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 116-127

focal brain lesions

lesions that are focal ,or localized to a specific area of the brain,are usually caused by cerebrovascular accidents such as strokes,and are relatively rare in children . however, children with congenital heart defects are particularly vulnerable cerebrocascular accidents and premature babies may suffer focal damage as a result of intracranial bleeding during their first weeks of life outside the womb.

reintegrating students with traumatic brain injury into the classroom

plan small group activities to help develop interaction skills

clarify verbal and written instruction by reading written instructions out loud and accompanying verbal instruction with written ones.repeat and paraphrase often,define unknow terms.

explain core vocabulary and concepts;pre-teach this information in individual sessions

pause when giving instructions to allow extra processing time

give the student extra time to respond ,since processing speed may be slow

avoid figurative language,or explain it when used

give the student a classroom"buddy"to help him or her keep on top of instruction,assignments,and classroom transition times

let the student use assistive devices,such as a computer or ipad

help the student"get organized"by having him or her keep a written (or computer based)log of classed,assignments,due dates,etc.;monitor the log regularly.

set aside time for the student to talk to a trusted adult about feelings and frustrations

plan extracurricular activities based on interests before the injury as well as on current abilities

advoid direct,confrontational questions in class;ask leading or indirect questions(tell me about......)to encourage responsiveness

decrease distractions in the classroom,if mobility problems are present,carefully arrange classroom furniture to allow freedom of movement.

modify assignments by reducing the number of questions to be answered,or material to be readed;let student record lectures,give test answers verbally to a scribe;go over tests and explain answers

augment textbooks with pictures and vocabulary lists ,highlight key information;provide a "podcast"with a summary of textbook information;assign review questions and use reciprocal teaching techniques

teach compensatory strategies

announce and clarify conversational/lesson topics

support communication with gesture,pictures,print,etc.

require and expect communcation,reinforce all communicative attempts;construct opportunities to communicate(e.g.,lunch buddies,paired classroom activiities)

practice higher level reasoning skills in small groups with peers engaged in problem-solving activities

encourage memory skills by teaching strategies such as categorizing, association, rehearsing, visualizing, and chunking 

seizure disorders(landau kleffner syndrome)

difficulties with comprehension often occur along with difficutlies speaking.

differences between language-learning disabilities and acquired language disorders(p.118)

反差有点大

DLD associated with psychiatric disorder

autism spectrum disorders

parents of children with ASD are no different from parents of other children with disabilities

differences between children are as striking as the similarities and an assessment or intervention approach that works well with one child may be completely inappropriate for another child with the same ASD diagnosis.

early communication

include reduced eye contact,socaial smiling,social interest,and social imitation,reduced response to their own name and fewer responses to bids for joint attention.

severity levels of ASD

level 3:requiring very sustantial support

level 2:requiring sustantial support

level 1:requiring suppot

cognitive characteristics

language characteristics

a significant percentage of children with minimal language skills in early life develop at least some spoken language skills by the age of nine.

form

content

use

pragmatic deficits are universal within ASD and may be particularly evident in higher level discourse processing and narrative tasks.

individuals with ASD have sinificant deficits in conversational skill,demonstrating either too many or too few initiations,poor topic maintenance,fewer contigent conversational responses,and non-contextual or socially inappropriate utterances.such deficits are also evident in narrative tasks with ASD individuals producing higher propotions of contextually irrelevant propositions,poor referencing throug-hout the narrative and ignoring the motivations of characters or events.understanding of language in context is regarded as particularly problematic for individual with ASD as evidenced by poor under-standing of figurative and metaphorical language.

literacy

had reading comprehension difficulties 

those with poor phonological skills tend to have problems with decoding text(i.e.,non-word reading and spelling),while those with poor semantics and grammar tend to have greater difficulty with reading com-prehension.

in additon to language,aspects of autistic cognition may also influence literacy development.

implications for clinical practice

parent involvement in intervention,individualization to each infant's developmental profile,focusing on a broad rather than a narrow range of learning target,temporal characteristics involving beginning as soon as the risk is detected and providing greater intensity and duration of the intervention.

conditions associated with ASD

pragmatic language impairment or semantic-pragmatic disorder

DLD(developmental language disorder)

children with pragmatic language impairment are those with intermediate symtom profiles that are not severe enough to warrant a diagnosis of autism,but whose language difficulties communication,social in-teraction,and use of language in context.

many children with ASD have additional language difficulties ,and that these children also have rigid interest and behaviors that will interfere with pragmatic language development.

nonverbal learning disability

children with nonverbal learning disability have particular difficulties with visual-spatial,visual-motor, an fluid reasoning measures compared to children with other developmental disorder.

ADHD

ADHD is a debilitating and chronic condition that affects the child's ability to control attention and behavior in an optimal and adaptive manner.

two components to the disorder:inattention and hyperactivity/impulsivity

12岁前出现，持续6个月，对社交、学习、工作造成困扰

diagnostic criteria for ADHD(p.124)

inattentive type:poor attention and concentration ,distractibility,poor organizational skills,and difficulty completing task without close supervision occur.在無監管下難以完成任務

hyperactivity/implusivity type:fidgety,always on the go,interrupting and talking incessantly,and acting without thinking.

cognition

executive functions are cognitive processes associated with the frontal lobes of the brain that enable us to remenber,plan,organize,and inhibit irrelevant information/responses in order to achieve our goals.

抑制、工作記憶、計畫這幾個方面受損

children with ADHD find it difficult to wait for something desirable,even if the pay off for waiting brings greater reward;if given the choice between $2 now or $20 tomorrow,children with ADHD are far more likely than peer to take the money and run.

without this ability(延遲滿足)it is very difficult to learn to control impulses,and distracting behavior results.these problems may be exacerbated with lower levels of arousal,which may lead to "sluggish" （不想動）performance and a lack of effort.

language

imagine the toddler who is irritable ,disruptive and constantly on the go--opportunities for engaging and interacting with this child in a way that supports language growth may be limited(not to mention the exhausted and frustrated parent may struggle to communicate optimally)!however,poor language skills may lead to behaivors that are reminiscent of ADHD.

form

language impairments,such as tense marking,sentence repetition,and narrative,

content

it is likely that receptive vocabulary scores will be in the average range,but that children with ADHD may have subtle difficulties rapidly accessing the lexicon,or making connections between words.

use

the ability to use language in socially appropriate ways is most likely to be a problem for children with ADHD.

children with ADHD are reported to have significant pragmatic language difficulties,sometimes indistinguishable from peers with ADHD.

inappropriate initiation,interruption,difficulty maintaining a topic,and responding with appropriate amounts of information.

literacy

early and consistent exposure to books and literacy as a pleasurable experience may help to increase motivation to read in these children.

implications for clinical practice

almost every classroom will include a child with ADHD.

會採取藥物治療:Ritalin/dexedrine/cylert,在短期內減少問題行為的發生

行為治療與藥物治療相結合

behavioral treatments will include family therapy and support to deal with challenging behavior and to foster good language and communication experiences,interventions aimed at modifying the environment at home and at school to maximize attention and minimize distraction,and direct behaivoral interven-tions with the child to help him or her internalize rules,develop strageties for planning and organizing work and managing his or her own behavior.

classroom strategies for children with ADHD

universal level of intervention

model and practice explicit strategies for memorization,test-taking,study,and active reading 

verbal and written practice focused on reading comprehension instruction

monitoring of how to organize notebooks and binders and written work

use planners and calendars

develop and teach clear school-wide for class-wide expectations

teachers use prompts and signals to remind sutdents to follow rules

staff practice active supervision,scanning for problem areas or interactions,and interacting frequently with students to reduce problem behavior

secondary(targeted)level of intervention

peer tutoring

providing choices

note-taking

parent involvemnt

tertiary(individualized)level of intervention

computer-assisted instruction provides students with ADHD immediate feedback,one-to-one attention, and content presented in an interesting way

well-constructed computerized instruction uses color and design to help the student focus on critical information,breaks material down into smaller chunks to promote mastery,provides immediate feedback, and addresses specific instruction objectives

functional behavioral assessment to identify behaviors of greatest concern and the triggers for those behaviors

implement plan to reinforce positive or pro-social behavior and reduce problems

encourage self-monitoring by teaching children to observe and record their own behaivors(such as on-task behaivor)

use a reminder system ,and electronic pager-type device that sends a silent pulsing signal and does not require verbal teacher remiders

provide checklists of important tasks or steps for students to complete tasks

selective mutism（選擇緘默）

selective mutism may be diagnosed in a child who consistently does not speak in certain situations,such as school,where there is an expectation for speech,but does speak normally in other situations,like at home.

it is much more common in girls（我曾經接觸過一個）

selective mutism is generally regarded as an anxiety disorder

self-consciousness about communicative abilities plays a part in maintaining the disorder

評估時孩子有可能保持沈默，治療師需要從家長方面獲取有用信息，觀察兒童在單獨遊戲或與父母、兄弟姊妹進行遊戲時的情形。

language therapy,positive reinforcement for speaking,desensitisation to anxiety-provoking situations, family therapy,and self-modeling techniques,in which the child listens to him or herself speaking in situations in which he or she is usually mute

at first,involving a parent or one person the child does talk to and increasing confidence with speaking to a familiar person(teacher),then group fo familiar people(classmates)before tackling unfamiliar people(restaurant or shop)

strategies for interventing with selective mutism(p.127)

1.stimulus fading:audience or setting changes,rather than the child

2.shaping:child's behaivor starts to change

3.desensitization:child gets used to thought of doing something that he or she would not previously have considered