School-Age and Adolescent Language Disorders

Communication Disorders: an impairment in the ability to receive, send, process, and comprehend concepts or verbal, nonverbal and graphic symbol systems. A communication disorder may be evident in the processes of hearing, language, and/or speech. A communication disorder may range in severity from mild to profound. It may be developmental or acquired. Individuals may demonstrate one or any combination of communication disorders. A communication disorder may result in a primary disability or it may be secondary to other disabilities.

*Ad Hoc Committee on Service Delivery in the School*

What is a Language Disorder?

Language disorder: 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.

  1. 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.

  1. Content of Language

Semantics is the system that governs the meanings of words and sentences.

  1. Function (Use) of Language

Pragmatics is the system that combines the above language components in functional and socially appropriate communication.


Communication difference/dialect is a variation of a symbol system used by a group of individuals that reflects and is determined by shared regional, social, or cultural/ethnic factors. A regional, social, or cultural/ethnic variation of a symbol system should not be considered a disorder of speech or language.


Augmentative/alternative communication systems attempt to compensate and facilitate, temporarily or permanently, for the impairment and disability patterns of individuals with severe expressive and/ or language comprehension disorders. Augmentative/alternative communication may be required for individuals demonstrating impairments in gestural, spoken, and/or written modalities.


  • Speech sounds: may have trouble saying sounds. He may not speak clearly and be hard to understand.

  • Language and literacy: may have trouble understanding what she hears. She may not follow directions or answer questions well. It may be hard for her to tell others about her thoughts. She may not say the correct words or say only short sentences. Language problems can also make reading and writing harder.

  • Social communication: may have trouble talking with other children. He may not make friends easily. He may not understand what others think or how they feel.

  • Cognitive communication: These are the thinking skills your child needs to remember, solve problems, and use her imagination. Learning disabilities and brain damage can cause these types of problems.

  • Feeding and swallowing: It may sound strange to think of eating as a school problem, but it can be. Feeding and swallowing problems can make it hard for your child to eat and drink enough during the day. This can make it hard to learn. It can also make social times, like lunch or snack, harder for your child.

  • Stuttering: may have trouble speaking smoothly. She may repeat sounds or words or have long pauses when she talks. Stuttering can make it hard to answer questions or give speeches in class. It can also make it hard to talk to friends.

  • Voice: may sound hoarse or lose his voice. He may sound like he talks through his nose, called nasality. His voice may be too loud or too soft. Voice problems can make it hard to talk in class or with friends.







  • You need language skills to communicate. And you need to communicate to learn. Reading, writing, gesturing, listening, and speaking are all forms of language. The better your communication skills, the better you will do in school.

  • Does your child have speech or language problems? He may not be able to do grade-level work. He may have trouble reading, writing, and spelling. He may not understand social cues, like what a person means when he nods or looks away as you speak. He may have trouble taking tests and may not want to go to school.

  • The school SLP should see your child. Each school has a process you need to follow to have your child seen. Your child may get referred to a child study team for testing. The SLP may be a part of this team, along with teachers, special education teachers, a psychologist, or others.




There are many causes of speech and language disorders, but often the cause is unknown.

Language disorders can be due to a brain difference that makes learning and understanding language difficult

Hearing loss

Autism

Cerebral Palsy

Neurological Disorders

Traumatic Brain Injury

Mental Retardation.

***Language disorders are not caused by cultural differences or by learning two or more languages at the same time.

Form for Adolescents: Example Form

I. Personal Information

Name: Date of Birth:

Age: Gender: male female

Address:

City: State: Zip code:

Parent(s) Names:

Home telephone: E‐mail:

Cellular telephone: Self: Mother: Father:

Parent(s) Work telephone: Mother: Father:

Emergency name and telephone number:

Name of Physician:

Referred by:

School: Hours of attendance:

Education – highest grade completed:

II. Statement of the problem

Describe in your own words your speech and/or language problems and your reasons for concern:


III. Education information

School(s) attended:

Current grade: Do you excel in any subjects?

Do you have any serious difficulty in any subjects?

Please list the school subjects you are the best in:

Please list the school subjects you enjoy the most:

Please list the school subjects you have the most difficulty in:

Why do you feel you are having difficulty with these subjects?

Do you have any future vocational goals?

If yes, describe:

IV. Health History

List 1) major illnesses, diseases, or operations; 2) age at the time of each; and 3) resulting health complications or handicaps.

Illnesses/diseases/accidents Age Resulting handicaps

Were you hospitalized for any of the above conditions?

If so, where and for how long?

Have you received, or are you now receiving rehabilitation treatment such as radiation therapy, physical therapy, occupational therapy?

If so, describe the reason for, type, duration and result of treatments:

Are you currently under the care of a doctor?

If yes, for what?

Are you currently taking any medications?

What kind?

For what?

How much?

How often?

Do you have any known allergies?

Describe:

Do you have any known drug sensitivities?

Describe:

Have you had seizures?

If yes, how often?

When was the most recent seizure?

Do you have any known hearing problems? Describe:

Do you have any known vision problems? Describe:

Do you wear glasses/contact lenses?

If yes, describe the condition:

IV. Present Speech, Language, or Hearing Problem

Describe the present problem:

How long has there been a problem?

What do you think caused the problem?

What types of speech and language services have you received?

How long have/did you receive services?

Where did you receive services?

From whom?

Why were you dismissed/stopped speech and language therapy?

How do you feel about your speech and language problem?

What is your primary means of communication?

Are you understood when you speak? If not, describe:

Do you avoid speaking situations?

If yes, describe:

Are there times or situations when your problem is better or worse?

Please describe:

PLEASE PROVIDE A COPY OF ANY EVALUATIONS, I.E.P.’S, PROGRESS REPORTS DISCHARGE REPORTS

What other information can you provide which will enable Cincinnati Center for Improved Communication, Inc. to better know and understand you?



https://ccicinc.com/assets/CCIC-adolescent-case-history.pdf

Assessment Information

SCREENING

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.

Screenings include:

  • Receptive language analysis

  • Expressive language analysis

  • Literacy/reading comprehension

  • Writing analysis

  • Audiology

Assessments of the school-aged children is usually weighed more towards standardization, however, informal assessments are an important component of a complete language evaluation.

Informal Screening:

  • Spoken language & written language

  • Conversation (Initiation and dominance)

  • Story telling

  • Sharing thoughts, ideas, and/or feelings

  • Understand others

Formal Language Tests Assess:

  • Specific areas of assessment:

    • Semantic

    • Syntactic

    • Pragmatic

    • Morphological

    • Vocabulary

    • Grammar

    • Writing

    • Language Processing

  • Standardized methods are used and compared to normative data. (Shipley, 2016)

Standardized/Norm-Referenced Tests

Table of Areas/Parameters/Skills Typically Assessed

EXPRESSIVE LANGUAGE

  • Provides information about ability to express through language

        • Grammar

        • Semantics

        • Pragmatics

        • Phonology

        • Morphology

May also include evaluation of:

  • Repetitions

  • Confrontation naming

  • Oral reading

  • Writing (mechanics and formulation)

Information Obtained may include:

  • Word finding difficulty

  • Paraphasia (semantic and phonemic)

  • Morphosyntactic errors

  • Level of fluency

  • Stimulability of cuing hierarchy

*Clinical Evaluation of Language Fundementals-

4th Edition (CELF-4) (Sewel, Wig & Secord, 2004)

*Test of Expressive Language (TEXEL) usually administered, ages 3 through 12. (academictherapy.com)

RECEPTIVE LANGUAGE

Provides information about ability to understand language ( disorder is not caused by hearing impairment)

        • Trouble following directions

        • Trouble answering questions

        • Asking people to repeat what someone is saying

        • Misunderstanding what is being said.

Auditory comprehension of spoken language is evaluated

  • Identification (real/pictured objects)

  • Commands: simple/complex (yes/no choice, "wh" questions, open ended question

  • Conversation/expository speech judged by accurate and contingent responses

  • Comprehension of written word across different levels

McIntyre, L. J., Hellsten, L. M., Bidonde, J., Boden, C., & Doi, C. (2017). Receptive and expressive English language assessments used for young children: a scoping review protocol. Systematic reviews, 6(1), 70. https://doi.org/10.1186/s13643-017-0471-1

LITERACY

Must be evaluated on many levels

NORMATIVE DATA/ RELEVANT STATISTICS

  • ASHA Your Child's Communication Development : Kindergarten Through Fifth Grade. Link below for more information.

https://www.asha.org/public/speech/development/communicationdevelopment/

  • K-12 Educational Learning Standards/Sciences/Mathematics/Literacy

Literacy Assessment Practices — The Literacy Bug

http://www.nysed.gov/curriculum-instruction/science-learning-standards

http://www.corestandards.org/ELA-Literacy/

  • Adolescent's Developmental Stages

Non-Standardized Assessments

Examples of Non-standardized tests: [dependent on student’s current skill set]


  • Classroom observations of the student interacting with peers, teacher, learning material and assignments.

  • Parent-Teacher reports and observations

  • Choosing selections from standardized tests or simplifying the full test to meet the student’s needs- data obtained here can’t be compared to normative data unless the student is appropriately represented.

  • Student’s writing samples from a set curriculum

  • Informal commercial tests

  • Ethnographic Interviewing- utilizing informal and open ended questions to gain perspective from the client or family members.


  • Non-Standardized testing can cover reading, writing, spelling and comprehension.


(ASHA, Assessment Tools Techniques and Data Sources, 2021)


DIFFERENTIAL DIAGNOSIS

Assessment Summary

What Pertinent Information should be included in an Assessment Summary?

  • Diagnosis:

      • Language component (oral, reading or written modality)

      • Language impairment secondary to a disorder

      • Severity Level

      • Intelligibility

  • Assessment findings

      • Standardized and non-standardized

      • Eligibility criteria

      • Areas of mastery

      • Identification of error patterns

  • Behaviorial observations

      • Any standardized assessments used and their results

      • Classroom observation

  • Literacy and written analysis

  • Further evaluations recommended

  • Dates of next planned assessments or meeting for review of plans

  • Prognosis

Information whether IEP or 504 plan are recommended

Shipley et au, 2016


IEP and 504 Plans

IEP (Individualized Education Plan): Plan authorized By IDEA. Is a written plan or program to ensure a child receives the services and accomodation needed . Can be provided in any setting.

504 Plan: Plan authorized by the Rehabilitation Act of 1973. yearly school specific plan created between family and school for a student to provide accomodations and only used in general education settings.

A 504 Plan or an IEP: Which is right for me? (click for great PDF resource.

Intervention Approaches

  • Use Curriculum-Based instruction (e.g., Common Core Standards)

  • Integrate oral, literacy, and written language

      • Focus on literate language use

  • Planning individualized instruction for students with varied patterns of strengths, needs, and diabilities

  • Collaborating with teachers and other professionals- prevent school failure also through RTI participation (see below)

  • Using technology for learning.

Response to Intervention (RTI)

Tier 1: Intruction happens within the classroom and usually conducted by the teacher.

Our Scope: no consensus. A preventative role may include

  • Possible goals is to collaborate with classroom teachers and pre-referral teams to make best use of literacy-rich context

  • can focus on organization of examination space, time, and scheduling dedicated to literacy activites. Ex. support young students with their emergent literacy with assistance in oral foundations.

  • Another point of view is that participation within this tier is not practical - with concerns of caseload.

Tier 2: Targeted interventions that also happen within the classroom, mostly with small groups. SLP's can act as informant's but teacher leads here.

Our Scope as a secondary preventional measure:

  • support with more intensive supplementary instruction; providing teacher with ideas of tasks for example.

  • Monitor children who do not respond to their TIER 1 reading experiences (inadequately to areas of phonological awareness or their ability to conduct these tasks of language such as rhyming, syllabification, clapping out syllables, segmenting into phonemes.

  • Code-based intervention (SLP as partners; if child has reading-related difficulties)

  • Oral-language-focused intervetion (taught by SLP); host smaller groups in a classroom and teach oral-language focused interventions.





Tier 3:

Our Scope: No longer preventative measures. We are lead treatment for the student.

  • Establishment/generalization/maintainence

  • Strategies and approaches

  • Treatment techniques and technologies






Brea, M., 2021

UDL At a Glance

Click the following for great resources:

What does UDL Look Like?

UDL progression rubric

UDL: Universal Design for Learning

A set of principles for curriculum development giving all individuals equal opportunity to learn. Ideas for multiple ways of: representation, engagement, and action/response:

  • Provides a blueprint for creating instructional.

  • Framework for teaching and learning

  • Includes proactive learning (goals, methods, materials, and assessment)

  • Flexible approaches

  • takes into account the variability of all learners

Brea, M., 2021

https://udlguidelines.cast.org

Literacy Intervention:

SCAFFOLDING Strategies: Zone of proximal Development: developmental limits where a child's ability can be stretched; Learners are active in the learning process; Learning can be co-constructed; strategies are goal-directed.

Key Components:

Context: Motivational role of participation in real activity; Joint goal-directed activity

Contingency: Responsive support; Online diagnosis of need (fostering genuine learning)

Challenge: Transfer of responsibillity to learner (self-regulation); performance in anticipation of understanding.

Instructional Technique: Listen, Examine, Decide, Plan a macrostructure, Plan to match scaffollding techniques to different contexts, Set motivational and instructional goals, choose to scaffold topics and strategies that you know well.

TYPES OF SCAFFOLDING

  1. Responsive Interaction Strategies: recasting

  2. Directed Interaction Strategies: based on behaviorism- prompting, shaping, reinforcements, and fading

  3. Blend Strategies: use of directive behavioral strategies buy in natural environments to promote generalization

General:

A. Offering explanations: Explicit statements emerging understanding about: What, Why, When, How

  • Supportive: assist in understanding underlying concepts, relevance of. applying concept, or how concepts are used

  • Directive: directed to attend to only one source

B. Questioning: Determine present knowledge

  • help connect to what they already know

  • help think critically

C. Modeling

  • Think-aloud:

  • Talk-aloud

  • Telling

  • Performance modeling

Brea, M., 2021

Planning an Intervention Sessions and Scaffolding

by Maria R. Brea, Ph.D., CCC-SLP:

Writing Intervention:

  • Process-oriented approaches focuses on the processes involved in writing, including developing ideas, planning (pre-writing), organizing, drafting, reflecting, revising, and editing.

  • Product-oriented approaches focuses on the written form, including vocabulary, spelling, and grammar; use of cohesive devices; use of writing conventions; and effectiveness of intended communication.

Note: should attempt to address both simultaneously

Three Intervention Scaffolds for Composing Expository Text: EACH requires, collaboration, individualization, and allowing students to progress at their own pace

Self-regulated Strategies Development (SRSD): 6 stages. 1. Develop background knowledge (e.g. develop vocabulary or read works on the genre); 2. Discuss it (e.g. Graphing, setting goals, establish student commitment; 3. Model it; 4. Memorize it; 5. Support it (e.g. plans for maintenance and generalization. 6. Independent performance (e.g. plans for maintenance and generalization implemented, self-regulation begins.

Writing Process (LI): process-oriented expository text strategies

EmPOWER LI: Involves the evaluation of a prompt, making a plan by selecting a specific graphic organizer, the organization of ideas that will be explained, then the writing the piece, and re-evaluate and rewriting at the end.

Self-regulating strategies:

Goal setting, self-instruction, Self-evaluation, coping/self-control (positive self talk), Self-reinforcement

Below is a nice example

ASHA; written language disorders

Brea M., 2021

Phonological Awareness Intervention:

Phonological Awareness and Common Core (1st grade):

  • Distinguish between long/short vowel sounds in monosyllables

  • Blend phonemes and consonant clusters

  • Isolate and pronounce intial, medial, and final phonemes in monosyllables

  • segment single-syllable words into their corresponding or constituent phonemes

Effective Practices in Phonological Awareness:

  • Intervention based on assessment data or persistent difficulty

  • Instruction focused at the phoneme level (identity, segmentation, blending, and manipulation tasks

  • Alphabetic knowledge integration

  • Phonological awareness tasks planned for differeing contexts and include activities that are culturally appropriate

  • vocabulary instruction embedded in instruction.

Sample Activity: For long vowel word sorts

  • Prompt spelling of the mono-morphemic words and multi-morphemic used in word sorts

  • As child gets more proficient- include more than one mono or multi- morphemic word list in each session

Targeted work in Sound comparison (phonemic awareness intervention)

  • Materials: rope, clothespins, markers, tagboard, glue, pictures, scissors, and laminated film

  • Use materials to build words where the letters have visual representation.

  • Have student match the picture card to the clothespin and hang it on the rope.

Brea, M., 2021

Continuum of Language complexity of the Oral register

Reading Layers:

Assess and prompt hierachy visuals

Brea, M. 2NYU

REFERENCES

https://www.asha.org/policy/rp1993-00208/

https://www.asha.org/public/speech/development/speech-and-language-services-in-schools/

American Speech-Language-Hearing Association. (2021). Assessment tools, techniques, and data sources. American Speech-Language-Hearing Association. Retrieved October 2, 2021, from https://www.asha.org/practice-portal/clinical-topics/late-language-emergence/assessment-tools-techniques-and-data-sources/.

American Speech-Language-Hearing Association. (2021). Central Auditory Processing disorder. American Speech-Language-Hearing Association. Retrieved October 3, 2021, from https://www.asha.org/practice-portal/clinical-topics/central-auditory-processing-disorder/.

American Speech-Language-Hearing Association. (2021). Attention-deficit/hyperactivity disorder (ADHD). American Speech-Language-Hearing Association. Retrieved October 3, 2021, from https://www.asha.org/public/speech/disorders/adhd/.

American Speech-Language-Hearing Association. (2021). Childhood apraxia of speech. American Speech-Language-Hearing Association. Retrieved October 3, 2021, from https://www.asha.org/practice-portal/clinical-topics/childhood-apraxia-of-speech/#collapse_1.

Written Language Disorders. American Speech-Language-Hearing Association. (2021). Retrieved October 3, 2021, from https://www.asha.org/practice-portal/clinical-topics/written-language-disorders/#collapse_6

Brea. M. (2021) Language Development and Disorders in School-Age Children. Lecture notes from week 4-10. 2NYU.

Shipley, K. G., & McAfee, J. G. (2016). Assessment in speech-language pathology: A resource manual (6th ed.). Boston, MA: Cengage.

IEP vs 504 plan. retrieved on september 30, 2021 from http://www.hopkinton-sepac.org/504-plan.html

https://www.cincinnatichildrens.org/-/media/cincinnati%20childrens/home/service/s/speech/hcp/doctor-info/information-language-pdf-adolescent-1.pdf?la=en#:~:text=There%20are%20many%20causes%20of,brain%20injury%2C%20or%20mental%20retardation.