Language Disorders:from Infancy through Adolescence:

Listening, Speaking, Reading, Writing, and Communicating

Rhea Paul, PhD, CCC-SLPProfessor, Yale Child Study Center

New Haven, Connecticut

Courtenay F. Norbury, PhD

Senior Research Fellow Department of Psychology Royal Holloway University of London London,England

pages 112-116

otitis media(中耳炎）

children who experience otitis media ,particularly with effusion,often suffer some degree of conductive hearing loss during the otitis media episode.

many developmental disorders such as Down Syndrome are particularly susceptible to otitis meida,which may exacerbate language-learning difficulties.

auditory processing disorder

auditory processing includes the auditory mechanisms that underlie the following abilities or skills;

1)sound localization and lateralization

2)auditory discrimination

3)auditory pattern recognition

4)temporal aspects of audition,including temporal integration,temporal discrimination(e.g.,temporal gap detection),temporal ordering,and temporal masking

5)auditory performance in competing acoustic signals(including dichotic listening)

6)auditory performance with degraded acoustic 

is language impaired because of auditory processing disorder,or is performance on the task compromised because of limitations in linguistic ability.

a child with poor attention and language delay may be diagnosed with APD by an audiologist, DLD by a speech-language pathologist,or ADHD by a clinical psychologist.

Deaf-Blind

there are two major causes of deaf-blindness.one is Ruella syndrome,the second major cause is Usher's syndrome.

have normal cognition

AAC intervention techniques for children with deaf-blind

signalling:such as coordinated rocking with reciprocal cues to start and stop

gestures:such as say hi,bye-bye,or head nods

anticipatory cues:such as rubbing the child's cheek with a washcloth to signal bath time 

adapted signs:gross approximations can be accepted and then gradually shaped to more conventional signing.

finger spelling：從有趣的遊戲開始，再到熟悉的物體和日常進行的活動

speech:有殘餘聽力可以，和其他形式的溝通並存

print/braille：充分利用殘餘視力、盲文學習

aided techniques

opticon,teletouch,communication boards,typing and writing

DLD associated with acquired neurological disorder

acquired brain damage can have severe and long-lasting effects on language, communication, and academic success.

traumatic brain injury

open-head injuries,such as gunshot wounds

closed-head injuries,such as those resulting from blows or collisions

road accidents and falls account for the largest proportion of cases

cognitive characteristics

reduced cognitive ability may affect speed of information processing and pragmatic skills such as narrative and discourse competence, deficits in executive function,with consequent difficulties with attention,conversation,and impulsivity.

language characteristics

mild deficits in naming ,word fluency,and expressive/receptive grammar are probable.

use

pragmatic language skills are particularly vulnerable in traumatic brain injury

problems with turn-taking,topic maintence,generating verbal responses,and understanding the intentions of others.difficulites understanding non-literal language,generating inferences,resolving ambiguous messages,and a heavy reliance on verbatim memory,rather than interpretation,in narrative tasks.

literacy

the extent of literacy impairment may depend crucially on the age of injury and the extent to which the child was already literate prior to injury.reading comprehension is more likely to be impaired relative to word reading and decoding skills.

implications for clinical practice

assessment needs

there are three stages to the assessment process in this population

phase 1:the child is recovering medically,usually in an acute-care facility(focus on physical care needs that affect treatment,such as respiratory,swallowing,or motor control problems.)收集孩子的相關信息，發病前能力處於什麼狀況，哪些方面存在優勢，哪些方便比較弱，幫助家庭了解孩子目前的情況。

phase2:the child is medically stable and ready to begin rehabilitation(focus on determing the child's functional strengths and needs in behavioral,cognitive,and communicative domains.)

phase3:ongoing assessment is needed in the child's educational and daily living settings(using formal and informal methods to establish baseline functions,identify goals for intervention, and evaluate change in the therapy program.an assessment of the child's environment will also be necessary,in order to identify the demands and expectation of the child's daily living situations)在每日生活環境中能有效進行溝通，減少溝通障礙

intervention issues

develping an intervention program with traumatic brain injury will involve close collaboration with both families and the multidisciplinary team managing the child's care.

seek to ratrain or develop cognitive skills.and those that teach compensatory strategies.

traumatic brain injury learning needs include:more marked memory deficits for recent events,potential for physical impairments(paresis or weakness),cognitive impariment,poor retention of new infromation,visual deficits,rapidly changing behavior,internal as well as external distractions,adverse effect on learning due to trauma-induced sluggishness or medication,reduced insight into his or her own learning problems,and labile and sometimes unpredictable emotions not always linked to immediate context.

assessment strategies for traumatic brain injury using WHO framwork

impairments in body structure and function

use standardized tests to examine all major areas of cognitive and communicative function-ing

intelligence,executive function,judgement and reasoning,problem solving,attention and concentration,memory,perceptual and perceptual motor skill,academic achievement, speech, language form and content,language use(pragmatics)

systematically manipulate test variables to identify factors that influence success or failure  on standardized tests.