Language problems. Language Impairment. A note of skepticism. Hearing impairment 5/15/11

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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 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 stand up to a simple t- test. 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 1

2 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 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 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 Hearing impairments 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 2

3 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, 24 at age 4 Big trouble with English morphosyntax Later, pretty good narrative, pragmatic skills 10%+ diagnosed with autism Williams syndrome Genetic Characteristic appearance, health issues Old claim: bad cognition, good language (reverse of DS) 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/ds Fragile X Problem with X chromosome (mostly boys affected; biggest source of ID w/known source in boys) Delayed language onset Poor oral-motor skills, articulation A little better than DS for language skills Perseveration in language As many as 25% with autism 3

4 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 ( watch?v=wsgwezetsqy) Rett syndrome ( v=rqvtgv7f2jm) PDD NOS Categories change from time to time Is Asperger different from hi-functioning autism? Are all cases from same source[s]? 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 socially-imitative play [Obsolete: must be evident by 30 months] Autism Age of discovery: ~2 years Signs may appear earlier Aberrant eye gaze Lack of responsiveness to name Hand flapping, toe walking About 1/3 reported to show regression Seeming increase in cases over time MMR vaccine? Probably not. Corresponding decrease in ID diagnoses 4

5 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 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 Autism & language Receptive, expressive correlated, both related to IQ Phonological skills better than others 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

6 Autism & language Echolalia: repeating things you ve heard 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 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 Autism treatment Autism treatment Behavioral interventions Lovaas (1977, 1987) Applied Behavior Analysis (ABA) Operant conditioning (reward/punish) Good outcomes in clinics Less if parents administer (< time?) Developmental social-pragmatic None meet strict criteria for efficacy. Multifaceted TEACCH approach New study: it improves range of skills Nonverbal? Picture communication (AAC or others) AAC: 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) 6

7 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 Language problems Several conditions are related to difficulties in spoken language acquisition: Hearing impairment Intellectual impairments Autism/PDD Specific language impairment SLI: The big picture Delayed (not deviant) learning May originate in toddlerhood (or earlier) with late talkers 25-50% of late talkers end up getting SLI diagnosis Family history Less likely to be caught than articulation problems (Wewease Wodewick, David Sedaris) Likely to cascade into reading difficulty What does SLI look like? Bad at mapping words to meanings Circumlocutions SLI kid: Something round and English for breakfast Trouble accessing words? [Like anomic adults!] Syntactic problems (big identifier) Tough time using grammatical syntax He run Me want cookie Even when you control for language age w/mlu! Pragmatic problems Which can cascade into social difficulties *Different symptoms in different languages 7

8 Where does it come from? Tip end of distribution? (Hard to say) The Brain? Genes? (KE family; Crago & Gopnik, 1994) Lots of kids with SLI tested, don t have this gene Controls motor sequencing in mice v=fg2rlokol9q 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 (modularish) Generalized Slowing Hypothesis: slower at executing a lot of perceptual/ 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 a toughie 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) 8

9 Other speech disorders Stuttering v=2jk3atlfwkq 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 Clues to language disorders No babbling by 12 months No conventionalized 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) Evaluation, possible therapy (speech-language pathologist) Testing: lots of options, varying in content validity Watch out for language variation that s not a disorder (different dialects) 9