Language Development/
Preschool Language Disorders
Combine the definition of Language Disorders with a child that is 3-5 years old and had not yet started Kindergarten
DEFINITION OF THE DISORDER
A language disorder is impaired comprehension and/or use of spoken, written and/or other symbol systems. 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.
Form of Language
Phonology is the sound system of a language and the rules that govern the sound combinations.
Morphology is the system that governs the structure of words and the construction of word forms.
Syntax is the system governing the order and combination of words to form sentences, and the relationships among the elements within a sentence.
Content of Language
Semantics is the system that governs the meanings of words and sentences.
Function of Language
Pragmatics is the system that combines the above language components in functional and socially appropriate communication
For Parents and Families
Children with language disorder have difficulty expressing themselves and understanding what others are saying
Unrelated to hearing problems
Hearing and Understanding
Birth–3 Months
Startles at loud sounds.
Quiets or smiles when you talk.
Seems to recognize your voice. Quiets if crying.
4–6 Months
Moves her eyes in the direction of sounds.
Responds to changes in your tone of voice.
Notices toys that make sounds.
Pays attention to music.
7 Months–1 Year
Turns and looks in the direction of sounds.
Looks when you point.
Turns when you call her name.
Understands words for common items and people—words like cup, truck, juice, and daddy.
Starts to respond to simple words and phrases, like “No,” “Come here,” and “Want more?”
Plays games with you, like peek-a-boo and pat-a-cake.
Listens to songs and stories for a short time.
Talking
Birth–3 Months
Makes cooing sounds.
Cries change for different needs.
Smiles at people.
4–6 Months
Coos and babbles when playing alone or with you.
Makes speech-like babbling sounds, like pa, ba, and mi.
Giggles and laughs.
Makes sounds when happy or upset.
7 Months–1 Year
Babbles long strings of sounds, like mimi upup babababa.
Uses sounds and gestures to get and keep attention.
Points to objects and shows them to others.
Uses gestures like waving bye, reaching for “up,” and shaking his head no.
Imitates different speech sounds.
Says 1 or 2 words, like hi, dog, dada, mama, or uh-oh. This will happen around his first birthday, but sounds may not be clear.
Hearing and Understanding
Points to a few body parts when you ask.
Follows 1-part directions, like "Roll the ball" or "Kiss the baby."
Responds to simple questions, like “Who’s that?” or “Where’s your shoe?”
Listens to simple stories, songs, and rhymes.
Points to pictures in a book when you name them.
Talking
Uses a lot of new words.
Uses p, b, m, h, and w in words.
Starts to name pictures in books.
Asks questions, like “What's that?”, “Who’s that?”, and “Where’s kitty?”
Puts 2 words together, like "more apple," "no bed," and "mommy book."
Hearing and Understanding
Understands opposites, like go–stop, big–little, and up–down.
Follows 2-part directions, like "Get the spoon and put it on the table."
Understands new words quickly.
Talking
Has a word for almost everything.
Talks about things that are not in the room.
Uses k, g, f, t, d, and n in words.
Uses words like in, on, and under.
Uses two- or three- words to talk about and ask for things.
People who know your child can understand him.
Asks “Why?”
Puts 3 words together to talk about things. May repeat some words and sounds.
Three to Four Years
Four to Five Years
Hearing and Understanding
Responds when you call from another room.
Understands words for some colors, like red, blue, and green.
Understands words for some shapes, like circle and square.
Understands words for family, like brother, grandmother, and aunt.
Talking
Answers simple who, what, and where questions.
Says rhyming words, like hat–cat.
Uses pronouns, like I, you, me, we, and they.
Uses some plural words, like toys, birds, and buses.
Most people understand what your child says.
Asks when and how questions.
Puts 4 words together. May make some mistakes, like “I goed to school.”
Talks about what happened during the day. Uses about 4 sentences at a time.
Hearing and Understanding
Understands words for order, like first, next, and last.
Understands words for time, like yesterday, today, and tomorrow.
Follows longer directions, like “Put your pajamas on, brush your teeth, and then pick out a book.”
Follows classroom directions, like “Draw a circle on your paper around something you eat.”
Hears and understands most of what she hears at home and in school.
Talking
Says all speech sounds in words. May make mistakes on sounds that are harder to say, like l, s, r, v, z, ch, sh, and th.
Responds to “What did you say?”
Talks without repeating sounds or words most of the time.
Names letters and numbers.
Uses sentences that have more than 1 action word, like jump, play, and get. May make some mistakes, like “Zach gots 2 video games, but I got one.”
Tells a short story.
Keeps a conversation going.
Talks in different ways, depending on the listener and place. Your child may use short sentences with younger children. He may talk louder outside than inside.
Preschool Language Disorder Difficulties
Receptive Language (Understanding)
Understanding what people mean when they use gestures, like shrugging or nodding
Following directions
Answering questions
Pointing to objects and pictures
Knowing how to take turns when talking with others
Expressive Language (Talking)
Asking questions
Naming objects
Using gestures
Putting words together into sentences
Learning songs and rhymes
Using correct pronouns, like "he" or "they"
Knowing how to start a conversation and keep it going
Changing how they talk to different people and in different places. For example, you speak differently to an adult than a young child. You can talk louder outside than inside.
*Expressive and Receptive Language Disorders (Combination of talking and understanding)
Early reading and writing
Holding a book right side up
Looking at pictures in a book and turning pages
Telling a story with a beginning, middle, and end
Naming letters and numbers
Learning the alphabet
*Phonological Awareness: the leading predictor of reading and writing success or failure.
*Phonological awareness relates to a student’s ability to be consciously alert to the sounds in words.
*Includes the ability to recognize and manipulate syllables and phonemes.
*Students with poor phonological awareness are at a significant disadvantage when learning to decode and spell.
ETIOLOGIES
Possible Causes of Preschool Language Disorder
Other people in your family having language problems
Being born early
Low birth weight
Hearing loss
Autism
Down syndrome or Fragile X syndrome
Fetal alcohol spectrum disorder
Stroke
Brain injury
Cerebral palsy
Poor nutrition
Failure to thrive
CASE HISTORY INFORMATION
Important Case History Information: Example Form https://www.kidspeakinc.com/wp-content/uploads/2016/12/updated-Preschool-Case-History-Nov-2016-form2.pdf
Medical History :
Length of pregnancy: Complications during pregnancy: Yes No If yes, please explain: Complications at birth/delivery: Yes No If yes, please explain:
In NICU: Yes No If yes, how long: Spit up frequently/acid reflux? Yes No Strong Suck? Yes No
Has your child had any major accidents/illnesses/hospitalizations? Yes No
If yes, please explain:
Has your child had any ear infections?
Yes No
How many?
Has your child ever received PE tubes?
Yes No
Does your child have a history of seizures?
Yes No
Has your child ever has tonsil and/or adenoid issues? Yes No Please list all current medications that your child is taking and what condition they are indicated for:
Please list any allergies your child has:
Describe your child’s sleep pattern:
Pediatrician’s name/Practice: Pediatrician’s phone:
Oral Development :
Please indicate (X) if your child does the following:
Uses pacifier/sucks fingers or thumb: Eats table food:
Drinks from an open cup: Drinks from a straw: Uses a spoon/fork: “Tongue tie” or a short lingual frenulum: _________
Repaired cleft palate or cleft lip: ______
Is your child a picky eater? Yes No
If yes, please explain:
Does your child gag, choke, or vomit with any foods? Yes No Do you have any concerns about your child’s feeding skills? Yes No
Developmental History :
Please provide the approximate age at which your child began to do the following:
Walk: Use single words: Ask/answer questions:
Combine words into phrases/sentences: Engage in conversation:
Current Communication:
Does your child…..
repeat sounds, words, or phrases?
understand what you are saying?
retrieve or point to objects on request (e.g., ball, cup)?
follow simple directions (e.g., “get your shoes” or “shut the door”)
respond correctly to yes/no questions?
respond correctly to what/where/who/when/why questions?
How does your child communicate at this time? Please check all that apply
Sign language Single words
Gestures or Pointing 2-3 word phrases
Sounds/Babbling 4+ word sentences
Grunting Other
Behavioral characteristics: please check all that apply
□ Cooperative □ Restless
□ Attentive □ Poor eye contact
□ Willing to try new activities □ Easily distracted/ short attention
□ Plays alone for reasonable length of time □ Destructive/ aggressive
□ Separation difficulties □ Withdrawn
□ Easily frustrated/impulsive □ Inappropriate behavior
□ Stubborn □ Self-abusive behavior
Educational History:
Child’s current placement: Home Daycare Preschool
Name of school/ City:
If in preschool/daycare, how many days per week & hours per day:
Has your child ever been evaluated for or received the following services?
Speech Therapy Occupational Therapy Physical Therapy .
Please list all previous and current therapies received:
Where received? Length/ Dates of Treatment:
Current Concerns :
Please describe your concerns today:
When was the problem first noticed? By whom?: What do you hope we can accomplish in therapy?
Differentiate between individuals who communicate within normal limits and those who may potentially have a language disorder.
When a child passes the screening, no further evaluation is needed. When a child fails the screening, a language, speech, and audiology evaluation is conducted.
ASSESSMENT INFORMATION
Informal Assessment evaluates:
Speech intelligibility (In words and conversation)
Attention to Tasks
Early social skills
Initiating social interactions with peers
Functional play (stacking blocks, fitting shapes into appropriate spaces)
Pretend play using dolls/animals
Emotional regulation (reacting/responding appropriately when things do not go according to plan)
Vocabulary development
Clear communication
Receptive language comprehension
Expressive language
Tasks may include:
Counting
Reciting the days of the week
Reading
Naming objects
Naming colors
Formal Assessment:
Fluharty Preschool Speech and Language Screening Test (2nd ed.) (Fluharty 2000)
Screen for receptive and expressive language disorders
(Pearson, 2019)
(Shipley, 2016)
(Child Success Center, 2019)
STANDARDIZED/NORM-REFERENCED TESTS
TEST ADMINISTRATION AGE
TIME (mins)
Preverbal
Communication and Symbolic Behavior Scales (CSBS) 50–75 0;8-3;4
Receptive Language Test
Boehm Test of Basic Concepts 30-45 K-2nd
Peabody Picture Vocabulary Test 10-15 2;6-90+
Expressive Language Test
Expressive One-Word Picture Vocabulary Test 20 2;0-80+
Expressive Vocabulary Test | Third Edition EVT-3 10-15 2:6-90+
Both Receptive & Expressive Language Tests
Receptive-Expressive Emergent Language Test 20 0;0-3;11
Bayley Scales of Infant and Toddler Development 30-60 0;1-3;6
Fourth Edition (Bayley-4)
Preschool Language Scales, Fifth Edition (PLS-5) 45-60 0;0-7;11
Clinical Evaluation of Language Fundamentals 30-60 5;0-21;11
Rossetti Infant-Toddler Language Scale Varies 0;0-3;11
(Shipley, 2016) (Pearson, 2019)
The PPVT-4/EVT-2 and ROWPVT-4/EOWPVT-4 are similar combinations which use similar methods to test receptive and expressive vocabulary. Both sets are co-normed so you are able to do a discrepancy analysis between the examinee's receptive vocabulary and expressive vocabulary.
Additional Considerations:
PPVT-4 and EVT-2 are shorter test
Always administer the most recent version of the test
No one test is perfect for all children and/or all clinicians. Be thoughtful when selecting a test.
TABLE OF AREAS/PARAMETERS/ SKILLS TYPICALLY ASSESSED
These Interactions are Observed Across 5 Levels of Child Language Development
Level 1: Pre-linguistic, precursory behaviors prior to first words
Level 2: Single Words
Level 3: 3 Constituents utterances (Often using coordination)
Level 4: Complex sentences (Combinations of two verb relations)
Level 5: Narratives (Storytelling can be additive, causal, temporal)
https://academiccommons.columbia.edu/doi/10.7
Content: The focus of communication and what is being communicated about
Form: Structures with which ideas are expressed
Use: Function and context of communication
Multi representational model of language use, function and content
NORMATIVE DATA/RELEVANT STATISTICS
Brown’s Grammatical Morpheme Table
Brown’s Stages of Language development
Evaluating Language Sample
#1 Identify Precursors of Language
-Form:
Imitating adult motor behaviors
-Content:
The use of object-specific action in play combining and diving objects
-Use:
Joint attention, turn-taking, regulating others, and identifying objects
NON-STANDARD ASSESSMENT PROCEDURES
Gathering Language Sample
Typically 100 word sample
Norms will not be compared
Use of objects, task and simulation will be used
Story-telling
Open-ended questions
#2 The Plan
-The plan will help the clinican evaluate content, form and use skills
-Helps clinican form goals for child
-Helps categorize child in eight phases of language development
#3 Identifying Narrative Language
-Identify a stimulus
-Identify the charaters being told in narrative
-Identify the time and order, in preschool children this will typically develop later
(Reuterskiold, A Plan for Language Learning Lecture)
DIFFERENTIAL DIAGNOSIS
Delay Vs. Difference Vs. Disorder
Communication Disorder-Impairment to be able to send, receive, and understand verbal, non-verbal, and symbol systems
Speech disorder-Impaired articulation of speech sounds, fluency, and voice
Articulation disorder-unable to produce sounds that interfere with intelligibility (i.e., omission, substitution, addition)
Fluency disorder-interrupts the speech by atypical rhythm, rate, and repeating of sounds, words, syllables, and phrases
Voice disorder-abnormal or absence of vocal quality, pitch, loudness, resonance, and duration
Language disorder-impaired understanding or us of spoken, written and other symbols
Hearing disorder-impaired auditory system
Difference-Variations of symbols used by a group that shares regional, social, cultural, and ethnic factors. This should not be considered a disorder of speech.
Delay-phonolgical processes are learned typically at a slower rate than other preschool children their age
(ASHA, Definitions of Communication Disorder, 2021)
Possible Diagnosis for Pre-School Language Disorders
Autism Spectrum Disorder
Low birth weight
Fetal Alcohol Syndrome
Brain injuries
Cerebral Palsy
Poor diet
Loss of auditory processing
Premature
Stroke
Genetics
(ASHA, Preschool Language Disorders, 2021)
ASSESSEMENT SUMMARY
What are pertinent information to include in an Assessment Summary?
Diagnosis:
Is it a Disorder, Delay or Difference?
Language impairment secondary to a disorder
Severity Level
Specifics of whether expressive, receptive, or mixed
considerations on maintaining factors: sensorimotor, psychosocial, cognitive
Characteristics language components:
if verbal – Results from language sampling: spontaneous speech; discuss narratives; semantic, syntax, phonology, pragmatics analysis
if nonverbal - prelinguistic skills: early social knowledge, gestures, cognitive processes that precede verbal language production
Observation of verbal vs. nonverbal communication
Formal assessments results:
results from Norm-referenced measures/standardized tests used (standard scores or quotients, composite scores percentile ranks and age-equivalent scores)
an impairment varies within the range of one to two standard deviations from the mean
Criterion-referenced results:
relies on pass/fail score or a percentage correct (Can included checklists and questionnaires)
distinguishing the nature of the errors that occurred
demonstrates strengths and weaknesses
Informal assessment findings
from Play observation (including pre-symbolic or symbolic)
Bloom and Lahey impressions
Pre - literacy behaviors
If relevant comparison on child’s development (during peri-natal to post-natal or if complication during delivery was present)
Prognosis
Stein -Rubin et au (2012)
TREATMENT
Child-Directed intervention
Interactive, nondirective, low structure, supportive
focus is on creating naturalistic environment
The clinician (SLP) follows the child's lead
modification are made generally in the area of input
Resembles play therapy but the clinician should manipulate the linguisitc context and non-linguistic context
Indirect lanugage stimulation
Techniques with nonverbal clients
Self-talk: clinician describes own actions while engaging in parellel play with child.
commenting on what you are doing- provides
provides match between words (form) and actions (content)
Parallel Talk: clinician describes child's actions, focus of attention
focusing on the smell, texture, or action of the items/object
Techniques with verbal clients
Buildups and breakdowns: Idea is to expand a child's utterances associated with language growth.
First, expand the child's utterance (ex. Child: apple tree; Clinician: yes the apple tree is big)
Then break it down into several phrase-sized pieces (ex. Clinician: the tree, the tree has apples, apples grow on tree, the apple tree is in front of the house)
Recast sentences: expand child's utterance into a different type of sentence (ex. Child: apple tree; Clinician: Is the apple tree in front of the house? Clinician: The apple tree is in the back of the house
Directive/Clinician-Directed intervention:
Behavior modification, traditionally high structured
Specific goals and responses are strictly predeterminded by clinician
Drills: elicited imitation and shaping
Modeling: using third-person model (parent, doll, puppet)
Hybrid Intervention Approaches
Focused Stimulation:
Clinician maintains controls, at times influencing the child to spontaneously produce targets in obligatory contexts
Clinician gives multiple examples of target form in contexts that highlight the Content and Use of that form.
Child not required to produce target
Clinician gives feedback, like expansions.
Milieu Teaching
Clinican attempts to use their specific principle and apply to a semi-naturalistics setting
Clinician arranges settings to elicit child's initiation
Uses child's interest and initiations as opportunities for modeling, prompting, and questioning to get child to produce language.
Uses extrinic and intrinic reinforcement.
Script Play
Create a routine or reenact scripts child already know with accompanying language
Once child knows the script, can "violate" the routine by asking child to do something outside the routine
Violations of routine challenges child to call attention to them
Idea: reduce cognitive load by embedding increased context of familiar routines
Reuterskiöld, C., 2Nyu
Factors to consider for Intervention
Settings: Intervention can take place in a variety of settings:
Child's own home, playground, or classroom to
Clinic room, teaching booth, or specified area in the classroom
Reinforcement:
Note: Reinforcement should come from naturally occurring reinforcers.
Extrinsic (secondary) reinforcement would be either verbal praises or a kind of token, or a check on a chart
Intrinsic (natural) is communicative success (listener attention, having questions answered, getting what child asked for)
Degree of Structure: Structive most conducive to learning. Highly structure vs. contexts representative of the child's daily life (low-structured).
Number of goals:
work on only one particular language goal at a time
work on a number of goals for different content categories
include all goals within a phase level (within Lahey C/F/U framework)
Note: one could cycle goals over a number of sessions.
Intensity of treatment: more frequent - shorter sessions vs. less frequent - longer sessions
Lahey, M. (1978)
Other Visuals and resources
http://speechandtalk.com/saigon_speech_therapy_autism/7-differences-autism-language-delay/
Click for resources:
Speech-Language Milestones resource list
Learn the Signs. Act Early a CDC resource Site with free materials and great parental guides
REFERENCES
American Speech-Language-Hearing Association. (1993, January 1). Definitions of communication disorders and variations. American Speech-Language-Hearing Association. Retrieved September 29, 2021, from https://www.asha.org/policy/rp1993-00208/
American Speech-Language-Hearing Association. (n.d.). Preschool language disorders. American Speech-Language-Hearing Association. Retrieved September 29, 2021, from https://www.asha.org/public/speech/disorders/preschool-language- disorders/#causes
American Speech-Language-Hearing Association. (n.d.) Definitions of Communication Disorders and Variations. American Speech- Language-Hearing Association. Retrieved September 30, 2021 from, https://www.asha.org/policy/rp1993-00208/
Lahey, M. (1978). Language disorders and language development. Macmillan Publishing company
Shipley, K. G., & McAfee, J. G. (2016). Assessment in speech-language pathology: A resource manual (6th ed.). Boston, MA: Cengage.
Stein-Rubin, C., & Fabus, R. (2012). A guide to clinical assessment and professional report writing in speech-language pathology. Delmar.
Reuterskiöld, Christina. Principles and Models of Intervention, theories of learning. Week 7. 2NYU.
https://www.healthline.com/health/mixed-receptive-expressive-language-disorder
https://childsuccesscenter.com/back-to-school/what-is-a-pre-school-speech-and-language-screening/
http://www.speechlanguage-resources.com/What-is-language.html