Navigating Speech and Language Through Preschool Years

Delay vs. Disorder?

OBJECTIVES

Participants will be able to:• Identify hallmarks of normal speech and

language development• Define speech/language delay versus disorder• Identify characteristics that differentiate

Autism vs. Language Disorder• Connect speech and language development to

literacy

FOUNDATIONS

COMMUNICATION

COMMUNICATION

NONVERBAL

NonlinguisticParalinguistic

VERBAL

Linguistic

6 BASES OF COMMUNICATIVE DEVELOPMENT

1. Neurological- development of structures and landmarks in the brain used for processing language

2. Cognitive-mental activities involved in comprehension of received information; development of symbolism

3. Perceptual-use of sensory information and previous experience to make sense of new sensory information

4. Motor-muscle movement and associated neuro-feedback5. Social –interactive processes that drive learning6. Communicative- development of communicative

intentions evident through goal directed behavior

NEUROLOGICAL FOUNDATIONS

Brain weight is associated with neural development

Early sensation and perception provide the input to increase the number and complexities of neural connections

Brain weight is tripled by 2 years of ageEARLY EXPERIENCES ARE CRITICAL!

Physiological change serves in the development of speech and language

COGNITIVE FOUNDATIONS

• Motor control

• cognition

• perception• Sensation

Cognitive development

Cognitive development

Cognitive development

Cognitive development

Cognitive growth sets the pace for linguistic growth.

MOTOR FOUNDATIONS

•Stability develops in an upward progression, motor control develops in a downward progression.•Motor sequences in the body will be mirrored in the mouth.

SOCIAL AND COMMUNICATIVE FOUNDATIONS

Used to expand an individuals understanding of entities and relationships

Language is used as a social tool, motivated by improving communication and social connections

Symbolic communication is developed by associating real things to cognitive representations.

IF YOU ARE TREATED AS A COMMUNICATOR, YOU BECOME A COMMUNICATOR!

EARLY DEVELOPMENTAL TRENDS

• Typical development happens without our efforts to make it progress

• Motor skills development allows for freedom of movement

• Freedom of movement allows for exploration

• Exploration, in turn, drives development• Changes in development lead to cognitive

and psychosocial development

EXPERIENCE DRIVES DEVELOPMENT

• Experience and interaction help organize the brain and mind for cognitive growth.

• Based on commonly accepted learning theories, we know cognitive growth sets the pace for linguistic growth.

• Parallel development between cognition and language. Play is a vehicle for learning. Language and play are interdependent. Play sequences should be mirrored in a child’s language.

STEPS IN LINGUISTIC PROCESSING

4 steps in linguistic processing:1. Attention- awareness to a learning situation2. Discrimination-identification of relevant

characteristics of different inputs3. Organization- chunking related bits of

information4. Memory-recall of previously learned

information (rehearsal is required for long term storage)

LANGUAGE

Language is an accepted system of arbitrary codes and signals/symbols used to communicate ideas.

Used as a toolHas specific rulesProductive and creative

COMPONENTS OF LANGUAGE

Form

Sounds

Combined sounds

Word order

Content

Vocabulary Word choice

Use

Attitude Emotion

Txt msgng…………………. OMG! …………………. :-P

SPEECH

Expression of language with soundsHumans understand speech by~ 7 months of

ageHumans use speech productively (goal

directed behavior) by ~ 12 months of age Overlaid onto a biological system that has its

roots in a primary survival function (feeding).

THE SPEECH CHAIN

1. Speaker formulates a message

2. Motor nerves send impulses to lungs larynx and articulators

3. Sound waves are transmitted to listener’s ear (enter feedback link)

4. Listener’s ear transforms message

5. Listener’s brain decodes message

SPEECH SOUND DEVELOPMENT

Sound classes, in order of emergence, based on *norms:

vegetative sounds, cooing, vowels, babblingEarliest sounds: /p, b, m, n, h, w/ Followed by: /k, ɡ, d, t, ŋ, f, / Then:/j, r, l/Finally: /s, ʃ , ʧ , z , v, Ө, ʤ/*hypothetical children do not exist. A wide range of

variability can be seen up to 36 months of age.

WHAT IS NORMAL SPEECH AND LANGUAGE?

Development in feeding, speech, language, voice and fluency that follows predictable developmental stages at expected age ranges

Goal directed- used to “get things done”SymbolicSocial and interactiveProgression is based on refinement of sensori-

motor and cognitive skills laid down in the first 24 months.

COMMUNICATIVE TIMELINE:0-6 months

Birthsensory and motor perception

drives learning.Oral reflexes, vegetative sounds

6 monthsMutual gaze, play routines

Co-action patterns, and “proto-conversations”

Pleasure sounds, reduplicated babbling, vocal play

COMMUNICATIVE TIMELINE:7 -12 months

7-9 months• ↑ᵈ goal directed behavior• “Early intentional communication”• Functional gesture and vocalization• more frequent and effective exchanges

12 months↑ᵈ cognitive growth

Shift from pre-symbolic to symbolic communicationFirst TRUE words appear

early phonological productions and simplification processes

COMMUNICATIVE TIMELINE:TODDLER ADVANCEMENTS

Form• SOUNDS-predictable patterns and processing

/p,b,t,d,k,g,h,m,w,n/• SOUND COMBINATIONS-one word relationships • 50% intelligible to unfamiliar listener

Use Ø presupposition

→Making demands→Expressing wishes/displeasure

→Attitudes/states

TODDLER’S RULESAuthor: Unknown

1. If I want it, it's mine 2. If it's in my hand, it's mine 3. If I can take it away from

you, it's mine 4. If I had it a little while ago, it's mine

5. If it's mine, it must never appear to be yours in any way

6. If we are building something together, all the pieces are mine

7. If it just looks like mine, it's mine 8. If I think it's mine, it's mine 9. If I give it to you and change

my mind later, it's mine 10. Once it's mine it will never belong

to anyone else, no matter what

PRESCHOOL ADVANCEMENTS

FormSOUNDS-↑ᵈ consonant development, processes dropped or

dissolving by age 4SOUND COMBINATIONS-syntactic agreements made to sentence

elements and word orderWORD ORDER- basic forms of English (s-v-o) and modifications to

this pattern

Use-situation dependent! Early presupposition

Participation in organized discourseLimited conversational repair and

topic maintenance

PRE-LITERACY FACTS

Children between ages 2-3 years should be able to tell about plans, use scripts and descriptions to describe routines.

At around 4 years of age children add physical and mental states to their descriptions.

Emergent reading phases precede reading, and at around 4 years of age children begin to recognize and identify environmental print, and know the direction of reading.

Narratives have roots in early social language skills.

EARLY SCHOOL AGE ADVANCEMENTS

Form-SOUNDS-by age 8 all sounds competently

producedCOMBINED SOUNDS/WORDS-↑ᵈ noun and verb phrase development, ↑ᵈ markings of

comparisons, action, and reversals (addition of prefixes and suffixes)

↑ᵈ conjoining, embedding, and passive sentence types

Use-↑ᵈresources available to adapt language and adjust to needs of

listenerPresupposition/alternation

Topic introduction and closureConversational repair with ↑ᵈ skill

Use of deictic terms

EXPECTED SKILLS Up to 4 years Up to 5 years Up to 6 years

SPEECH

RECEPTIVE LANGUAGE

EXPRESSIVE LANGUAGE

FLUENCY

/p,b,m,n,h,k,g,t,d/ /f, v, ʃ, ʤ,ȝ, j, w, l, s/ /Ө, r, r+vowels/

Basic concepts, pronouns, Qualitative ,spatial concepts, Time /sequence,Negatives, categories, time concepts, noun +2 early math, Analogies modifiers inclusion/exclusion passive voice

Object ID, asks ?’s, varied word Gives location, reason, Similarities, 1:1 combinations, 4-5 word categorizes, adjectives, divergent naming,sentences, categorizes, past tense, convergent repairs absurditiesobject use, possessives, namingdescriptors, Hypothesizes, gives analogies

Partial/whole word repetition, reformulations, phonemic Reformulated phrasesRepetitions with ↑ᵈ production accuracy

ATYPICAL DEVELOPMENT

When things go wrong…

Dyspraxia Language Disorder Autism

WHAT COULD GO WRONG?

Children quickly compensate for their own missing links. What initially may have appeared to be a delay may actually be a disorder hiding under the “wide range of variability in early childhood development.

Language Disorder: receptive/expressive or bothArticulation Disorders :dyspraxia, dysarthria,

phonological processing disorderAutism or Spectrum DisordersCongenital Disorders: Acquired or Degenerative Disorders

BROKEN LINKS

When skill sets do not appear when expected, we must define a delay or a disorder.

Developmental delay implies “…an impairment… in the meeting of milestones that a child should achieve by a specific chronological age.” (Taber’s Cyclopedic Medical Dictionary, 2001)

The term “disorder” implies a pathologic or abnormal condition. In other words, absence or atypical acquisition and/or presentation of a skill.

RISKS As high as 70% of children exhibiting oral language

impairments will later exhibit difficulties with literacy. Toddler and preschool language development is critical for

school success. Autism is the fastest growing childhood disorder, and is

primarily a disorder of verbal and non-verbal language. A labeling of “delay” does not necessarily mean an

absence of disorder. Excellent memory for rehearsed or rote learned skills

(colors, letters, numbers) is not the same as symbolic learning.

RED FLAGSfor AUDITORY PROCESSING

• Difficulty with phonemic awareness• Asking “what” repeatedly after directions are given, or “I

don’t know” to avoid responding• Answering wh- questions incorrectly• Using semantic substitutions (word for word)in expressive

language that cannot be explained by articulation concerns

• Evidence of increased distraction or fatigue after periods of listening

• Body language indicating “shutting out” of active or potential communicative partners

RED FLAGS for RECEPTIVE LANGUAGE

• Need for frequent repetition• Need for extra explaining before following through with

directions• Difficulty answering questions• Difficulty understanding time concepts• Difficulty understanding prepositions or spatial concepts• Difficulty with 1:1 correspondence• Difficulty organizing or categorizing• Poor eye contact during listening tasks

RED FLAGS for EXPRESSIVE LANGUAGE

• Switching or omission of pronouns (sometimes I am you and you are me and me is you)

• Omission or difficulty using spatial or time concepts• Difficulty retelling actions or events• Omission of connector or functor words (telegraphic speech)• Verb irregularity• Frequently switching topics in conversation• Overuse of rote phrases and communicative exchanges• Inability to tell about something

RED FLAGS for ARTICULATION

• Inconsistent speech sound substitutions• Immature sounding speech toward later preschool years• Irregular airflow during speech• “wet” speech• Hypernasal/hyponasal• Jaw sliding during speaking• Parent difficulty understanding speech• A child should be 80% intelligible to their primary caregiver by 3

years of age, to other listeners by 4 years of age• Messy eating, drooling, or restricted food preferences• Poor stability; open mouth posture, uncoordinated gate +

immature or disorganized speech or feeding.

RED FLAGS for VOICE

• Hoarseness or raspiness in the absence of chronic allergies or recent illness

• Loss of voice within an utterance or conversation

• Breathiness during speech• Difficulty changing pitch during speaking

RED FLAGS for FLUENCY

• Repetitions of phoneme at the beginning of a word, thought or phrase

• Episodes of stopped airflow and/or sound during speech

• Very rapid speech• Variable rate of speech• Avoidance of conversational interaction

IS IT AUTISM?

• DSM-IV (1994)Criteria for Autism requires specific characteristics that include a total of at least 6 variations and manifestations from the following categories:

• “qualitative impairment in social interaction…, qualitative impairments in communication…, restricted repetitive and stereotyped patterns of behavior, interests and activities…”

• “Delays or abnormal functioning in at least one of the following areas, with onset prior to age 3 years: (1) social interaction, (2) language as used in social communication, or (3) symbolic or imaginative play”

• “The disturbance is not better accounted for by Rett's Disorder or Childhood Disintegrative Disorder”

AUTISM vs. LANGUAGE DELAY?

Based on DSM-IV criterion, the primary difference between a language delayed/disordered child and an autistic child is that the child with Autism will demonstrate impairment in areas of social interaction and symbolic play, as well as language form, content, and/or use. A child without spectrum characteristics will still initiate and/or engage in social interactions and play routines.

AUTISM FACTS• According to Pathfinders for Autism, Maryland estimates indicate 1:142 children

are diagnosed with Autism, a complex neurological disorder. Boys are 3-4 times more likely to be diagnosed with Autism than girls. http://www.pathfindersforautism.org/aboutAutism.aspx

• According o the National Institute of Mental Health, causes of Autism have been investigated with the following results: “The Institute of Medicine (IOM) conducted a thorough review on the issue of a link between thimerosal (a mercury based preservative that is no longer used in vaccinations) and autism. The final report from IOM, Immunization Safety Review: Vaccines and Autism, released in May 2004, stated that the committee did not find a link. ..All these disorders are characterized by varying degrees of impairment in communication skills, social interactions, and restricted, repetitive and stereotyped patterns of behavior…Evidence points to genetic factors playing a prominent role in the causes for ASD. A U.S. study looking at environmental factors including exposure to mercury, lead and other heavy metals is ongoing.” http://www.nimh.nih.gov/health/publications/autism/complete-index.shtml

WHAT TO DO?

1. Educate yourself. Find out what is “typical”.2. Be the “eyes” of the community. Be observant for early

warning signs. 3. Document your concerns. It is hard to remember details

as time goes by.4. Interview the child in a non-threatening way. Many

children are aware of their own weaknesses.5. Come alongside parents who suspect their child has a

problem and direct them to community resources.6. Use community resources. Pediatricians, Child Find, and

private practice specialists can help.

ADDRESSING CONCERNS WITH PARENTS

Be prepared. Have all of your observations, papers, and examples ready. Plan how you want the meeting to go.

Educate yourself. Consult a speech-language pathologist about concerns you may have.

Make an approach. Ask the parent when would be a good time to talk about some observations your have noticed in your setting.

Use sensitivity. No-one wants to be told their child is different or irregular. Chose words like “I noticed”, or “based on classroom performance/behavior”, or “lets err on the side of caution and have [concern] ruled out”.

Emphasize the importance of early intervention! Labels can drop off with early and appropriate intervention.