Speech and Language Disorders in Children Implications for the Social Security Administration's Supplemental Security Income Program (2016) / Chapter Skim
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3 Treatment and Persistence of Speech and Language Disorders in Children
3 Treatment and Persistence of Speech and Language Disorders in Children
Pages 81-124
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Nevertheless, even children with the most severe disorders can develop enhanced, functionally important communication skills that have a meaningful impact on their lives even though their speech and language disorders have not been completely resolved.
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Agent(s) of Change Treatment programs for speech and language disorders nearly always require that someone, usually an adult, provide an environmental milieu that promotes speech and language growth (Paul and Norbury, 2012)
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. In the past two decades, however, speech and language intervention has moved out of these special-purpose environments (Peña and Quinn, 2003)
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This type of learning requires repeated exposure or practice, and the resulting knowledge builds gradually. Speech and Language Knowledge Is Abstract The implicit knowledge that accumulates during speech and language development is abstract.
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POLICIES AND GUIDELINES THAT INFLUENCE THE PROVISION OF SPEECH AND LANGUAGE SERVICES TO CHILDREN Numerous factors influence the range of treatments and services received by children with speech and language disorders. Within the universe of children with such disorders who receive SSI benefits, several sets of policies might be expected to play an especially prominent role: the Individuals with Disabilities Education Act (IDEA)
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. This includes "diagnostic, screening, preventive, or corrective services provided by or under the direction of a speech and language pathologist or audiologist."2 Specifically, the EPSDT benefit provides coverage for • the identification of children with speech or language impairments; • diagnosis and appraisal of specific speech or language impairments; • referral for medical or other professional attention necessary for rehabilitation of speech or language impairment; • provision of speech and language services; and • counseling and guidance of parents, children, and teachers (ASHA, n.d.)
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From page 87... ...
As a result, and in keeping with the ASHA guidelines, treatment often is protracted, particularly for children with severe speech and language disorders. TREATMENT FOR SPEECH AND LANGUAGE DISORDERS The primary objective of treatment for speech and language disorders is to ameliorate a child's communication difficulties and thereby reduce or minimize the negative sequelae associated with these disorders.
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. Similarly, children who are born deaf or hard of hearing have very high rates of speech and language impairment.
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Early Intervention (Birth to Age 3) for Language and Speech Sound Disorders Early Intervention Approaches The need for language intervention may be identified quite early in an infant's life, particularly when the child has comorbid disabilities that are known to be consequential for speech and language development (e.g., Down syndrome, cerebral palsy, fragile X syndrome, autism spectrum disorder, traumatic brain injury, being deaf or hard of hearing)
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This approach builds on decades of research showing that children exposed to conversational talk that is responsive have better rates of language development than those who are not (Cross, 1978; Goldfield, 1987; Landry et al., 2006; Tamis-LeMonda et al., 1996)
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BOX 3-2 Selected Examples of Targets and Treatment Goals in Early Language Intervention (birth to age 3) Treatment Goals Prelinguistic • ncrease prelinguistic behaviors that are foundational I communication language development in preverbal children (Warren to et al., 2008; Yoder and Warren, 1998, 2002)
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Joint • Caregivers learn to encourage child's participation engagement in social routines by being responsive and focusing routines with on child's interests (Girolametto et al., 1994; adult responsivity asari et al., 2010; Yoder and Warren, 2001) K Focused • Clinician identifies specific language targets (e.g., stimulation vocabulary, grammar, language functions)
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. In recent years, many of these children have been provided with cochlear implants, which have been shown for some to provide very good speech and language outcomes (Niparko et al., 2010; Tomblin et al., 1999)
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Results, which were statistically significant, showed that family-centered help-giving practices and family-systems interventions directly influenced parental self-efficacy and well-being and that there were indirect effects on parent–child interaction and child development, mediated by caregiver self-efficacy and parental well-being. Another meta-analysis focuses on 18 studies evaluating the effects of parent-implemented interventions for toddlers and preschoolers with language impairments (Roberts and Kaiser, 2011)
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The factors that influence language treatment programs for preschool children with language disorders fall into four general areas: (1) treatment goals, (2)
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Third, although treatment goals for children with severe language disorders may be itemized
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. Finally, specific treatment goals will be based on the child's developmental readiness for learning.
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First, an effort is made to increase the amount of language experience provided to the child. Learning theories in psychology often acknowledge that more trials in a learning task will result in better learning, and this principle also has been found to apply to language development (Hart and Risley, 1995; Huttenlocher et al., 1991; Matthews et al., 2005; Moerk, 1983)
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Most language intervention programs combine several of these methods, along with a general emphasis on overall increments in the frequency of language use. Learning context Most language intervention programs for preschool children use multiple modes of teaching.
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. In summary, considerable evidence shows that clinical treatment for language disorders can improve preschool children's language abilities.
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. Preschool children who are nonspeaking because of poor language ability are likely to have lifelong needs for support, particularly if their deficits reflect severe receptive language disorders and/or other neurodevelopmental disorders.
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Evidence concerning the relative effectiveness of classroom-based and pull-out services for children with language impairments is mixed (McGinty and Justice, 2006)
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identifies two subcomponents that contribute to successful reading comprehension: word recognition and language comprehension. Oral language skills play an important role in each of these subprocesses, as shown in Figure 3-2.
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Treatment for Speech Sound Disorders As with language disorders, the severity of speech disorders can range from relatively mild to quite severe, up to and including a complete inability to speak. Broadly, intervention for speech disorders can be completed at
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. In more severe speech disorders, the focus of intervention may be on improving global speech intelligibility, wherein whole word production rather than individual phonemes is targeted (see Camarata, 2010; Camarata et al., 2006; Levy et al., 2012; McLeod, 2006)
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Although treatment goals often focus on individual speech sounds (phonemes) , the authors note that motor practice principles can include syllables, words, and even phrases: "The possible types of targets are numerous and diverse, and include isolated speech movements, speech sounds, syllables, phonetically modified words, real words, nonsense words, and phrases/sentences" (p.
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. A different approach to treating speech disorders is rooted in considering speech sounds within the context of word productions (see Storkel, 2004)
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found evidence for improvement in specific skills targeted by the treatment and improvement in the use of the devices, but it is difficult to determine whether such interventions result in long-term improvement in speech intelligibility. In summary, as with language disorders, a substantial literature indicates that short-term improvements are observed following intervention for speech disorders.
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It should be noted that, although late-talking children may also display speech disorders, longitudinal studies of this group have not systematically assessed speech skills during followup. Children who are late talkers are more likely to continue to manifest language development at the lower end of the normal range, often lagging behind their same-age peers (Dollaghan, 2013; Thal et al., 2013)
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found that only 21 percent of the 6-year-olds in their cohort continued to have specific language impairment by 10 years of age. A 28-year follow-up of early-school-age children with and without speech disorders (Felsenfeld et al., 1992)
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As with mild to moderate speech disorders and mild to moderate language disorders, relatively minor dysfluencies of preschool children tend to resolve by the time children enter school or shortly thereafter. In a longitudinal study, for example, Kloth and colleagues (2000)
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3-7. Children with language disorders at the age of 5 or 6 are likely to have persistent language problems throughout childhood.
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1983. Characteristics of adult speech which predicts children's language development.
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1994. Comparison of conversational recasting and imitative procedures for training grammatical structures in children with specific language impairment.
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in severe mixed receptive-expressive language impairment: Outcomes from a randomized controlled trial. Journal of Speech, Language, and Hearing Research 48(3)
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2003. Ten principles of grammar facilitation for children with specific language impairments.
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2008. The efficacy of Fast ForWord language inter vention in school-age children with language impairment: A randomized controlled trial.
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2005. Lexical training through modeling and elicitation procedures with late talk ers who have specific language impairment and developmental delays.
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1996. Effects of imitative and conversational recasting treatment on the acquisition of grammar in chil dren with specific language impairment and younger language-normal children.
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2015. Predicting vocabulary growth in children with and without specific language impairment: a longitudinal study from 2; 6 to 21 years of age. Journal of Speech, Language, and Hearing Research 58(2)
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2001. Omissions of obligatory relative markers in children with specific language impairment.
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The influence of age at implantation, social and linguistic environment on language development in children with cochlear implants. Journal of Speech Language and Hearing Research 55(6)
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1994. A prospective longitudinal study of language development in late talkers.
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