Language Disabilities in ChildrenDevelopmental Language DelaysSchool Age Language DisabilitiesDevelopmental Language Delays (DLD)Delay in language skills compared to peersCan be in any part of languageForm, Content, UseNot language differences/dialectsInfant and pre school agesWide varietyDelays may beExpressive or receptiveMild or severeCan occur even before the child uses first wordsPre language skillsGestures, joint attention, poor social skillsLanguage Disabilities in ChildrenSymptomsFirst sign – late onset of first wordsSlow progression to 2 words and moreSlow vocabulary and concept developmentSlow to use language to interact sociallyDelays pre-reading and early academic skillsMay also be slow in developing speechCausesPrenatal – during gestationMaternal ageAdequacy of prenatal careMaternal health and nutritionDrug use during pregnancyFamily history of developmental delaysPerinatal – at or around the time of birthPrematurityLow birth weightBrain hemorrhageRespiratory problemsHyperbilirubinemiaPostnatal – after birthBonding and attachment issuesSocioeconomic statusEducational level of parentsChronic otitis mediaConditions that may include DLDGenetic and chromosomal disordersSensory deficitsNeurological impairmentsExposure to drugs and alcoholAutism and pervasive developmental disordersSpecific language impairmentGenetic and chromosomal disordersDown syndromeFragile X syndromeUsually display global developmental disorders/delaysDevelop speech language skills in same order as typically developing children but at a slower rateDevelopmental Language DelaysSensory deficits (hearing and vision)Visual impairment aloneSome genetic and/or birth defects affect bothHearing deficitsNeurological ConditionsCerebral palsyMany have delays in language development and many have cognitive deficitsMotor control and speech deficits commonMany need an augmentative/alternative communication system11/2Ischemic StrokesComplete or part occlusion of arteriesMost common typeA lot of recovery right away, recovery slows downBlood clot- may travel from other part of body (heart, hip)Thrombosis – clogging of arteries in brainHemoragic StrokeRecovery at beginning is slower, recover fastIschemic StrokeRecovery is quick at right, then slows downNeither has better prognosis, both about 6 months longTraumatic Brain InjuryMost often young adults (males 18-25)Take more risks, play more sportsCommon causes - car or motorcycle accidentsDamage is more generalized – affects more of brain due movement of brain in skull (doesn’t affect specific area of brain)Damage in wider area (from side to side or front to back, brain rickasheas)Mild cases of traumatic brain injury = concussionNot really aphasia, in fact these patients do well on aphasia testingAphasia can only be on left side of brainThis is through whole brainPrimarily cognitive-linguistic deficitsNot specific problems, general onesCognitive-Linguistic DeficitsAttentionMemory/word finding problemsOften cant remember what happened to themHave trouble coming up with words that they want (like aphasia)Learning difficulties: esp. for NEW infoDecreased inhibition, poor pragmatic skillsSay rude things to doctors, etcOrganizational skills (frontal lobe) planning and executing actions, problem solvingFrontal lobe is most commonly injuredEx. Couldn’t spread past topic (cats, reds), hard to do specific tasksRecovery from TBIGo through stages that are relatively predictable (8 stages-Rancho Los Amigos Scale)Need ongoing evaluation and treatmentChanging everydayOften going from comatose to re-entry into communityDepends on severity of brain injuryOften may have swallowing and/or speech problems as well as cognitive-linguistic onesUsually think of brain injury as a language problem, but often have frontal lobe damage, where motor skills are (may have swallowing, speech, movement problems)Right Hemisphere Disorders (RHD)NOT APHASIAMore difficult to detectNot quite as obvious to family members or care giversInclude some cognitive-linguistic problems: memory, orientation, awareness of deficits (don’t really believe there is anything wrong with them)Could have paralysis of left side (crosses over)Left side might not be working and still say they have to leave hospital to go to work… deny deficits like there’s nothing wrong with themSometimes don’t think left side of body belongs to themVisual Neglect-usually unilateral-problems reading, using any visual materialsDon’t visual this side of body, often don’t visualize anythingIgnore a whole left side of picture when asked to redraw itWork on having them look all the way overEspecially important in reading – might start in middle of page, can’t figure out why it doesn’t make sense to themLanguage is often confused, tangential, irrelevant due to poor organizationTangential – go off on tangents even if they don’t make senseMANY PRAGRATIC PROBLEMSDon’t initiate conversation very well, likely to sit all day long and never initiate conversationAssessment/Treatment of RHDHas own set of tests- NOT aphasia testsNeed to look at visual problems, attention, neglect, memory, organizational skillsSometimes you actually have to treat them by teaching them these things – how to initiate communication, use facial expressionsVideotape them in a conversation with someone, and show it to themDon’t understand why people don’t communicate with them and why its hard to communicate with themTeaching pragmatics, facial expression, initiation of communicationProgress depends on amount of damageDementiaProgressive, irreversible, generalized damage in all cognitive abilities including languageGets worse, can’t get better, some medicines can slow progression but nothing will stop itInterferes with all cognitive abilitiesMost common type: Alzheimer’s diseaseCan get it from multiple strokes, parkinson’s disease for a long period of time (parkinson’s type dementia), senile dementia (from being old)Earliest symptoms are memory loss and word-finding problemsCant remember answers to very simple questions, often cant remember names of thingsEnd stage patients may use stereo-typical responses or be mute (have been through all the stages of dementia)Don’t recognize people. Don’t remember who they are or where they areGo through some combativeness like head injury patients, but less common than in head injuriesUsually also have swallowing problemsas if they have forgotten how to swallow, don’t know what to do