragmatics
Children start to say “please” (depending on the
parents!)
Children start to LIE! Or, at least, to understand the
concept of lying/teasing.
Children gain object permanence in their language;
will talk about things/people that aren’t present.
“Symbolic play” – using one object to stand in for
another (a block for a truck, etc)
Two to Two and a Half Years
Syntax/Morphology
“Brown’s Stage 2”
Use of –ing, in, on, plural –s
Use of “no, not, can’t don’t” as negation of a verb
Questions formed with rising intonation
Verbs “gonna, wanna, gotta, hafta” appear
Phonology
Rhyming (highlight re: literacy)
This is often the age when children with language
disorders may be identified
Two and a Half to Three Years
Pragmatics
Children will maintain a topic and ask for clarification
if needed
Narratives start to take the form of a sequence rather
than a “heap” of disconnected events
Semantics
Understanding and use of “why” questions –
sometimes too much!
Use of spatial pronouns like in, on, out, under, etc
Two and a Half to Three Years
Syntax/Morphology
“Brown’s Stage 3”
So-called “helping” verbs like “can” and “will” are
used with basic verbs like be/go
Past-tense overgeneralized (“I ranned there”)
Phonetics
Speech is 75% intelligible to familiar listeners
Three to Three and a Half Years
Pragmatics
Indirect requests (“can you...” “would you…”)
Narratives start to take on thematic/temporal
organization. “At school I … and then I …”
Semantics
Color words
Use of words like “and,” “or,” “then,” and “because” to
conjoin sentences
Three to Three and a Half Years
Syntax/Morphology
“Brown’s Stage 4”
First complex sentences (two sentences conjoined)
Irregular past tenses (“I ran”)
Use of articles (a, the) and possessive –s
Phonology
Some perceived articulation errors automatically
resolve (final consonant deletion, etc)
“I can do a hantan!”
Three and a Half to Four Years
Pragmatics
New communication functions emerge, including:
Reasoning, predicting, empathy, creating imaginary
props during play
Semantics:
Full understanding of “when” and “how” Q’s
Basic shape vocabulary (circle, square, triangle)
Basic size vocabulary (big, small)
Three and a Half to Four Years
Syntax
“Brown’s Stage IV” continued
Prepositional clauses (“in the house”)
Phonology
Decreased use of cluster reduction (“playing” for
“paying”)
Overall articulation becoming much more clear
Four to Five Years
Pragmatics
Use of hints; like “those cookies look good!”
Narratives now have a plot, but often no climax or
resolution
Semantics
Knowledge of letter names and their corresponding
sounds
Knowledge of numbers and counting
Four to Five Years
Syntax
“Brown’s Stage 5”
Regular past tense verbs and third person –s understood
and used (“He walks, he walked”)
Gerunds! (“Playing is fun”)
Phonology
Speech 100% intelligible to familiar listeners
Understanding of syllables within words
Mild errors with s, r, l, and th may persist past this point
Literacy Check In!
By age five…
Learns order and format of print (left to right)
Recognizes own name
Recognizes some other familiar words
May invent spelling
Begins to write name
5-7 Years
Pragmatics
Narratives are true stories, with climax/resolution
Semantics
Average expressive vocabulary of 3-5,000 words
So-called lexical “explosion” occurs
Syntax
Mastery of grammatical “exceptions” begins
Phonology
Last residual speech errors remediate spontaneously
7-9 Years
Pragmatics
Language used to establish/maintain social status
Becomes more successful in persuasion
Semantics
Acquisition of “literate vocabulary”
Can name synonyms in word definitions
“Polysemy” understood; words with multiple
meanings
7-9 Years
Syntax
Begins to acquire/understand more complex syntax
required for academic interaction
“in order to,” “if you,” “prior to …”
Some errors in syntax still persist
Phonology
Articulation largely error-free
Sound manipulation – “pig latin”
Phonological knowledge used for spelling
More Literacy!
By age 9 …
Reads for pleasure (fiction and nonfiction)
May invent secret codes
Can “sound out” words
Some phonic patterns known (like silent e)
Begins to learn punctuation rules
Knows many conventional spellings
Can make errors in spelling due to phonological
correspondences
9-12 Years
Pragmatics
Use of jokes and riddles based on lexical ambiguity
“what has four wheels and flies?”
“where does Napoleon keep his armies?”
Semantics
Acquires and uses more abstract vocabulary from
school texts
Common idioms are understood (“piece of cake”
“apple of my eye”)
9-12 Years
Syntax
Continues to acquire more complex syntax from
textbooks
Word order can be varied creatively. “I drew a bear
for my art project” -> “For my art project, I drew a
bear”
Phonology
“Metaphonological” skills
Literacy Check!
By age 12 …
Reading is fluent
Comprehension is now the focus
Reads both for pleasure and to seek info
Fewer spelling errors
Begins to use persuasive and expository writing in
school curriculum
12-14 Years
Pragmatics
More use and understanding of humor and riddles
Developing peer norms in social language use
Semantics
Can offer abstract, dictionary definitions for words
Syntax
Begins to use (and not just comprehend) more complex
syntax in writing
Phonetics
Proper rules of stress (“RECord, recORD”)
15-18 Years
Pragmatics
Ability to persuade and argue is near-adult
Semantics
Average expressive vocabulary of a high-school
graduate: 10,000 words
Syntax
Perfect aspect (“I had just finished, when …”)
Able to write for an academic audience
Passive construction of sentence
Phonology
Knowledge is now at adult level
18-21
At this stage, phonology and pragmatics are often
near the end of their development.
However, semantics and syntax continue to
develop if the individual continues to be engaged in
an academic environment
Literacy also develops as the student reads
“beyond the high-school level”
… and beyond!
We never stop learning about language!
Discipline-specific information; “jargon”
Technological advances change language
Abbreviations
Communication and
Language Disorders
Let’s look at some common
communication disorders
Articulation
http://www.youtube.com/watch?v=PYxM229pAzw
Stuttering
http://www.youtube.com/watch?v=y1kGNUk_Hp0
Both communication disorders but different
from language disorders!
What is a Language Disorder?
Remember, there is a WIDE range of normal!
Language Disorder
Difficulty understanding and/or using language
Difference ≠ Disorder
May involve deficits in any language domain
Impairment in one or more domains
PHONOLOGY: how individual speech sounds can
be sequenced
SYNTAX: word order and relationships between
words in sentences
MORPHOLOGY: word structure and how the
meaning of words can be changed (plurals, past
tense)
SEMANTICS: the meaning of words; vocabulary
PRAGMATICS: how language is used socially
Language Disorders
No single cause
Primary Language Disorder:
No other conditions or disorders; no known cause
Often called specific language impairment (SLI)
Secondary Language Disorder:
Language disorders often co-occur with
developmental, genetic, or acquired disorders
Specific Language Impairment
Impairment specific to language
No known cause
May be slower starting to talk
Varied language profile
Specific Language Impairment
Phonology:
May have co-occurring speech sound disorders
May have difficulties with phonological
awareness
Syntax & Morphology:
Shorter length of utterance
May omit grammatical elements and
morphemes (past tense, plurals, etc.)
Pronoun errors
Difficulty with wh- questions
Specific Language Impairment
Semantics:
Slower rate of vocabulary development
May have smaller vocabularies
May have difficulty with word retrieval
Pragmatics:
Pragmatic skills vary greatly
May have difficulty with:
Topic Initiation & Maintenance
Repairing communication breakdowns
Narrative skills
Perspective taking
Video
http://www.youtube.com/watch?v=UmLu8rzbHhE
Language & Literacy
Strong connection between oral language abilities
and literacy skills
Children with oral language disorders are at risk for
difficulties with reading and writing
Impairments in any domain
can impact reading and writing
SLI & Dyslexia
Dyslexia & SLI are distinct conditions but can cooccur
Early signs of dyslexia and SLI may be similar in
some young children
Possible delays in speaking
Articulation errors may be present
Difficulty with rhyming and phonological/phonemic
awareness
Difficulty with word retrieval; imprecise language
Language Disorders
in Special Populations
Language disorders commonly co-occur with many
genetic and developmental disorders
A diagnosis does not predict an individual’s language
abilities
Lots of variability
Let’s explore some possible language
characteristics in selected populations
Intellectual Disabilities
Autism Spectrum Disorders
Traumatic Brain Injuries
ADHD
Complex Communication Needs
Intellectual Disabilities
Significant limitations in cognitive functioning (IQ score
significantly below average) and adaptive skills
IQ does not predict language skills
Language development is delayed
Different patterns of strengths/weaknesses
Intellectual Disabilities
Phonology: May have speech sound disorders
Syntax/Morphology:
Shorter and less complex sentences
Often omit morphemes and function words
Semantics:
Slower vocabulary growth
Concrete vocabulary is a strength, difficulties
with abstract vocabulary
Intellectual Disabilities
Pragmatics:
Down Syndrome: generally considered a strength
Williams Syndrome: overfriendliness, difficulties
providing appropriate/contingent responses
Fragile X: Individuals who also have co-occurring ASD
will demonstrate significant pragmatic deficits
Literacy:
Variable
Improving oral language abilities can provide a
foundation for literacy
Autism Spectrum Disorders (ASD)
Deficits in social communication and social
interaction
Often see early differences in social
communicative behaviors
Delayed speech and language is common
Pragmatic differences are universal
ASD
Phonology
Varies; may have very limited speech skills
Syntax/Morphology
Variable; can be completely intact
May use short, simple sentences
May use incorrect word order, omission of grammatical
morphemes
Semantics
Wide variability
More difficulty with abstract vocabulary, figurative
language
ASD
Pragmatics
May lack interest in communication
Difficulty maintaining conversation
Use of language in perseverative manner
Difficulty with perspective taking
Literacy
Decoding may be a strength
Comprehension may be more challenging
Traumatic Brain Injury
Age, location, and severity of brain injury is related
to language and literacy outcomes
Language impairments
from minimal
Deficits in attention and
impact language & literacy
range
to severe
memory
ADHD
Language can be typical
Language & literacy challenges can include:
Difficulties with complex grammar and vocabulary
Pragmatic Difficulties
Literacy outcomes may be influenced by processing
speed, attention, comprehension monitoring
Complex Communication Needs
Some children may be unable to speak and use
verbal language
Alternative and Augmentative Communication
(AAC) systems
language
can provide access to
Plus Many More!!
Many other conditions or disorders may have cooccurring language disorders
No matter what, individualized assessment and
intervention is key
Supporting Language Development
KEEP TALKING!
I’m Listening!
Supporting Language Development
Model appropriate speech and language
Respond to all attempts to communicate
Offer choices
Ask questions
Read to your child to
vocabulary
increase
Zone of Proximal Development
Build upon a child’s current language skills
Scaffolding
Example:
If a child is saying two-word
sentences, we want to
model three-word sentences
(next developmental step)
Supporting Language Development
Birth to 2 years
Use language to describe what you are doing
Self Talk
Parallel Talk
Use gestures when communicating
Imitate facial expressions and sounds
Expand upon the child’s babbling/words
Explore written materials like books
Supporting Language Development
2 to 4 years
Expand upon what the child says
Expansion: Repeating what child
says with adult-like grammar
Child: “Car go”
Adult: “Yes, the car is going”
Extension: Add new information
“The car is going fast”
Supporting Language Development
2 to 4 years
Label objects/items to introduce new words
Specific vocabulary (categories)
20 introductions across different settings
Supporting Language Development
4 to 6 years
Think about scaffolding and the zone of proximal
development
Give two- or three-step directions
First sharpen your pencil, then get your notebook
Sharpen your pencil, get your notebook, and then
sit down
Supporting Language Development
4 to 6 years
Introduce new words, explain what they
mean, and use in multiple contexts
Example: Combine and tractor
Similarities and differences
Functions
Supporting Language Development
4 to 6 years
Play games involving
language
I spy
20 questions
Discuss opposites and attributes
Size (big, small, heavy)
Shape
Color
Supporting Language Development
School-Age
Ask open-ended questions
Make connections between school, home, and
other activities
Follow the child’s lead in his/her interests and
preferences
Use interest areas for vocabulary growth
THANK YOU!!!
ANY QUESTIONS?
References
American Speech-Language Hearing Association. (2013). Activities to encourage speech and
language development. Retrieved from: http://www.asha.org/public/speech/development/parent-stimactivities.htm.
American Speech-Language Hearing Association. (2013). Suggestions for parents. Retrieved from:
http://www.asha.org/public/speech/development/suggestions.htm.
Catts, H. W., Adlof, S. M., Hogan, T. P., & Weismer, S. E. (2005). Are specific language impairment
and dyslexia distinct disorders? Journal of Speech, Language, and Hearing Research, 48, 1378-1396.
Owens, R. (2010). Language disorders: A functional approach to assessment and intervention (5th
edition). Pearson Education, Inc.
Owens, R. (2012). Language development: An introduction (8th edition). Upper Saddle River, NJ:
Pearson Education, Inc.
Paul, R. & Norbury, C. (2012). Language disorders from infancy through adolescence: Listening,
speaking, reading, writing, and communicating (4th edition). St. Louis, Missouri: Elsevier Inc.
Roseberry-McKibbin, C. & Hegde, M. N. (2011). An advanced review of speech language pathology
(3rd edition). Austin, TX: Pro-Ed.
Shaywitz, S. (2003). Overcoming dyslexia: A new and complete science-based program for reading
problems at any level. New York: Vintage Books, Random House Inc.