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 127-136

developmental language disorder associated with extreme environmental disavantage

developmental language disorders that result from substance abuse,such as alcohol,or from parental maltreatment,such as abuse and neglect,are some of the most tragic aspects of our clinical practice because these kinds of disorders could have beeb prevented.

environmental disadvantage can have a profound effect on structural and functional brain development, especially in the domains of language and prefrontal executive control.

置身/處於不良生存環境中

abuse/neglect

types of maltreatment may include physical abuse,sexual abuse,emotional abuse(excessive belittling, verbal attack,or overt verbal rejection),and neglect(abandonment,inadequate supervision,failure to pro-vide necessary items such as adequate nutrition or clothing)

difficulties using language to articulate their feelings and needs as necessary for self-regulation;to convey abstraction,which is necessary for advanced literacy and reading comprehension;and to sustain coherent narrative dialogue,which is key to social exchange.

maltreatment children are more likely than peers to engage in challenging behaviors that are likely to elicit further negative reactions from teachers and peers.

fetal alcohol spectrum disorder

a mother (or father)who is frequently drunk,high on drugs or driven to get drugs by any means necessa-ry is not a person who can devote much energy to childrearing.these parents often have difficulty understanding their children's communication attempts and may not respond appropriately to them,often rejecting or criticizing their efforts.

children with fetal clcohol spectrum disorder have a generalized deficit in the processing and integration of information,with resulting deficits in nonverbal IQ scores and measures of language processing,relative to their peers.

characteristics of fetal alcohol spectrum disorder(p.128)

clinical implications

clinicians have a legal duty to report maltreatment and prevent the child coming to harm.

any practice that causes a real and present danger to the child requires immediate action.

careful monitoring of hearing status

reduce undesiable behaviors and encourage language for the purpose of reflection,negotiation,and behavioral control.

severe speech-motor disorders

particular relevance is that a communication device that provides voice output,in other words it "speaks"what the child selects to communicate,is very effective in stimulating speech and language growth.

used on an iphone ,itouch or ipad

users of AAC must be able to do more than request,protest,and answer questions,they must also com-ment,ask questions,express emotions,and build relationships.

reduce challenging behaviors by providing an alternative means of rejecting unwanted approaches and requesting help.

when introducing word combinations and sentences,it may be more important to stress the communicative functions of these utterances,rather than focusing strictly on the grammatical forms needed to express idea.

it will be important for clinicians to begin to introduce some talk about past time,predictions about future events,discussions of pretend,and so on.

children using consumer electronic devices like ipads,rather than more unfamiliar dedicated devices,will find peer partners willing to communicate through the device with them,because of its"cool"factor.

improving basic language development

provision of early,intensive exposure to story-book reading,opportunities for carefully scaffolded phonemic awareness,and letter-sound association.

strategies for developing literacy skills in children using AAC(p.131)

sound blending,phoneme segmentation,letter-sound correspondence,decoding,shared book reading,sight word recognition,reading simple sentences and stories,reading comprehension

reading comprehension

targets may include:summarizing,generating questions,answering questions,semantic/graphic organizers,predict next words/sentences in text,activate prior knowledge

childhood apraxia of speech

兒童期言語失用症，也被稱為發展性言語失用症,是指當兒童在發語音、音節，和文字時出現困難。 此種困難並非肇因於肌肉無力或麻痺，而是大腦在計畫說話所需的身體部位(例如，嘴唇，下巴，舌頭)時，出現困難。 兒童知道他們想說什麼，但是他們的大腦在協調說話所需的肌肉動作時，出現問題造成此種疾病的確切原因是未知的部分觀察指出，基因遺傳為導致兒童期言語失用症的原因，因為許多患者都具有溝通障礙的家族病史。兒童期言語失用症無法被治癒，但是透過適當且密集的介入，患有此種運動言語障礙的人， 可以獲得顯著的進步。

「兒童期言語失用症是種小兒神經性的言語-語音障礙，是指在沒有神經肌肉缺損(例如異常的反射、異常的張力)的前提下，其說話時基本動作的精準度及一致性受到損傷。已知的神經性疾病、已知或未知的複雜神經行為障礙，或是原發性的神經性言語-語音障礙，皆可能導致兒童期言語失用症。其核心損傷主要出現在計畫動作序列之時間與空間向度上，導致在發音時，語音和語韻的錯誤。」美國聽語學會(2007)

https://zh.wikipedia.org/wiki/%E5%85%92%E7%AB%A5%E6%9C%9F%E8%A8%80%E8%AA%9E%E5%A4%B1%E7%94%A8%E7%97%87

it can be very difficult for a clinician to te definitive about whether a child is experiencing childhood apraxia of speech or developmental speech sound disorder.

intervention approaches for children with childhood apraxia of speech

motor approaches

massed practice

use block practice schedules early on 

use random practice schedules later

provide feedback

provide slowed-down models

practice,practice,practice

prosodic approaches

practice analyzing words into syllables

identify stressed syllables in words(if necessary,use backward chaining to achieve this(e.g.,have the child say y, city,tricity,lectricity,electricity)

match phrases with meaning according to stress patterns

have children identify stressed words in sentences

use "wh-"questions

誰吃了芝士？🐭

🐭吃了什麼？芝士

🐭在幹嘛？吃芝士

the nonverbal child with ASD

a small but significant proportion of children with ASD fail to acquire any verbal language.

some requests and protests are expressed,but joint attention or social interactions are not.

provide some conventional means-gestures,signs,vocalizations,words,or some form of augmentative communication such as a picture board-for expressing the intents the child is already producing.

provide extensive support for eliciting joint attentional and social interactive behaviors.

intervention approaches for the child with ASD who is nonverbal (p.133)

establish receptive joint attention

establish initiation of joint attention

work with parents to increase synchronous responses to child's behavior/communication attempt

focus on language input

encourage imitation:start by imitating the child;then reward the child's imitation of the adult.

encourage development of social interactive routines

use sounds the child is already producing to encourage first words

replace unconventional communication

expand range of communicative functions

develop strategies to maintain and repair breakdowns

provide environmental supports to enhance social communication

AAC IN ASD

everyone needs some way to communicate

object(such as a spoon to represent a bowl of cereal to eat) or picture exchange systems

pecture exchange communication system

it is important to make every effort to elicit speech during the preschool period.

for individuals with ASD,it would seem important to include direct attempts to elicit and develop spoken language so that they may have more opportunity to reach their potential.

every assessment will need to start with the child and his or her family,and we must ensure that we do not miss anything important that may not fit out stereotypical profile of a child with a given disorder.

knowing a child's diagnosis is only a signpost,we need to work closely with families to discover their primary concerns and prioritiess,and to conduct a thorought assessment of a broad range of language and related functions.

we need to develop intervention goals and methods based on the assessment data,choosing among a repertoire of procedures and contexts.

cognitive and language characteristics across diagnostic categories(p.135)