1
Q
How do we learn to communicate?
A
Interaction from birth
Protoconversations
First words = objects
Need to hear to understand spoken language
2
Q
What is how we learn to communicate dependent on?
A
Environment born into- differs in social/cultural contexts
- ie: no hard and fast rules
3
Q
Why is knowledge of typical development very important?
A
Need knowledge of typical SLC child development t understand variations and differences in development
4
Q
At what point does ‘variation’ become ‘needs support’?
A
Ages + stages guides this
Child is checked and referred for support if needed
5
Q
What is the issue with saying ‘typical development’?
A
Stigmatises non-typical
6
Q
Approximately, when does a child start to say babblings sounds?
A
6 months
7
Q
Approximately, when does a child start to say their first words?
A
By 1 year
8
Q
Approximately, when does a child have a spoken vocab of more than 10 words?
A
1y - 18 months
9
Q
Approximately, when does a child understand short spoken phrases eg: shoes on?
A
By 18 months
10
Q
Approximately, when does a child engage in functional play?
A
18m - 2 years
11
Q
Approximately, when does a child start to put their spoken vocab into phrases eg: more juice?
A
18m - 2 years
12
Q
Approximately, when does a child understand 3-4 key word instructions?
A
2-3 years
13
Q
Approximately, when does a child engage in imaginative play?
A
By 3 years
14
Q
Approximately, when does a child use grammar / tense to talk about something that happened in the past?
A
By 3 years
15
Q
Approximately, when does a child say complex sentences with the word because, eg: I’m not going swimming later because I’ve got to go to Granny’s party ?
A
4-5 years
16
Q
Approximately, when does a child use spoken language for a range of reasons, eg: to argue, narrate, reason, explain ?
A
By 5 years
17
Q
Approximately, when does a child say most speech sounds clearly / intelligible speech?
A
By 5 years
18
Q
Approximately, when does a child have meta knowledge about language? eg: number of syllables, semantic categories, first sound of words
A
5-6 years
19
Q
What are 10 approaches to consider?
A
Medical
Social
Impairment
Developmental
Educational
Functional
Psychological
Biopsychological
Ecological
Neurodiverse
20
Q
What are 6 examples of less inclusive terminology? What is the name for this?
A
Medical language
Impairment
Disorder
Disability (though legislation to protect this trait)
Deficit
Problem
Atypical
21
Q
What are 5 examples of more inclusive terminology?
A
Neuro-affirming language
Needs
Challenges
Support
Diverse
Difference
22
Q
Which type of terminology dominates autism research?
A
Medical language continues to dominate over neuro-affirming language
23
Q
What is the neurodiversity paradigm?
A
Incorporates Alternative Neuro-affirming Language (ANL) to describe autistic
experiences without presuming incompetence / pathology
24
Q
What is a visible example of the neurodiversity paradigm?
A
Use of identify-first language (IFL) -“autistic person”
Instead of person-first language (PFL) -“person with autism”
25
What are neuro-developmental disorders / conditions / differences?
Impairment based/medical approach
Complex genetic + environmental factors interact to change brain development
Some neurodevelopmental disorders have common causes
26
Who coined the term neurodiversity?
Judy Springer- located in the social model of disability, asset rather than deficit approach, identifying strengths
27
What is neurodiveristy?
Group of people with different brain types
Neurotypical = fits into typical model
Neurodivergent = diverges from typical profile
- both together makes neurodiverse
note: in practice neurodiversity is usually non-neurotypical
28
What is Bronfenbrenner's bioecological model?
Developmental model with child at centre, showing their interactions with different systems
29
According to Bates et al, what should be the comprehension/understanding of single words at 10 months?
0-144 words
30
According to Bates et al, what should be the comprehension/understanding of single words at 16 months?
80-300 words
31
According to Bates et al, how many words should children be saying at 12 months?
0-24 words
32
According to Bates et al, how many words should children be saying at 24 months?
89-534
33
According to Bates et al, when should children say 2 word combinations?
Between 16 months - 2 years
34
Describe typical 2 year old speech, language and communication development
Understand more than can say
Good functional + symbolic language
Can say range of words but still more to learn (eg: can say flower, not dandelion)
Expressive vocab 2-300 words
Says 2-3 word sentences
Asks + understands simple questions (eg: what's that, where's a broccoli)
Speech sounds not all easily understandable
35
How can teachers/parents help language development for 2 year old children?
Repeat + extend (conversational recasting + conversational expansion)
36
Which sounds can children say at around 3 years 9 months?
/b/
/d/
/m/
/t/
/k/
/g/
/s/
/f/
+ most vowels
in different word positions
37
What sounds are more difficult for a child at 3 years 9 months to say?
/ʃ/
/tʃ/
/θ/
/ð/
/ɹ/
/j/
/l/
38
Describe the attention, listening, and play of a child with ASD
Hard to attend + listen to others (eg: doesn't respond to name)
Initially not interested in adult, more interested when adult sings, seems to enjoy physical interaction
Not interested in playing with toys but likes sensory properties
39
Describe the speech/language of a child with ASD
Vocalises- no words that can be identified/understood
40
What is an educational challenge for children with ASD?
Difficulty to interact + follow instructions in mainstream school
41
What is an ecological challenge for children with ASD?
Hard if in large family: restrictive diet, needs a lot of care + attention
42
How can teachers/parents help communication development for children with ASD?
Intensive interaction to establish reciprocal communication
43
What are some speech and language challenges for children with DLD?
Much later than others to start understanding + talking (uses visual communication: pics/symbols)
Learnt more language as grow older, but language and communication difficulties persist
44
Why is it difficult for children with DLD to transition to secondary school?
Hard to learn academic language
Might be hard to engage / progress
45
Describe the speech language and communication of children with down syndrome?
Communicates well with others
Speech can be hard to understand
Language not as expected for age
46
What are 7 risk factors for speech, language, communication difficulties?
Genetic + chromosomal syndromes of learning disability
Family history
Physical/motor difficulties (eg: cerebral palsy)
Chronic illness
Sensory difficulties (eg: hearing, visual)
Environmental factors (eg: social disadvantage, neglect)
Biological factors eg: gender (male), prematurity, low birth weight
47
What is a language delay?
note: outdated term
Follows typical rate + progress of SLC development, but slower than expected
Delay resolves
Common: to 10% of 3 years olds have a language delay
Some factors may explain (eg: mild fluctuating
hearing loss), or may be no obvious reason
Children with delays don't usually have significant medical factors eg: learning disability
48
What is a language disorder?
note: outdated term
Often an obvious / clear cause for disorder
Don't follow typical rate + progress of SLC development
Don't catch up: disorder persists throughout life
Negative outcomes in literacy + education + psycho-social + well-being
Some children with a language disorder will also have a significant learning disability, some won't
49
What is the continuum of delay and disorder?
There is a point where delay becomes so severe it is considered a disorder
- though this is very simplistic + linear, it is much more complex than this, it's not a straightforward distinction
50
What is the critical age hypothesis? (Bishop)
If language difficulties (delay / disorder) still present by 5y, much more unlikely to resolve
- when a language difficulty persists, we usually use the term Developmental Language Disorder (DLD)
51
What is Developmental Language Disorder (DLD)?
Language difficulties that create barriers to communication / learning in everyday life
Unlikely to resolve by 5y, but can be identified before age 5
Language difficulties not caused by known biomedical condition (though complex as can co-occur with other neurodevelopmental disorders)
52
Why is it important to identify children with speech, language and communication
difficulties?
Language delay is common sign of neurodevelopmental disorders
Identify children at risk of DLD who will need support
Delays do resolve, 50% at age 3 resolved by school age with/without support: target interventions to those most in need
Supporting SLC helps with learning + life chances
53
What will a typical child at 2 years start moving onto doing?
Uses space words (eg: in, on)
Uses negation
Uses word endings (eg: -ing, plural s)
54
What would a public health approach to supporting speech, language + communication look like for pre-school children?
Children’s SLC needs are a public health need, not a clinical/medical condition
SLT services adopt public health principles eg:
prevention, intervention
Move away from diagnosis to supporting the whole population (not putting too many eggs in the wrong basket)
Recognise SLC as essential to life chances
55
There is no specified cause of autism- what are some myths as to the cause?
Cold parenting
MMR jab
Food additives
Tylenol
56
What model does a diagnostic criteria for autism look at?
Focuses heavily on ‘impairment’ (medical model)
Faced criticism for pathologizing neurodivergent characteristics
- call for more focus on differences rather than difficulties / deficits (neurodiversity paradigm)
57
According to the DSM-5. what are the main 2 diagnostic criteria for autism?
Persistent deficits in social communication + social interaction across multiple contexts
Restricted, repetitive patterns of behaviour / interests / activities
58
What are the 3 subcategories of social communication + social interaction that must be present currently / historically for a diagnosis of autism?
Deficits in social-emotional reciprocity
Deficits in nonverbal communicative behaviours used for social interaction
Deficits in developing, maintaining, understanding relationships
59
What are the 4 subcategories of restricted, repetitive patterns of behaviour / interests / activities, where at least 2 must be present currently / historically for a diagnosis of autism?
Stereotyped / repetitive motor movements, use of objects, speech
Insistence on sameness, inflexible adherence to routines, ritualised patterns of verbal/nonverbal behaviour
Restricted, fixated interests abnormal in intensity or focus
Hyper / hypo reactivity to sensory input, unusual interests in sensory aspects of environment
60
What are 3 other diagnostic criteria for autism?
Symptoms must be present in early development period
Symptoms cause clinically significant impairment in social, occupational, other important areas of current functioning
Disturbances not better explained by intellectual disability (IDD) or global developmental delay
61
What are 3 historical diagnoses relating to autism, though no longer diagnosed?
Asperger syndrome
High functioning autism
Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS)
note: some adolescents/adults may still identify with these diagnoses
62
What is the neurodiversity paradigm/s perspective on autism?
Autism (& other neurodivergent conditions) are not disorders- they're not intrinsically harmful/pathological, they are valuable / natural / normal parts of human neurocognitive variation
- rejects diagnosis
63
What is the controversy of the neurodiversity paradigm?
Accused neurodiversity advocates of presenting a sanitised view of autism, deflecting attention + resources away from the struggles of severely affected individuals + families
64
What are some strengths of the diagnostic criteria for autism?
Tools can help highlight need for access to support + services (eg: EHCP)
Provides common language for different professionals + stakeholders
Can support self-exploration + identity
Allows diagnostic sensitivity + specificity (making sure diagnosis is accurate)
65
What is the autism 'spectrum'
Individual variation: each person has set of traits in different areas of spectrum (must be understood to specify meaningful supports)
Acknowledges functioning is transient, varying with time + place
66
Describe autism as a diagnostic concept in the 1940s
Developed by Leo Kanner
Identified many behaviours, but not in terms of variation
Understood as a single entity- a behavioural syndrome
67
Describe autism as a diagnostic concept in the 1940s / 50s / 60s
Lots of change in diagnosis
Differential research to decide whether autism is a distinct entity
68
Describe autism as a diagnostic concept in the 1970s / 80s
Lorna Wing + Judith Gould
Continuum of severity + Triad of Impairment to explain variation in Autism
69
State 4 points from the diagnostic criteria of autism from the DSM-III (1980s)
Pervasive lack of responsiveness to others
Gross deficits in language development, many minimally verbal
IDD common (75%)
Absence of delusions / hallucinations
70
How has the education changed of children with autism from the DSM-III time to DSM-V?
DSM-III : most children in special education provision
DSM-V : most children in mainstream schools
71
At the time of DSM-V, how many with autism also have IDD?
25%
72
What is a major change from the DSM-III to the DSM-V?
Speech and language deficits no longer in criteria
73
What is the prevalence of autism in the 1980s?
6 in 10,000
5/10 : 1 male to female
Under diagnosis
Diagnosed mostly in children
74
What is the prevalence of autism in the 2018?
1 in 100
3 : 1 male to female
Over diagnosis?
Diagnosed in children and adults
75
Who researched the incidence of autism?
Russell et al (2021)
Population based study: primary care database of 6-9 million individuals
Between 1998 - 2018
Aged 0 years+
76
What did Russell et al find about the incidence of autism?
New record of autism diagnosis each year
From 1998 → 2018 787% increased in recorded incidence
Increase greater in females
Increase greater in adults
77
Why does the incidence of autism seem to be increasing?
Increased reporting and application of diagnosis
More widely recognised + identified across all the population
78
What are the 3 aspects in the triad of impairment?
Social interaction
Communication & language
Rigidity in thought & behaviour
79
What are some differences in speech and language of autistic children?
Infodumping
Perseveration
Idiosyncratic language
Neologism/jargon
Pronoun reversal
Differences in pitch, rhythm, intonation, stress
- Some no spoken language at all to communicate: pre-verbal / minimally verbal / nonverbal
80
How may autistic children have differences with more abstract / inferential language?
Deictic words – “here”, “there”, pronouns, “this”, “that”…
Time words – “before”, “after”, “while”, “later”…
Humour/sarcasm/irony
Metaphors + similes
Narrative
81
What is echolalia?
Repetition of words / phrases, sometimes a feature of autistic language
May be in a functional or stimming way
82
What are 7 subtypes of echolalia from across the literature?
Immediate echolalia
Delayed echolalia
Unmitigated echolalia
Mitigated echolalia
Ambient echolalia
Interactive
Non-interactive
83
What is immediate echolalia?
Repetition of speech immediately after utterance
84
What is delayed echolalia?
Repetition of speech sometime after utterance
85
What is unmitigated echolalia?
Repeating exactly as said, without changes
86
What is mitigated echolalia?
Repeating with some alteration (eg: change intonation, modifying phrase)
87
What is ambient echolalia?
Repetition of words / sentences from the environment
88
What is gestalt language processing (GLP)?
Not ages and stages- learns script/phrase then breaks it down
Larger groups of words have meaning over single words/grammar
May have clear or unclear meaning
89
Evaluate the evidence base for GLP and Natural Language Acquisition (NLA)
Strong advocacy from clinicians + autistic community
Recent systematic review found no empirical research evaluating the effectiveness of approaches related to GLP/NLA (Bryant et al)
More high-quality research required
90
How should SLTs approach helping social skills for autistic people?
Never make a neurodivergent individual appear more neurotypical
Advocate for neurodivergence: value all forms of social interaction as no agreed set of typical social skills (complex, intricate, varied, context-specific)
91
What is masking?
Conscious / subconscious suppression of
natural autistic responses
Practicing/performing certain behaviours to be more like others
note: has negative consequences on mental health
92
What is speech in terms of anatomy?
Complex + rapid sequence of practise coordination of over 100 muscles
93
What are the 3 main systems of speech?
Respiratory
Phonatory
Resonating / articulatory
94
What does neurology say the production of speech requires?
Integration of diverse information sources to generate the intricate pattern of muscle activation required for fluency
Feedback based to tune to accuracy
95
What sources help the production of speech?
Auditory
Somatosensory
Motor
Linguistic information
Cerebral cortex + associated subcortical structures
96
What is the definition of articulation?
Physiological movements modifying airflow to produce speech sounds, using the vocal tract above the larynx
97
What is phonetics?
Branch of linguistics that focuses on production + classification of world's speech sounds
98
What is phonology?
Speech sound systems of languages: how meaning is contrasted + how phonemes may be legally sequenced to form words
99
What is perception?
Discrimination from environmental sound, perception of known phonemes from not known / phonetic variations
100
What is morphology?
Study of internal structure of words, how they can be analysed into word elements eg: stem, prefix, suffix
101
What are the different levels discrimination can occur at?
Sound
Syllable
Words (& within multisyllabic words)
Close phonological forms
102
At 1y which phonemes are present?
note: not bold = 75% time
bold = 90% time
[ ] = inconsistent
103
At 1-2y which phonemes are present?
note: not bold = 75% time
bold = 90% time
[ ] = inconsistent
104
At 2-3y which phonemes are present?
note: not bold = 75% time
bold = 90% time
[ ] = inconsistent
105
At 3-5y which phonemes are present?
note: not bold = 75% time
bold = 90% time
[ ] = inconsistent
106
How does intelligibility change from 1y to 5y?
1-2y = 26%-50%
2;6 = 51%-70%
3;0 = 71%-80% (95.68% to parents)
3;5-4y = 82%-97% (4 = 93% to unfamiliar)
5y = 98%
107
How does syllable structure change from 1y to 3y?
1y = primarily monosyllabic
1-2y = + polysyllabic
2-3y = + CV, CVC, CVCV, CVCVC (CCVC and CVCC developing)
108
What is a speech delay?
Child demonstrating typical developmental processes BUT beyond age expected
- typical patterns seen in <90% of peers
109
What is a speech disorder?
Child demonstrating atypical patterns of development
- disorder patterns seen in <10% of children of any age eg: ICD, backing
110
In Morgan et al's research, out of 93 participants, how many had a delay / disorder? How many of these were resolved / persistent?
Nearly 42% did not reach intelligibility comparative to age app levels by 7
BUT 71 kids we know nothing about (~43%)
111
What is the prevalence of speech sound disorders?
3.5-5% of 4y olds
112
Do we know what causes SSD?
No
- heterogeneity within the group is agreed
- multifactorial genetic + environmental factors are suggested but specific aetiology remains unknown
113
How can SSD impact learning + applying knowledge?
Difficulty with recall + calculation
Difficulty with language + literacy + mathematical thinking
Approaches to learning
114
How can SSD impact general tasks + demands?
Less independent = more frustration
115
How can SSD impact communication?
Weak oral + written language skills
116
How can SSD impact interpersonal interactions + relationships?
Withdrawal
Social + behavioural problems
Bullying
117
How can SSD impact major life areas?
Decreased school enjoyment + connection
Increased remedial assistance
Occupational differences
Harassment
118
What is an SSD? What are the 2 broad categories according to McLeod & baker?
Difficulty with perception, articulation/motor production, phonological organisation, and representation of speech
- phonology
- motor speech
119
What are the 2 types of SSDs within phonology?
Phonological impairment: cognitive linguistic difficulty with learning the phonological system of a language, categorised by pattern based errors
Inconsistent speech disorder: phonological assembly difficulty without accompanying oromotor difficulties, characterised by inconsistent production of the same lexical terms
120
What are the 3 types of SSDs within motor speech?
Articulation impairment: difficulty with physical production of speech, characterised by speech errors typically involving distortion of sibilants / rhotics /s/ /r/
Childhood AOS: difficulty planning + programming movement sequences, errors in speech sound production + prosody
Childhood dysarthria: difficulty with sensorimotor control processes involved in speech production, affects tone
121
What are 3 other classification systems of SSDs?
Medical model
Functional model
Descriptive-linguistic based (Dodd) (no dysarthria)
122
How does the medical model classify SSD?
note: vast majority don't have this aetiology
123
How does the functional model classify SSD?
124
What is an articulation disorder?
Difficulties with motor processes to produce particular perceptually acceptable speech (speech sound form)
125
What is a phonological disorder?
DIfficulties with the system + pattern of phoneme usage (speech sound function)
126
What are the 3 stores in Stackhouse and Wells' psycholinguistic speech production model?
Phonological representation
Semantic representation
Motor program
127
What might articulation errors look like?
Dental + palatal + lateral lisps
Hyper/hypo nasal speech
128
What are 4 structural phonological processes and when they are resolved?
Reduplication = 3;0
FInal consonant deletion = 3;3
Weak syllable deletion = 4;0
Cluster reduction = 4;0
129
What are 10 unusual / idiosyncratic / atypical patterns of error?
- Failure / late onset of canonical babbling
- Persistence of a process beyond expected age range
- Backing (in English)
- Predominance of one sound eg /d/ /g/
- Atypical sound substitutions eg /s/ for /f/
- Emergence of later developing sounds before earlier sounds
- Initial consonant deletion
- Vowel errors
- Missing / error consonants
- Glottal replacement
130
What are 4 systemic phonological processes and when they are resolved?
Context sensitive voicing = 2;6 - 3;0
Fronting = 3;6 - 3;9
Stopping = 3;0 - 5;0
Gliding = 5;0
131
What is the systematic approach for determining whether to intervene / what is the appropriate intervention?
132
What are SSD risk factors in early childhood?
Weak sucking at 4 weeks
Not often combining words at 24 months
Limited use of word morphology at 38 months
Unintelligible to strangers at 38 months
133
What are school-age predictors of SSD?
Maternal report of difficulty reporting certain
sounds and hearing impairment at 7y
Tympanostomy tube insertion any age up to 8y
History of coordination problems
134
What are childhood risk factors for SSD?
Born biologically male
Ongoing hearing problems + ear infections
Reactive / anxious temperament
Presence of older siblings
135
What are childhood/parental protective factors for SSD?
Breast fed
Persistent temperament
Maternal wellbeing
Parents speaking languages other than English
Presence of older siblings
136
How should you assess a child for SSD?
Assessment needs to be detailed + accurate enough to allow diagnosis of correct SSD subtype to inform intervention + management
137
What is dynamic assessment + stimulability?
Constant change in activity
Is sound stimulable at...
- sound/phoneme level
- with vowels in CV / VC / VCV
138
What is independent analysis?
Independent of adult form
- what sounds attempted, even in play
- what sounds using irrespective of accuracy
- what is their phonetic inventory (PI)
139
What is relational analysis?
Relating / comparing to adult form
- what sounds omitted
- what sounds changed and how
- what phonemes do they have productive phonological knowledge (PPK)
140
What is the PPSA?
Phonetic and Phonological Systems Analysis
Supports analysis of formally obtained assessment data / informal data obtained via play
141
What is the difference between equality, euqity, justice, and agency?
142
WHat are 4 universal and targeted interventions designed, delivered, and evaluated in low socioeconomic contexts?
Talking Time
Talk Boost
Nuffield early language intervention (NELI)
Language enrichment activity program (LEAP)
143
How is mother-child interaction related to speech in the context of social disadvantage?
Maternal education
Quality of child directed speech from primary caregiver
Mother's sensitivity
Measurable quality of mother-child interactions
144
What are different terms for social deprivation?
Socioeconomic inequality
Socioeconomic status
Social class
145
What are different measures of social deprivation?
Post code data (IMD)
Low income indicators (eg: free school meals)
Mothers completes last year of school
Poverty line (£17,760 for family of 4)
Maternal education / family literacy measures
Parental occupation
Number of books in home
146
How many people in the UK live in poverty?
14.4 million (1 in 5)
4.2 children (29%)
147
Which groups of people are more at risk of poverty
Disabled (24% of families in poverty)
Head of household from Pakistani or Bangladeshi ethnic groups
148
What are the 3 types of capital?
Financial capital
Cultural capital
Social capital
149
What is financial capital?
Income
Disposable income
Wealth
Security
150
What is cultural capital?
Entwined with wider privilege
Within schools- what gets studied?
151
WHat are the 3 types of social capital (relationships)?
Bonding
Bridging
Linking
152
What is bonding social capital derived from?
Relationships between similar persons )eg: sociodemographic + socioeconomic characteristics)
153
What is bridging social capital derived from?
Dissimilar persons at the same level of hierarchy
154
What is linking social capital derived from?
Relationships between persons across levels of hierarchy and power
155
How can work centred on social + cultural reproduction explain social deprivation?
Habitus- power+ structures that perpetuate inequality
156
What would define a pupil as disadvantaged?
Eligible for free school meals between Y6-Y11
Looked after for at least one day
Adopted from care
157
What is pupil premium?
Additional government funding for schools to help disadvantaged pupils improve their educational outcomes
158
What fraction of pupils at the end of KS4 in state-funded schools recorded as ‘disadvantaged’?
1/4
159
What % got grade C / 4 (or higher) in maths + english? How does this compare with those categorised as disadvantaged?
45%
27% for disadvantaged
160
Of boys eligible for free school meals, which demographics had the lowest results? And for girls?
Mixed white and black Caribbean backgrounds
Gypsy / Roma
Girls = also write British
161
What is positionality?
The social + political context that creates your identity regarding: race, class, gender, sexuality, ability status
How your identity influences & potentially biases your understanding of / outlook on the world
162
Is socioeconomic status (SES) linked to language development?
Young children have striking variation in language competence
This variation is *sometimes* linked to socioeconomic status
- otherwise = family history, neurobiology, male
- can also impact school readiness and perpetuation of education inequalities
163
According to research, how is language development linked to socioeconomic status?
Fernald + Marchman + Weisleder
- at 24m, 6m gap between SES groups in processing skills crucial to language development
Levine et al
- SES has significant effect on vocab, syntax, language processing
164
What are some problematic and prejudiced views about SES linking to language delay? (Marshall, Goldbart, Phillips, 2007)
Nothing wrong with preprogramming
Haven’t been spoken to
Haven’t had stories read to them
Haven’t been played with
TV had been left on
165
What can maternal language skills have significant consequences for?
Vocab, syntax, language processing
Cognitive skills eg: executive function
Mathematical skills
Social skills
- impacts school readiness
- impacts perpetuation of education inequalities
Thus: transmission of SES is facilitated
166
What are some population studies that don't show an effect between SES and language development?
Zubrick et al: LLE risk NOT associated with...
- parental educational levels
- socioeconomic resources
- parental mental health
- parenting practices
-family functioning
Reilly et al (Victoria Language Study)
- risk factors at 2y accounted for small variance in language outcomes
- at 4y can moderately predict low language ability with a range of risk factors
166
167
Who is most research about SES and language directed at?
Mother
- some attempts to investigate fathers + influence of other family members
168
How is language socialisation 'anomalous' in terms of global cultural practices?
Infant directed, contingent, reciprocal conversation is socio-culturally defined
Maternal language input varies widely in quality + quantity across cultures
Children in societies with little routinely direct interaction with infants still reach linguistic milestones at similar rate, no lasting consequences
169
Where have most intervention studies been based?
Small intervention studies to large scale application policies and programmed in USA + Europe
170
What do intervention studies suggets?
To change the language environment (despite lack of evidence for what constitutes an 'appropriate environment', and what aspects of poverty affect language)
- might cause harm to families
171
What is an important, widely referenced study in research and policy?
Hart and Risley (1995)
172
Explain the method of Hart and Risley's study
Longitudinal study of expressive language of 42 mother-child dyads from varying socioeconomic backgrounds in USA
Socioeconomic index of occupation classified families:
- 13 professional families
- 23 working class families
- 6 families with welfare benefits
Every month for 2.5y, each family was observed + recorded for 1h in their home (23-30h per family)
Sessions were transcribed + analysed
173
What are 2 methodological issues of Hart and Risley's study?
Recruitment bias- they knew the professional families
Conflating social class with ethnic variation- 1/13 families in professional group for African American, all 6/6 were in the welfare group
174
What did Hart and Risley find in their study?
Low SES families = smaller number & range of words than children from mid + high SES groups
Quantity of language input differs: positive correlations between SES and number of utterances addressed to the child
175
What is the word gap that Hart and Risley found?
Professionals = 2100 words/h
Welfare = 600 words/h
By 4y, 48mil vs 13mil words
30-million-word-gap
176
How did Hart and Risley decide which language skills they should be undertaking to improve?
From advantaged children what skilled spontaneous speech at 4y is regarding grammar and content
177
What is Sperry, Sperry, and Miller's (2019) evidence against Hart and Risley?
Replicated study with 42 families from 5 communities, ethnographically informed
Concluded no word gap when including multiple caregivers + overheard talk, infact working-class communities show advantage in number of words children heard
178
What is Golinkoff et al's (2019) outraged response to Hart and Risley?
Highlighted poorer quality of bystander talk
Highlighted lack of highly educated comparison group
179
What is the association vs causation of language disorder and SES?
There is a positive association between social disadvantage and children's language skills
It is seldom possible to disentangle the
causal paths behind this association (unless in cases of extreme neglect)
180
How should we frame our own communication?
Identify individualised patient needs through verbal + nonverbal communication
Culturally sensitive communication: critically reflect on own values and understanding of traditions and practises of culturally diverse communities
181
What does culturally sensitive communication look like in practice?
Encouraging patients / families to participate in communication and decision-making to the degree comfortable
Prioritising cultural considerations in the planning + provision of care
Developing a trusting relationship with patient + family
Professional interpreter for language differences
182
What are some problems with how linguistic difference / variation (eg: slang) has been studied?
Lack of cross-disciplinary collaboration between sociolinguistic research + linguistic anthropology research
Detailed knowledge about how spoken language functions rarely communicated effectively
Social + cultural aspects of language over-simplified
Speakers themselves rarely engaged in research (despite rich understandings of the social functions their language performs in their communities)
183
What are 5 ways to teach people with DLD?
Someone to read in tests
Additional time in tests
Explicit teaching
Interactive teaching
Visual aids
184
What is the prevalence of children and young people that have a profile
matching a DLD diagnosis?
7%
185
What is the definition of DLD? (term used consistently since 2016)
Individuals develop expressive / receptive / pragmatic language abilities differently to most age-matched peers
- absence of a known biomedical cause / sensory impairment
- has functional impact on daily living
- lifelong
186
What are some examples of language differences for children with DLD?
Developing language abilities at a slower pace
Developmental linguistic immaturities
Atypical, idiosyncratic pattern of language development
187
What other areas may children with DLD have difficulties in?
Low IQ
Reading
Motor
Attentional
Social
Mental health
188
What is Speech Language and Communication Needs (SLCN)? (Bercow, 2008)
UK umbrella term in relation to children / young people who struggle to communicate, due to social / environmental causes, neuro-developmental difficulties, or sensory impairment
189
What is Bishop's model of SLCN?
190
What is the communication chain?
191
What areas of difficulty may children with language disorder have?
* Phonology
* Syntax
* Semantics
* Pragmatics and social use of language
* Discourse
* Verbal learning and memory
* Reading and writing
* Processing
note: differs between individuals- need to work out unique profile of strengths + needs to understand how to support them
192
What is Ebbels' chart as to how DLD is differentiated from other conditions?
193
What are some examples of language disorder associated with X?
* Known genetic condition (e.g. Down syndrome, Klinefelter syndrome)
* Cerebral Palsy
* Acquired brain injury
* Sensorineural hearing loss
* Severe intellectual disability
* Autism
194
What are 4 theories of DLD?
* Neuroanatomy- brain difference involving the basal ganglia (Ullman et al., 2024)
* Central learning difference (West et al., 2021)
* Memory (Robertson & Joanisse, 2010).
* Linguistic accounts (Montgomert et al., 2017)- trouble building grammatical structures requiring “syntactic movement”
195
What are DLD indicators for poor prognosis between 1-2y?
No babbling
Not responding to speech / sounds
Minimal / no attempts to communicate eg: through gestures
196
What are DLD indicators for poor prognosis between 2-3y?
Minimal interaction, no intention to communicate
No words
Minimal reaction to spoken language
Regression/stalling of lang development
197
What are DLD indicators for poor prognosis between 3-4y?
Max two-word utterances
Don't understand simple commands
Close relatives cannot understand most speech
198
What are DLD indicators for poor prognosis between 4-5y?
Inconsistent / abnormal interaction
Max 3-word utterances
Poor understanding spoken language
Close relatives cannot understand more than half of speech
Strangers cannot understand most speech
199
What are DLD indicators for poor prognosis at 5y+?
Difficulty producing narrative
Difficulty understanding spoken word / reading
Difficulty remembering / following spoken instructions
Talking a lot but difficulties engaging in reciprocal conversation
Over-literal interpretation
200
How are standardised assessments interpreted?
ICD-10 says standardised language test must be two standard deviations below the mean
Tomblin says 2+/5 composite receptive/expressive language scores below 10th centile (1.25 SD) has language disorder
201
What are 5 impacts of DLD?
* Anxiety
* Social frustration
* Strengths and differences
* Isolation for family due to lack of awareness
* Difficulties accessing support
202
When can a DLD diagnosis feel hard? (Harvey, 2023)
* They’ve not been trained
* Unclear diagnostic criteria
* Complex clients
* Anxiety about giving the wrong diagnosis
* No clear service pathways for support
* Concern about stigmas
203
When can a DLD diagnosis feel easier? (Harvey, 2023)
* Colleagues provide support
* Matches family needs and expectations
* Clear benefits to diagnosis
* Wider ‘medical model’ approach
204
How can a neurodiversity affirming approach by used with DLD?
* Consider word ‘disorder’
* Interventions develop skills / traits linked to a fulfilling life (not ‘normalising’ an individual)
* What do children want from interventions?
* More inclusive environments s
* Identification of strengths
* Continued advocacy and awareness
205
How can DLD impact grammar?
Verb endings
Missing regular past tense marker -ed
Difficulty with irregular past tense
Missing third person singular -s
Missing 'is' / 'are'
Missing auxiliary verbs
No complex sentences/utterances
note: consider dialects eg" Caribbean English
206
How can DLD impact syntax?
Fewer instances of complex syntax
More grammatical errors within complex syntax
Difficulty with object relative clauses
Difficulty with wh- questions
Difficulty with sentences with non-canonical word order eg: passives
Difficulty with passive
207
How can DLD impact vocabulary?
Early + persisting difficulty acquiring breadth & depth of vocab knowledge
Difficulty establishing lexical representations (phonological + semantic)
Then difficulty establishing syntactic + orthographic + articulatory representations
Hard to develop word knowledge into LT memory
208
How can DLD impact word finding?
Difficulties as not automatic / efficient
209
How can DLD impact word discourse?
Difficulties telling stories /
Poor narrative analysis (characters, time, space, objects, relationships, problems, resolutions)
210
What is childhood psychiatric disorder?
Children who show severe impairments in behaviour, development, learning, mood, and social functioning
- not adequately explained solely by primary medical factors
211
Who diagnoses childhood psychiatric disorder?
Child + adolescent psychiatrists
Paediatricians
Clinical psychologists
212
Who manages childhood psychiatric disorder?
Child and Adolescent Mental Health Services (CAMHS)
Schools
Social services
Educational psychologists
Multi Agency Support Team (MAST)
213
What is SEMH?
Social, emotional, and mental health
Introduced in Special Educational Needs and Disabilities (SEND) code of practice in 2014
214
What terms did SEMH replace?
BESD (behaviour emotional social development)
EBD (emotional and behavioural difficulties)
215
Why did SEMH replace other terms that focused on behaviour?
Behaviour only ever communicates something more significant
Too much focus on behaviours on display, rather than needs behind the behaviour
216
What is social-emotional development and competence (Denham)?
Complex psychological construct
Children who can positively engage with those around them and can regulate/manage emotions + how they're expressed
Foundation for engagement and learning
Interacts with other development eg: lang + communication
217
What is social competence?
Child engages appropriately in social interaction
- relies on appropriate social communication skills
218
What is emotional competence?
Child aware of own / others emotions, and can manage/regulate how they express emotions to others
- relies on learning emotive vocabulary
219
What is self-perceived competence?
Child aware of own strengths/weaknesses in relation to peers -> can use this to their own motivations
- need to be effective communicators with interactive strengths
220
What is temperament?
Biopsychological theory that child has intrinsic personality in how they react and manage experiences
Disruptions = risk of SEMH difficulties
221
How is attachment related to communication?
Infant needs pre-requisite intent to be communicative and to encourage caregivers to communicate
Adult needs communicative + emotional capacity
222
Why is language important for mental health?
Threshold needs to be good enough for language to support SEMH needs eg: words to talk about how they feel = resolved
223
What is attachment?
Process where a caregiver/ parent establishes a relationship with child, making child feel safe + secure + protected
- secure attachment = foundation of child's development regarding psychosocial adjustment
224
How can attachment be disrupted?
Seriously inadequate caregiving environments eg: neglect, emotional / physical abuse
→ has significant impact on SE development, apparent in how they communicate
225
What are the 3 defining features of ADHD?
Impulsiveness
Inattention
Hyperactivity
226
How may impulsiveness present in ADHD?
Interrupting others
Behaviour + don't consider consequences
Difficulty waiting for turn
Blurting out answers before questions are finished
227
How may inattention present in ADHD?
Unable to attend to task sufficiently
Easily distracted
Difficulties maintaining attention to 1 task
Not listening when spoken to
Doesn't follow instructions through
228
How may hyperactivity present in ADHD?
Fidgety
Running or climbing excessively + inappropriately
Constantly on the go
Talking excessively
Poor sleep
229
What are some conditions for a diagnoses of ADHD?
Behaviours present before 12y
Behaviours impact negatively on child across several aspects
Difficulties in psychosocial functioning eg: antisocial behaviour, relationships affected, school negatively impacted
230
How did the DSM-V definition of ADHD change from the DSM-IV?
Recognition that ADHD continues into adult life
ADHD symptoms must be present before 12y (was before 7y in DSM–IV)
Recognition of co-morbidity
231
What is the prevalence of ADHD?
5-7% (though an underestimate)
More boys
232
What are some risk factors explaining ADHD?
Mix of environmental / genetic
- biological relatives with ADHD
- extreme early life adversity
- pre/post natal exposure to lead
- low birth weight/prematurity
233
How is ADHD being rethought through the neurodiversity movement?
Strengths based + needs led approach
Not necessarily medical intervention
Holistic approach with co-morbidities eg: ASD, DLD, learning disability
234
What is the medical approach to manage ADHD?
Psychostimulants (methylphenidate / ritalin and amphetamine derivatives)
- can have significant side effects eg: weight loss
235
What is the psychological approach to manage ADHD?
Helping child understand their difficulties
236
What is the parent/carer approach to manage ADHD?
Facilitating effective strategies for child eg: sleep hygiene
237
What is the school approach to manage ADHD?
Enabling schools to implement strategies for children eg: physical breaks, externalise info, glucose, changing motivators, self-affirming statements
238
What are 4 explanations for co-morbidity of speech and language difficulties and ADHD?
Co-morbidity of neurodevelopmental disorders
May have learning disability which slows rate of language learning
Attention difficulties may impact listening to environment, thus language learning
Impulsivity may impact social communication
239
What are 3 other terms for selective mutism?
Reluctant talkers
Situational mutism
Elective mutism
240
What is selective mutism?
Anxiety results in consistent failure to speak in specific social situations where that is an expectation to speak, despite speaking in other situations
241
What are some other diagnostic criteria for selective mutism in DSM-V?
Interferes with education / occupation / social communication
Must last for min 1 month (not first month of school)
Not due to lack of knowledge of language
Not better explained by other communication disorders
242
What is reactive mutism?
Sensory shutdown- seen in ASD
243
When does selective mutism often start?
2-5y
244
What is the prevalence of selective mutism?
1/140 under 8y
Slightly more common in girls + multilingual families
Seen post-COVID as school refusal
245
What are the 3 main symptoms of anxiety?
Apprehension- fear something bad will happen
Motor tension- increased stress, children may describe as stomach/headache
Autonomic activity- fight/flight response from adrenaline
246
What is the non-pharmacological (i.e., behavioural) intervention for selective mutism?
Reduce anxiety / fear response / pressure around talking
Desensitise child to talking, and increasing their confidence in talking
Consider
- communication environment
- communication load of the task
247
For graded exposure for selective mutism, what are the 10 talking stages from easy to hard?
1. Gestures
2. Private audio recordings
3. Written messages
4. Whispering printed messages
5. Whispering in answering to questions
6. Whispering simple responses
7. Loud whispering
8. Vocalisations
9. Soft voice
10. Full voice
248
For graded exposure for selective mutism, what are the 6 situations from easy to hard?
1. With key family member
2. Individual SLT sessions
3. Psychologist + psychiatrist involved
4. Classroom teacher in individual situation
5. Classroom
6. Dinner lady in dining room
249
What are the 9 stages of confident speaking?
1. No communication or participation
2. Co-operation but limited communication
3. Visual but not verbal communication
4. Can use non-verbal sounds
5. Can speak within ‘earshot’ of someone
6. Single words with certain people
7. Connected speech with certain people
8. Generalising to others
9. Communicating freely
Speech and Language Therapy Y2
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