Language Conditions in Children Notes

Unit 1: Introduction to Language
Conditions in Children
Definitions & Terminologies
LANGUAGE
- A code whereby ideas about the world are expressed through a
conventional system of arbitrary signals for communication.
PURPOSES OF LANGUAGE
1. To communicate ■ Indirect Code

○ Purposes/Intentions ● Sounds,
○ Varies upon words used words,
○ Pertains to language sentences
use ○ Pertains to language
2. To express ideas form
○ Perceptions 4. To create a system
○ Knowledge ○ Organization
○ Ideas about events ○ Linguistic creativity;
○ Mental representations variations of expression
○ Pertains to language 5. To follow a convention
content ○ Something agreed upon
3. To represent concepts ○ For a common
through code understanding within a
○ A means of community
representation ○ Shared knowledge, a
■ Direct Code sense of belongingness
● Picture, ○ Norms; agreed by the
map, graph community
3 DIMENSIONS OF LANGUAGE
Content Form
● Object, object knowledge, ● How language is formed
object relations, event relations ● Phonology, Morphology,
● Semantics Syntax
● Categorization of concepts
Language Conditions in Children | 1

Use Interaction of CFU
● Pragmatics ● Knowledge of language or
● Contingency to conversation language competence
● How you interact with others, ● How we produce our
maintain a conversation, language, how CFU interact
respond, and inform with each other
Language Disorders: Definitions, Characteristics, & Models
LANGUAGE DISORDER
- Any disruption in the learning and use of one’s native language as
evidenced by language behaviors that are different from (but not superior
to) same-age peers.
DEVELOPMENTAL LANGUAGE DISORDER

- A language delay qualitatively severe enough to be classified as a disorder
- The clinician’s call; requires clinical reasoning as support
DELAY
- Normal development, but developing later and slower than same-age
peers
- Also called maturational lag
DEVIANT, DISORDER, DISABLED, IMPAIRED

- Qualitatively different from typical; not just developing later
TYPICAL AND ATYPICAL DEVELOPMENT

TYPICAL ATYPICAL
Successful development and

Disruption in learning/use of CFU
interaction of CFU
CHARACTERISTICS OF LANGUAGE DISORDERS

IDEA Difficulty with formulation or conceptualization
CODE Cannot match used code with conventional code
CONVENTIONS Cannot match language with the linguistic community
SYSTEM Cannot use learned code for certain context or purposes
May develop idea, code, convention, system, but do so

COMMUNICATION
later

MODELS OF LANGUAGE DISORDERS
1. Systems Model
○ Communication problems are not “in the child” but because of the
environment
○ Child: Behavior, Predisposition
○ Environment: Culture, Dialect, Communicative Partners; considered
a greater influence than the child themself
○ Does not require normal or standard levels of language to be used
○ Focuses on making the communicative context more supportive
2. Categorical Orientation Model

○ Medical model
○ Organizes language disorders on the basis of the syndromes or
behaviors they accompany
○ Attempts to move through symptoms, pathology
○ Cluster of unexpected behaviors
○ Revolves around diagnostic labels and categories playing a causal
etiological role
■ Specific Language Impairment - exists when a child’s
language difficulty cannot be accounted for by a general
delay in development, hearing loss, physical abnormality of
the speech apparatus, ASD, apraxia, or acquired brain injury.
■ Intellectual Disability - when a person has certain limitations
in cognitive functioning and skills, including conceptual,
social, and practical skills, such as language, social, and
self-care skills
■ Autism Spectrum Disorders - a neurological and
developmental disorder that affects how people interact with
others, communicate, learn, and behave
■ Learning Disabilities - disorders that affect the ability to
understand or use spoken or written language, do
mathematical calculations, coordinate movements, and other
learning processes
○ Language problems are secondary to the diagnoses
(+) (-)
Syndromes or neurological conditions

Summarizes how child is different
are not always causative of language
from typical children
disorders

3. Specific Abilities Model
○ Shows within child variation
○ Not looking at categories but strengths and rooms for improvement
○ Abilities/Disabilities, Strengths/Areas for Improvement influence
language development
○ Information Processing (Memory, Attention, Discrimination,
Association) also influences language development
○ Teach according to strengths and remediate/work around child’s
areas for improvement
4. Descriptive/Developmental Model
○ Focuses on detailing developmental milestones, child’s language
skills
○ Describes the entire range of language performance (CFU)
○ Developmental: determine where the child is in the sequence of
development and where to go next
○ Not always possible to identify the cause of the language
impairment; only identifies delays in development
DESCRIBING LANGUAGE DISORDERS BASED ON CFU
Developmental Delay
- (+) CFU Interactions
- (-) Age of Acquisition; later
Raw Standard Score Percentile Age

Subset (Normal limits for (Normal limits for Equivalents
Score AC&ECs: 85-115) AC&ECs: 16-84) (XXX’s Age: 4Y 6M)
Auditory
42 77 6 3Y 6M
Comprehension (AC)
Expressive
44 79 8 3Y 7M
Communication (EC)
SUM: 156
Total Language Score 86 5 3Y 5M
SS: 76
Disruptions of Content
- Echolalic; automatic and non-voluntary repetition
- Contingent but inappropriate
- No sense; superficial
- Hyperverbal, cocktail party speech
- Does not know the meaning of what they are saying

Disruptions of Form
- Cannot use words properly
- Primary language behaviors are gestures, nonverbal acts, vocalizations,
circumlocution
- Wanting to say something but not having the words to say it
- Difficulty learning phonology, morphology, and syntax
Disruptions of Use
- More intrapersonal than interpersonal
- Less inclination to initiate or maintain conversation
- Rarely verbalizing even when questioned or prodded
- Talking about something out of context
Distorted CFU Interaction

- Limited use; uses language forms to respond, regulate attention, or request
- Meaning wanted to convey is inappropriate to the context
Separation of CFU
- Unrelated; not responding to prior linguistic context
- Stereotypic utterances
- Not contingent on anything
DEFICITS
Comprehension Deficits
- Difficulty with receptive language
- Difficulties in understanding words and word combinations in both oral
and written forms
- Characterized by difficulties with word recognition skills, reading fluency,
social, cognitive, or linguistic skills, semantic processing, and syntactic
processing.
Production Deficits
- Difficulties with expressive language
- Difficulties in using words and word combinations
- May occur either on the phonological level in which the incorrect
phonological form of the word is selected but implemented correctly, or
the phonetic level in which the correct sound segments are selected but
articulatory implementation is impaired

Unit 2: Causes & Prevention of
Language Disorders + Language &
Pediatric Disabilities
Causes & Prevention of Language Disorders
LEVELS OF EXPLANATION FOR DLD
Biological Factors
Differences in genetic risk and neurological structure and
function associated with disorder
Reduced Asymmetry
KIAA0319 (The Dyslexia Susceptibility Gene)
CMIP (modulates phonological short-term memory in

language impairment)
Motor Cortex Anomalies
CNTNAP2 (associated with language disorders and

Environmental Factors sequential learning and phonological buffer's
External experiences that performances)
either increase risk of
disorder or that are ATP2C2 (implicated in language disorders by linkage and
protective in the face of association studies)
biological risk
Family History Cognitive Factors

Differences in perception and information processing
Maternal Education associated with disorder
Intervention?
Limited capacity system
Procedural learning deficit
Inefficient auditory processing
Behavioral Features
Overt differences in behavior that characterize the disorder
Delayed language acquisition
Errors in morphosyntax
Poor understanding of grammar/discourse

GENETIC FACTORS IN DLD
● Hereditary
○ Primary DLD tends to run in families
○ Genes may influence susceptibility to disorder
○ Inconclusive; families share environments as well as genes
● Maternal and Paternal Age
○ Paternal age of more than 40 years; maternal age of more than 35;
increases risk for DLD
ENVIRONMENTAL FACTORS IN DLD

● Exposure to teratogens
○ Can cause low birth-weight, withdrawal symptoms, birth defects, or
learning or behavioral problems
● Exposure to language
○ Exposure to two or more languages does not cause or compound
DLD
○ Families are advised to provide rich linguistic input to their children
in whichever language they themselves are most comfortable
speaking
● Socioeconomic status
○ Language impairment is mediated by maternal education, via the
quantity and quality of mothers’ interactions with their children
○ Measures of income or maternal education are not reliable
predictors of long-term language impairment
COMORBIDITY IN DLD
● Refers to a situation in which a child may experience two or more disorders
simultaneously
● Concerns the nature of the relationship between these two disorders:
○ Do they arise from completely independent causal origins, or are
they causally related?
Example: Comorbid relationships between speech sound disorders, reading

disorders, and DLD.
Levels of Prevention as Defined By ASHA

PRIMARY PREVENTION
● The elimination or inhibition of the onset and development of a disorder by
altering susceptibility or reducing exposure for susceptible persons.
Example: Inoculation/Immunization to prevent rubella.

SECONDARY PREVENTION
● Early detection and treatment are used to eliminate the disorder or delay
its progress, thereby preventing further complications
Example: Newborn hearing screening to detect hearing loss and provide early
amplification or cochlear implantation.
TERTIARY PREVENTION
● Intervention is used to reduce a disability by attempting to restore effective
functioning
Example: Providing rehabilitation and special educational services to a child

with Down Syndrome
Intellectual Disability
- A disability characterized by significant limitation both in intellectual
functioning and in adaptive behavior, which covers many everyday social
and practical skills.
- Originates before the age of 18
Definitions of Intellectual & Adaptive Function

(From the American Association on Intellectual & Developmental Disabilities)
● General mental capacity:

Intellectual ○ Learning
Functioning/Intelligence ○ Reasoning
○ Problem-Solving
● Language & Literacy ● Number Concepts

Conceptual
● Money ● Self-Direction
Skills
● Time
● Interpersonal Skills ● Ability to follow

● Social Responsibility rules/obey laws
● Self-Esteem ● Ability to avoid being
Adaptive Social Skills
● Gullibility victimized
Behavior
● Naïveté
● Social Problem-Solving
● Activities of daily living ● Schedules/Routines

Practical ● Occupational skills ● Safety
Skills ● Healthcare ● Use of money
● Travel/Transportation ● Use of the telephone

COGNITIVE CHARACTERISTICS
● Similar pattern of cognitive development to typically developing children,
but a slower developmental trajectory
● Impairment in adaptive behavior (e.g. problem-solving, etc)
LANGUAGE CHARACTERISTICS
● Delayed acquisition
● EL > RL
● Similar with typical young children
● Shorter and less complex sentences
● Pragmatic skills lag behind
Language Disorders with Known Genetic Origins
DOWN SYNDROME
● Most common chromosomal cause of ID
● Occurs in approximately 1 in 700 live births
● Extra third copy of chromosome 21; hence, trisomy 21
● Increasing maternal age significantly increases risk of
Down Syndrome
Characterized By: Associated With:
Mild to moderate ID Higher Risk for Congenital Heart

Defects
Hypotonia (low muscle tone)
Gastroesophageal Reflux Disease
Microgenia (abnormally small chin) (GERD)
Round Face Recurrent Ear Infections
Relative Macroglossia (protruding or Obstructive Sleep Apnea

oversized tongue)
Thyroid Disfunction
Epicanthal Fold (Fold of skin on the
Eyelid)
Short Stature
Shorter Limbs
Hyperflexibility of Joints

● Global developmental delays in fine and gross motor skills
● Poor to moderate IQ; majority of IQ scores between 40 & 70
● Poor working memory; especially with verbal material relative to
visuospatial working memory
● Poor executive functioning skills and cognitive processes integral to
adaptive, goal-directed actions
Examples: Executive Functioning Skills & Cognitive Processes
Problems with Response Inhibition (Impulse Control)
● Reduced generation of strategies for delaying gratification
● Difficulties persisting with learning tasks
● Engaging in more off-task behavior
Cognitive Flexibility
● Difficulty learning new rules and applying them
Planning
● Take longer to solve problems
● More likely to abandon efforts at problem-solving
● Reflecting difficulties with planning
● Difficulties with persistence
● EL < RL
● Poor speech intelligibility relative to cognitive ability
○ Especially in connected speech, coarticulation and transitioning
○ Vowel distortions and inconsistent pronunciations are evident
○ Attributed in part to anomalies of the articulatory structures or
complications arising from frequent bouts of middle ear infection
● Apraxia of speech also reported in DS
● Lesser vocabulary; disproportionate difficulties acquiring and using syntax
● Short and less complex sentences, fewer question/negation forms
● Good pragmatic skills

WILLIAMS SYNDROME
● A complex neurodevelopmental disorder that results from the deletion of
approximately 25 genes on one copy of chromosome 7q11.23
● Rare: 1 in 7,500 live births
Associated With:
● Characteristic Facial
Dysmorphology
Physical Features ● Cardiovascular Disease
● Growth Deficiency
● Cognitive Tissue Abnormalities
Cognitive Features ● Discussed below
● Overfriendliness
Behavioral Features ● Social Gregariousness
● Marked Anxiety
● Global developmental delays
● Mild to moderate ID
● Some will have IQs within the low average range; others will experience
more severe impairment
● Difficulties with visual-spatial construction
● Deficits in adaptive behavior, particularly in the areas of motor
development and independent living
● Dissociations between cognitive and linguistic skill
○ Suggesting “exquisite mastery” of syntax and vocabulary in the
context of pronounced nonverbal cognitive deficits
● Onset of first words and phrases is delayed; canonical babbling is delayed
● No reports of SSD or reduced intelligibility, grammar is intact
● Understanding and production of concrete vocabulary are relative
strengths
● Pronounced pragmatic difficulties
○ Emergence of joint attention is delayed
○ Atypical temporal relationship between gesture & word production
○ Impaired integration of gaze cues for communication purposes
○ Less likely to provide contingent and informative responses; made
more social evaluative statements and fewer cognitive inferences
○ Difficulty monitoring comprehension and signalling when
conversational partners provide ambiguous or inadequate messages

FRAGILE X SYNDROME
● A single gene disorder, caused by an expansion of the
trinucleotide (CGG); repetitions of the FMR1 gene
● An inherited disorder, most common inherited form of ID
● 1 in 4000 males; 1 in 8000 females
Characterized By: Associated With:
Elongated Face Occasional Joint Dislocations
Long & Prominent Ears Recurrent Otitis Media
Highly Arched Palate Strabismus
Enlarged Head Mitral Valve Prolapse
Hypotonia Dilation at the Base of the Aorta

and Gastrointestinal Reflux
Flat Feet
High Rates of Co-morbid Condition
Hyperextensible Finger Joints ASD
Large Testicles (Macroorchidism)
● ID is the predominant cognitive characteristic
● Rate of intellectual growth is half that of typically developing children
● Deficits in executive function
○ Sequential processing ○ Selective attention
○ Working memory deficits ○ Inhibitory control
○ Cognitive flexibility problems
○ Planning ○ Fine & gross motor delay
● Girls > Boys; in terms of linguistic competence
● Reduced intelligibility in connected speech
● Phonological processing and phonological short-term memory is impaired
and less well developed
● Delayed understanding and production of grammar and morphosyntax;
shorter MLU, expressive vocabulary and growth are impaired
● Poor narrative production or conversational skills
○ Increased use of tangential language, perseverative and repetitive
speech, delayed echolalia, and use of stereotyped phrases
○ Poor with false belief tasks due to poor inhibition control

Language Disorders Associated with Sensory Impairments
VISUAL IMPAIRMENTS
● Experience early delays in language acquisition, but resolved by school age
● May learn to read through specially adapted writing systems
○ Braille - main system of writing and reading
○ Computer programs - converting text to speech
● Literacy skills are usually delayed
○ No visual references
○ Unable to imagine the objects
○ Cannot associate sound to letter
● Difficulties are attributed to early visual experiences, i.e. triadic joint
attention
● Limited language use
○ Nonverbal cues; gestures are limited
○ Difficulty understanding each others’ referents
● Pragmatic skills are vulnerable
○ Extensive, and sometimes inappropriate, use of questions
○ Scarce communicative gestures
○ Extensive use of imitative speech, repetitions, and verbal routines; i.e.
echolalia
HEARING IMPAIRMENTS
● Types: Conductive, Sensori-neural, Mixed
● Degree: Mild to Profound
● Most common type: Congenital Deafness
● No biofeedback mechanism
● Use of Sign Language
● No access to auditory language; main way of interacting is through the
visual world
● Majority are born to hearing parents, delaying early language and
communication opportunities since they may not be immediately aware
that their child has a hearing impairment
● Slow articulatory transitions between consonants and vowels, frequent
pauses in speech
● More likely to produce voicing errors, extra nasality, and initial syllable
omission
● Speech intelligibility is lower—depending on aids/implantation, listener
experience, and topic content
● Challenging for them to develop skills in spoken language morphology and
syntax.
● Vocabulary and word learning are also delayed, depending on the use of
cochlear implants

DEAF-BLINDNESS
● Both senses are restricted
● Deficits in both hearing and vision exhibit a multisensory deprivation that
encompasses language concerns in both visual and hearing impairments.
● Contextualized and dynamic assessment techniques are necessary for
identifying this population’s communicative needs.
● A form of augmentative and alternative communication is almost always
useful in these cases.
Language Disorders Associated with Acquired Neurological

Disorders
TRAUMATIC BRAIN INJURY
● Can be focal in nature
○ If focal, usually open-head injuries, i.e. gunshot wounds
○ Impact on language development is similar to that described for
other focal lesions
● Closed-head injuries tend to involve diffuse damage, affecting large areas
of the brain and are the more common type of TBI in childhood
○ E.g. blows, collisions, road accidents, and falls
● Boys are more likely to experience TBI than girls
● Reduced cognitive ability affecting speed of information processing and
pragmatic skills; i.e. narrative and discourse competence
● Deficits in working memory and executive function, i.e. attention,
concentration, and impulsivity; personality changes
● Dysarthric or nonfluent (aphasic); mute and may only follow simple
commands
● Sparse language production; less likely to initiate communication
● Slow speech; prosody is affected, making speech sound monotonic and flat
● Swallowing disorders are also common during the beginning phase of
recovery
● Excess speech production; talks too much, tangential statements that are
off-topic, irrelevant, and sometimes inappropriate
● Deficits in discourse processing
○ Problems with turn-taking, topic maintenance, generating verbal
responses, and understanding the intentions of others
● Slow in recognizing non-literal language, generating inferences, resolving
ambiguous messages, and a heavy reliance on verbatim memory instead of
interpretation in narrative tasks

FOCAL BRAIN LESIONS
● Localized in a specific area of the brain that are usually caused by CVAs
● Relatively rare in children
● Early delays in word comprehension and gestures (more likely following
right hemisphere lesions than left)
● Delays in word and sentence production (more pronounced if lesions
occurred in left temporal brain regions, as opposed to more frontal areas)
SEIZURE DISORDERS
● Landau-Kleffner Syndrome, aka acquired epileptic aphasia; a rare seizure
disorder that causes severe language disorder
○ Distinction: A seizure refers to a single surge of electrical activity in
your brain. A seizure disorder is a condition in which a person has
multiple seizures.
● Onset is usually between 3 and 6 years of age; but can occur any time in
childhood
● Rapid loss of language skills after a normal period of development;
comprehension is severely affected—may be able to understand single
words or short phrases but others may no longer understand any spoken
language, not even their names
● Problems with processing auditory input
● May lose speech altogether and resort to gesture to convey meaning; there
is a genuine loss of language
● Selective mutism depending on child’s history of verbal communication
● Behavioral and social problems similar with ASD
● Language problems may persist into adulthood
● Use of alternative means of communication might help
● Behavioral changes
Language Disorders Associated with Other Neurodevelopmental

Disorders/Psychiatric Disorders
AUTISM SPECTRUM DISORDER (ASD)
● An umbrella term that encompasses a range of disorders that are
characterized by core impairments in social communication and a
restricted repertoire of interest and behavior.
EARLY COMMUNICATION
● First year of life: indistinguishable from low-risk peers in terms of social
behavior
● Earliest signs of atypical development: subtle differences in motor
development, visual attention, and interest in objects; may be markers of
other developmental disorders as well

● Second year: differences in social interaction behaviors become more
apparent and some children show signs of regression
● Social behaviors include: reduced eye contact, social smiling, social interest,
and social imitation, reduced response to their own name, and fewer
responses to bids for joint attention
● Symptoms typically observed by 12-24 months (15-18 months)
● May be seen <12 months
● May not become fully manifested until social demands exceed limited
capacities, or may be masked by learned strategies in later life
○ May not have language difficulties; may present typical language
skills in childhood stages and have the disorder manifest at a later
stage
● Media depiction of possessing super abilities in skills such as music, math,
or drawing
○ Individuals with “splinter skills” (abilities that are disconnected from
their usual context and/or purpose) form only a minority of the ASD
population
● 50%-70% with ASD also have intellectual disability
● Deficits in executive function
● Deficits in social cognition/understanding other minds
○ Problems understanding the intentions of speakers, learning new
words, and understanding non-literal language
● Phonological short-term memory is impaired and phonological processing
is universally challenging, e.g. rhyme awareness is poor
● Deficits in morphosyntax and grammar relative to phonology and lexical
knowledge
● Use fewer grammatical morphemes to mark verb tense and agreement
● Pragmatic deficits are particularly evident in higher level discourse
processing and narrative tasks
○ Significant deficits in conversational skill
○ Too many or too few initiations
○ Poor topic maintenance
○ Fewer contingent conversational responses
○ Higher proportions of contextually irrelevant propositions
○ Poor referencing throughout the narrative
○ Ignoring motivations of characters or events
● Poor understanding of language in context
○ Poor understanding of figurative and metaphorical language
○ Poor inferencing skills
○ Reduced ability to resolve ambiguous language

BEHAVIORAL CHARACTERISTICS
SOCIAL COMMUNICATION & SOCIAL INTERACTION according to DSM-5
Deficits in social/emotional reciprocity
Deficits in nonverbal communication behaviors used for social interaction
Cannot maintain and understand relationships
RESTRICTED & REPETITIVE PATTERNS OF INTEREST, BEHAVIORS, & ACTIVITIES
Stereotyped or repetitive motor movement, use of object, or speech
Insistence of sameness, inflexible adherence to routines, or ritualized

patterns of verbal and nonverbal behavior
Highly restricted, fixated interests that are abnormal in intensity and focus
Hyper- or hypo-reactivity to sensory input or unusual interest in sensory

aspects of the environment
Stimming; fulfilling a sensory need through repetitive behaviors
Rigid and inflexible
NEUROBIOLOGY
● Volume abnormalities in both grey and white matter
● Early brain overgrowth especially in frontal, temporal regions, and limbic
area; also precocious enlargement of amygdala
● Cerebellar hypoplasia; developmental condition in which the cerebellum of
the brain fails to develop properly
● Affects how individuals with ASD respond to cognitive functions
○ Social intelligence
○ Cognitive control
○ Communication
● Decreased cortical specialization: mild shifting of cortical location in
response to a variety of tasks
● Amygdala: Processing emotions and behavior
● Hippocampus: Learning and Memory
CLINICAL IMPLICATIONS
● Early identification to provide appropriate and holistic intervention
● Family involvement to discuss desired outcome
● Reduction of ASD symptoms or improvement of adaptive functioning

NONVERBAL CHILD WITH ASD
● Reduced motivation to communicate with others
● Provide other conventional means—gestures, signs, vocalizations, words, or
some form of augmentative communication such as a picture board—for
expressing the intents the child is already producing
● Provide extensive support for eliciting joint attentional and social
interactive behaviors
● Multimodal/Total Communication is encouraged; not restricting them to
one form of communication; AAC
ATTENTION DEFICIT HYPERACTIVITY DISORDER (ADHD)

● Prevalence: 3%-5%; Males > Females (4:1)
● Population: 103.3M; ADHD: 3-5.1M
● Average age of diagnoses: 6.2 YO
Characterized By:
Distractibility
INATTENTIVENESS Poor organizational skills

(EXECUTIVE FUNCTIONS)
Difficulty completing tasks without
close supervision
Fidgety
Always on-the-go
HYPERACTIVITY & IMPULSIVITY
(SELF-REGULATION)
Interrupting and talking incessantly
Acting without thinking
NEUROBIOLOGY
● Delayed cortical maturation
● Reduced total brain volume and volume of some brain structures
● Frontal and Temporal Lobe size reduction; decreased activity in both lobes
● MRI studies show less blood flow in regions of the brain while working on
tasks in people with ADHD vs. Non-ADHD
● Majority has difficulties in executive function processes that are associated
with the Frontal Lobe (e.g. inhibition, working memory, planning)
● Difficulties in deferring gratification

● Variable language profiles and high rates of comorbidity
● Decreased vocabulary and semantic skills
● Limited ability to use language in socially appropriate ways
● Inappropriate initiation, topic maintenance, and responding with
appropriate information
CLINICAL IMPLICATIONS
● Pharmacological intervention; i.e. adderall
● SLPs should be prepared to work closely with the child’s family, physician,
and school nurse regarding the child’s medication regime and any
changes in prescription or behavior
● Children who can’t pay attention can’t learn
SELECTIVE MUTISM
● Child consistently does not speak in certain situations, such as school,
where there is an expectation for speech, but does speak normally in other
situations, like at home
● SM must persist for more than 1 month (not including the first month of
school), and cannot be accounted for by a DLD or by unfamiliarity with the
language environment
● Relatively rare disorder - 0.3-0.8 per 1000; much more common in girls with
a gender ratio of 2:1
● Self-consciousness about communicative abilities plays a part in
maintaining the disorder
● Regarded as an anxiety disorder rather than a variant of DLD
● Treatment: Behavioral + Pharmacological Interventions
Language Disorders Associated with Motor Impairments
SEVERE MOTOR SPEECH DISORDERS

● Can leave the understanding and formulation of language, as well as
general cognitive skill, more or less intact, resulting in more circumscribed
speech impairments
Examples: Cerebral Palsy, Congenital Facial Anomalies, Neuro-Motor Tract Brain

Injuries
REASONS
● External Barriers
○ Cannot learn through the usual sensorimotor interactions with
people and objects because of their physical disabilities

○ Do not have constant access to their mode of communication as
speakers do; if they use a board or device, someone has to get it and
set it up for them before they can communicate
○ Limited mobility gives them fewer opportunities to interact with
other people
○ Aren’t able to develop from babble to speech by playing with sound
and using sound as an interaction tool; devices and outputs are
chosen for them and may not be the best match for their abilities
and intentions
INTERVENTION
● In designing language-learning systems for individuals who use AAC
systems, the usual approach needs modification:
○ Change Focus in Intervention
■ Instead of focusing on the next developmental stage of
language output, focus more on the child’s functional skills:
comprehension, pragmatic, and cognitive aspects and use
these as bases for treatment
● Other techniques and devices that can help involve:
○ Offering not just single nouns but also using language chunks; e.g.
“don’t do that,” “lemme see”
○ Stressing the communicative function rather than grammar
○ Focusing on what is more functional for them
○ VOCAs (Voice Output Communication Aids)
CHILDHOOD APRAXIA OF SPEECH

● A neurological childhood speech sound disorder in which the precision and
consistency of movement underlying speech are impaired in the absence
of neuromuscular deficits
● The core impairment in planning and/or programming spatiotemporal
parameters of movement sequences results in errors in speech sound
production and prosody
● Not the result of muscle weakness, paralysis, or obvious neurological
impairment but a difficulty in motor planning
○ Knows what they want to say but cannot coordinate speech
structures or articulators necessary to say it
● “Developmental Verbal Apraxia” or “Dyspraxia”
● Inconsistent stress production involving the naming of two-syllable words
● Degree of variation in the timing of speech
● Affects language form and use
● Affects suprasegmentals of language (tone, stress, etc.)

INTERVENTION
● Pre-verbal: Vocabulary Building
● Verbal: Develop Motor Patterns
Language Disorders Associated with Extreme Environmental

Disadvantages
ABUSE/NEGLECT
● Disrupts development, especially for language and executive control
processes
● Interferes with normal social-interaction processes
● Reduces opportunities for language learning in socially meaningful
exchanges
● Reduced rates of vocabulary growth & shorter MLU
● Deficits in expressive syntax persist into school age and adolescence
● Difficulty using language to articulate feelings and needs
○ Necessary for self-regulation to convey abstraction
○ Necessary for advanced literacy and reading comprehension
○ Sustain coherent narrative dialogue
FETAL ALCOHOL SPECTRUM DISORDER (FASD)

● A syndrome of birth anomalies associated with excessive alcohol intake
during pregancy
PRENATAL DEVELOPMENT
● Substances can cross the placental barrier and affect the intrauterine
environment
● Fetus is unable to metabolize the alcohol as an adult can
● Alcohol acts as a teratogenic agent and interferes with chemical processes
in fetal cells
● Abuse of other drugs, such as cocaine, can increase the probability of
premature birth
CAREGIVING ENVIRONMENT
● Parents who are frequently drunk, high on drugs, or driven to get drugs by
any means necessary cannot devote much energy to childrearing
● These parents have difficulty understanding their children’s
communication attempts and may not respond appropriately to them,
often rejecting or criticizing their efforts
● They will create an environment not conducive for language learning
● “Double jeopardy,” it is challenging to separate the effects of the substance
itself from the chaotic environments that are prevalent in maternal
substance abuse

Unit 3: The Evaluation Process
Principles & Purpose of Evaluation
STUDYING NORMAL & DEVIANT LANGUAGE DEVELOPMENT
● Allows for the profiling of the child’s language skills and the comparison to
some standard or model
● Compares child’s language capacity to standardized tools for a holistic
evaluation
OBJECTIVES IN DESCRIBING DEVIANT LANGUAGE
Identify if the child has a language disorder
Plan the appropriate intervention
Estimate prognosis
Quantify and qualify differences between deviant and normal language

development
Foundations of Assessment
ASSESSMENT
● Describing a child’s language behavior for the purpose of identifying a
problem, planning intervention, or estimation prognosis
● Process of collecting valid and reliable information, integrating it, and
interpreting it to make a judgment or a decision about something
PRINCIPLES OF A GOOD ASSESSMENT

1. A good assessment is thorough.
○ Incorporates as much relevant information as possible so that an
accurate diagnosis and appropriate recommendations can be made
2. A good assessment uses a variety of assessment modalities.
○ Includes a combination of interview and case history information,
formal and informal testing, and client observations
3. A good assessment is valid.
○ Truly evaluates the intended skills
4. A good assessment is reliable.
○ Accurately reflects the client’s communicative abilities and
disabilities
○ Repeated evaluations of the same client should yield similar findings,
provided there has been no change in the client’s status

5. A good assessment is tailored to the individual client.
○ Assessment materials that are appropriate for the client’s age,
gender, skill levels, and ethnocultural background should be used
Plan for Assessment
OBJECTIVES
1. To determine whether there is a problem that needs further assessment
and intervention.
2. To determine the goals of intervention—to indicate what the child needs to
learn, and what the child should be able to learn—in terms of the
content/form/use of language.
3. To suggest procedures of intervention—to indicate the factors that need to
be taken into account for the child to be able to learn language skills most
effectively.
4. To determine what kind of progress is expected from the provided
intervention plan.
OBJECTIVES OF & INFORMATION FROM ASSESSMENT
OBJECTIVES INFORMATION NEEDED

Why use a procedure? What will the relevant procedure produce?
1. To determine the existence of a A comparison of language behavior

problem. with language behaviors of children of
comparable age.
2. To determine the goals of A description of the content/form/use

intervention. of the child’s language behavior
3. To plan procedures of intervention
a. To reduce the effect of Amount and type of language

maintaining factors exposure in the environment; social
and cognitive development; sensory
acuity; general health
b. To determine the role others Description of home and school

can play environment
c. To provide motivators and Child’s interests, likes, and dislikes;

reinforcers child’s social interactions
d. To plan structure of Child’s attention span and degree of

intervention sessions distractibility in different contexts
e. To plan methods of presenting Sensory acuity and association of

input meaning with the signal
Reactions to variations in acoustic

signals, such as rate, intensity, and
prosody
Response to different modalities, in

combination and alone
f. To determine the form of the Oral motor capabilities; ability to make

output signal auditory-vocal associations
4. To determine prognosis Results from previous attempts to

facilitate language; all maintaining
factors
Obtaining the Evidence
OBSERVER CONTEXT
● Chooses the behavior to be ● Where the behavior occurs

described ● Physical setting
● Acuteness and accuracy is of ● Persons interacting with the
utmost importance child
● Materials objects in that
specific location
● Structure imposed by the
observer
TECHNIQUES USED IN OBTAINING EVIDENCE

● As with the study of normal language development, the techniques used in
obtaining evidence include observation in naturalistic interactions and
observation of responses to the experimental manipulation of one or
another of the components of content, form, and use.
● In addition, there are observations that fall somewhere on the continuum
between high and low imposition of structure that are referred to here as
nonstandardized elicitations.

STANDARDIZED TESTING
● Highest degree of structure is imposed on a situation when this is
administered
● Most common means of obtaining evidence about deviant language for
clinical purposes
● Helpful when you are trying to control the situational variables that may
differently influence the test result
● Knowledge of directions and methods are needed when administering the
test
● Use preset categories for description and thus do not allow for other
interpretations
(+) (-)
Less flexible, restricting, does not allow

Norm-referenced
for other interpretation
NATURALISTIC OBSERVATIONS
● Allows the clinician to observe the child’s spontaneous behaviors
● Familiar and comfortable setting; one where the child has the opportunity
to interact verbally
● Little intrusion from the clinician
● The child is both the initiator and responder
(+) (-)
Clinician may not elicit other specific

Longer acquired sample
skills
NON-STANDARDIZED ELICITATION
● Midway between high and low degrees of observer-imposed structure
● Observer may suggest certain tasks and probe responses but the child’s
responses and interests determine the exact procedures that are used
● Identify what a client can and cannot do according to a predefined
criterion; functions to observe the child’s performance, not compare
● Assume that there is a level of performance that must be met for a
behavior to be acceptable. Any performance below is considered deviant.
(+) (-)
Objective, efficient, widely recognized, Unnatural/not representative of real

individualized life, evaluates isolated skills

Reasons for Assessing Language Performance
SCREENING
● Identifies children with hidden language impairments
● Must cover a broad range of language and communication functions
● Used only to identify if a child is at risk for DLDs, not conclude if a child has
one (screening ≠ diagnosis)
ESTABLISHING BASELINE FUNCTION

● Identifies the child’s current level of functioning
● Gives a profile of the child’s strengths and rooms for improvement
● Examines all areas of communicative functions and areas related to the
child’s ability to use language—such as hearing, cognitive skills, and
oral-motor abilities
● Must assess the child in different familiar settings (i.e. home, school, etc.)
● Provides a broad picture of language and communication functioning
ESTABLISHING GOALS FOR INTERVENTION

● Identifies appropriate targets and procedures for intervention
● Areas below the expected functioning level of the child will be targeted for
intervention
● Must integrate a comprehensive understanding of the typical sequence of
the acquisition of language skills
MEASURING CHANGE IN INTERVENTION

● Determine whether the goals of the program have been met
● Adjust if there are necessary changes—if more change is needed, if more
change is possible, and if more change can be achieved without costs that
outweigh its benefits
● Decide regarding discharge—once the child functions in naturalistic as well
as structured settings, the child has achieved the goals set in the
intervention program
Instruments for Assessment

FORMAL INFORMAL
● Preschool Language Scale - 5 (PLS-5) ● Low- and High-Structured Language

● Clinical evaluation of Language Sampling
Fundamentals (CELF-4) ● Mecham’s Verbal Language
● Comprehensive Assessment of Spoken Development Scale (MVLDS)
Language (CASLTM) ● Westby’s Symbolic Play Scale (WSPS)
● Social Language Development Test -
Elementary (SLDT-E)
● Test of Problem-Solving (TOPS-3)

Considerations in Test Selection
PURPOSE
● If the purpose of description is identification, is it to identify overall
language knowledge or knowledge of a particular aspect of language
knowledge?
RELEVANCE
● Does the test provide information about the following areas?
○ Overall language knowledge,
○ Content/form interactions (vocabulary, morphological inflections,
function words, word order, complex sentences, etc.)
○ Content?
● Is this information relevant to the purpose of description?
APPROPRIATENESS
● Is the population on which the test was normed representative of the
population of which the child is a member? That is, are the norms
appropriate for the child?
○ Some tests are normed on children from a restricted geographic
area, such as a small midwestern city; a particular social class; a
particular dialect pattern; or a narrow range of intelligence. Is the
population relevant to the child?
○ Some tests tell only what the average score is for children of different
ages or grades (equivalent scores) and not the distribution of scores
for children of the same population (standard scores). Which is most
relevant to the purpose of description?
Unit 4: Formal Assessment Tools

Preschool Language Scales (PLS-5)
DESCRIPTION
● Individually administered test
used to identify children who
have a language delay or
disorder
● Consists of a picture manual,
examiner’s manual,
administration and scoring
manual, and manipulatives
● For: Birth to 7.11 YO

ADMINISTRATION TIME DEPENDS ON:
Age Ability Cooperation
SCOPE & INCLUSIONS

AREAS TESTED
● Presence of a language delay or disorder
● Whether the problem is primarily receptive, expressive, or both
● Both expressive and receptive language skills
○ Attention ○ Vocal Development
○ Gestures ○ Social Communication
○ Play ○ Concepts & Structures
STANDARDIZED SCALES & WHAT THEY ASSESS
Auditory Comprehension Scale Expressive Communication Scale
● Scope of a child’s comprehension ● How well a child communicates

skills ● Vocal development and social
● Language precursors communication
○ Joint Attention ● Naming common objects, using
○ Object Play objects, and expressing quantity
○ Turn-Taking ● Use of specific prepositional
● Basic vocabulary, concepts, markers and sentence structures
morphology, and early syntax ● Emergent literacy skills
● Complex sentences ● Integrative thinking skills
● Comparisons and inferences ○ Simile use
○ Synonym use
SUPPLEMENTAL MEASURES
Articulation Screener Language Sample Checklist
Determines need for further Overview of content, structure, and

articulation testing use of spontaneous utterances
ADMINISTRATION PROCESS
● Case History
● Home Communication Questionnaire
● Repeat instructions or questions only once; any more than that, it is
considered a cue/prompt that may skew the results
● Quiet, attentive, and ready

CONSIDERATIONS
Environment Examiner Child Reinforcements
General Rule of
Thumb in Static
Assessments:
Do not give
Are you ok? Are reinforcements,
you regulated cues, or prompts
enough? Are you based on the
Lighting, sensory Well-regulated
prepared and child’s responses
accommodations, and ready to
capable of
comfort level interact
administering the Do not react or
test? Is your tone give any indicator
appropriate? of their
performance
Inform the
caregiver as well
CALCULATING THE CHRONOLOGICAL AGE

● Take the difference between the day, month, and year of birth and the day,
month, and year of when the test is administered.
Year Month Day
Test Date 13 54 7 37
Birth Date 7 1 11
Chronological Age 6 3 26

GENERAL DIRECTIONS
Suggested Start Point: Start at the heading corresponding to the child’s
chronological age
● Give verbatim instructions
● Can administer tasks under specific headings out of sequence according to
what allows the child to perform
Basal: Three consecutive scores of 1 (child responds/performs correctly). Reverse

to the previous age start point until three consecutive scores of 1 are achieved.
● Definition: Foundational Skills or “Lowest” Skills
● Achieving Basal means that preceding items are also 1 (can be performed
correctly)
Ceiling: Six consecutive scores of 0

● Definition: Upper Limit or “Highest” Skills
Practice Items: Provided to give the child a chance to rehearse

● No scoring
Clinical Evaluation of Language Fundamentals (CELF-4)

DESCRIPTION
● Individually administered standardized test that determines whether a
student has language disorder or delay
● Consists of 19 subtests (e.g. word definition, phonological awareness,
expressive profile, etc.)
● For: 5-21 YO
● Can be administered by SLPs, school psychologists, SpEd, diagnosticians
○ Must be trained to administer and interpret the tests
● Pinpoints language and communication strengths and weaknesses
● Makes educationally-relevant recommendations
SCOPE & INCLUSIONS

AREAS TESTED
● 4 aspects of language (The 4 must be assessed in order while all other skills
may be assessed in any sequence)
○ Morphology & Syntax ○ Pragmatics
○ Semantics ○ Phonological Awareness
● Administration time: 30-60 minutes
● Subtests were designed in correspondence with educational mandates
○ Eligibility for services
○ Identification of strengths and weaknesses
○ Performance within tasks related to the standard educational
curriculum

SUBTEST DESCRIPTION
Determine student’s ability to interpret oral directions,

Concepts & Following
recall names, and discriminate pictures, objects, form,
Directions
several choices
Word Structure Student’s use of morphological rules
Measures ability to infer word meanings from on class

Word Definitions
relationships and shared meanings
Phonological Measures acquisition of sound structure and ability to

Awareness manipulate sound
Comprehend and explain relationships between

Word Classes 1 & 2
images or target words
Measures ability to recall and imitate sentences of

Recalling Sentences
variable length and complexity
Formulated Formulates a sentence about the visual stimuli

Sentences presented using target words or phrases
Familiar Sequences Names days of the week, counts backward, and orders
1&2 other information while being timed
Number Repetition Repeats numbers forward and backward
Word Associations Names words in specific categories in 1 minute
Rapid Automatic Names familiar colors, shapes, and shape-color

Naming combinations while being timed
Produces two semantically and grammatically correct

Sentence Assembly sentences from visually and orally presented words or
groups of words presented in the Stimulus Book
After listening to a sentence, the student selects the

Semantic
two correct choices from four options that answer a
Relationships
target question
Responds to questions about a paragraph presented

Understanding orally by the examiner. The questions target the
Spoken Paragraphs paragraph’s main idea, details, sequencing, and
inferential and predictive information
Identifies an object, person, or activity portrayed in the

Expressive Vocabulary
Stimulus Book
Sentence Structure Points to a picture that illustrates the given sentence

ASSESSMENT PROCESS MODEL (LEVELS)
1. Identify whether or not there is a language disorder
2. Describe the nature of the disorder
3. Evaluate the underlying clinical behaviors
4. Evaluate language and communication in context
● 30-45 minutes: For the four subtests required to
complete a core language score
● Depends on the age and responsiveness of the
student
● Time for remaining subtests varies, depending
on age, language ability, level of motivation, and
the subtests selected
Pragmatics Profile Observational Rating Scale
Examiner elicits information from a Parent, teacher, and student each rate
parent or teacher about the student’s student’s classroom interaction and
social language skills communication
TESTING ENVIRONMENT
● Availability of Rest Period
○ Take breaks at the end
○ If testing must be interrupted, RE-ADMINISTER
● Encouragements
○ General comments
● No repetition; DO NOT repeat item when the first response was incorrect
● Repeat at student’s request or when they were not attending
RECORDING & SCORING RESPONSES

● Tape record
● Transcribe
● Score
● Score revision so long as given prior the next time
START POINTS & DISCONTINUE RULES

● Perfect score on first two items
● Full credit for prior items
● If not, go back to item 1
● Do not re-administer items

Social Language Development Test-Elementary (SLDT-E)
PURPOSE & INCLUSIONS
● Assesses language-based skills of social interpretation and interaction with
friends
● Gain insight into the student’s social understanding and social language
competency
TARGET POPULATION NOT INCLUDED
● 6-11.11 YO ● Younger than 6 YO

● Grades 1-6 ● Doesn’t use English as their 1st
● 12 YO but overall functional social language
language abilities are within the ● Nonverbal
performance range of the test ● With hearing loss
DESCRIPTION
1. Substantiate the influence of students’
language disorders on their social
disorders and qualify them for therapy
2. Assess language-based responses to
portrayed, peer-to-peer situations
3. Assess the language required to:
○ Approximately infer and express
what another person is
thinking/feeling within a social context
○ Make multiple interpretations
○ Take mutual perspectives
○ Negotiate with and support their peers
4. Tasks reflect the development refinement of social language
comprehension and expression
5. Differentiate typically developing children from those with language
learning disorders or autism
SLDT-E SUBTESTS
SUBTEST A: MAKING INFERENCES
● Inferring what someone in a picture is thinking
● 1st Question: Pretending to be in the photo and making an inference about
the person’s thoughts
● 2nd Question: Saying what information was used in the photo in making
an inference

Example: I will ask you to pretend to be the person in a picture and tell me what
you are thinking. Then I will ask you why you are thinking that thought. Let’s try
one.
a. Pretend you are this boy. What are you thinking? Tell me the words in the
thought bubble. (Point to the thought bubble.)
b. What do you see that tells you what he’s thinking?
Allowable Prompt: If the student gives a general reference to “face” or “facial

expression” on b items, prompt with “What else can you tell me?”
SUBTEST B: INTERPERSONAL NEGOTIATIONS

● Pretending to be in conflict with a peer
● 3 Tasks:
○ Identify the problem
○ Propose an appropriate resolution
○ Explain why that resolution is mutually satisfactory
Example: I want you to pretend each story I tell you is really happening to you.
There will be a problem in each story. I will ask you questions about the
problem. Let’s try one.
Situation: Pretend you and a friend decide to ride bikes together. You want to
ride to the park but your friend wants to ride to the school playground.
a. What is the problem?
b. What could you do?
c. Why would (repeat student’s proposed solution) be a good thing to do?

SUBTEST C: MULTIPLE INTERPRETATIONS
● Showing flexible thinking by giving two different, plausible interpretations
of the same photo
Example: I will show you some pictures and ask you for two different ideas
about what’s going on.
Look at this picture.
This girl is wearing headphones and her mouth is open. Tell me two different
ideas about what’s going on.
SUBTEST D: SUPPORTING PEERS

● Pretending to be in a situation with a peer
● Student tells what to say in reaction to the friend’s situation
● Degree of support = What to examine
Example: Sometimes telling the truth can hurt someone’s feelings. We can
protect our friends by saying something kind instead. Let’s try an example.
Situation: Your friend sat on some gum stuck on a chair. She is embarrassed
because she can’t get the gum off her pants. What would you tell your friend
about her pants to make her feel better?
SLDT-E TEST PROCEDURES

1. Begin with the demonstration form
2. Demo items may be altered or explained

3. Administer all the items of the test
4. Subtests A and C require the picture stimuli book
5. Some prompting is allowed
6. Item repetition is allowed only when the student does not respond to a test
item or requests a repetition
7. Non-demo items may not be reworded or paraphrased
Test of Problem-Solving 3 (TOPS-3)

DESCRIPTION
● Assesses a student’s language-based critical thinking skills
● Areas targeted include:
○ Skills based on language strategies using logic and experience
○ A range of critical thinking skills such as inferring, predicting,
determining causes, sequencing, answering negative questions,
problem-solving
○ Linguistic ability to think and reason
○ Not primarily a test of pragmatic or social language skills
○ 18 situations that examine 6 thinkings tasks
● 6-11.11 YO ● Younger than 6 YO

● Grades 1-6 ● Doesn’t use English as their 1st
● 12 YO but overall functional social language
language abilities are within the ● Nonverbal
performance range of the test ● With hearing loss
TOPS TEST PROCEDURES

1. Begin with demonstration item
2. Demo items may be altered or explained
3. Administer all the items of the rest
4. Administration time: 35 minutes
TOPS TASK DESCRIPTIONS

TASK A: MAKING INFERENCES
● Giving a logical explanation about a situation
● Combining what the student knows or can see with previous experiences
and background information

TASK B: SEQUENCING
● Determining and explaining logical, everyday sequences of events (i.e.,
what must be known/done before taking action in a situation; what must
be done first in a given situation)
TASK C: NEGATIVE QUESTIONS

● Asking why something would not occur or why one would not take a
particular action in a specific situation
TASK D: PROBLEM SOLVING

● Recognizing a problem
● Thinking of alternative solutions
● Evaluating the options
● Stating an appropriate solution for a given situation
● Starting how to avoid specific problems
TASK E: PREDICTING
● Grasping a presented situation and make a likely prediction about what will
happen or what would happen if a certain action were taken in a situation
TASKE F: DETERMINING CAUSES

● Giving a logical reason for some aspect of a situation presented in a picture.
Example Picture:

ITEMS 2 1 0
Allowable Prompt:
“Can you tell me more?” Any reference to: Any reference to: Any reference to:
How do you know this ● Feeling his ● Lying down, being ● His eyes being
boy is sick? head/forehead in bed closed
● Looking ● Dad looking ● Wearing a robe
pale/flushed/fevere concerned
d
● Dad taking his
temperature
The dad checked the ● Putting him in ● Reading the ● Making him go to
boy’s temperature. bed/on couch thermometer the bathroom
What did he do next? ● Covering him up ● Giving ● Asking what’s
● Giving medicine drink/soup/food/ wrong
● Undressing ice pack ● Feeling his
● Putting pajamas ● Letting him sleep forehead
on ● Taking him to the ● Looking at him to
doctor see if he’s sick
● Calling the doctor
● Asking him if his
throat hurts
Comprehensive Assessment of Spoken Language 2nd Edition (CASL-2)

DESCRIPTION
● Composed of a battery of tests to measure the skills of children who have
delayed language, oral language disorders, dyslexia, aphasia, impaired
hearing, or intellectual disability
● Data can also be used in determining English language competence of
students who are learning
● Provide information on oral language skills that children and adolescents
need to become literate and to succeed in school and in the work
environment
● Provide information to help regular classroom teachers determine which
specific aspects of oral language to emphasize in their classes
PURPOSE & INCLUSIONS

● Provides in-depth evaluation of:
○ Oral language processing systems of auditory comprehension, oral
expression, and word retrieval
○ Knowledge and use of words and grammatical structures of
language
○ Ability to use language for special tasks requiring higher-level
cognitive functions
○ Knowledge and use of language in communicative contexts

● 3 to 21 years old ● Not proficient in English

● Clients with language disorders,
delayed language, dyslexia,
aphasia, hearing impairment,
intellectual disability
LANGUAGE CATEGORIES ASSESSED

● Measure the process of comprehension, expression and retrieval in 4
language categories:
1. Lexical/Semantic - Knowledge and use of words and word
combination
2. Syntactic - Knowledge and use of grammar (morphology and syntax)
3. Supralinguistic - Measures comprehension of complex language in
which meaning is not directly available from lexical or grammatical
information
4. Pragmatic - Awareness of the appropriateness of language in
relation to the situation in which it is used; ability to modify language
to the situation
● Start on age-appropriate items
● If the examinee has a hard time with age-appropriate start items, begin
testing with an earlier start item
Basal Rule
● Score of 1 on three consecutive items
Ceiling Rule
● Score of 0 on five consecutive items (except Paragraph Comprehension of
Syntax and grammaticality Judgment)
Table 1.6
CASL Core Battery Administration Time in Minutes, by Age
MEDIAN ADMINISTRATION
CORE TESTS AGE
TIME IN MINUTES
3-0 to 3-5 17
3 Core Test 3-6 to 3-11 20

(Basic Concepts, Syntax
Construction, Pragmatic
Judgment) 4-0 to 4-5 22

4-6 to 4-11 23
4 Core Tests
5-0 to 5-11 36
(Antonyms, Syntax
Construction, Paragraph
Comprehension, Pragmatic
6-0 to 6-11 40
Judgment)
7-0 to 7-11 51
5 Core Tests
(Antonyms, Syntax
8-0 to 8-11 59
Construction, Paragraph
Comprehension, Nonliteral
9-0 to 9-11 57
Language, Pragmatic
Judgment)
10-0 to 10-11 57
5 Core Tests
(Antonyms, Grammatical 11-0 to 11-11 46
Morphemes, Sentence
Comprehension, Nonliteral
Language, Pragmatic 12-0 to 12-11 46
Judgment)
13-0 to 13-11 49
5 Core Tests
14-0 to 15-11 47
(Synonyms, Grammatically
Judgment, Nonliteral
16-0 to 17-11 43
Language, Meaning from
Context, Pragmatic
18-0 to 18-11 43
Judgment)
19-0 to 21-11 45
CASL-2 SUBTESTS
LEXICAL/SEMANTIC
● Comprehension of Basic Concepts
○ 43 items
○ Measures knowledge of words needed during the first few years of
school
○ Student points to a picture that best represents the meaning of a
word
● Synonyms
○ 61 items
○ Assess word knowledge through presentation of similar words
○ Student will choose one of four words that has a similar meaning to
the given word
○ Student can respond verbally or nonverbally
● Antonyms
○ 55 items

○ Assess word knowledge in a decontextualized setting to determine
vocabulary knowledge
○ Student will express words with opposite meaning to the given word
○ Student must respond verbally
● Sentence Completion
○ 61 items
○ Examine the ability to retrieve and express the correct word to
match the meaning of a spoken sentence
○ Students must provide words that are missing at the end of every
sentence
● Idiomatic Language
○ 49 items
○ Assess expressive knowledge of idioms
○ Student will be instructed to “tell what has been left out” in a
sentence that meaningfully uses an idiom
SYNTACTIC
● Syntax Construction
○ 56 items
○ Assess the ability to formulate syntactically correct words, sentences,
and phrases elicited from black and white presented pictures
○ Children: Imitate and formulate simple phrases and sentences
○ Adolescents/Adults: formulate more complex sentences
● Paragraph Comprehension of Syntax
○ 8 paragraphs; 5-7 questions each
○ Assess the ability to comprehend syntax from orally presented
stories that are read without pictures
○ Student responds by pointing to ¼ pictures (choices)
● Graphic Morphemes
○ 60 items
○ Assess the ability to use metaliniguistic knowledge pertaining to
morphemes and application of morphological rules
○ Student must identify the relationship and apply the rule to the
presented word
● Sentence Comprehension
○ 21 items; 2 paits of sentences
○ Assess comprehension and interpretation of the meaning between
two different sentence formulation
○ Student determines if the 2nd sentence has same meaning with the
1st
● Grammaticality Judgment
○ 57 items
○ Assess the ability to identify grammatically correct or incorrect
sentences

○ Student will fix one word of the sentence without altering the overall
meaning
SUPRALINGUISTIC
● Nonliteral Language
○ 50 items
○ Assess the ability to comprehend and interpret figurative language
○ Student will explain what was meant by the nonliteral language
● Meaning from Context
○ 48 items
○ Assess the ability to use context clues to derive meaning from an
unknown word presented in the sentence
○ Student will say what they think the target word means given the
context of the sentence
● Inference
○ Assess the ability to integrate appropriate world knowledge with
information provided in an orally presented story
○ Student will answer the questions based on their understanding of
the sentences
● Ambiguous Sentences
○ 43 items
○ Assess the ability to comprehend, infer, and provide two possible
meanings of a sentence
○ Student will give two possible and different meanings of the
sentence
PRAGMATIC
● Pragmatic Judgment
○ 6 items
○ Assess the ability to use appropriate language in social situations
○ Student will judge and suggest what is appropriate for the given
situation
Example: (For Ages 5-9)
Say: I am going to say a word. Then you will tell me a word

that is very different from the one I say. You will say a
word that is the opposite of what I say. If I say push, you
will say pull. If I say soft, you will say hard. Let’s try one.
Tell me the opposite of yes. Either yes or ___.

Correct: If the examinee responds correctly with “no,” say:
That’s fine. No is the opposite of yes. Now we will try
another one.
Continue with Example 2 on the next page.
Incorrect: If the examinee responds incorrectly or does not respond,

repeat the example and model the correct response by
saying:
No is the opposite of yes. Now we will try another one.
Remember to say just the opposite of what I say.
Continue with Example 2 on the next page.
Unit 5: Informal Language

Evaluation
Westby Symbolic Play Scale (WSPS)
● Developed by Carol E. Westby
● Has 2 versions: 1980 & 2000
● Checklist format
● Aims to assess child’s language while also assessing the child’s cognitive
level
PURPOSES
1. Determine if a child should be given priority for receiving language
remediation.
2. If language remediation is indicated, determine what communicative
functions, semantic concepts, and syntactic structures should be taught.
THEORETICAL FRAMEWORK
● Assess child’s development of REPRESENTATIONAL THOUGHT
○ Use of mental imagery or language to represent or describe what is
perceived
● Done by examining child’s SYMBOLIC PLAY
○ Also pretend play; how a child represents concepts while playing
○ Essential prerequisites for meaningful communication
○ Means to express: embody mental representation of the world;
window to what they know
○ Means to interpret: learn about the world

DEVELOPMENT
1976-1977
● Observation: Piagetian based language program for a SpEd class
● Observation: Day care center for typically developing children
1978-1979
● Additional stages: Child care center for typically developing children
HOW IT’S ADMINISTERED

1. Consider the following before evaluating
○ Child’s past experience (with toys, activities, etc.)
○ Environment for play evaluation (culture in the area)
○ Adult’s role in the evaluation process (level of guidance in play)
■ Will help you interpret play evaluation results later on
2. Structure the Play Environment
○ Provide: Variety of toys representing differing cognitive
developmental levels, gender-based toys/preferences, and themes
○ Under 18 months: manipulative toys; cause-effect toys
○ Early Stages of Symbolic Play: high realism toys; not low realism toys
○ Symbolic Play: Familiar and unfamiliar; high & low realism; pretend
play toys
○ Formal Play Area: Toys grouped according to the developmental
level; space to move around the room
■ Presymbolic Area
■ Familiar, high realism toy area (i.e. home, store, doctor)
■ Familiar & Unfamiliar

Unit 6: Algorithm for the Assessment
of Language Disorders

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Unit 1: Introduction to Language

1. To communicate ■ Indirect Code

Language Conditions in Children | 1

Language Disorders: Definitions, Characteristics, & Models

DEVELOPMENTAL LANGUAGE DISORDER

DEVIANT, DISORDER, DISABLED, IMPAIRED

TYPICAL AND ATYPICAL DEVELOPMENT

Successful development and

CHARACTERISTICS OF LANGUAGE DISORDERS

CODE Cannot match used code with conventional code

CONVENTIONS Cannot match language with the linguistic community

SYSTEM Cannot use learned code for certain context or purposes

May develop idea, code, convention, system, but do so

Language Conditions in Children | 2

2. Categorical Orientation Model

Syndromes or neurological conditions

Language Conditions in Children | 3

DESCRIBING LANGUAGE DISORDERS BASED ON CFU

Raw Standard Score Percentile Age

Language Conditions in Children | 4

Distorted CFU Interaction

Language Conditions in Children | 5

KIAA0319 (The Dyslexia Susceptibility Gene)

CMIP (modulates phonological short-term memory in

Motor Cortex Anomalies

CNTNAP2 (associated with language disorders and

Family History Cognitive Factors

Procedural learning deficit

Inefficient auditory processing

Delayed language acquisition

Poor understanding of grammar/discourse

Language Conditions in Children | 6

ENVIRONMENTAL FACTORS IN DLD

Example: Comorbid relationships between speech sound disorders, reading

Levels of Prevention as Defined By ASHA

Example: Inoculation/Immunization to prevent rubella.

Language Conditions in Children | 7

Example: Providing rehabilitation and special educational services to a child

Definitions of Intellectual & Adaptive Function

● General mental capacity:

● Language & Literacy ● Number Concepts

● Interpersonal Skills ● Ability to follow

● Activities of daily living ● Schedules/Routines

Language Conditions in Children | 8

Language Disorders with Known Genetic Origins

Characterized By: Associated With:

Mild to moderate ID Higher Risk for Congenital Heart

Round Face Recurrent Ear Infections

Relative Macroglossia (protruding or Obstructive Sleep Apnea

Language Conditions in Children | 9

Examples: Executive Functioning Skills & Cognitive Processes

Problems with Response Inhibition (Impulse Control)

● Reduced generation of strategies for delaying gratification

● Difficulties persisting with learning tasks

● Engaging in more off-task behavior

● Difficulty learning new rules and applying them

● Take longer to solve problems

● More likely to abandon efforts at problem-solving

● Reflecting difficulties with planning

● Difficulties with persistence