1
Q
5 subcategories in DSM for communication disorders
A
- language disorder
- social (pragmatic) communication disorder
- speech sound disorder
- childhood-onset fluency disorder
- unspecified communication disorder
2
Q
bishop (2017) on language disorder
A
- potential for labels to stigmatise/create low expectations
- labels can ensure lang problems aren’t trivialised
- misleading to assume co-occurring conditions cause of lang disorder
- DLD could co-occur with milder neurodev disorders that didn’t have a clear biomedical aetiology
- multifactorial aetiology is heterogeneous in terms of lang features & overlaps with other neurodev disorders
3
Q
tension between use of standardised tests & qualitative observations
bishop (2017)
A
- standardised - relatively objective & reliable assessment
- qualitative - capture functional aspects that aren’t picked up on formal assessments
4
Q
language disorder in DSM
A
- persistent difficulties in the acquisition & use of lan across modalities due to deficits in comprehension or production
- lang abilities are substantially & quantifiably below those expected for age, resulting in functional limitations in effective comm, social participation, academic achievement, or occupational performance, individually or in any combination
- onset of symptoms is in the early developmental period
- the difficulties are not attributable to hearing or other sensory impairment, motor dysfunction, or another medical or neurological condition & are not better explained by intellectual disability or global dev delay
5
Q
persistent difficulties in lang disorder
DSM
A
- reduced vocab
- limited sentence structure
- impairments in discourse
6
Q
epidemiological characteristics of lang disorder
A
- apparent by age 4, lifelong
- ~7.6% of primary school kids higher in areas of lower SES (Norbury et al., 2016)
- fairly even gender balance
- runs in families: 9x more likely if family member with it (Tomblin, 1989)
7
Q
social (pragmatic) communication disorder
A
- new diagnosis in DSM-5 concerning problems with pragmatics e.g. social use of lang & comm
- bears some relation to idea of pragmatic lang impairment
8
Q
SCD in DSM-5
A
- persistent difficulties in social use of verbal & nonverbal comm
- deficits result in functional limitations in effective comm, social participation, social relationships, academic achievemtn, or occupational performance, individually or in combination
- onset of symptoms in early dev period
- symptoms arent attributable to another medical or neurological condition or to low abilities in the domains of word structure and grammar, & are not better explained by ASD, intellectual disability, GDD or another mental disorder
9
Q
persistent difficulties in social use of verbal & nonverbal comm in SCD
DSM
A
- deficits in using communication for social purposes, such as greeting and sharing information, in a manner that is appropriate for the social context
- impairment of the ability to change communication to match context or the needs of the listener, such as speaking differently in a classroom than on a playground, talking differently to a child than to an adult, and avoiding use of overly formal language
- difficulties following rules for conversation and storytelling, such as taking turns in conversation, rephrasing when misunderstood, and knowing how to use verbal and nonverbal signals to regulate interaction
- difficulties understanding what is not explicitly stated and nonliteral or ambiguous meanings of language
10
Q
epidemiological characteristics of SCD
A
- cant be distinguished before 4-5
- ~7-11% of 8th graders (weismer et al., 2021)
- most common males 2.5:1
no studies on heritability of SCD but pragmatic difficulties highly heritable in autism
11
Q
speech sound disorder
A
- sometimes called ‘phonological disorder’
- speech sound production isnt consistent with expectation for chronological or mental age
12
Q
SSD in DSM
A
- persistent difficulty with speech sound production that interferes with speech intelligibility or prevents verbal comm of messages
- disturbance causes limitations in effective comm that interfere with social participation, academic achievement, or occupational performance, individually or in any combination
- onset of symptoms is in early dev period
- difficulties are not attributable to congenital or acquired conditions, hereditary and genetic conditions are excluded from this criterion
13
Q
epidemiological characteristics of SSD
A
- ~6-18% of 8yos (Roulstone et al., 2009)
- <3% at high school graduation (Flipsen, 2015)
- more common in males than females
14
Q
childhood onset fluency disorder
A
- AKA stuttering/stammering
- involves speech production
15
Q
COFD in DSM
A
- disturvances in normal fluency & time patterning of speech that are inappropriate for the ind’s age & lang skills, persist over time, & are characterised by frequent & marked occurrences of at least 1 of the following
- disturbance causes anxiety about speaking or limitations in effective comm, social participation, or academic or occupational performance, individually or in any combination
- onset of symptoms is the early dev period
- not attributable to a speech-motor or sensory deficit, disfluency associated with neurological insult, or another medical condition
16
Q
marked occurrence in COFD
DSM
A
- sound & syllable repetitions
- sound prolongations of consonants as well as vowels
- broken words
- audible or silent blocking
- circumlocutions
- words produced with an excess of physical tension
- monosyllabic whole-word repetitions
17
Q
epidemiological characteristics of COFD
A
- emerges in early childhood
- ~5-8% in preschool children, reduces with age
- more common in males than females
- recovery rate ~80%
18
Q
2 types of explanations for lang disorder
A
- linguistic - focus on underlying issues with learning grammatical morphology
- processing - focus on cog processes
19
Q
linguistic accounts
DLD
A
- LD isnt just a delay in lang but arises due to specific issues with acquiring certain aspects of lang
- tend to focus on morphology = smallest structural units of lang that convey meaning
- words or parts of words - meaning changes depending on how they are combined
20
Q
linguistic accounts: agreements
DLD
A
- deficits of agreement (Clahsen, 1992)
- agreement relations = when a word changes in lang depending on the other words it relates to
- e.g. subjects & verbs
- e.g. number agreement in noun phrases
21
Q
deficits of agreement
rice & oetting (1993)
A
- analysed data from kansas lang transcript database
- compared children with LD & lang-matched TD children (MLU)
- LD children showed poorer agreement between subjects & verbs - difficulty adding ‘s’ for 3rd person singular present (36% vs 54% correct usage)
- LD children showed poorer agreement between quantifiers & nouns (71% vs 90% correct usage)
22
Q
linguistic accounts - EOI
DLD
A
- extended optional infinitive (rice er al., 1995)
- dev stage where marking of tense in main clauses isnt obligatory
- e.g. -ed for past tense
- e.g. -s for third person singular present
- this stage proposed to be longer in those with LD
23
Q
extended optional infinitive
rice & wexler (1996)
A
- children with LD, CA & lang-matched (on MLU) groups
- lang analysed based on spontaneous speech samples, plus probed samples
- transcribed & coded for diff morphemes in relation to tense
- third person singular -s: LD differs from both control groups, dont use third person singular as successfully showing area of difficulty
- also the case for -ed
- results suggest LD isn’t just a delay in all aspects of lang but issues are more specific
findings not replicated in italian speaking sample (leonard et al., 1992)
24
Q
processing accounts - perceptual
A
- perceptual deficits
- issues with speech perception common e.g. phonemic discrimination (elliott et al., 1989)
- issues with perceptual discrimination may not be limited to auditory modality
- children with LD worse on tasks that involved discriminating 2 simultaneously presented touches on fingers, or other body parts & a test of integrating rapidly-presented audio & visual stim
- tallal (1990) - impairment in processing rapid sequential info
25
processing accounts - phonological
| LD
* phonological deficits observed in children with LD
* gathercole & baddeley (1990)
* poor repetition of non-words
* many morphological rules have phonological components e.g. pronunciation of past tense depends on the final phoneme of the final phoneme of present tense verbs
26
phonological deficit
| LD
* perceptual salience of morphemes inpacts LD children's performance
* may help explain variability between langs in which aspects of grammar are affected (leonard et al., 1987)
27
procedural deficit hypothesis
| ullman & pierpont (2005)
* ppl with LD have problems with procedural mem system of brain - responsible for learning new skills & procedures & control of old ones
* procedural mem involved in lang acquisition especially in relation to linguistic rules
* frontal/basal ganglia circuitry
* declarative mem is spared & may permit compensation for procedural problems
* SLI can be largely explained by abnormal dev of brain structures that constitute the procedural mem system
28
procedural deficit account
| lum et al. (2014)
* meta-analysis of serial reaction time task (SRT) performance
* SRT involves no lang at all, often used as a measure of procedurall mem
* typical dev: as go through repeated sequence, ppts tend to respond quicker than novel, learning sequence, learning at motor level
* LD: poorer procedural mem, at least trends towards this finding
29
explanations for COFD
* very wide range of accounts for stammering
* emotional/psychological perspectives
* sensorimotor explanations
* lang processing
* neurological explanations
30
emotional/psychological aspects of COFD
* historically stammering was considered to be a neurotic disorder
* trait anxiety higher in adults who stammer (craig et al., 2003)
* social anxiety disorder very common in adults who stammer (iverach & rapee, 2014)
31
temperament & COFD
| ntourou et al. (2013)
* narrative task involving telling a story from pictures
* preceded by one of two conditions, experimental condition was designed to be provoking where no solution to problem presented with
* beh coded for emotional reactivity e.g. +ve & -ve affect & emotional regulation: self-speech/distraction
* although no diffs in disfluencies between conditions, stuttered disfluencies -vely corr with distraction in COFD group
32
COFD and dual diathesis stressor model
| walden et al. (2012)
* temperamental characteristics predispose some inds to developing stammering
* stressors also have to be present in the environment for stammering to occur
33
sensorimotor explanations COFD
* failure to form stable underlying motor programmes speech
* speech coordination processes become less variable with age (smith & zelaznik, 2004)
* walsh et al. (2015): boys who stammered had higher variability in articulatory movements, less mature speech coordinative patterns
34
language processing and COFD
* stammering onset usually occurs when children's lang abilities are rapidly developing e.g. MLU increases
* children stammer more for more syntactically complex sentences
* variability of speech-oral motor patterns greater with increased syntactic complexity (MacPherson & Smith, 2013)
35
are lang difficulties more common in COFD
* caseload studies - examine co-occurrence of COFD & LD
* e.g. arndt & healey (2001) - 30% children who stammered had LD
* nippold (2004) - 71% speech lang therapists would recommed treatment if a child's only problem was stuttering but 94% said they would recommed treatment if the child also had LD
36
are lang abilities poorer in COFD
| nippold (2012)
* critique of meta-analysis
* only 4 studies in meta analysis matched groups on age, gender & SES
* often control group selected to score at 20th centile or higher but not in COFD group
* children who stutter show full range of lang abilities, lang deficits arent associated with stuttering onset or persistence, stuttering has little or no impact on lang dev
* connection between stuttering & lang ability not supported
* children who stutter may have a compromised motor control system
37
are phonological abilities poorer in COFD
| anderson et al. (2006)
* nonword repetition
* children with COFD show poorer non-word repetition
* clear group diffs
* less pronounced as syllable length increases but this could be due to ceiling effects
38
ERP of phonological abilities
| weber-fox et al. (2008)
* rhyming judgement task
* prime then target - judge as quickly as possible whether they rhyme
* ERPs measure to both words
* brain processes underlying phonological abilities may be diff in those with COFD
* prime & target rhyme, orthographic didn't make a difference
* COFD consistently worse
* both groups show increased N400 for non-rhyme vs rhyme trials
## Footnote
conclude that the neural functions related to phonological rehearsal & target anticipation are immature in children with COFD
39
neurological diffs & COFD
* most studies with adults
* anatomical studies show deficits in connectivity between areas for speech production & auditory-motor integration e.g. chang et al. (2011)
* other studies implicate corpus callosum, basal ganglia, cortico-spinal tract & cerebellum (watkins et al., 2008)
* fMRI - reduced activity in LH speech areas & overactivation in RH (braun et al., 1997)
40
children's grey matter & COFD
| chang et al. (2008)
* persistent stammering, recovered stammering, no stammering (fluent)
* fluent > stuttering
* fluent > persistent
* fluent > recovered
* less diffs between the groups of persistent & recovered so hard to explain why some recover & others dont
41
children white matter in COFD
| chang et al. (2015)
* corr with stammering severity
* lots of antomical diffs
* white matter vol in areas such as superior temporal gyrus in COFD
42
multifactorial dynamic pathways
| smith & weber (2017)
* stammering arises due to ongoing interactions between motor, linguistic & emotional factors during dev
* period of dev where COFD emerges: MLU dramatically increases, emotional regulation dramatically increases, growth of synapses reaches peak
* stuttering reflects impairments in speech sensorimotor processes, its course over the life span is strongly conditioned by linguistic & emotional factors
* pathways theory motivates experimental & clinical work to determine the specific factors that contribute to each child's pathway to the diagnosis of stuttering & those most likely to promote recovery
Understanding neurodevelopmental disorders
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