Speech Organs and Human Brain
The human capacity for language is intrinsic. In other words, language is acquired with universal regularity. Human anatomy has speech organs, which are dual-purpose organs for survival and for the production of sound in our language (I.e., tongue, teeth, soft palate, larynx). Speech breathing also occurs naturally by utilizing a different set of muscles, lung pressure, and changes in the timing of exhalation. Areas of the human brain are dedicated to language, which allows us to be more complex in comparison to other species. The acquisition of language occurs through exposure rather than being a taught skill. Cognition and the environment are the underlying contributors to language development. Regarding the cognitive aspect, there are many existing theories suggesting how and when language skills are acquired, but regardless of the timing/reasoning, the majority agrees that language acquisition is innate. The environmental aspect of acquisition is the natural exposure of language from caretaker to child.
Comprehension of Language
A language disorder is a deficiency in the use and/or comprehension of language (spoken or written). Language disorders range in severity from mild to severe and can occur within the context of other conditions. The disorder may be solely expressive, solely receptive or impact both expressive and receptive language (mixed receptive-expressive language disorder). Any and all of the five language domains could be impacted. Syntactical deficits would lead to difficulty acquiring rules regarding word order and present as an inability to express and/or organize ones ideas. A sematic disorder would be characterized by inappropriate use of word meanings and poor vocabulary development. A phonological disorder would lead to incorrect use of sounds when communicating and present as sound errors (omissions, substitutions, distortions). A morphological disorder would cause difficulty using grammatical morphemes to signal alternate meanings. A pragmatic disorder would cause problems comprehending and using language appropriately in social contexts. Due to the impact on communication, children with language disorders typically have trouble expressing their wants and needs, as well as comprehending what peopling are expressing to them.
Cause Of Developmental Language Disorders
When considering the cause of developmental language disorders, experts are unsure. Research considers both environmental and genetic components that play a part in the development of language, but a specific cause is still unidentifiable. Risk factors for language disorders include premature birth, low-birth weight, certain genetic syndromes, neglect/abuse, maternal drug use, etc. Acquired language disorders are typically caused by damage to the brain (I.e., CVA, TBI, seizure). Other causes of language disorders are prelingual hearing loss, ASD, intellectual disabilities, and neurological disorders. Regardless of the etiology of the disorder, language disorders can impact a child’s academic achievement. The school setting is fast-paced-requiring adequate expressive and receptive language skills to be successful. Language disorders in adults typically impact word recognition, word comprehension, sentence comprehension, paragraph comprehension, conversational issues, phonological aspects, word retrieval, sentence formulation, narratives, and/or discourse.
When assessing for language disorders, a combination of formal and informal measures should be utilized. Formal language assessments analyze multiple language domains via standardized tests such as the Clinical Evaluation of Language Fundamentals- Fifth Edition, the Preschool Language Scale- Fifth Edition, the Test of Language Development- Fourth Edition, etc. Formal measures allows for normative comparisons and administration guidelines. Informal measures include language samples, curriculum-based assessments, client/parent questionnaires, and client/parent interviews. These informal measures allow for a detailed case history and medical history to be obtained (interview), MLU and type token ratio to be calculated (language sample), academic achievement compared to similar-aged peers (curriculum-based assessment), grammatical elements of language to be analyzed (language sample), and pragmatic analysis of language (naturalistic observation). The assessment process for adults with language disorders would be similar, but replace academic assessments with vocational assessments.
Children With Language Disorders
Habilitation is the teaching of a skill to a person, where rehabilitation is the re-teaching of a skill. Intervention for language disorders varies depending on the age of the client (habilitation versus rehabilitation), cause of the language impairment (congenital versus acquired), severity of the disorder (mild, moderate, severe), comorbid factors, etc. Depending on the area(s) impacted, individual and/or group speech-language therapy may be the most appropriate.
When planning intervention for children with language disorders it is important to choose targets within the client’s zone of proximal development, while moving around on a continuum of naturalness. Targets/goals need to be appropriate for the client’s phonological abilities, while improving their communicative effectiveness. Intervention can range from clinician-directed approaches (drill, modeling, etc.) to child-centered approaches (self-talk/parallel talk, imitations of child, expansion, extensions, recasted sentences, etc.) with hybrid approaches in between (focused stimulation, vertical structuring, milieu teaching, script therapy, etc.). Clinician responses to client utterances are vital in language intervention (reinforcement and specific feedback). In addition, SLPs must always program for carryover; meaning that therapy materials should be similar to those found in the child’s natural environment as much as possible. Intervention responsiveness must be monitored throughout the intervention process to ensure that a client is receiving benefits from the plan of treatment. If they are not, the intervention plan needs to be reconsidered and adjusted to better meet the needs of the client.
Adults with Language Disorders
When planning intervention for adults, there is a focus on the client’s skills in real life environments rather than on specific language skill development. Intervention approaches are typically selected based on the specific language impairments, while factoring in other coexisting conditions. Intervention approaches can be traditional, functional, or a combination of both. Traditional approaches target fixing the underlying processes that have been impacted. Traditional approaches include linguistic stimulation approaches, visual action therapy, melodic intonation therapy (MIT), and cognitive linguistic therapy. Functional approaches target effective communication and/or compensation. Examples of direct approaches are PACE: Promoting Aphasiac Communication Effectiveness, environmental systems, and group/conversation therapies. Therapy combining traditional and functional approaches aim to get the client effectively communicating as soon as possible, while targeting the underlying deficits. Similar to intervention with children, Intervention responsiveness must be monitored throughout the intervention process to ensure that a client is receiving benefits from the plan of treatment. Adults have responsibilities that children don’t, which is why ‘reentry into the community’ is extremely important with this population.
Speech-language pathologists play a critical role in the assessment and intervention of language disorders. Parents and teachers must be informed and educated about what to look for in order for proper, early detection of language problems. Early identification and intervention is crucial for academic success. SLPs should collaborate with classroom teachers to develop material based on curriculum standards to ensure that students are developing age-appropriate skills. This collaboration will act as a screening tool to identify students who may be at risk. Resources should be sent home to parents in preschools and early elementary years providing them with normative information in addition to professional contacts if they feel that their child may be at risk. Intervention for language disorders is highly successful- especially at an early age. SLPs must do their part in spreading to word to prevent lifelong impacts caused by language disorders. With the adult population, SLPs need to make it known that help is available while providing alternative resources to help with the psychological toll. There are far too many cases of people who do not receive help simply because they do not know it is out there.