Language Disorders versus Language Differences

Katie Engle

When discussing language, it is important to identify the differences between a difference in language versus that of a disorder. A child demonstrating a language difference, will present with a dialect outside of the mainstream American English dialect. For example, a child born and raised in Alabama will have a Southern American English dialect when speaking. A child from Wisconsin would present with a North-Central American English dialect. When comparing the pronunciation of the same words between these two children, the listener will likely hear differences in the individual sounds that make up the word (Owens, 2024). Dialect also plays a role in the labels used to identify certain objects. For example, an individual from the Midwest might call a certain drink “pop” while someone from the South knows the drink as “soda”. When we talk about dialectal differences, it is vital we remember this simple fact: dialect is not a disorder.

ASHA explains an individual with a spoken language disorder as demonstrating continuous difficulty in the acquisition and utilizing of the necessary skills for listening and speaking across the domains of language (semantics, syntax, pragmatics, phonology, morphology) (ASHA, n.d.). The term Speech Language Impairment (SLI) is gradually being replaced by the name of Developmental Language Disorder (DLD.) As mentioned, a language disorder consists of varying deficits in the domains of language. Difficulties initiating conversation and comprehending other’s emotions during conversation are examples of common pragmatic challenges for these individuals. Theory of mind, which is the understanding that oneself may think differently than another individual is also a pragmatic concept affected for individuals with DLD. Difficulty learning words and their meaning as well as limitations recognizing phonological concepts are examples of deficits in semantic and phonology. Challenges in structuring words and complex sentences affect syntax and morphology. One area impacted significantly for individual’s with a DLD is working memory which is a function of the brain that stores and manages new and complex information (Owens, 2024).

ASHA, Spoken language disorders. (n.d.). https://www.asha.org/Practice-Portal/Clinical-Topics/Spoken-Language-Disorders/

Owens, R.E. (2024). Language Disorders: A Functional Approach to Assessment and Intervention in Children, (7th edition). San Diego, CA: Plural Publishing.

Role of Language Facilitators

Chloe Lyman

In order to maximize the benefits of speech therapy sessions, it is important to involve parents. caregivers, teachers, etc in order to better aid each client. In doing so, we are allowing therapy to extend beyond the speech room and generalize progress in the client's everyday life. In a blog post by a certified Speech Language Pathologist, he offers approaches on how to involve parents suggesting things like asking the parent to join the session and sending home specific activities to complete with their child. The author goes on to say, "Our main professional goal focuses on improving the speech and language development of a client. But spending time involving and educating parents or other caregivers increases the opportunities a client has to make progress" (Suarez, 2017). Think of it like taking a class at school. If you only used the time given in class to prepare for tests or comprehend material, you may never pass the class. Homework and study time outside of class is utilized to better understand and gain the neccessary skills and knowledge to pass the class. It is the same when working on speech and language goals: the more time spent outside of therapy, the more generalized and solidified the skills can become.

By inviting parents and caregivers to take part in the therapy, we are giving the child more opportunities to grow. The parents are able to aid in generalization of therapy by continuing to target goals at home in more natural settings. The parents can also provide key information on their child to better help us, the SLPs, set and target goals that will be maximally beneficial for their child. A study on the effectiveness of collaboration between parent and therapist stated, "In this way, as a profession we could begin to answer the questions of what works, for whom and in what circumstances" (Klatte et al., 2020). By inviting this collaboration, treatment revolves around the client.

Klatte, I. S., Lyons, R., Davies, K., Harding, S., Marshall, J., McKean, C., & Roulstone, S. (2020). Collaboration between parents and SLTs produces optimal outcomes for children attending speech and language therapy: Gathering the evidence. International journal of language & communication disorders, 55(4), 618–628. https://doi.org/10.1111/1460-6984.12538

Suarez, J. (2017, August 17). My 4 favorite tips to involve parents in treatment. The ASHA LeaderLive. https://leader.pubs.asha.org/do/10.1044/my-4-favorite-tips-to-involve-parents-in-treatment/full/

Traditional vs. Functional Approach

Jenny Olson

Owens (1991) states that, “The traditional approach to teaching language is a highly structured, behavioral one, emphasizing the teaching of a specific language features within a stimulus-response-reinforcement model. The SLP could have more control over the material, situation, and cues and can often predict the responses. Traditional approach can include drills, scripts and can be repetitive.

Owen (1991) states that the, “Functional approaches give more control to the child and decrease the amount of structure in intervention activities.” The functional method makes it more generalized and can transfer to every day circumstances. It is a communication first approach and helps the student/child/person communicate more effectively with those around the student including his family members, teachers, friends, and more.

One of my favorite language practices that I did, was to have the student place an order at Café Rio. This was his favorite place to eat and he was very passionate about it. We talked about what he wanted to order in great detail, we typed it out and practiced a lot. When he felt confident, I called Café Rio and made arrangements so that they would be patient and work with the student. We then went to Café Rio and had him place his order of his favorite meal. The smile and feeling of success that we saw from him was worth gold. He is now more confident at ordering at restaurants for himself. That is by far a favorite memory with him and his mom.

ASHA states that person-centered functional goals are, “goals identified by the child, in partnership with the clinician and family, that allow participation in meaningful activities and roles.” They continued by discussing the benefits of person-centered goals. Which includes having outcomes that lead to functional improvements that can benefit the person and family, it can help them better participate in activities at school, home, the playground, etc.

(2018, March 14). Person-Centered Focus on Function: Language Disorder. https://www.asha.org/siteassets/uploadedfiles/ICF-Language-Disorder.pdf?srsltid=AfmBOooWDM5IPaZpTjbz9dRUb9JfWlmlxan-tQ51nZPj8M9XjYg6CSyH

Owens, R. E. (2024). Language Disorders. A Functional Approach to Assessment and Intervention in Children. (7th ed.). Plural Publishing Inc.

(ASHA, n.d.)

Evidence-Based Practice

Mindy Wender

Evidence-based practice is the way speech-language pathologists (SLPs) can evaluate the efficacy of a treatment as well as the best treatment for a client. According to the American Speech and hearing association (ASHA; n.d.) “Evidence-based practice (EBP) is the process of applying current, best evidence (external and internal scientific evidence), patient perspective, and clinical expertise to make decisions about the care of the individuals you treat.” In order to implement EBP the clinician must look at the scientific knowledge on the topic, consider their past clinical experience, and acknowledge their client’s needs (Owens, 2024). ASHA (n.d.) gives four steps to the evidence-based practice process. They are to frame the clinical question, collect evidence, evaluate the evidence, and then make the clinical decision. The first step is to frame the clinical question, to do this a PICO question should be established. PICO stands for population, intervention, comparison, and outcome (ASHA, n.d.). The purpose of the PICO question is to solidify what you would like to research. The second step is to gather the evidence. Both internal and external evidence should be used. Internal evidence is the data that you gather from clients to ensure they are making progress. External evidence is scientific research and studies. The third step is to assess the evidence. Not all research is created equally, and it is important to consider the quality of research before making a decision. The last step is to make your clinical decision. The decision should be based on the three pillars of EBP, evidence, clinical expertise, and client perspectives (ASHA, n.d.).

Greenwell and Walsh (2021) conducted a survey of 317 SLPs about their perceptions, use, and perceived barriers of EBP. The authors found that an increase of EBP usage correlated to exposure during graduate school and CF as well as EBP career training. In addition, they found that the most used pillar of EBP was their client’s preferences. The second highest source of EBP was research and the third highest was clinical expertise. Time and caseload size were the biggest perceived barrier to EBP. Other barriers included lack of access to journal articles and little familiarity with statistical analysis (Greenwell & Walsh, 2021).

American Speech-Language-Hearing Association. (n.d.). Evidence-Based practice process. https://www.asha.org/research/ebp/evidence-based-practice-process/

Greenwell, T., & Walsh, B. (2021). Evidence-based practice in speech-language pathology: Where are we now? American Journal of Speech-Language Pathology, 30(1), 186-198. https://doi.org/10.1044/2020_AJSLP-20-00194

Owens, R. E. (2024). Language Disorders. A Functional Approach to Assessment and Intervention in Children. (7th ed.). Plural Publishing Inc.

Reinforcement and Natural Consequences

Ellie Hooper

Utilizing reinforcements may be a successful way for an adult to elicit speech or a desired outcome from a child. For speech therapists, we use this concept in order to reach goals or influence the child's productions. Natural consequences are the results of an individual's actions or lack thereof. This concept is not necessarily planned, but occurs as a result of a cause-and-effect relationship

There are several types of reinforcements that may be used. These include negative, secondary, fixed interval, and fixed ratio. SLPs may use fixed interval or fixed ratio during game-like settings, reaching a production goal, or to reduce behaviors. These types of reinforcements suggest that a particular number of a set goal must be reached before the motivator is used. For example, on a fixed interval reinforcer, a child may need to produce 5 productions of /k/ before having a turn in a game. Another example includes using a verb in a sentence before continuing a scavenger hunt. These examples are used in order to elicit productions which may result in a reduction of negative behaviors. The purpose of these reinforcements is to create a feedback loop of positive feedback to the child's attempts (Whitehurst & Valdez-Menchaca, 1988). This may increase the progress. In therapy, an SLP may use what is called intermittent reinforcement. This is due to the naturalness of which it may occur. Typically, a child would not receive a reinforcer after every desired response. This is unnatural and may set unrealistic standards. By using an intermittent schedule, the child receives what they are more likely to encounter in real world situations.

Natural consequences are used to help teach individual’s what they need to know from their own actions. To help children learn this concept, teachers and adults can find ways to help a child learn how to predict outcomes of their own choices (Locke, 1996). For example, if you don’t study for a test, you may not make a good grade. Another example is if a child climbs on a chair, it may tip and hurt him/her. Further, the same is true for requests. If a child requests an item, an adult may give it to him/her if it doesn’t cause harm.

Locke, J. L. (1996). Why do infants begin to talk? Language as an unintended consequence. Journal of Child Language, 23(2), 251–268. doi:10.1017/S0305000900008783

Whitehurst, G. J., & Valdez-Menchaca, M. C. (1988). What Is the Role of Reinforcement in Early Language Acquisition? Child Development, 59(2), 430–440. https://doi.org/10.2307/1130322

Functional vs. Traditional Language Approach

By Skylar Stringer

Owens (1991) details the "functional approach" to treating language impairments and how this new approach contrasts from more traditional methods. The goal of the functional approach, according to Owens (1991), is to improve communication for the client's natural communicative environment. This involves choosing therapy activities and targets that are relevant to the child's natural social environment and interests to facilitate greater generalization outside of therapy. This approach is also described by Owens as a "conversational approach". If a clinician is able to maintain conversational flow while providing feedback, it is more likely for the child to respond in a more positive manner and generalize language skills (Owens, 1991). As shown in the attached image (Owens, 1991), pragmatics are traditionally viewed as an equal component among phonology, syntax, morphology, and semantics. In a functional approach to language therapy, pragmatics is seen as an umbrella that covers other aspects of language. Therefore, the pragmatics (or everyday context) of therapy goals and targets should be considered along with each other aspect.

Roqueta et. al. (2012) examines the relationship between pragmatic language and social cognition in children with Specific Language Impairment. The results of this study revealed a significant correlation between pragmatic language skills and social cognitive abilities in children with SLI. This study affirms the idea that pragmatic language skills should be addressed in intervention of language impairments.

Owens, R. E. (1991). Language Disorders: A Functional Approach to Assessment and intervention. http://ci.nii.ac.jp/ncid/BB08522769

Roqueta, C. A., Estevan, R. a. C., & Buils, R. F. (2012). Social cognition and pragmatic competence. The case of children with specific language impairment. International Journal of Psychological Research, 5(1), 59–69. https://doi.org/10.21500/20112084.752

Roles of Generalization in Intervention

by: Alyson Louque

Owens, R. E. (1991). Language Disorders: A Functional Approach to Assessment and intervention. http://ci.nii.ac.jp/ncid/BB08522769

Whitworth, A., & Webster, J. (2015). Generalisation: exploring change across language levels. Aphasiology, 29(11), 1235–1239. https://doi.org/10.1080/02687038.2015.1071128

Generalization can be one of the hardest concepts in the intervention process. It is important to take small steps toward the large goal of generalization during intervention. Generalization is also called the carry-over. The end goal of intervention is to achieve the target goal in everyday environments like home, school, and new places a client might encounter. When generalization is not achieved three things are taken into consideration the learning characteristics of the patient, the materials selected for teaching, and the design of the teaching (1991). Generalization should be on going and continuous in the interactive process for a client and acquired language target. It is an essential part of learning and a goal for all clients to achieve. Each client will have different needs for everyday communication and not all target work will work with each client to produce.

When children are learning a new utterance sometimes it is out of context. The example in Owen's book discusses about a child requesting a cookie. The child may not know that asking for a cookie in the bank is not the appropriate place to request a sweet treat, but when the child asks for a cookie at home to their mom and recieves a cookie. The child has learned that asking for a cookie at home is the correct way to use the utterance (1991).

Generalization has two broad variables: content and context generalization. Under the content generalization, it stands for the training target and items. It normally answers the question: "What the speech therapist is teaching?" The second variable is context generalization. Context generalization answers the question: "How the material is being delivered?" This variable is broken into categories of methods of training, language facilitators, training cues, consequences, and location of training. Communication context should be taught in the natural environment and in the teaching so that it is the same in both areas.

Dimensions of Communication Context

By: Erika Hembree

Chapter one in the textbook mentions that language is used within a dynamic context affecting the form and content of language. Communication context includes interactions of various forms of factors such as purpose, content, type of discourse, participant characteristics, setting and activity, and mode of discourse. During a conversation, each participant uses these factors to make connections and to better understand the changing relationships during the interactions. The communication context factor, purpose will affect what and/or how the participant projects their language onto the listener. The content used will affect the form and style of the language. The type of discourse will depend on other factors of the communication context. However, an example of the type of discourse used would be the difference between an argument and a bedtime story. The participant characteristics can have an impact on the following factors above. These characteristics may include the participant's background knowledge, life experiences, age and status, and their moods. The setting and mode of discourse may also have an impact on the purpose, content, and how the participant responds.

The communication factors listed above are important for a child to understand how to monitor the context among participants. It is important for the SLP to be aware of how each child with a language disorder views and processes each factor of language. The language goals targeted should be generalized as they occur in the child’s daily communication context. Pragmatic context for daily communication is an important part of language intervention with a child with a language disorder. Rosenbaum and Simon (2016) discuss the factors that influence the treatment of language disorders. These factors may include the developmental level of the child, tools used during the session, and the treatment setting. To help the child improve their communication context skills, the SLP must promote growth in the child’s implicit language knowledge base across a range of communication skills (Rosenbaum & Simon, 2016).

References:

Owens, R. E. (2024). Language Disorders. A Functional Approach to Assessment and Intervention in Children. (7th ed.). Plural Publishing Inc.

Rosenbaum, S. & Simon, P. (2016). Treatment and Persistence of Speech and Language Disorders in Children. Speech and Language Disorders in Children: Implications for the Social Security Administration’s Supplemental Security Income Program. The National Academies Press. https://www.ncbi.nlm.nih.gov/books/NBK356271/.

Functional Approach: Background Information & Application

by: Grace Bowen

This approach for language disorders comes from the function of using natural language. Meaning, this approach pushes the use and practice for natural language for the patient. Natural language for each patient can be different (Bates et al., 1991). For example, if a patient who is nonverbal loves to play with trucks and bubbles, the clinician can present these materials to the client and allow the client to identify which one they would like to play with. While the patient is playing, the clinician can model functional language and apply a goal for the patient to mimic the clinician until the patient uses functional language on his/her own.

The functional approach is a great treatment method for patients who have goals for receptive language that include maintaining attention, implementing skills for choosing between objects, and applying directions given. There can also be goals for expressive language that are appropriate in using the functional approach. These goals could be imitating the clinician, responding to questions being asked, and beginning interactions with others. It is important to understand the best way for the patient to communicate. Some patients will best communicate with an AAC device (SLPCarrie, 2017). From clinical experience, I have learned that when a child is starting out with an AAC device, it is important to set a goal for the patient to use one or few words/ buttons before they can successfully use an AAC device. It is important to start them out small and let them grow once they show success in their goal for one or few words used on the AAC device. For example, if your patient is a toddler who is nonverbal and has a hard time expressing their wants/ needs, start them out on an AAC device that uses the word "more." The functional approach can be used for the patient to play with toys of his/her choice and be modeled how to use the word more when they want more of that item. If the patient wants to color the clinician can start by giving them few colors and modeling the word "more" applicator on the AAC device for the patient to eventually reach their goal on using the AAC device to communicate their needs on wanting more materials.

Bates, E., Thal, D., & MachWhinney, B. (1991). A Functionalist Approach to Language and Its Implications for Assessment

and Intervention. Pragmatics of Language, 133-161. https://doi.org/10.1007/978-1-4899-7156-2_5

SLPCarrie. (2017). Functional Communication- Speech And Language Kids. Speech and Language Kids. https://www.speechandlanguagekids.com/functional-communication/

The Vital Role of Pragmatics in Intervention

Bye: Hailegh Wingo

Think of language as a garden, with each flower representing a piece of communication syntax, vocabulary, phonology, and more. Pragmatics is like the gardener, This gardener will be thoughtful as to where he puts each flower to make sure that they can thrive. Flowers are of course beautiful however how they are organized and create a balanced environment with the other flowers makes it successful. Without a gardener to follow the rules and the knowledge to help the flowers, the garden could become weak or start to do poorly.

Pragmatics in language is about using words correctly in everyday situations. It’s not just knowing all of the different rules but how we are supposed to use them knowing the rules of language and understanding how to apply them. For example, choosing the right words and tone to ask for assistance, tell a story, or have connections with others is a form of pragmatics. This ability transforms language from a collection of rules into a tool for meaningful interaction.

For language intervention, it's important to focus on pragmatics to make sure the goals of speech therapy move from a person having just a few communication skills to being able to use those skills in day-to-day life. Language learning should be focused on everyday conversations and social situations. This approach makes learning feel normal and helps children connect their new language skills to functional applications. It’s like showing a child how to use their words not just in therapy but also at recess, playing with friends, and talking to other adults.

Research by Parsons et al. (2017) supports this perspective, particularly for children with autism spectrum disorder. The article's study pointed out how pragmatic language interventions help kids get better at communication and their skills in social environments. These kids often feel overwhelmed by challenges in forming friendships, and learning about pragmatics provides a way to connect with other people and to help them thrive in social events

citations

Owens, R. E. (2024). LANGUAGE DISORDERS A Functional Approach to Assessment and Intervention in Children. Plural Publishing, Inc. https://www.pluralpublishing.com/

Parsons L, Cordier R, Munro N, Joosten A, Speyer R. A systematic review of pragmatic language interventions for children with autism spectrum disorder. PLoS One. 2017 Apr 20;12(4):e0172242. doi: 10.1371/journal.pone.0172242. PMID: 28426832; PMCID: PMC5398499.