Other Speech and Language Impairments
The prevalence (occurrence) and type of speech and language impairments are highly variable depending on a speech-language pathologist’s geographical location and area of clinical practice (i.e. hospital, public school, private practice clinic). For example, speech-language pathologists working in public schools may see less severely disabled clients than professionals working in an acute hospital. This section will describe other speech and language impairments not already discussed. It will also address other types of disorders that affect or influence speech and language.
Dyslexia is a fairly well known language disorder. Many people believe that it is strictly a reading/writing problem characterized by the reversing of letters. However, it has been redefined recently as a broader language disorder. Many dyslexic persons, in addition to reading/writing problems, have difficulties such as those discussed in past sections: Developmental Language Disorders, Expressive Language Disorders, and Disorders of Written Expression (please refer back to these sections for more information). Recent brain imaging research has found similarities between the brain shapes/functions of dyslexics and persons with developmental language disorders.
Dyslexia is a neurologically based, often genetic, disorder, which interferes with the attainment of language skills, (including phonological processing), in reading, spelling, writing, handwriting, and, at times, arithmetic. It varies in degrees and symptoms. It exists despite adequate intelligence. It does not result from a lack of motivation, sensory impairment, inadequate conventional instruction or environmental opportunities, or other limiting conditions. It may co-occur, however, with these other conditions. It is a lifelong disability; however, individuals with dyslexia frequently respond successfully to timely and appropriate intervention.
Dyslexia may be considered under the DSM IV ICD code as 315.00 which states the following: “reading achievement, as measured by individually administered standardized tests of reading accuracy or comprehension, is substantially below that expected given the person’s chronological age, measured intelligence, and age appropriate education; the disturbance (in the above criterion) significantly interferes with academic achievement or activities of daily living that require reading skills; if a sensory deficit is present, the reading difficulties are in excess of those usually associated with it.”
Hearing impairment and cleft palate are two conditions that influence speech and language. If a hearing impairment is present at birth (congenital hearing loss), speech and language will not develop normally. Sign language, hearing aids, or a combination of sign and speech (with a hearing aid), are methods of treatment. Hearing loss may be transient (not permanent) in middle ear infections (otitis media); however, if a child experiences frequent ear infections early in life (i.e. as a toddler), his/her speech and language development will be affected (see section on otitis media in descriptions of disorders we see commonly). Hearing loss that is acquired after speech and language has developed normally (i.e. due to injury, genetic hearing loss that develops over time, etc.) may affect speech. Speaking is difficult when a person cannot hear his/her own speech. Hearing aids or other amplification, sign language, and speech therapy are examples of treatment methods.
A cleft palate occurs when the bones and tissues of the hard palate (roof of the mouth) fail to fuse before birth, leaving a hole in the roof of the mouth. Transient hearing loss due to frequent otitis media is also common in these persons. Prosthetic dental devices and/or surgery in combination with speech therapy are used to treat the difficulties caused by the cleft (i.e. nasal-sounding speech). Speech/language therapy will also address any speech/language learning difficulties caused by transient hearing loss.
Psychological, psychiatric, emotional and behavioral disorders can also influence speech, language, and social and/or communication skills by affecting the person’s thinking and behavior. Examples include Attention Deficit Disorder (ADD or ADHD) and various emotional disturbances (i.e. conduct and oppositional disorders, anxiety and affective disorders, selective mutism, etc.). Emotional/behavioral problems can be neurological in nature, or they may be caused by events in a person’s life (e.g. environmental deprivation, child neglect). Emotional or behavioral disorders may also be the by-product of other learning issues including learning disabilities, ADHD, autism, and other disabilities. ADHD and emotional disturbances will be discussed below.
ADD/ADHD is a controversial disorder that has only recently received a precise definition (diagnostic criteria). ADHD in the DSM (Diagnostic Statistical Manuel) IV manual refers to 1) Attention Deficit/Hyperactivity Disorder Combined Type, 2) Attention Deficit/Hyperactivity Disorder/ Predominately Inattentive Type, or 3) Attention-Deficit /Hyperactivity Disorder, Predominately Hyperactive-Impulsive Type. Overall, behaviors include hyperactivity, impulsivity, and inattention, depending on the diagnosis. These behaviors must occur to a degree, which is maladaptive and inconsistent with development level, and occur in at least two settings over a period of at least 6 months. These behaviors interfere with speech/language learning, academic performance and social activities (i.e. making friends, sustaining friendships). The disorder is typically diagnosed before the age of 7, or symptoms were present before this age. There must also be the present of related impairment in social, academic, or occupational functioning.
Some behavioral characteristics of those with Attention Deficit Disorder without hyperactivity (predominately inattentive) include: easily distracted by extraneous stimuli, often fails to give close attention to detail, difficulty listening and following directions, difficulty focusing and sustaining attention, difficulty concentrating and attending to task, inconsistent performance in school work, makes careless mistakes, tunes out and may appear “spacey,” disorganized (e.g., loses belongs, desks and room may be a total disaster area), poor study skills, difficulty working independently.
Some behavioral characteristics of those with Attention Deficit Disorder with hyperactivity include: high activity level (e.g., appears in constant motion, often fidgets with hands or feet, squirms, falls from chair, difficulty remaining seated, finds nearby objects to play with, roams around classroom), impulsivity and lack of self control (e.g., blurts out verbally and/or inappropriately, poor at waiting for turns, interrupts, talks excessively with poor self monitoring, gets in trouble because he/she doesn’t “stop and think” before acting), difficulty with transitions, aggressive behavior, easily over stimulated, socially immature, low self-esteem and high frustration.
Not all symptoms occur in each child, and they will vary in degree. Also, any one of these behaviors is normal in childhood to a certain degree at various developmental stages. It is when a child exhibits a significantly high number of these behaviors when they are developmentally inappropriate, that a problem arises.
One can see how these behaviors may affect the clear and consistent development of listening and language skills. If linguistic difficulties are suspected, they should be assessed by a speech pathologist.
The physician, psychiatrist and/or psychologist working on the child’s team may discuss and consider medication to manage attention and behaviors to optimize learning. Only a physician or psychiatrist may issue medication. Medication has been shown to be effective in many cases, and combining behavioral and/or cognitive training (implemented by parents, speech-language pathologists, psychologists, classroom teachers) is even more powerful in helping these children.
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Lastly, there are genetically based syndromes that affect speech and language. These disorders occur due to genetic abnormalities (e.g. presence of extra chromosomes). Examples include Down Syndrome, Fragile X Syndrome, etc. They are referred to as syndromes since they are defined by a number of characteristics. A syndrome may include such characteristics as physical deformities, mental retardation, and congenital hearing loss. A geneticist diagnoses these disorders, and treatment is often undertaken by a team of professionals (i.e. occupational therapist, speech-language pathologist, audiologist, etc.).
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