There are four diagnostic criteria for Speech Sound Disorder (APA, 2013).
Respond to the student below by providing at least two contributions for improving or including in their Parent Guide and at least two things that you like about their guide.
Matthew
Communication Disorder Parent Guide
COLLAPSE
Normal language Development of a child will follow specific paths for most children to include:
By 1 year of age the child should recognize their own name (Sadock, Sadock & Ruiz, 2014). Be able to follow simple directions, speak approximately 1 or 2 words, and use pointing and other gesturers as a way to communicate (Sadock, Sadock & Ruiz, 2014).
By 2 years of age the child should be able to express up to 300 different words (Sadock, Sadock & Ruiz, 2014). Will know the name of and be able to say everyday common objects (Sadock, Sadock & Ruiz, 2014). Begin to speak in sentences of two words or longer, and use prepositions and pronouns (Sadock, Sadock & Ruiz, 2014).
By 3 years o age the child’s vocabulary should have expanded to 1000 words (Sadock, Sadock & Ruiz, 2014). Should be able to create simple 3 and 4-word sentences using verbs and subjects correctly (Sadock, Sadock & Ruiz, 2014). The child should also be able to follow simple two step commands. Speech will normally be understood by most family members (Sadock, Sadock & Ruiz, 2014).
By 4 years of age the vocabulary will have expanded to 1600 words (Sadock, Sadock & Ruiz, 2014). The child will be able to tell about past experiences and stories (Sadock, Sadock & Ruiz, 2014). Will understand questions about the environment around them, begin to add in conjunctions, and speech will be understood by people outside of the family (Sadock, Sadock & Ruiz, 2014).
By 5 years of age the vocabular will have expanded to 2300 words (Sadock, Sadock & Ruiz, 2014). The child can begin to discuss their feelings, will follow three step commands, and begins to develop print skills such as writing their own name (Sadock, Sadock & Ruiz, 2014).
By 6 years of age the child should be able to identify and define words by functions and attributes (Sadock, Sadock & Ruiz, 2014). Can speak well developed complex sentences, can use all the various parts of speech, and understands the sounds individual letters make when reading (Sadock, Sadock & Ruiz, 2014).
By 8 years of age the child can read simple books for enjoyment (Sadock, Sadock & Ruiz, 2014). Will understand and enjoy riddles and jokes, begin to infer information from statements, and can produce all the sounds of speech similar to adults (Sadock, Sadock & Ruiz, 2014).
Communication disorders include the following:
Expressive Language Deficits
Mixed Receptive and Expressive Deficit
Speech Sound Disorder
Child-Onset Fluence Disorder (Stuttering)
Social (Pragmatic) Communication Disorder
Expressive Language Deficits
Expressive language deficits are present when a child demonstrates a selective deficit in expressive language development relative to receptive language skills and nonverbal intellectual function.
As explained by (Sadock, Sadock & Ruiz, 2014), the specific causes of the expressive components of language disorder are likely to be multifactorial. Scant data are available on the specific brain structure of children with language disorder but limited magnetic resonance imaging (MRI) studies suggest that Language disorders are associated with diminished left right brain asymmetry in the perisylvian and planum temporale regions.
Results of the one small MRI study suggested possible inversion of brain asymmetry (right> left). Left handedness or ambilaterality appears to be associated with expressive language problems with more frequency than right handedness (Sadock, Sadock & Ruiz, 2014)
Signs & Symptoms:
Your child may: Speak using Vague words such as “Stuff” and “Things” as filler words (Trouble with Expressive Language: What You’re Seeing, n.d.). Have a decrease in vocabulary that is below age appropriate levels (Sadock, Sadock & Ruiz, 2014). The child will often point and gesture rather than use the correct word to make their needs met (Sadock, Sadock & Ruiz, 2014). They are quiet, and when they do speak, they are hard to understand (Trouble with Expressive Language: What You’re Seeing, n.d.).
Diagnosing Expressive Language Deficits:
Diagnosis of Expressive Language Deficits is made based on a combination of assessment and diagnostic tools (APA, 2013).
Individual history (APA, 2013).
Family history (Sadock, Sadock & Ruiz, 2014).
Observation of symptoms in various setting’s such as home, school, or work (APA, 2013).
Standardized testing of language ability and nonverbal intelligence tests (Sadock, Sadock & Ruiz, 2014).
Treatment of Expressive Language Deficits:
Parent Child Interaction Therapy (PCIT) to improve the child’s initiation, duration, and frequency of speech (Sadock, Sadock & Ruiz, 2014).
Speech and Language Pathology Consult to educate parents and teacher on strategies to encourage therapeutic language techniques and teach the child communication and social interaction strategies (Sadock, Sadock & Ruiz, 2014).
Child psychotherapy for emotional and behavioral symptoms (Sadock, Sadock & Ruiz, 2014).
Family therapy to teach parents constructive communication strategies to reduce stress and frustration (Sadock, Sadock & Ruiz, 2014).
Mixed Receptive and Expressive Deficits
Children with both receptive and expressive language impairment may have impaired ability in sound discrimination, deficits in auditory processing, or poor memory for sound sequences. Children with mixed receptive – expressive disturbance exhibit impaired skills in the expression and reception that is understanding and comprehension of spoken language (Sadock, Sadock & Ruiz, 2014).
In most cases of receptive dysfunction, verbal or sign expression (encoding) of language is also impaired and children with mixed receptive-expressive language disturbance have difficulty recalling early visual and auditory memories and recognizing and reproducing symbols in proper sequence (Sadock, Sadock & Ruiz, 2014). Some children with mixed receptive-expressive language disturbance have difficulty recalling early visual and auditory memories and recognizing and reproducing symbols in proper sequence (Sadock, Sadock & Ruiz, 2014).
On the other hand, some children with mixed receptive-expressive language deficits have a partial hearing defect for true tones, an increased threshold of auditory arousal, and inability to localize sound sources (Sadock, Sadock & Ruiz, 2014).
An audiogram is indicated for all children thought to have mixed receptive-expressive language disturbance to rule out or confirm the presence of deafness or auditory deficits (Sadock, Sadock & Ruiz, 2014).
Signs & Symptoms:
Include a notable impairment in both comprehension of language and expression of language (Sadock, Sadock & Ruiz, 2014). The deficits are similar to those seen with expressive language deficit; however, it tends to be more severe (Sadock, Sadock, & Ruiz, 2014). Receptive problems typically appear before age 4 with severe forms appearing by the age of 2 (Sadock, Sadock & Ruiz, 2014). These children will show a significant delay in comprehensive language abilities in both verbal and non-verbal areas (Sadock, Sadock & Ruiz, 2014). They will also have difficulties when attempting to integrate both auditory and visual information (Sadock, Sadock & Ruiz, 2014). This will continue into the child’s ability to recall information from visual and auditory memories, and the ability of the child to recognize and reproduce symbols and information into proper order (Sadock, Sadock & Ruiz, 2014).
Diagnosis of Mixed Receptive and Expressive Disorders:
Mixed Receptive and Expressive Disorders are diagnosed based on a combination of assessment and diagnostic tools (APA, 2013).
1. Individual history (APA, 2013).
2. Family history (Sadock, Sadock & Ruiz, 2014).
3. Observation of symptoms in different setting such as home, school, or work (APA, 2013).
4. Standardized and comprehensive testing of receptive and expressive language abilities (Sadock, Sadock & Ruiz, 2014).
Treatment of Mixed Receptive and Expressive Deficits:
Parent Child Interaction Therapy (PCIT) to improve the child’s initiation, duration, and frequency of speech (Sadock, Sadock & Ruiz, 2014).
Speech and Language Pathology Consult to educate parents and teacher on strategies to encourage therapeutic language techniques and teach the child communication and social interaction strategies (Sadock, Sadock & Ruiz, 2014).
Child psychotherapy for emotional and behavioral symptoms (Sadock, Sadock & Ruiz, 2014).
Family therapy to teach parents constructive communication strategies to reduce stress and frustration (Sadock, Sadock & Ruiz, 2014).
Speech Sound Disorder
Children with speech sound disorder are delayed in, or incapable of, producing accurate speech sounds that are expected for their age, intelligence, and dialect (Sadock, Sadock & Ruiz, 2014).
Children with speech sound disorder may have various concomitant social, emotional and behavioral problems, particularly when comorbid expressive language problems are present (Sadock, Sadock & Ruiz, 2014). Also, children with speech sound disorder have difficulty pronouncing speech sounds correctly due to omissions of sounds, distortions of sounds, or atypical pronunciation (Sadock, Sadock & Ruiz, 2014).
Signs & Symptoms:
Often children with speech sound disorder will substitute one sound for another easier to produce sound (Speech Sound Disorder, n.d.). They may drop the R in a word like rabbit and add a W sound to pronounce it wabbit, they may drop harder to pronounce sounds from the beginning or end of words (Speech Sound Disorder, n.d.). The child’s speech may be slurred due to poor articulation, and the tongue may protrude at incorrect times (Sadock, Sadock & Ruiz, 2014).
Diagnosis of Speech Sound Disorder
There are four diagnostic criteria for Speech Sound Disorder (APA, 2013).
Ongoing difficulty with the production of speech sound that interferes with verbal communication or ability for others to understand speech (APA, 2013).
Speech sound difficulties are not appropriate for age and cause limitations in in social, school, and work settings (APA, 2013).
Onset of symptoms began in early childhood (APA, 2013).
The speech sound issue is not better explained by other health conditions (APA, 2013).
Treatment of Speech Sound Disorder
Speech and Language Pathologist Consult
Phonological approach to practice specific sounds for difficulties pronouncing consonants (Sadock, Sadock & Ruiz, 2014).
Traditional approach to practice placement of the tongue and mouth to improve pronunciation of problems sounds (Sadock, Sadock & Ruiz, 2014).
Parental counseling including monitoring of peer relationships and support of positive social activities (Sadock, Sadock & Ruiz, 2014).
Child -Onset Fluency Disorder (Stuttering)
Disturbance in normal fluency and motor production, including repetitive sounds or syllable, prolongation of consonants or vowels sounds, broken words, blocking, or words produced with an excess of physical tension. Associated behaviors are eye blinks, facial grimacing, head jerks, abnormal body movement.
School age children who stutter chronically may have impaired peer relationships as a result of teasing and social rejection. These children may face academic difficulties, especially if they persistently avoid speaking in class (Sadock, Sadock & Ruiz, 2014).
Stuttering is associated with anxiety disorders in chronic cases, and half of individuals with persistent stuttering have social anxiety disorder (Sadock, Sadock & Ruiz, 2014).
Signs & Symptoms:
Signs and symptoms include onset between 18months and 9 years of age (Sadock, Sadock & Ruiz, 2014). Onset is slow and insidious with initial repetition of initial consonants, it progresses to include the first word of a phrase and or longer sounding words (Sadock, Sadock & Ruiz, 2014). As time progresses the repetition becomes increasingly frequent (Sadock, Sadock & Ruiz, 2014). In some cases, the stuttering may disappear when the individual talks to pets, inanimate objects, is singing or during oral readings (Sadock, Sadock & Ruiz, 2014).
Diagnosing Child-onset Fluency Disorder
There are four diagnostic criteria for Child-Onset Fluency Disorder (APA, 2013).
Ongoing disturbances in fluency and time patterns of speech that are below expectations for age and include one or more of the previously described symptoms (APA, 2013).
The disturbance causes anxiety that causes limitations in communication, social, school, or work settings (APA, 2013).
Onset of symptoms began in early childhood, usually between ages 18 months and nine years (APA, 2013).
The fluency issue is not better explained by other health conditions (APA, 2013).
Treatment of Child-Onset Fluency Disorder (Stuttering)
Speech and Language Pathologist Consult
Behavioral distraction (Sadock, Sadock & Ruiz, 2014).
Directed speech modification (Sadock, Sadock & Ruiz, 2014).
Relaxation techniques to reduce associated anxiety that can worsen fluency symptoms (Sadock, Sadock & Ruiz, 2014).
The Lidcombe Program teaches parents request children self-correct stuttered words and to use praise when children go for time periods without stuttering (Sadock, Sadock & Ruiz, 2014).
Cognitive Behavioral Therapy (CBT) and/or medication treatments for comorbid anxiety and depressive disorders (Sadock, Sadock & Ruiz, 2014).
Social (Pragmatic) Communicative Disorder
Social (pragmatic) communicative disorder is characterized by impaired ability to effectively use verbal and nonverbal communication for social purposes and occurs in the absence of restricted and repetitive interests and behaviors (Sadock, Sadock & Ruiz, 2014). The deficits in social communication lead to impairment in function in social situations, in developing relationships, and family and academic settings (Sadock, Sadock & Ruiz, 2014).
Social (pragmatic) communications disorder is a new disorder: however, the concept of children with social communication deficits without repetitive and restrictive interests and behaviors has been identified for many years and is often associated with delayed language acquisition and language disorder.
Signs & Symptoms:
Typically diagnosed between 4 years of age and adolescents (Sadock, Sadock & Ruiz, 2014). The individual diagnosed with social communication disorder will have difficulties in the areas of verbal and nonverbal communication in social situations (Social Communication Disorder, 2020). IT is characterized by an inability to communicate in ways that are appropriate for the social setting, the inability to match ones communication and context to the needs and development of the listener, inability to follow the social norms of conversing in turns and storytelling, difficulty understanding ambiguous language, and difficulty with comprehension of items that are not explicitly stated (Social communication disorder, 2020).
Diagnosing Social (Pragmatic) Communication Disorder
There are four diagnostic criteria for Social (Pragmatic) Communication Disorder
Ongoing issues with verbal and nonverbal communication in social situations (APA, 2013).
The issues cause limitations to communication, social, school, or work settings (APA, 2013).
Onset of symptoms began in early childhood (APA, 2013).
The fluency issue is not better explained by other conditions including autism spectrum disorder, intellectual disability, or global developmental delay (APA, 2013).
Treatment of Social (Pragmatic) Communication Disorder
There is currently no evidence-based treatment for Social (Pragmatic) Communication Disorder but reports from parents and teachers endorsed improved social communication skills after intervention that included the following.
Social understanding/interaction (Sadock, Sadock & Ruiz, 2014).
Verbal and nonverbal pragmatic skills, including conversations skills (Sadock, Sadock & Ruiz, 2014).
Language processing, learning new words, making interpretations (Sadock, Sadock & Ruiz, 2014).
If you believe that you or a loved one are in need of assessment and help for a speech language disorder please contact your child’s pediatrician or your primary care physician. Or you can contact your local Infants and Toddlers office, or the local special education department within your school system.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadocks synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia: Wolter Kluwer/Lippincott Williams & Wilkins.
Social Communication Disorders: Overview. (2020). Retrieved September 10, 2020, from https://www.asha.org/Practice-Portal/Clinical-Topics/Social-Communication-Disorders/
Trouble With Expressive Language: What You’re Seeing. (n.d.). Retrieved from https://www.understood.org/en/learning-thinking-differences/child-learning-disabilities/communication-disorders/trouble-with-expressive-language-what-youre-seeing
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