Language problems. Language Impairment. Hearing impairment. Hearing impairment. Hearing impairment 5/17/16

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1 Language problems Language Impairment Several conditions are related to difficulties in spoken language acquisition: Hearing impairment Intellectual impairments Autism/PDD Specific language impairment A note of compassion, and a note of skepticism Keep in mind that: Something being wrong with your child is frightening--parents are motivated to seek solutions Any therapy costs $money$--other people are motivated to provide solutions The notion of evidence-based practice: if it really works, it should work in an actual experiment, not just for one person who writes a testimonial on a web site Hearing impairment 1 million kids in US, 90% to hearing parents Most prelingually deaf Trouble developing oral language This cascades into difficulty in language comprehension, reading Difficulty is usually related to how profound the hearing loss is Hearing impairment Can we just fix it? Not exactly. Cochlear implants show some efficacy* Stimulate auditory nerve directly, past site of problem Still not the same as actual speech input Requires speech-language therapy Active area of research Just lip-read? Not as easy as it sounds. Some sounds not visible (Ex.: /l/, /g/, /k/) Some sounds look alike (/m/, /b/, /p/) Hearing impairment Problems in language development Phonology Not very intelligible, even with training CI: more intelligible, but still not great articulation Language development, lexicon Reading skills, vocab max 4th grade level Grammar Poor grasp of English syntax (e.g. passives, etc. that are hard for non-deaf children) Better to teach use of [written] language to communicate effectively 1

2 Hearing impairment Hearing impairment Educational philosophies Oral/aural (auditory-verbal therapy) Can be effective if cochlear implant, residual hearing; resurgence due to implants Cued speech: handshapes to supplement lips Total communication Response to old oral/aural ed and bad outcomes Make up sign systems yoked to English (SEE) Bilingual/bicultural (bi-bi) Learn ASL first, then English as second language Good in principle, limited by teachers expertise Cochlear implants: controversy See improvements in language skills, esp. if implanted young, but Not like real hearing Still need lots of educational support Threat to Deaf culture Best solution: learn both Down syndrome (poor language) Williams syndrome (preserved language?) Fragile X syndrome Range of cognitive difficulties Sometimes, physical difficulties Poorer categorization, generalization Early intervention!! Down syndrome Trisomy 21 Achievement related to working memory skills Look like younger TD children, mostly Behind by 20 mos at age 3 years; 24 at age 4 years Big trouble with English morphosyntax Later, pretty good narrative, pragmatic skills 10%+ diagnosed with autism Williams syndrome Williams syndrome Deletion on chromosome 7, including elastin protein Characteristic appearance, health issues Old claim: bad cognition, good language (reverse of Downs) Language module idea New claim (see Karmiloff-Smith s work): language abilities in keeping with overall cognitive abilities; still behind for chrono age Interesting holistic/analytic split w/downs h)ps:// 2

3 Fragile X Problem with FMR1* gene on X chromosome Mostly boys affected; biggest source of ID w/known source in boys Specifics: over 200 CGG repeats (normal: ~30) Premutation: repeats Long face, high forehead Delayed language onset Poor oral-motor skills, articulation A little better than DS for language skills Perseveration in language 25% also have autism (more, by some estimates) All of these: therapy of all types (speech, occupational, behavioral) Language instruction (DS especially): Catch it early Teach real-life language skills Teach so as to generalize skills Train learning/rehearsal of new info If severe, try augmentative or alternative communication (AAC) Symbols/pictures Signed system (complex but can mold a handshape better than a speech sound) For DS, keep teaching throughout adolescence (still developing) Autism Part of a spectrum of disorders, incl.: Asperger syndrome Re) syndrome AuEsm [spectrum] Categories change from Eme to Eme Is Asperger different from high-funceoning auesm? DSM-V: same thing Are all cases from same source[s]? Nominal fallacy Autism Diagnostic criteria: Highly delayed onset/absence of language Impaired conversation starting, responding Use lg skills in stereotyped, repetitive way Lack of age-appropriate pretend-play or sociallyimitative play Autism Age of discovery: ~2 years Signs may appear earlier Aberrant eye gaze Lack of responsiveness to name Hand flapping, toe walking Pierce et al. 2011: visual preference for geometric patterns > people About 1/3 reported to show regression Seeming increase in cases over time MMR vaccine? No original article discredited Corresponding decrease in ID diagnoses Get more intervention services for child if autism diagnosis Autism Likely genetic basis Siblings at risk Families tend to have some of the behaviors Heritability likely, a little hard to tell b/c don t have kids Many brain differences Accelerated growth during time when symptoms first ID ed 3

4 Autism: Social & communicative problems Poor joint attention On 1st birthday, lack of pointing/showing Didn t faces, respond to name Symbol use is difficult Conventionalized gestures (wave, point) Banana phone Theory of mind is underdeveloped Understanding others intents, perspectives Alternatively: impaired executive function or weak central coherence Autism & language Language outcome strongly linked to Age of diagnosis Initial cognitive profile Initial language profile Amount of speechlanguage intervention 5 word vocab Receptive & expressive deficits Structure OK but poor pragmatics Autism & language Autism & language Receptive, expressive correlated, both related to IQ Phonological skills better than other skills Problems with intonation and stress Confuse you and I Difficulty imitating (but echolalia) Hard to tell about really early b/c diagnoses late Not catalyzed by desire to socially interact 5 word vocab Receptive & expressive deficits Structure OK but poor pragmatics Echolalia: repeating things you ve heard Just another self-stimulatory behavior? Doesn t tend to covary with other ones Also, typically-developing kids do it (early in development; Bloom et al., 1976) Immediate vs. delayed Exact vs. mitigated Actually, a lot of it is mitigated Communicative strategy? Tends to disappear as they acquire more spontaneous speech May be stepping stone Break down larger pieces Autism & language Wodka et al. (2013) studied language delay 535 children with autism who were Age 8+ Had no phrases by age 4 (37% of 8+-y-o s) 253 (47%) attained fluent speech after age (70%) could at least produce phrases Non-verbal IQ, social engagement were predictors Stereotypies, sensory sensitivities: doesn t matter Good news! Late language no language Autism treatment Intervention guidelines Early Intensive (up to 25 h/wk!) Involve family Social, pragmatic communication Systematic but customized to child Generalization Evaluation Until recently, mostly small N studies 4

5 Autism treatment Autism treatment Behavioral interveneons Lovaas (1977, 1987) Applied Behavior Analysis (ABA) Operant condieoning (reward/punish) Good outcomes in clinics Less if parents administer (< Eme?) None meet strict criteria for efficacy. Developmental social-pragmaec MulEfaceted TEACCH approach New study: it improves range of skills Not just treating language, of course ABA: quite good for reducing harmful behaviors If can communicate better, aggression, inappropriate behavior may drop Functional analysis: what s motivation/function of bad behavior? Shape into better behavior Medication Often, undesirable side effects (weight gain, dyskinesias) Nonverbal? Picture communicaeon (AAC or others) Autism treatment Things that don t work Auditory integration therapy (AIT) uses filtered and modulated music to help stimulate the audiological and neurological systems Facilitated communication (FC) Facilitator offers physical support (usually to type) May have helped small handful of people (4ish) Most scientists think authorship is facilitator s And someemes It goes away! Fein et al. (2013) Kids with symptoms at age 5 or earlier Delayed language RepeEEve behaviors Symptoms now gone Normal range social interaceon Language Face recognieon Only difference from kids with high-funceoning ASD: Milder social symptoms early on Perhaps 3-25% of diagnosed kids end up losing diagnosis Outgrow? IntervenEon works? Language problems Several conditions are related to difficulties in spoken language acquisition: Hearing impairment Intellectual impairments Autism/PDD Specific language impairment 5

6 SLI: The big picture Delayed (not deviant) learning May originate in toddlerhood (or earlier) with late talkers Some late talkers end up with language in normal range Esp. if receptive language is okay (L. Rescorla, 2011) 25-50% of late talkers end up getting SLI diagnosis Family history Less likely to be caught than articulation problems (David Sedaris s ) Likely to cascade into reading difficulty What does SLI look like? Bad at mapping words to meanings CircumlocuEons SLI kid: Something round and English for breakfast Trouble accessing words? [Like anomic adults!] SyntacEc problems (big idenefier) Tough Eme using grammaecal syntax He run Me want cookie Even when you control for language age w/mlu! PragmaEc problems Which can cascade into social difficulees *Different symptoms in different languages Where does it come from? Tip end of distribution? (Hard to say) The Brain? Genes? (KE family; Crago & Gopnik, 1994) Lots of SLI kids tested, no FOXP2 mutation In mice: Difficulty in motor learning (French et al., 2007, Genesis) Aberrant vocalizations (Gaub et al., 2010) Poor sound-behavior associations (Kurt et al., 2012, PLOS One) Differences in brain development in multiple regions Where does it come from? Deficits in temporal auditory processing (Tallal) Surface Hypothesis: Hard time processing grammatical morphemes with low salience (they don t get stressed in the speech signal) Trouble with linguistic rules (modular-ish) Generalized Slowing Hypothesis: slower at executing a lot of perceptual/motor tasks SLI interventions Imitation Repeat the therapist Modeling Kid makes new version of what therapist says Recasting Restating what kid says (Some others too) As always, generalization is big challenge Other speech disorders Cerebral palsy Impaired motor control Comprehension, cognition often OK Cleft palate Physically impossible to produce certain sounds Again, cognition and comprehension fine Functional articulation disorders (NOS) Otitis media? (ear infections) 6

7 Other speech disorders Stuttering Starts after speech sounds acquired Part-word repetitions Not just And and this one time But also t-t-t-t-time Children often aware (unlike other disorders) Many resolve in a few years h)ps:// Clues to language disorders No babbling by 12 months No conveneonalized gestures by 12 months No spoken words by 18 months Less than 50 words, no 2-word combos by 24 months Speech or language regression First steps: Is it a hearing problem? (audiologist) EvaluaEon, possible therapy (speech-language pathologist) TesEng: lots of opeons, varying in content validity Watch out for language varia5on that s not a disorder (different dialects) Brain lesions Studies of children who had prenatal or perinatal brain injury Before language production started Not necessarily before getting language input Range of lesion locations and sizes Big questions: does L or R hemisphere damage matter for language ability? Is impairment related to lesion size? Brain lesions Methodological problems: Small N Huge variability in Timing of lesion Underlying cause (Stroke? Seizures?) Sensitivity of tests Extreme views of language specialization: Equipotentiality Determinism Compromise: emergentism Brain lesions Early work: Bates and colleagues Large set of kids with similar etiology By about age 6, most had recovered to lownormal levels No relationship to hemisphere damaged Lesion size x performance: U-function: tiny and large did better, medium did worse (consistent with animal lit-- fresh start H) Later, U-function did not hold 7

8 Brain lesions long-term The happy story: Temporary impairment Then recover to normal by about 6 BUT Studies after this age show overall below-normal IQ (verbal and performance) Artifact of more impaired kids continuing to see doctors? Brain lesions long-term After initial recovery of function, is there a decline in IQ later in development for kids with unilateral focal lesions? Levine et al. examined 15 kids who were IQtested pre- age 7 and post- age 7 Unusual--a longitudinal study 12 of 15 showed an IQ decline Equivalent declines in verbal and performance Brain lesions long-term *Side note: what does a decline in IQ mean? IQ tests have age-based norms A 2-y-o who performs like a UCSD undergrad has a higher IQ than that undergrad* Not gaining skills as rapidly (Still improving, but not as fast as normal) Brain lesions long-term Relationship to lesion size? Smaller is worse Relationship to earlier IQ? Higher IQ early on meant bigger decline Why does this happen? Not enough processing power to keep up Artifact--IQ tests start demanding abstract reasoning (maybe a deficit all along) Comparisons across language difficulties Reilly et al. used narratives Look at this picture book and explain story Tests both formal language (e.g., syntax) and cognitive abilities (understanding the story) Do SLI kids look like FL ( focal lesion ) kids? WS (Williams syndrome) kids? 8

9 Study 1: SLI vs. early lesions Measures: Story length Complexity of sentences Rate of morphological errors Assessment Count total # of propositions Count errors, divide by prop. count Assess diversity of syntactic constructions SLI, FL below typical at age 4-6 Lesion group approached normal at SLI, FL below typical at age 4-6 Lesion group approached normal at SLI, FL below typical at age 4-6 Lesion group approached normal at SLI, FL below typical at age 4-6 Lesion group approached normal at ImplicaEon: SLI worse than missing part of brain!! Study 2: SLI vs. Williams (WS) 9

10 Study 2: SLI vs. Williams (WS) Measures: Story length Morphological errors Narrative coherence (major points, theme) Study 2: SLI vs. Williams (WS) SLI: more errors at 4-6 than WS Comparable on complex syntax Study 2: SLI vs. Williams (WS) But WS has harder time maintaining structure of narrative (boy looks for frog) TD: They looked in the beehive and in the hole but could not find the frog. SLI: The dog is trying for the bees and the boy s looking for the frog. WS: And then all of a sudden the dog finds some bees flying. Study 2: SLI vs. Williams (WS) WS use more social evaluation devices Voices, sound effects, exclamations--audience attention TD: They looked in the beehive and in the hole but could not find the frog. SLI: The dog is trying for the bees and the boy s looking for the frog. WS: And then all of a sudden the dog finds some bees flying. Overall picture for SLI Grammatical competence really poor Worse than focal brain injury Narrative skills not so bad 10