CDIS 3113 Final Questions And Questions

CDIS 3113 Final CDIS 3113 Final Standardized Assessment - ANS It should be self-sufficient in terms of stimulus materials and recording forms. The standardized assessments are created based on testing of a large population to provide generalized findings. Norm-referenced vs Criterion reference tests - ANS Standardized assessment may include both norm-referenced and criterion- referenced tests. All norm referenced test are standardized. However, all criterion-referenced tests may or may not be standardized Norm referenced test - ANS These tests compare a child with his or her peers (aged matched comparison). Examples: PLS-5, CELF-4, REEL-3 Normal distribution of a norm-referenced test is represented as a bell-shaped curve. The normal bell-shaped curve has majority of scores in the middle (median or mean score) with a rapid decrease in the number of people as scores move away from middle in either direction. Criterion referenced test - ANS These tests identify a client's strengths and weaknesses based on whether or not they pass criteria. Here clients are not compared with their peers. Eg- Rosetti Infant Language Scale Information provided by norm reference tests - ANS The sample size should not be less than 100 as smaller samples provide extremely limited generalizability. Greater variety for ethnocultural and socioeconomic levels of individuals provide higher applicability of the test. More varied geographical distribution of the samples lead to wider applicability of the test. The range of education, IQ, medical status, and occupation of sampling individuals should be mentioned in the test manual. The test manual should include descriptive statistics. Mean - ANS It is the statistical average of an individual's performance and it may or may not exactly correspond to the mean. It may deviate from the mean. Example: 200 points(mid-point=100) Standardized deviation - ANS It refers to the extent by which the individuals score deviates from the mean. Normal bell shaped curve - ANS 68.26% of all scores fall within 1 S.D. of the mean (34.13% above and 34.13% below the mean). 95.44% of all scores fall within 2 S.D. of the mean (47.5% above and 47.5% below the mean). 99.72% of all scores fall within 3 S.D. of the mean (49.85% above and 49.85% below the mean). Raw Score - ANS Refers to the initial score a client receives based on the number of correct responses on the test items. Raw scores are calculated with basal and ceiling scores in mind. Percentiles - ANS Represents percentage of individuals in the standardized sample scoring at or below a given range. Example: Abby is at 30th percentile (she has a lower performance as she is lower than 70% of the sample who did better). Percentage of raw scores - ANS It is calculated as the number of correct and incorrect responses out of the total number of test items. Z-score - ANS (Individual score- Mean)/ SD T-scores - ANS based on a normal probability distribution. Here the mean is 50 and SD is 10. Basal score - ANS Entry level or the starting point in a test Ceiling score - ANS Terminating score in a test The ceiling refers to the highest number or level of test items at which the test was stopped as the remaining higher level items are all considered failed. Test purpose - ANS A test must be designed with a clear statement of progress Stimulus items - ANS The test items should be assessed for three things: relevance (importance), validity (accuracy), and reliability (consistency). Test administration and scoring procedures - ANS For effective test administration and scoring, written directions must outline exactly what the examiner does and says to give test instructions and administer the test. Normative sample - ANS Test developers typically select a much smaller normative sample that is expected to represent the population Statistical analysis - ANS Different statistical analyses are completed to define the test score. Reliability - ANS It is the consistency of finding similar results. All standardized test should ideally have high reliability (r=0.8) and high validity (r=0.8). Interobserver reliability (AKA interjudge reliability) - ANS Consistency of test scores when recorded by two or more examiners administering the same test to the same individual. Intraobserver reliability (AKA test-retest reliability) - ANS Consistency in test scores of an individual when the same examiner re-administers the test or repeats a naturalistic observation. Alternate or parallel form reliability - ANS Consistency in test scores when two forms of the same test are administered to the same person or a group of participants. Split-half reliability - ANS Here the examiner correlates the scores from one half of the test with those from the other half of the test. Both halves of the test should be equivalent in content and difficulty level. Validity - ANS Refers to accuracy of measurements Content validity - ANS Related to the fact that the test includes items that are relevant to assess the particular skills. Construct validity - ANS Related to a degree that a test measures a predetermined theoretical construct. Criterion validity - ANS Degree to which a particular test measure is correlated with another meaningful variable Questionnaires and Developmental Inventories - ANS In addition to standardized tests, SLPs include questionnaires and developmental inventories. Advantages of parent-based questionnaires - ANS Provides unique perspectives Offers information about changes in child's skill over an extended time period. Give insights about parents actions and reactions Gather information about young children's communication skills Provide information in addition to the standardized assessment. Provide a valid and efficient means of assessing a child's naturalistic communication skills. Offer a means of assessing the reliability of information obtained during clinical assessment. Strengths of standardized tests - ANS Shows you child's performance with respect to peers Has specific scoring and rating procedures Specific instructions for administering the test The findings are very objective and do not vary from region to region The findings are sometimes key for providing services as well as getting reimbursed by insurance Variety of speech and language skills can be assessed in a relatively shorter duration of time Some of the standardized tests are relatively inexpensive making them more accessible to clinicians Limitations of standardized tests - ANS May not apply to all the clients Allows for little individual variation and not as useful to look at the overall strengths of the client May be too structured which can sometimes be a challenge to elicit responses from specific clients Some of the tests may be expensive and not as accessible for use Often includes verbal language skills and overlook the preverbal or nonverbal communication Multidisciplinary Approach - ANS This setting involves multiple health professionals who perform independent assessments as well as provide independent recommendations and treatment. Example: 3-year old with language and motor delays will have 3 separate sessions: PT may work on gross motor skills, OT may work on fine motor skills, and ST/SLP may work on language and communication skills. Transdisciplinary Approach (AKA arena assessment) - ANS Different team members are familiar with each other's area of expertise and collaborate together to perform assessments and treatments for the client. Play and Gesture Assessment - ANS Important to assess a child's play and gestural skills as research suggests a relationship between cognition and language skills. Children cannot be expected to use symbolic language until they have achieved certain cognitive milestones such as object permanence, use of objects, and symbolic play. Language and play are interdependent on each other. Information provided by play assessments - ANS Play assessments provide a nonlinguistic comparison for gauging a child's conceptual and imaginative abilities. Carpenter's Play Scale - ANS Instructions for the assessment: A parent is asked to play with the child by engaging in four play scenes with appropriate props: a tea party, a farm, and scenes related to transportation and nurturing. Parents are advised to respond naturally with the child and let the child play without continually talking or giving directions. Parents are given specific prompts to provide only when the child will not touch or play spontaneously with a set of toys. Formal assessment examples - ANS McAurthur-Bates Communicative Development Inventory (includes parental reports), Communication and Symbolic Behavior Scales-Developmental Profile (includes direct assessment and parental reports), Functional Communication Inventory (criterion-referenced tool with developmentally appropriate approaches for young children). Informal assessments - ANS Strategy developed by Crais and Roberts (1991) and Paul (1991): Different areas of communicative functioning are assessed independently instead of a general assessment of communicative functioning. More emphasis on direct interaction with the child and use of more child-initiated activities for observation and evaluation. Assessing communicative intention - ANS The communicative intention begins in children before they actually use verbal forms. Communicative intention types: It can either be non-verbal (gestures and sounds) or verbal (single words or combination of words) Communicative intention transforms during the second and third year of life. With age, it becomes more verbal and with increased frequency. Late talking toddlers tend to demonstrate lower rates of communication, vocalization, initiation, and joint attention than typical peers. Early communication can have two basic functions - ANS Proto-imperatives Proto-declaratives appear normally between 8-18 months of age. Other new communicative functions appear about 18-24 months Proto-imperatives - ANS These are communicative intents that are used to get an adults attention on an object or event or to indicate the need to do or not do something. Examples: Requests for objects, requests for actions, rejections, protests Proto-declaratives - ANS These are verbal communicative intents to gain an adult's attention including comments used to point out objects. Children with autism - ANS Are more likely to produce proto-imperative functions compared to proto-declarative functions Children with Down syndrome - ANS Are more likely to produce proto-declarative functions compared to proto-imperative functions Children with slow language development - ANS Are more likely to demonstrate fewer proto-declarative intentions compared to normally speaking peers. Frequency of Expression of Intentions - ANS The frequency of communicative intentions changes with age. 18-month: Likely to produce two instances of intentional communication per minute. Likely to use short phrases or combination of words. 2-year olds: Likely to produce five instances of intentional communication per minute Significantly low level interaction for emerging language age children: Fewer than 10 acts of communicative intent within a 15 minute period. Research suggests that if a child produces fewer than three proto-declarative communication act within a 15-minute observation period, there is a risk for development of functional speech. In such cases, intervention includes both verbal and non-verbal communicative intentions. Gestures - ANS 8-12 months Combination of gestures and word-like vocalizations containing consonants - ANS 12-18 months Conventional words or word combinations - ANS 18-24 months Forms of communication - ANS According to Yoder et al. (1998), children who produced fewer than one vocal communication act every 4 minutes were significantly less likely to develop functional speech a year later. For children using gestures and non-verbal intentions, intervention should include efforts to facilitate vocalizations for functions the child is demonstrating with gaze and gestures. Communication intention worksheet: May be used to track frequency and types of communicative acts (gesture, vocalization, or conventional word). Parent interactional style and cultural differences contribute to communication styles. Parents from all cultures do not talk to toddlers in the same way. Assessing comprehension - ANS Limited tests are available for assessing receptive language in children younger than 3 years. Standardized test Examples: Peabody Picture Vocabulary Test- Revised (PPVT-4), Communication and Symbolic Behavioral Scales-DP Parent checklists: Receptive-Expressive Emergent Language Scale (3rd edition), Sequenced Inventory of Communicative Development It is possible to have an isolated language production deficit. In this case the child is referred to have an expressive language disorder. A pervasive language disorder is suspected when a child has more delays in language comprehension compared to communicative intentions. In other words, this condition occurs when the child has poorer language receptive abilities when compared to language expressive abilities. For children with expressive and/or comprehension deficits, intervention can include techniques to facilitate expressive language such as focused language stimulation, verbal script activities, and child-centered approaches. In addition, facilitative play and modeling of play behaviors may be included. Assessing Speech-Motor Development - ANS It might be challenging to assess speech motor development in younger children. Childhood apraxia of speech (CAS) can be difficult to assess in children with limited speech. Feeding assessment is also completed as part of speech motor development Speech Samples - ANS Speech samples can be helpful in identifying the child's communicative abilities. Speech samples can be collected either at home or from a parent diary. Parent diary: Includes a child's interaction during 10-15 minute intervals during the course of 1 week. Speech or vocalization samples can be also used to examine phonological skills and vocabulary. Phonological Skills - ANS Children with small expressive vocabularies also show small phonetic inventories of consonants and a restricted number of syllable shapes. Consonant production is an important element of phonological development. Typical 18-24 month olds produce an average of 14 different consonants in a 10-minute communication sample. 2-3 year olds produce an average of 18 consonants during the same amount of time. Lexical Production (refers to words produced or one's vocabulary) - ANS This area helps us with assessment of semantic skills. Lexical production can be assessed by screening measures (e.g., McAurthur-Bates Communicative Development Inventory), parental reports (e.g., Vineland Adaptive Behavior Scales II- Communication Domain), and direct language samples. Research indicates high correlation between parental reports and direct language assessment. Semantic-Syntactic Production - ANS Most children in emerging language stage have little or limited productive syntactic skills. If a child has fewer than 50 words in his/her vocabulary, the focus should be on increasing the vocabulary size. Children typically begin to combine words once they have 50 or more words in their vocabulary. Typically developing children have relatively small range of semantic relations in their speech. Some of the common relations observed are: attribute-entity (big shoe), possessor-possession (mommy eyes), agent-action (daddy come), action-object (hit ball), agent-object (daddy ball). Intervention-family centered practice - ANS Assessment and intervention for children in emerging language period (18-36 months) is always family-centered. Individual Family Service Plan (IFSP) is designed by a team of professionals including SLP. Parents are important to the intervention plan as parent-implemented intervention facilitates more generalization and overall improved communication skills. Parents and family should be actively involved in setting goals for the intervention program. In addition, parents should be consulted about what they most want the child to learn and how much of the intervention they would like to deliver themselves. Different training resources are available for parents of toddlers Developing Play, Gestures and Intentional Communicative Behaviors - ANS What to do if a child does not demonstrate any appropriate or semi appropriate use of objects for symbolic play and gestures? The intervention on these cases is going to focus on use and imitation of conventional and symbolic play. Prelinguistic milieu teaching (PMT) - ANS This treatment program focuses on following a child's lead and providing modeling and prompts to help facilitate child's communicative acts. ***A modified version called the Enhanced Milieu Teaching is used for children who are older Indirect language stimulation (ILS) - ANS This is a treatment program for 18-36-month-old children that provides multiple opportunities for the child to try out different comprehension strategies and develop expectations about conversations. Receptive language - ANS Parent training programs including Hanen Program has been found to be very useful in facilitating receptive language skills. Developing Sounds, Words, and Word Combinations - ANS Primary goal is to increase the size and range of child's vocabulary. Imitation can be used to facilitate consonantal production. Close to half of normally developing children produce nouns as their first words. Early vocabulary can also be facilitated by using child-centered (CC) approaches including natural play. Hybrid approaches including milieu teaching, script therapy and incidental teaching method may also be used to elicit words from a child. 3 therapy approaches - ANS Clinician directed, clinician centered, hybrid Clinician directed - ANS Clinician has full control of the session and decides about the activities Child centered - ANS Child/client shows interest and you follow the child's lead. The session is based on what the child wants to do. Hybrid (combination of clinician-directed and child-centered) - ANS This type of approach includes combination of clinician's motives as well as client's interests and initiations Play and gesture - ANS Both verbal and nonverbal skills should be assessed and included in the intervention plan. Parent based reports and brain measures can provide additional information about children with severe disabilities and limited verbal skills. Modifications should be made with assessment as needed for the child's level of skills. Intentional Communication - ANS Both conventional and nonconventional means of communication should be assessed. What needs to be assessed for children without functional speech? For children without functional speech, nonverbal aspects including gestures, limb actions, facial expressions, and body posture should be considered. In case the child demonstrates any maladaptive behaviors, the source for these behaviors should be identified and amended. Use of AAC: Different forms of AAC device would be considered and evaluated Comprehension - ANS Assessment modifications needed for children with severe cognitive and/or physical deficits. Both phonological and lexical skills should be assessed. Spontaneous vocalizations and communicative functions should be periodically assessed for effective intervention. Prerequisites for normal speech production - ANS Intact vocal and articulatory structures and normal neural mechanism Speech production involves articulatory structures including - ANS lips, tongue, teeth, hard palate, velum, and alveolar ridge Role of lungs - ANS The lungs provide air supply that helps to set the vocal folds in action. Role of healthy vocal folds - ANS The vocal folds vibrate and carry the air forward which is further used to articulate speech sounds. Oral and Nasal cavities - ANS These regions add resonance to speech sounds produced by the articulators. Structural deviations - ANS Cleft palate: Incomplete or absence of a palate during development Short or malformed velum Ankyloglossia: Tongue is too short (reduced tongue length) Poor nasal opening Severe dental abnormalities Severe malocclusion: May include overbite (upper jaw is too far ahead relative to lower jaw) or underbite (lower jaw is too far ahead relative to upper jaw) Severe underbite may lead to difficulties in producing different consonants (including /f/) Neurophysiological systems - ANS essential for normal speech production. Speech production structures are directly or indirectly controlled by a complex set of nerves. Specific to speech and language functions, frontal and temporal lobes are important structures. Frontal regions (motor cortex, premotor area and Broca's area) are important for speech production and motor planning and programming. Temporal areas such as primary auditory cortex is important for normal hearing functions and Wernicke's area is important for language planning and comprehension. Trigeminal (CN V) - ANS Jaw movements, chewing functions Facial (CN VII) - ANS Facial muscle, facial expression, some tongue functions Glossopharyngeal (CN IX) - ANS Tongue functions, pharyngeal functions Vagus (CN X) - ANS Swallowing, tongue functions, pharyngeal functions, laryngeal functions Accessory (CN XI) - ANS Shoulder muscles Hypoglossal (CN XII) - ANS Tongue movements Auditory branch of vestibuloacoustic nerve (CN VIII) - ANS Important for hearing functions and thus important for speech sound learning and production Dysarthria - ANS A speech sound disorder that is caused due to muscle weakness and incoordination. It is usually caused due to pathologies in the CNS (brain and spinal cord) or PNS (cranial nerves, spinal nerves) Causes: Stroke, car accident, TBI Children: Cerebral Palsy Adult conditions: Parkinson's disease, multiple sclerosis, ALS Apraxia of speech (AOS) - ANS A speech sound disorder that is caused due to problems in motor programming and sequencing. In this condition, there is no muscle weakness or incoordination of the speech structures. When this condition occurs in children it is termed Childhood Apraxia of Speech (CAS). It is a controversial diagnosis due to lack of adequate knowledge about the deficits and source of problems. Examples of environmental variables - ANS Presence of multiple languages, influence of different dialects, presence of diverse ethno cultural backgrounds, or family history for speech and language disorders. Approx. 39% of children with articulation disorders have some familial history of same or similar speech disorder Intellectual Disability - ANS No influence of intelligence on speech skills of children, it cannot be concluded that intelligence is unrelated to articulatory proficiency in children. Significantly poor intellectual levels have a marked impact on speech and language learning in children. The lower the level of intelligence, the greater chances of possible speech and language deficits in children. It is important to assess the intellectual abilities during a detailed speech and language assessment. A child with intellectual disability should be formally evaluated by a psychologist Hearing Loss - ANS Children with hearing loss may demonstrate different types of speech sound disorders Phonetics - ANS Study of speech sounds Phonetic Principles - ANS Descriptions of how people produce sounds of their language Place - ANS Location in the vocal tract where a consonant is formed Manner - ANS Description of how the consonant is produced Voicing - ANS Presence of absence of voicing during production of a consonant Cross-sectional studies - ANS These studies include simultaneous observation of children in different age groups Longitudinal studies - ANS these studies include long term observations of children as they pass their chronological milestones Earlier studies vs. recent studies - ANS The earlier studies show older ages of mastery compared to recent studies. All age norms should be carefully interpreted Phonology - ANS The linguistic study of speech sound systems of languages According to phonological rules, children simplify the adult sounds and sound combinations as they learn to produce their speech sounds Unstressed syllable reduction - ANS the deletion of a syllable, typically unstressed in words ([nænə] banana [pa] pocket [medo] tomato) Final consonant deletion - ANS the omission of a single consonant that terminates a word or syllable [hæ] hat [da] dog [bu] book Initial Consonant Deletion - ANS The omission of a single consonant that initiates a word ([æt] cat [ʌn] sun [u] shoe) Cluster reduction - ANS the omission of one or more segments in a cluster so that the cluster is omitted or reduced to a singleton ([neɪk] snake [peɪm] plane [tɪŋ] string) Epenthesis - ANS the insertion of an unstressed vowel or a new phoneme into a word ([pəleɪ] play [fweɪs] face [sθup] soup) Metathesis - ANS the transposition of two sounds ([æks] ask [bəskɛdɪ] spaghetti [æmɪnəl] animal) Reduplication - ANS repetition of a sound or syllable in place of all the others ([wawa] water [bæbæ] basket [tata] television) Fronting - ANS the substitution of a more anteriorly produced phoneme, such as alveolar for a velar ([tændɪ] candy [do] go [bɪd] big [was] wash) Backing - ANS the substitution of a more posteriorly produced phoneme for an anteriorly produced phoneme ([ku] shoe [bok] boat [gag] dog) Alveolarization - ANS the substitution of an alveolar sound for a labial or linguadental phoneme ([tɑɪ] pie [deɪ] they [bæs] bath) Palatalization - ANS adding a palatal component to a nonpalatal phoneme ([kop] soap [wɪŋ] win) Depalatalization - ANS the palatal component is deleted from a palatal phoneme ([wats] wash [su] shoe [dʒu] cue) Affrication - ANS the substitution of an affricate for a nonaffricate sound [tʃu] shoe [tʃup] soup Deaffrication - ANS the substitution of a fricative or a stop for an affricate ([ʃɛr] chair [tɛr] chair [keɪʒ] cage [keɪd] cage) Denasalization - ANS substitution of a stop for a nasal phoneme [do] no [baɪ] my [rig] ring Gliding - ANS the substitution of a glide for a liquid ([wɛd] red [pweɪ] play [dʒɛwo] yellow) Stopping - ANS the substitution of a stop for a nonstop phoneme, usually a fricative or affricate ([tʌm] thumb [wat] watch [top] soap) Vowelization - ANS the substitution of a vowel for a liquid phoneme ([ka] car [bato] bottle) Stridency deletion - ANS the omission of a strident or the substitution of a nonstrident sound for a strident sound ([ta] saw [wʌd] was [kɪ] kiss [up] soup) Labial Assimilation - ANS production of a nonlabial sound instead of a labial because of another labial in the word ([wæp] wax [mab] moss [bom] bone) Velar Assimilation - ANS production of a velar sound instead of a nonvelar ([kek] take [gog] goat [kik] keep) Nasal Assimilation - ANS Production of a nasal sound instead of a nonnasal because of another nasal in a word ([non] nose [mam] mop [maim] Mike) Prevocalic Voicing - ANS A voiceless sound preceding a vowel is changed into voiced ([deɪk] take [bɛn] pen [baɪ] pie) Postvocalic Devoicing - ANS A voiced sound following a vowel is devoiced ([bis] bees [pɪk] pig [sæt] sad) Distortions - ANS distorted production of a particular sound Substitutions - ANS A different sound articulated in place of target sound Omissions - ANS Target sound is omitted Cerebral Palsy Associated with Dysarthria - ANS A non-progressive disorder due to brain injury either at the time of birth or immediately after birth Cerebral Palsy Causative Factors - ANS Prenatal: Maternal infections, exposure to radiation, drug toxicity, fetal anoxia Perinatal (at the time of birth): Complications during delivery, fetal cerebral hemorrhage, anoxia (lack of oxygen), premature birth Postnatal: Head trauma, viral infections, asphyxia, sepsis Subtype- Spastic - ANS Increased muscle tone with slow, effortful, and jerky movements Subtype- Athetoid - ANS Slow writhing movements Subtype- Ataxic - ANS Cerebellar damage with problems in gait and balance Subtype- Rigid - ANS Deficits in higher motor control centers and characterized by simultaneous contraction of all muscles as well as slow and effortful movements Subtype- mixed - ANS Combination of two or more types of cerebral palsy (example: spastic+ ataxic; spastic+ athetoid) Respiration - ANS rapid breathing, reduced activity of ribcage muscles and chest, weak respiratory system Phonation - ANS weak voice, reduced speech loudness, high pitch, and strained vocal quality Articulation - ANS imprecise articulation, predominance of omission errors Resonance - ANS hypernasality, nasal emission, poor oral resonance Prosody - ANS monotone speech, monoloudness, lack of smooth flow of speech Childhood Apraxia of Speech (CAS) - ANS Neurogenic speech disorder with problems in motor planning and programming. It is not associated with any muscle weakness or incoordination Articulation disorder - ANS When the child has the correct phonological representation of the sound but has difficulties producing (or articulating it). Phonological disorder - ANS When the child has difficulties with phonological representations and as a result has difficulties producing it. Spontaneous Speech Sample - ANS Provide naturalistic speech samples compared to standardized tests A minimum of 50 utterances should be collected. Supplements findings from standardized tests Written case history - ANS A written questionnaire completed by the child's caregiver, family member, and/or the client (if possible). Understand past and present background of the client Pure Tone Audiometry - ANS Helps to determine the hearing sensitivity between 250-8000 Hz. Humans can hear 10-10000 Hz. Hearing Screening - ANS Typically administered at 20 dB for 500 Hz, 1000 Hz, 2000 Hz, and 4000 Hz Orofacial examination - ANS assess structures and functions of the oral mechanism Diadochokinetic Tasks (DDK) - ANS Tasks used to assess a child's ability to produce rapidly alternating sounds /papapapa/: lip muscle strength and coordination /tatatata/: tongue tip and alveolar ridge coordination /kakakaka/:soft palate (velum) coordination calculated as repetitions per second Stimulability - ANS Refers to a child's responsiveness to trial treatment procedures Multidisciplinary - ANS Includes professionals from different disciplines where each professional completes an independent evaluation and comes with a separate set of recommendations. Most common Interdisciplinary - ANS Consists of professionals from different disciplines with a more collaborative relationship. A case manager may coordinate the services between the different disciplines. The case manager can be any health professional on that team (PT, SLP, Social worker, Neurologist, Psychologist). Transdisciplinary - ANS Team members from different disciplines share information as well as skills. It involves a collaborative assessment where one individual may do all or most of the interaction while other professionals may either observe or make suggestions for the interactor to use during the assessment process. Team members may train each other. Appraisal - ANS Includes data collection from existing records, and case history, interviews, and questionnaires completed by parents/family members, and direct exam results of the client Diagnosis - ANS Includes the identification and labeling of a problem IEP - ANS is designed for school age children and focuses exclusively on educational outcomes IFSP - ANS is designed for children from birth to 3 years as a comprehensive plan to support their development in the context of family. It includes information about the family resources, skilled child care services, and other social services for the family that might help to cope with the stress. Pre-linguistic phase - ANS It is the period before children begin to say meaningful words. It ranges from birth to 18 months. Prematurity - ANS Refers to birth before 37 weeks of gestation accompanied with low birth weight (less than 2500 grams or 5 ½ pounds). Very low birth weight - ANS 1500 grams or 3 1/3 pounds Hearing loss - ANS Presence of hearing loss is typically identified only after birth Suckling - ANS It is a primitive form of sucking where the baby has tongue extension and retraction as well as up-and-down jaw movements and loose closure of lips Sucking - ANS It is a more mature version of suckling where the baby has more intraoral negative pressure. The tongue is elevated rather than extended and retracted with more rhythmic jaw movements and firm lip closures Rooting - ANS The infant turns his/her head towards the source of tactile stimulation of the lips of lower cheek Phasic bite reflex - ANS During stimulation of teeth and gums, the infants display a rhythmic bite and release pattern observed as series of small jaw openings and closings Nasogastric (N-G tube) - ANS The N-G tube is inserted through the nose and descends down the pharynx into the stomach Orogastric (gavage tube) - ANS inserted through the mouth Nasojegunal tube - ANS This is inserted through the nose and goes into the second part of the intestine Gastronomy (G-tube) - ANS Surgical option: Here food is sent directly to the stomach. This is used when nonoral feeding is expected to continue for extended periods. G-tube also allows supplementary feeding by mouth Turning in - ANS In this stage, the baby is very sick and cannot participate in any reciprocal interactions. All of infants' energies are devoted to maintaining biological stability Coming out - ANS Once the baby recovers from acute illness, he/she may become responsive to the environment, may breathe adequately, and begin to gain weight Reciprocity - ANS This stage usually occurs at some point before the infant is discharged from the hospital. The infant is now able to respond to parental interactions in a predictable manner. In case, and infant is unable to achieve this stage, it is a signal of potential developmental deficits Kangaroo Care - ANS A recent medical innovation where skin to skin contact between parents and child is encouraged during the NICU stay. Parents are encouraged to swaddle the baby to their unclothed chest for about 30 minutes each day. Studies have indicated that this type of care leads to decreased length of hospital stay, shorter periods of assisted ventilation, increased alertness durations, and an enhanced sense of nurturance of the child from the parent's part Cervical auscultation - ANS determines changes in upper aerodigestive tract sounds Videofluoroscopic - ANS swallowing function studies can be used to determine oral and pharyngeal movements during feeding and determine risk for aspiration Ultrasound - ANS provide visual display of movement patterns of oral and pharyngeal structures Feeding management - ANS Oral stimulation should be encouraged. As baby reaches 6 months and above, feeding of solid foods may be introduced whenever determined to be safe Prelinguistic milieu teaching (PMT) - ANS It is a treatment technique which includes multiple steps including contingent motor imitation and prompts to facilitate an infant's transition to intentional behavior Language - ANS the method of human communication, either spoken or written, consisting of the use of words in a structured and conventional way. Semantics - ANS meaning of language Syntax - ANS arrangement of words and phrases. Grammar Morphology - ANS the study of the forms of words Pragmatics - ANS Social use of language Categories of words - ANS simple/concrete, complex, multiple, abstract, figurative Morpheme - ANS Smallest meaningful unit of language Free morpheme - ANS a morpheme that can stand alone as a word Bound morpheme - ANS a morpheme that can only appear as a part of a free morpheme Phoneme - ANS units of sound Mands - ANS Vocal behaviors which allow a child what they want and don't want. Includes asking for reinforcers Tacts - ANS Vocal behaviors in response to an environmental event Echoics - ANS Verbal repetition of what the parent/speaker said, sometimes it could also be repetition of self utterances Intraverbals - ANS Vocal behaviors in response to what another person says. These are considered to be fill-in responses/statements started by another person. Singing a rhyme or happy birthday Intellectual disabilities - ANS Children with language disorders often have deficits in intellectual abilities. Lower levels of IQ lead to greater severity of language disorders. Autism spectrum disorders - ANS The spectrum includes autism, Asperger's disorder, Rett's disorder, and childhood disintegrative disorder. o Features include significant emotional and behavioral problems, lack of appropriate emotional responses, stereotypic interests and activities, and stereotypical play behaviors Asperger's syndrome - ANS IQ levels within normal or even superior range. These children tend to have highly specialized interests Rett's disorder and Childhood Disintegrative Disorder (CDD) - ANS less common than autism. These children have typical language development during the first 2 years of life before the symptoms appear. Rett's disorder - ANS almost exclusively females and features include repetitive hand movements, gradual loss of purposeful hand movements, deficits in gait, decelerated head growth, and regressive language skills CDD - ANS primarily affects males and features include sudden and serious regression of language skills. Other deficits include self-help, social, and motor skills. Down Syndrome - ANS Congenital syndrome including presence of extra chromosome (47 instead of usual 46). They are more likely to have frequent ear infections and conductive hearing loss Fragile X-syndrome - ANS Sex-linked genetic syndrome due to abnormal chromosomal configuration. Features include significant language problems including jargon, echolalia, telegraphic speech, perseverations, and inappropriate and irrelevant language Prader-Willi syndrome - ANS Genetic syndrome caused by deletion of Chromosome 15. Features include intellectual deficits, slow but somewhat accelerated language. The language deficits often depend on level of intellectual deficits. Tourette's syndrome - ANS Genetic syndrome associated with language disorders, presence of tics and facial grimaces, palilalia (repetition of own utterances), and stuttering Fetal alcohol syndrome - ANS Congenital syndrome due to maternal alcoholism during pregnancy. Features include craniofacial anomalies, growth retardation, heart and kidney problems, and intellectual disabilities TBI - ANS may affect the different language components including semantics, syntax, morphology and pragmatics. May cause socially inappropriate behaviors, personality changes, aggression, and lack of control over own behaviors. Specific Language Impairment (SLI) - ANS Refers to significant impairment of language skills in the absence of neurological damage, hearing impairment, or intellectual disability. diagnosed only after the age of 4 years to allow development some of the major language milestones MLU - ANS Morphemes divided by utterances Type-token ratio - ANS Refers to variety of different words a child produces. Total number of different words produced/ Total number of words produced Developing language phase - ANS Kids aged 2 through 5 years with more than 50 words would be considered in this stage Screening - ANS A quick method to determine whether or not the child needs a details evaluation Fluharty Preschool Speech and Language Screening Test - ANS 3-6:11 years; can be used for multiracial and multiethnic groups of English speaking children Hodson Assessment of Phonological Patterns - ANS Preschool Phonological Screening (preschool; gives pass/fail score) Preschool Language Scale- 4 Screening Test Kit - ANS 3-6:11 years; screens different components including articulation and language Deep Test of Articulation - ANS 3-12 years; Articulation is tested in different phonetic contexts Goldman-Fristoe Test of Articulation - ANS 2-21 years; Administration time: 10-15 mins for single word portion Clinical Evaluation of Language Fundamentals- Preschool - ANS 3-6 years; concepts, syntax, semantics, morphology Test of Language Development-3; Primary (TOLD-3:P) - ANS 4-8:11 years; Uses imitation, sentence completion, picture pointing to assess receptive and expressive semantics and syntax Speech intelligibility - ANS Refers to number of words completely understood by the listener Percent intelligibility - ANS Number of intelligible words divided by total number of words Expected percent intelligibility - ANS 2 years (50%), 3 years (80%), and 4 years (100%) Phonetic Inventory - ANS Clinician tests child's production of all the consonants in a language and compares to adult standards. Alternatively, a phonetic inventory can be created based on consonants produced by the child Early 8 - ANS m,b,j,n,w,d,p,h Middle 8 - ANS t,ŋ,k,g,f,v,ch,j Late 8 - ANS sh, th- voiceless and voiced, s, z, l, zh voiced Decontextualized setting - ANS Here there is no relevant background to the skills that are being tested- clinic situation- no real toys or scenarios for play Contextualized settings - ANS Here there is relevant background in terms of toys, a scripted activity, and prompts Minimal pairs - ANS pair of words differ based on only one feature Maximal pairs - ANS pair of words where the target sound is substituted by a sound with more distinct differences Drill play - ANS Use small cards with each card containing a picture drawn by the client representing one of the target sounds Indirect Language Stimulation (ILS) - ANS Contingent feedback: Clinician saying something related to what child said/did. Balanced turn taking: Letting the child take lead and then responding, rather than clinician initiating a conversation. Extension of child's topic: Clinician extending a child's productions Facilitated Play - ANS Enhancing narrative ability by engaging child in metalinguistic planning of roles and play outcomes. Facilitating turn taking by facilitating child to communicate to multiple play characters. Increasing opportunities for decontextualized language by gradually using more abstract props and situations. Enhancing expression of communicative intentions: Create play opportunities where child has to negotiate roles and plans. Increasing vocabulary: Including words specific to play activities for multiple opportunities for listening and use of target words. Developing emergent literacy: Include play situations where child pretends to write and read, make lists and write notes and precautions. Clinician-Directed Methods - ANS Clinician decides the activities for the session and leads the session. Clinician would select the specific target words, how many times the clients need to repeat those, as well as the play items/reinforcements for the session Child-Centered Approaches - ANS The child chooses what he/she wants to do. Here the clinician follows the child's lead. Hybrid Approaches - ANS These are a combination of clinician-directed and client-centered approaches. Script therapy - ANS Script therapy can be used to reduce cognitive load of language training by embedding it in the context of familiar routines Structured Play - ANS Activities focus on awareness of letters and matching of letters. Fluency - ANS Relatively fluent flow of speech without too many disruptions. Fluent speech is typically produced without much muscular effort or ideational effort Topographical measurement - ANS Count the number of fluent utterances or syllables or words in a speech sample. Sometimes number of dysfluencies can be measured as response units (words, phrases, or sentences). For example, determine the level at which client has maximum dysfluencies (single words, two-word phrases, or sentences) Temporal durations - ANS Measure the most frequently observed fluent duration in speech. Longer fluent utterances are associated with fewer disfluencies Intraobserver reliability - ANS When the same clinician observes or codes a speech sample two or more times. When two or more clinicians observe or code the speech sample independently to make sure the observations are consistent Cluttering - ANS A type of fluency disorder associated with extremely fast rate of speech Cancellations - ANS After a stuttering moment has happened, the client waits for few seconds and then produces the word again in an easier way with a slow and controlled rate of speech or reproduce the stuttered word more fluently Pull outs - ANS The person catches themselves in the moment of stuttering and produces a pull out by easing themselves out of the event. Preparatory sets - ANS Used prior to the production of an upcoming word that the person anticipates will be stuttered. Begin with a slow rate, use light articulatory contacts, begin the first sound slowly, and then complete the word in a slow manner. Minimally verbal children - ANS There is no clear definition of what refers to "minimally verbal" Some studies define children with anywhere between 5-30 functional words as minimally verbal. According to the textbook, children who produce simple isolated word responses, maybe a few phrases but no sentences may be considered to be minimally verbal. Nonverbal children - ANS Children who are essentially speechless. They may still be able to vocalize and use gestures to some extent. Voice - ANS result of phonation 3 main factors influencing vocal fold vibration - ANS vocal fold length, mass, and tension Pitch - ANS Perceptual counterpart of fundamental frequency. Unit is Hertz (Hz). More vocal fold tension = faster vibrations = higher pitch Larger vocal folds = more mass = slower vibrations = lower pitch Pitch range - ANS Measured as the range from lowest possible pitch (basal) to highest possible pitch level (ceiling) Loudness - ANS Perceptual counterpart of vocal intensity. Unit is decibel (dB). It is measured objectively by a sound level meter. Quality - ANS Perceived as harsh (rough voice quality), breathy, or hoarse (combination of harsh and breathy) quality Dysphonia - ANS This includes voice characteristics which are deviant in one or more domains. Types of dysphonia include: disorders of pitch (frequency), disorders of loudness (intensity), disorders of quality, and disorders of resonance Aphonia - ANS Refers to absence of voice. Pure aphonia is rare in children or adults Organic disorders - ANS Disorders are usually caused due to structural problem. Examples: vocal fold paralysis, vocal fold tumors, vocal nodules Functional disorders - ANS Disorders that do not typically have structural problems or underlying medical pathology in the laryngeal or neural mechanisms. Examples: Dysphonia following trauma or family loss; due to emotional problems; faulty behaviors Inappropriate pitch - ANS voice that is inappropriate to a person's age and gender Pitch breaks - ANS These refer to sudden uncontrolled upward or downward changes in pitch Three possible cause for pitch breaks - ANS Typical pubertal changes in boys Due to faulty use of pitch (either too high or low habitual pitch) Vocal fatigue associated with vocal hyperfunction Monopitch - ANS Refers to lack of typical pitch variations in speech Diplophonia - ANS Presence of two distinct frequencies at the same time Excessively loud voice - ANS May be associated with hearing loss or due to faulty learning (functional voice disorder). Excessively loud voice can lead to vocal nodules, polyp, or laryngeal hyperfunction Excessively soft voice - ANS May be caused by neurological disorders or laryngeal pathologies. Excessively soft voice in children may be a functional disorder in children Monoloudness - ANS Refers to lack of normal intensity variations. Can be caused by neurological damage, psychiatric problems, or a habit Breathy voice - ANS Characterized by incomplete VF vibration. May be result due to VF lesions including edema, nodules, or polyps or in some cases due to faulty learning Harsh/rough voice - ANS Associated with hard glottal attacks and perceived as unpleasant, strident, or rough voice quality. Possible causes include neurological disorders, problems in laryngeal structures, vocal abuse, or faulty learning Hoarse/rough voice - ANS Characterized by irregular VF vibration and is combination of harsh and breathy voice. Possibly caused by irritations, masses, swelling or other upper respiratory infections. It lacks clarity and voice is noisy. Sometimes hoarseness may be a result of voice abuse or misuse. Hypernasality - ANS Refers to excessive nasal resonance on non-nasal speech. May be caused due to craniofacial disorders (cleft palate, short malformed velum) and velopharyngeal insufficiency. Hyponasality - ANS Refers to inadequate nasal resonance and characterized by inadequate nasal resonance for speech sounds. May be caused due to blocked nasal passage due to infections or allergies, structural deformities, hearing loss, or faulty learning. Assimilation nasality - ANS Refers to nasalized oral sounds due to influence of neighboring nasal sounds. May be caused due to velopharyngeal insufficiency or faulty learning. May be noticed in children with cerebral palsy Nasal emission - ANS Refers to audible escape of unvoiced air during speech production. It may sometimes co-occur with hypernasality Functional aphonia - ANS Refers to loss of voice or inability to phonate in the absence of any organic pathology. It can be constant or intermittent. It has a relatively sudden onset and can be caused due to behavioral or psychological causes. Children with functional aphonia will be still able to phonate during non-speech acts such as coughing, throat clearing, or laughing. Elective or selective mutism - ANS Refers to partial or complete withholding of vocal communication. It usually occurs due to functional or behavioral causes Vocal abuse - ANS Refer to injurious vocal habits or voice misuse. It includes yelling, screaming, cheering, making noise while playing, grunting, excessive crying, and chronic throat clearing Vocal nodules - ANS Refer to localized growths on VFs due to frequent and hard VF collisions. They are usually bilateral but sometimes may be unilateral Acute or chronic laryngitis - ANS Acute laryngitis refers to VF inflammation due to exposure to noxious agents, allergies or vocal abuse. Chronic laryngitis refers to VF abuse during periods of acute laryngitis and leading to serious deterioration of VF tissue. Vocal fold paralysis - ANS May be unilateral or bilateral. Bilateral VF paralysis is seen more frequently in neonates and unilateral VF paralysis is seen more in older children. Can be classified as abductor paralysis or adductor paralysis Acoustic analysis - ANS Measurement of phonatory (jitter- frequency to frequency perturbation; shimmer- intensity to intensity perturbation, phonation time) aspects. Commonly used programs: KAYPENTAX, MDVP, PRAAT Electroglottography (EGG) - ANS Here changes in VF function is studied based on low-voltage sensors. Electromyography (EMG) - ANS Used to study VF movements and is helpful in diagnosis of VF paralysis. Aerodynamic measures - ANS Used to assess both respiratory and phonatory functions. Laryngeal imaging - ANS Includes laryngoscopy to view the laryngeal structures Questions And Questions