Chapter 2 Syndromes, Developmental Disabilities, and Motor and Sensory Impairments that Affect Language and Speech

Objectives Identify the primary characteristics of a variety of disorders associated with pediatric language deficits Differentiate between sequence and a syndrome Differentiate between the descriptive terms genetic, chromosomal, and heredity Describe the effects of hearing loss on a child’s development of form, content, and use of language, then discuss the impact of cochlear implantation on language and speech Discuss the impact of prematurity on cognition and language development Discuss the effects of alcohol, nicotine, and other drugs on speech, language, and cognitive development

ASHA Definition of “Language Disorder” Impaired _______________, ______ and/or other ___________. The disorder may involve (1) the form of language (phonology, morphology, syntax), (2) the content of language (semantics), and/or (3) the function of language in communication (pragmatics) in any combination. Students need label (eligibility) based on the society that we live in. That is how children receive services in school as well as government assistance such as medicaid.

Genetic VS Chromosomal Genetic - Specific characteristics or traits passed from __________________. Genetic Disorders – Disorders carried on _____. May be ______ (gene undergoes mutation), or may be ________ Chromosomal Disorders – A disorder in the structure or number of __________ or both. May be inherited or acquired, as well. The terms genetic and chromosomal are used as though they are synonymous. Each human being has 46 chromosomes – 23 from the mother and 23 from the father = Any variation of this creates a problem Chromosomal disorder ( page 39)

Sequence VS Syndrome Sequence – a disorder where many of the anomalies are actually ________ disorders, caused by a ________ anomaly which sets off a chain reaction of changes in the developing embryo that result in other anomalies Syndrome – the presence of _______ anomalies in the same individual, with all of those anomalies having a ____________. Possible for a child to have a syndrome and a sequence, such as having Stickler syndrome in Robins sequence. Stickler syndrome is a group of hereditary conditions characterized by a distinctive facial appearance, eye abnormalities, hearing loss, and joint problems. These signs and symptoms vary widely among affected individuals. A characteristic feature of Stickler syndrome is a somewhat flattened facial appearance. This is caused by underdeveloped bones in the middle of the face, including the cheekbones and the bridge of the nose. A particular group of physical features, called Pierre Robin sequence, is also common in people with Stickler syndrome. Robin sequence includes an opening in the roof of the mouth (a cleft palate), a tongue that is placed further back than normal (glossoptosis), and a small lower jaw (micrognathia). This combination of features can lead to feeding problems and difficulty breathing. (pg. 53)

Down Syndrome Down Syndrome is a _________________ Presence of ___ copies of chromosome ___ rather than ___. _____ – _____ births are Down Syndrome Cognitive ability ranges _____ to ______ Also known as trisomy 21 3 copies of chromosome #21 rather than the usual 2

Characteristics of Down Syndrome Dysplagia – ________________ Prognathism – ______________ Hypotonia – ________________ Small ___________ Mouth breathers; open _____________ Large ___________ Late ____________ Hard palate is _____ and _________ Possible ______________ Motor, speech and language delays are present in ______ down syndrome children Dysplagia – round face with development of tissue of the midface area and a prominent jaw (prognathism) Speech Intelligibility is difficult

Although the degree of disability varies, all babies with Down syndrome show a ____________ with regards to their motor, speech, and language development. Studies show little difference in the quality and quantity of vocalizations in babies with DS up to ____ months of age Delay becomes more apparent at 12 months, and DS children often do not begin to use words until ______ months General rule: DS achieve developmental milestones at about twice the age that typically developing children achieve milestones. Example: DS sit at 11 months, creep at 17 months, walk at 26 months, and speak first words around 18 months

Oral Development Palate

Speech and Language Skills Articulation errors tend to be ________ with typical children Voice quality ________, _______ and _______ ________ is fairly common Receptive language is _____ ______ than expressive language Use more ________ especially when their __________ of lexicon exceed 100 words Very ________ Language skills tend to plateau at about ___ years of age As DS child gets older gap _________

Speech and Language Skills Dissociated verbal comprehension and production As DS child gets older gap widens Particularly in syntax and morphology (expressive language) Issues with vocabulary use Typical MLU _____ words at ___ years, ____ words at ___ years, and ____ words at ___ years of age Want to work on increasing length of utterance Motor – low muscle tone, hypotonic, hyperflexive

Hearing Impairments in Down Syndrome Small___________ Congenital malformation of the _________ Congenital malformation of the ____________ Suffer from impacted ___________ Frequent _______________ Conductive hearing loss, coupled with frequent middle ear infections can affect ______________ ____ of DS children suffer a hearing loss Page 47

Fragile X Caused by a long arm on the __ chromosome AKA _________ syndrome Mild to moderate _____________ Linked to 2-3% of all cases of ______ More prevalent in _____ than ______ 1 in 1000 males; 1 in 2000 females 2nd most common genetic syndrome

Characteristics of Fragile X _________________ is linked to 1/3 to ½ of the cases of mental handicaps Characteristics are often not apparent until late in ______________. Large ______ Prominent _____ Generally _________

Speech and Language Skills of Fragile X _________ delays Language Deficits – more _______ than __________ Auditory Reception Grammatic Closure Auditory sequential memory Severity can be mild to nonverbal Use of echolalia Perseveration Word Finding issues – impacts their ability to answer direct questions Delayed syntax Pragmatic deficits Varied intellectual impairment – There intellectual and language impairments do impact academic growth They may look like autism however, they are social ( may receive a secondary dx of autism) – may be tactile defensive Along with speech, language and hearing deficits these children may also have: Poor eye contact Hyperactivity Cognitive deficits more common in boys than girls Social deficits Receptive language and semantic skills may be unaffected Poor turntaking

Motor and Sensory Deficit Static Encephalopathy - AKA – __________ May affect a child’s _________ skills due to muscle tone Hearing Impairment Depends on the ___________ and the ____ at which the child becomes hearing impaired (or when the hearing loss is detected), as to the language disorder associated with the hearing impairment Motor and sensory deficits can contribute to language deficits b/c they affect the degree to which children can explore their environment, and hence, learn language through this exploration.

Let’s Talk “Think About It” page 73 in text book

Hearing Impairment ASHA definition – page 74 Deaf Hard of Hearing Language disorders of a hearing impaired individual can be variable – based on when the impairment occurred Variable based on when you became hearing impaired of deaf

Other factors are: Whether or not the hearing loss is ______________ Whether it is ________________ What _________ of hearing loss the child demonstrates How much __________ the child has received Family __________

Types and Levels of Hearing Loss Prelingual and Postlingual Hearing Loss Prelingual hearing loss – the acquisition of a hearing loss _____ to the development of speech and language Postlingual hearing loss – the acquisition of a hearing loss _____ the development of speech and language. Table 2-8 page 76 – look at and review this table Mild – may choose to do some environmental manipulation Moderate – facilitat the understanding of conversational speech trouble with auditory perception, auditory discrimination, and auditory memory (definitions page 77) Severe - Speech and language skills are likely to be delayed Profound – significant difficulty discriminating her sounds even with amplification

Otitis Media and Otitis media with effusion OM – ________________ OME – Inflammation of the middle ear accompanied by the ____________________________ Problems that may occur Both cause _______________ depending on presence of fluid in the middle-ear system Page 78 The effects of hearing loss on specific language areas

Fetal Alcohol Syndrome .6 – 3 in every 1000 children are diagnosed with FAS One of the leading causes of ________disabilities. _____ preventable

Diagnosing FAS Diagnosis of FAS must include _________________ The child must exhibit three primary symptoms _________________

Alcohol Related Neurodevelopmental Disorder – Fetal Alcohol Effect Diagnosis when all three primary symptoms are _____ ______ Diagnosis found __ times more than fetal alcohol syndrome (FAS) Anomolies can be found pre or post natally

Physical Characteristics Insufficient development of _______________ Short __________ Small ___________ Possible ______ fingers and/or toes Abnormal __________ Hip ___________ Kidney __________ _______ Minor ______________ Abnormal __________ ___________ Generalized __________

Language Deficits found in FAS _________ __________ Expressive language skills are ______ than receptive language skills Word _______ Word ___________ Issues with ___________ Also impacting Learning and Language are: _________ problems _________ deficits ___________ IQ is at times approximately 70 – borderline range Issues with social language rules

In the classroom a child with FAS may exhibit: Conceptual deficits such as ____ and _____ Comprehension of both ________ and _____ material Basic ____________ ______ and ______ memory deficits Disruptive in the classroom Issues with academic completion

Let’s Talk “Think About It” page 72 in text book

Intellectual Disability Descriptive criteria for labeling a child intellectually disabled is: Difficulty ______________ Delays in __________________ _____________ Lack of ______________ Delay in development of __________ such as self-help or self-care skills Page 89 – DSM – IV After reviewing the slide and the dsm review page 90 IQ

Intellectual Disability is based on IQ Classification Borderline 70 – 80 Mild 50 – 69 Moderate 35 – 49 Severe 20 – 34 Profound Below 20

Acquired Language Disorders A result of illness ________________ Difficult to describe a typical language pattern with children with acquired language disorders b/c the brain is not consistent.