How is a child evaluated to determine if there is a delay or disorder?
Typically, a child is accompanied by their caregiver to an office setting where the evaluation will take place. The caregiver serves as the informant and provides information pertinent to the child’s development including birth history, medical history, areas of concern and developmental milestones. The SLP evaluates the child using formal, standardized tests that are designed to assess specific areas as well as informal observations. Standardized test scores are obtained which will determine if a delay or disorder is present. Informal observations are recorded and taken into consideration when making recommendations.
What is the difference between a delay and a disorder?
The order in which children learn speech sounds and language is predictable. Most children follow the same pattern of development. When a child is developing speech and language skills in the typical order but is doing so at a slower pace, a speech and or language delay is present. However, when a child presents with gaps in development or uses language forms that not typically used by any child at any age, this may be a sign of a disorder.
How do you know if you should recommend a speech/language evaluation?
Research has shown that the brain has the most plasticity between birth and age seven- allowing for new skills to be acquired easier. Therefore, the earlier the child is diagnosed and can receive the necessary treatment, the better his/her prognosis. Treating language difficulties early on can prevent potential problems with behavior, learning, reading, and social interaction.
Expressive Language
defined as the words children use to express themselves- not be confused with speech
Typical Development from age 2.6- 5 years:
Receptive Language
defined as the ability to decode words and know what they mean
Typical Development from age 2.6- 5 years:
Pragmatics
also known as “social language”
Involves three major communication skills:
- Using language for different purposes- greeting, informing, demanding, promising, requesting, commenting
- Adapting or changing language according to the needs or expectations of the listener or situation
- Following rules for conversation and narrative
Typical Development from age 2.6- 5 years:
Central Auditory Processing Disorder (CAPD)
Individuals with CAPD may present with difficulties with read, spoken, and written words. However, they typically can derive the meaning of language from written words. Auditory processing is a term used to describe what happens when your brain recognizes and interprets the sounds around you. The “disorder” part of auditory processing disorder means that something is adversely affecting the processing or interpretation of the information.
CAPD goes by many other names. Other common names are auditory perception problem, auditory comprehension deficit, central auditory dysfunction, central deafness, and so-called “word deafness.”
The cause of CAPD is often unknown. In children, auditory processing difficulty may be associated with conditions such as dyslexia, attention deficit disorder, autism, autism spectrum disorder, specific language impairment, pervasive developmental disorder, or developmental delay. Sometimes this term has been misapplied to children who have no hearing or language disorder but have challenges in learning. A hearing test should be conducted to rule out a hearing impairment. An audiologist is responsible for diagnosing CAPD and typically cannot do so until the child is at least 6.5-7.0 years old.
What are the symptoms of possible CAPD?
Children with auditory processing disorder typically have normal hearing and intelligence. Over time, they may have learned to compensate for their auditory processing weakness; however, these skills will not always be efficient. They may be observed to have:
- Difficulty with reading, comprehension, spelling, and vocabulary
- Trouble recognizing subtle differences between sounds in words- small changes in sounds can be big changes in meaning and can lead to a multitude of problems in academic and daily life.
- Poor listening skills/ poor attention
- A dislike of reading because it is difficult and tedious
- Difficulty listening in the presence of background noise
- Say “what”, “I don’t know”, “huh” often
- Problems carrying out multi-step directions
- Noticeable fatigue at the end of the day
- Stronger academic performance in quiet, one-on-one learning setting or small groups
- A need for more time to process information and may need the information to be repeated
- Trouble paying attention to and remembering information presented orally
- Low academic performance
- Speech and language problems
- Sensitivity towards certain sounds
- Behavior problems
- Language difficulty (e.g., they confuse syllable sequences and have problems developing vocabulary and understanding language)
- Difficulties reading and writing because they are directly linked to language
- Difficulty spelling due to hearing sounds incorrectly
- Low frustration tolerance due to not being understood or not able to understand what is going on
- Difficulty localizing sounds
- Difficulty processing new vocabulary or information
- Weaknesses in phonics, reading and spelling
- Inconsistent performance
- May seem lazy, over dependent, or inattentive
What treatments are available for CAPD?
Much research is still needed to understand CAPD problems, related disorders, and the best intervention for each child. Several strategies are available to help children with auditory processing difficulties. Some of these are commercially available, but have not been fully studied. Any strategy selected should be used under the guidance of a team of professionals, and the effectiveness of the strategy needs to be evaluated. Researchers are currently studying a variety of approaches to treatment. Several strategies you may hear about include:
- Auditory trainers are electronic devices that allow a person to focus attention on a speaker and reduce the interference of background noise. They are often used in classrooms, where the teacher wears a microphone to transmit sound and the child wears a headset to receive the sound. Children who wear hearing aids can use them in addition to the auditory trainer. FM system- a wireless amplification system.
- Environmental modifications such as classroom acoustics, placement, and seating may help. An audiologist may suggest ways to improve the listening environment, and he or she will be able to monitor any changes in hearing status.
- Exercises to improve language-building skills can increase the ability to learn new words and increase a child’s language base.
- Auditory integration training may be promoted by practitioners as a way to retrain the auditory system and decrease hearing distortion. However, current research has not proven the benefits of this treatment.
Language Processing Disorder (LPD)-
Individuals with LPD demonstrate difficulty with both heard and read words.
Accommodations/ modifications for children with APD or LPD
- Send materials home in advance- books that will be read, vocabulary, themes that will be targeted
- Break up multi- step directives- “wash your hands first; come back to the table after” versus “wash hands; come back to the table”
- Have the child repeat back directives to ensure they understand
- Seat child away from window, doors, areas where there may be more noise or distraction
- Smaller group instruction
- Assign the child a “buddy”
- Classroom modifications- carpeting, felt bottom chairs, white erase boards
- Allow extra time for the child to think about and form their thoughts
- Omit non-essential details- keep language simple
- Get down to their level
- Use visuals and gestures
- Don’t choose this child first when going around to answer a question
- Allow for breaks from work
- When giving directions make sure the room is quiet, child is looking at you
- Decreasing noise levels
- Games to play- “telephone”, “simon says”, “grocery shopping list”
- Paraphrase and restate key information
The Importance of Social Interactions
Social interaction includes not only conversations but also the identification and understanding of nonverbal cues. These cues, including facial expression, tone of voice and eye contact, provide important information when interacting with others. We learn these cues with experience throughout childhood and gradually integrate them into any social interaction.
Pragmatics refers to the way people use language in social situations and the way that language is interpreted. Pragmatics focuses not on what people say but how they say it and how others interpret their utterances in social contexts
The single best predictor of a healthy emotional interaction is a lot of face- face communication. It’s the best way to learn emotions and develop human-contact skills. Emotional literacy is the ability to read someone else’s or your own emotions so you can tune into their feelings. Children with good emotional intelligence are smarter, happier and more resilient. Children are physically healthier and score higher academically.
- 4T rule- no texting, tapping, talking on cell or TV viewing when others talk
- Always look at the color of the talker’s eyes
- Talk about feelings
- Role-playing and acting can expand perspective taking
- Make books available
- Two- Kind Rule
- Encourage children to learn one new thing about their friend or family member
- Play cooperative games
The American Academy of Pediatrics offers the following advice for screen time:
- Avoid screen time in infants and children under 2
- Limit screen time in children older than 2 years old to no more than 2 hours a day
- Establish “screen free” zones in your home, such as in the bedroom and dining room
- Consider the rating system of shows, movies, and games to avoid exposing your child to inappropriate content
- Monitor your child’s use of screens and put questionable content into context
- Teach your child about the use of advertising on children
- Offer your child educational media and non-electronic content in the form of books, newspapers, and board games
- Encourage your child to play outside, read, participate in hobbies, and use their imaginations in free play