Adolescent Language Impairment(Exam 3)

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Tweens

Back 1

9-11 years of age

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Adolescent

Back 2

• 12-20
o Angst
o Moody
o Rebellious

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Statistics

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• 1 of 4 teens are at risk of not successfully entering adulthood

1.2 Million fail to graduate from HS
• Dropping out of high school has an impact on the adolescent on integrating to adulthood
71% National graduation rate/ < 50% AA and Hispanic students
• 71% of high school students graduate on time with a normal diploma. But among African American and Hispanics, only half are at that time
• Children from the top 25% of income families are 7 times more likely to graduate compared to the lower 25%

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Reasons for dropping out of school

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• No basic academic skills
• Lack of social and academic engagement
• Teen Pregnancies

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Definition of Adolescence

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• Adolescence- a developmental stage that is influenced by our culture. Goes through a biological, sociocultural and psychological.
• In western cultural, you get to be an adolescent longer:
o More money
o Not required to take on adulthood as early
o Technology

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Biological factors of Adolescence

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• Onset of puberty to the completion of bone growth.

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Sociocultural factors of Adolescence

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• Laws about compulsory education
• Child labor laws-15 ½ - 16 years of age

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Psychological factors of Adolescence

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• A period of accelerated cognitive growth and personality.
o Learn to think abstractly and establish personal identity.
• 7% of birth to 20 year old have communication impairment
• Many adolescent that have language impairment do not receive services
o At 12-20, many people believe that they may be stuck in that impairment
 Fell through the cracks
 “Language growth has already occurred, why work on it?”

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Metalinguistic

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a person’s ability to consciously reflect on their language
o Writing a research paper on you stand on abortion and give 17 facts that support your stand. And then you look at your paper and start to ask yourself if you are answering this correctly.

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3 Guiding principles

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Assess in context and not isolation
Standardized test can be use but do not stand alone
When assessing school-age and adolescent children, consider the curriculum demands

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Classroom observation

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i. When doing class room observation, you can also observe the teacher as well as the student
1. Does the teacher talk to fast?
2. Can the student keep up with the instructions?
3. What kind of modifications or accommodations does the child need in the classroom?
4. The teacher has to follow the modifications or accommodations of the child is it’s written on the IEP

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Student Interview/ case history form

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ii. Student interviews can help you gain insight of what the child thinks is wrong

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CELF-4

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Up to age 21

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Non Standardized assessment

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Portfolio assessment

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Guiding principle 3.
When assessing school-age and adolescent children, consider the curriculum demands

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a. Curriculum content standards
b. Teacher Language Self-evaluation form
c. Curriculum Analysis form

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b. Teacher Language Self-evaluation form

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i. Teacher language self-evaluation form is a way for a student to evaluate the language of the teacher

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c. Curriculum Analysis form

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ii. Curriculum Analysis form are used to analysis the textbooks and materials of the curriculum. And with that information they find equivalent but alt. for children with LI

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Type of reinforcement I would typically use with an Adolescent

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secondary- specific information and natural

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The therapy techniques I would likely to use with an adolescent

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modify linguistic input, extension, expansion, self-talk

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The structure of therapy sessions

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academic

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Mental Retardation

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• Mental retardation is a developmental disability that can appear from birth through the age of 18. People who are mentally retarded function at an intellectual level that is below average and have difficulties with learning and daily living skills.

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The frequency of Mental Retardation

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• Approximately 2.5 to 3% of the total population are mentally retarded.
• Lifelong condition
• No connection between race and gender with the disorder

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Causes for Mental Retardation

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Unknown
Heredity
Result of behavior during pregnancy
Birth defects
Acquired MR
Environmental Factors

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Unknown Cause of Mental Retardation

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The cause most of the time is unknown

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Heredity cause of Mental Retardation

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a. 5% of all mental retardation can be linked to heredity
i. Inherit an abnormal gene or mutation of a gene or chromosomal defect
ii. One of the most common is Down syndrome. Child is born with an extra chromosome.
iii. Another is fragile X syndrome. Defect in the chromosome that determines the sex of the child

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The result of behavior during pregnancy to cause Mental Retardation

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a. Poor nutrition
b. Smoking
c. Drink alcohol
d. Prescription medications
e. Mothers that contract rubella
f. High blood pressure
g. Blood poisoning
h. Exposure to radiation

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Birth defects that cause Mental Retardation

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a. Some impact on the central nervous system and brain can cause mental retardation but not always

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Causes for acquired mental retardation

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a. Child can be born with normal intelligence and acquire mental retardation
b. Childhood illnesses
i. Chicken pox
ii. Measles
iii. Whooping cough
iv. Meningitis
c. Childhood injuries
i. Shaken baby syndrome
ii. Traumatic brain injury
1. Bike accident
2. Car accident

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Environmental factors that causes mental retardation

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a. Emotional and physical neglect can result in mental retardation.
i. No adequate nutrition
ii. Placed in a closet
iii. Lack of emotional and mental stimulation
iv. Lead Paint Poisoning
1. Children who live in older apartments or homes with lead paint are at risk of mental retardation.
a. Very quickly on the children do not develop as the same level as other children

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Early Language Learning

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Goal= acquire spoken language
Primary source of language stimulation= spoken communication
Learn language in nondirected, informal settings
Literal interpretations of language
Concrete language and reasoning
Do not always take the listener’s perspective
Does not require metalinguistic competency

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Later Language Learning

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Goal= acquire written communication
Primary source = spoken and written
Learn through formal instruction
Increasing ability to understand figurative meanings
Increasingly abstract language and reasoning
More aware of listener and reader’s perspectives and adjust spoken and written messages.
Metalinguistic competency is required- especially for reading and writing

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TD Adolescent Syntax

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• Sentence length increases in oral and written contexts

• Noun phrases expand through appositives, prepositional phrases, and complex subjects

• Verb phrases expand though modals, perfect aspect, and passive voice

• Sentences become more complex and sophisticated with the use of subordination, participial phrases, gerunds, and infinitives

• Usage of cohesion devices improves, especially adverbial conjuncts (ex. Moreover, consequently

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TD Adolescent Semantics

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• Understanding of literate verbs gradually increases (ex. Interpret, concede, predict, infer)

• Increased comprehension of figurative expressions (idioms, metaphors, proverbs

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TD Adolescent Pragmatics

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• Strategies for resolving interpersonal conflicts improve. Older adolescents use strategies that involve mutual agreement and compromise

• Increased knowledge of slang expressions

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Adolescent with LI Syntax

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• Use shorter sentences due to simpler sentence structure

• More maze behaviors (false starts, hesitations, revisions)

• Use less subordination and syntactic sophistication is lower than that of TD peers

• Don’t use as many cohesion devices

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Adolescent with LI Semantics

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• Have a poorer understanding of literate verbs which increases the risk for academic failure

• Have difficulty understanding expressions with abstract or multiple meanings

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Adolescent with LI Pragmatics

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• Poorer pragmatics skills, more problems solving interpersonal conflicts and understanding slang

• Problems with pragmatics, syntax, and semantics lead to academic and social limitations

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Impaired cognitive functioning

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a. Each child is going to have strengths and weaknesses on subtests
i. They’ll do better on visual test compared to listening test
b. Children with MR can sustain attention as TD children.
i. The only difference is that they can’t pick the important information to pay attention to.
c. Memory is impaired- typically STM more impaired than LTM
i. Because of their impairment in memory, they are going to have trouble storing information for a later time.
ii. Difficulty learning memory strategies
d. In general visual information is better remembered than auditory.
i. Remember pictures better than words
ii. But for auditory information they remember tunes of songs better than the words.
e. Very difficult to generalize information learned.

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Cognitive characteristics that would impact therapy

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Attention
Memory
Auditory vs. Visual
Generalization

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Attention

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• Limit distractions
o No music
o No fun pictures
o Highly motivating materials
• Directing them to the key words of directions and questions
• Check for comprehension memory

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Memory

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• Provide as much sensory info as possible
• Repetition
• Following similar routines with a similar structure
• Make small steps of change/advancement in our teaching

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Auditory vs. Visual

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• Add visual information and demonstration to all teaching
• Pair visual and auditory
• Sentences have to be shorter and simpler.
• Smaller vocab
• No monotone voice
• Emphasis on key words
• Experiential learning rather than auditory learning

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Generalization

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• Teach the skill in the environment you want the child to use it in
• Breaking a skill down into certain steps in order to teach that skill to that child

Front 44

Language Characteristics

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Quantitative vs. qualitative
Phonological errors
Morphological and Syntactic Characteristics
Semantic Characteristics
Pragmatic Characteristics

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Quantitative vs. qualitative

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• There are differences
• Quantitative- MR typically follow the same guidelines as TD students just at a much slower rate
• Qualitative-Language skills that do not occur normally
o Echolalia

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Echolalia

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the automatic repetition of vocalizations made by another person

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Phonological errors

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• Multiple sound errors
• Very difficult to understand
• Speech unintelligibility extends into adulthood sometimes. It sometimes can not be corrected
• Many kids that are MR have a motor speech disorder like Dysarthria

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Dysarthria

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Muscle weakness and discoordination that result in general slurred speech in a slow rate and accompanied by a hoarse voice quality. People often have trouble controlling their saliva

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Morphological & Syntactic Characteristics

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• They continue into adulthood with simple sentences and grammatical errors

Front 50

Semantic Characteristics

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• Develops later
• Made up of mostly nouns and concrete words and not abstract
• Has trouble with verbs

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Pragmatic Characteristics

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• Very diverse
• Tend to be more passive
• They delay before answering a question or do not answer it at all.
• Have trouble staying on topic
• Have difficulty repairing a breakdown in communication
• Talking about the same topic excessively and returning to it once the topic of the conversation is switched

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Purpose of Intervention of MR students

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• Change the disorder by teaching specific language behaviors
• Accommodations or modifications to the learning environment

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Basic Approaches to Intervention for MR

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• Developmental
• Emergent Literacy
• Functional
o Second Language Learning
• Combined

Front 54

Structure of the Therapy sessions for MR

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• Play
• School age kids
o Academic task

Front 55

Reinforcement for MR

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• Younger kids-Primary
• Move to secondary as quickly as possible
• Natural

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Schedule for MR

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• Continuous
• Intermittent
• Fixed
• Ratio

Front 57

Therapy Techniques for MR

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• Any strategy will work
• Joint routine, joint reading
• Modify Linguistic Input all the time

Front 58

Selected Characteristics of Down Syndrome

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Genetic cause
Varying levels of MR
Recurrent middle ear infections
Hypotonia
Articulation-Phonology
Language

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Genetic cause of Down Syndrome

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o Unknown

Front 60

Recurrent middle ear infections/ impact speech and language development of Down Syndrome

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Estuation tube remains level in development

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Hypotonia of down syndrome

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Low tone
Large tongue compared to oral cavity
Oral motor problems
Decreased speech intelligibility
Challenging to establish intelligible speech

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• Articulation-Phonology of down syndrome

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o Generally follow typical guidelines just slower
o Periods of hearing loss and craniofacial anomalies interfere with speech sound development
o May incorporate sign language
 Its easier for them to learn sign to express emotions rather than use verbal communication.
 Once they use verbal expression they stop using sign naturally
o May consider AAC
 Augmentative Alt. Communication
• Alt. method of communication

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Language of Down Syndrome

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o Expression lags behind comprehension
o Gap increases with age
o Can learn to read/reading skills may exceed cognitive and language test scores

Front 64

1. The authors identify 6 counterarguments or rationale for providing speech language therapy services at the secondary level. What are those 6 counterarguments?

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a. Adolescents with LI require continued SLP services
b. SLP provides instruction in social and vocational communication areas as well as academic areas
c. Students generally transition to formal cognitive development period and are now able to learn abstract concepts
d. Effective SLP programs combined with other specialized instruction have successfully reduced dropout rates.
e. Adolescents make progress in language intervention programs. SLPs need to document this growth as evidence of student improvement
f. Taxpayers will ultimately pay for these students in the form of remedial education if we don’t provide successful services in school

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2. Define the Prototype Service Delivery Model in your own words

Back 65

The Prototype model, designed for adolescents, involves providing language intervention as a course for HS credit. The model includes additional 1:1 or small group services as well as classroom consultation as needed to meet a student’s needs. The Prototype model works primarily with adolescents with LI and may be considered to be a more restrictive environment. However, the progress students have been able to make in this service delivery model supports it implementation.

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3. Define the REI Inspired Consultation Model in your own words

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The Regular Education Initiative Inspired Model is another viable model for service delivery for adolescents with LI. In the REI model the SLP can provide services through consultation rather than direct services to the student. The SLP may consult on a regular basis with classroom teachers to provide modifications, accommodations or techniques to help the adolescent with LI gain access to and be successful in the curriculum. The REI model can also be implemented by the SLP working directly with the adolescent student in the regular education classroom. The SLP would provide intervention while the student completes classroom assignments

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4. What are the differences in these two models? Which method do the authors recommend for use with adolescents?

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 REI is accomplished in the regular education classroom with typically developing peers while the Prototype Model is conducted in a more restricted classroom with other adolescents with LI
 The Prototype Model offers language intervention services for course credit while REI does not
 The Prototype Model is primarily a direct service delivery model while the REI Model can be conducted either as a consultation model or as a direct service delivery model
 The authors recommend using the Prototype Model based on their clinical experience. While the model selected needs to be based on the needs of individual students, the authors report the greatest success with the Prototype Model.