Education of Persons with Language and Communication Difficulties

Course Code: SNIE 3052 Module Code: SNIE-M3051

Module Name: Inclusive Education III ECTS -3
Degree Program: Undergraduate (Regular)

I. Introduction
1. A) Aspects of Normal Communication and Language development
1.1. Definition of Communication, Language, and speech.

Communication is so fundamental to the human experience that we cannot stop

communicating even when we want to. You may decide to say nothing, but sometimes saying
nothing communicates a great deal. Still, imagine trying to go through an entire day without
speaking. How would you make contact with other people? You would be frustrated when others
did not understand your needs and feelings. By the end of the day, besides feeling exhausted
from trying to make yourself understood, you might even start to question your ability to
function adequately in the world.

For many people, the terms communication, language, and speech mean essentially the
same thing, but to special educators and speech-language therapists these are significantly
different concepts that require different approaches to instruction:

Before we define communication disorders, a discussion of some basic terms is necessary.

 Communication

Communication is the corner stone of the teaching learning process. A successful school is
the one in which communication is good. In its broadest sense, communication is an interaction
that transmits information and establishes common understanding. Communication is the
process of exchanging knowledge, ideas, opinions, and feelings. Communication is the broadest
of the three terms (communication, speech, and language), includes both speech and language.
Communication also includes cues such as intonation (accent), pace of speech, and stress
(emphasis), as well as nonverbal information such as gestures, facial expressions, and eye
contact.
Every effective communication involves the following elements;

 A message
 Channel or means in which the message would be transmitted
 Expressive communication by the sender
 Receptive communication by receiver
 Interpretation of the message and giving response
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 Message Sender

Channel
Response

Interpre
Receiver
tation

Communication encompasses individual’s use of language and speech to make a full

interactional process. Language and Speech are the major tools of communication. It is
through these tools that human’s communication becomes clear, understandable, and
meaningful.

 Language

Language is a socially shared code or conventional system that represents ideas through the use
of arbitrary symbols and rules that govern combinations of these symbols.

Conventional system: it is a matter of agreement between people to relate expression and

meaning.

Arbitrary symbols: no rational for assigning certain sounds or words to represent a certain
message

Rules: the combination of these arbitrary symbols is not random they are governed by rules to
convey meaning for the audience.

 Speech

Humans express thoughts, feelings, and ideas orally to one another through a series of complex
movements that alter and mold the basic tone created by voice into specific, decodable sounds.

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 1.1. Aspects of Normal Language and Speech Development

How Do Children Learn Language?

The most intensive period of speech and language development for humans is during the first
three years of life, a period when the brain is developing and maturing. These skills appear to
develop best in a world that is rich with sounds, sights, and consistent exposure to the speech
and language of others.

There is increasing evidence suggesting that there are “critical periods” for speech and
language development in infants and young children. This means that the developing brain is
best able to absorb a language, any language, during this period. The ability to learn a language
will be more difficult, and perhaps less efficient or effective, if these critical periods are allowed
to pass without early exposure to a language.

The beginning signs of communication occur during the first few days of life when an
infant learns that a cry will bring food, comfort, and companionship. The newborn also begins to
recognize important sounds in his or her environment. The sound of a parent or voice can be one
important sound. As they grow, infants begin to sort out the speech sounds (phonemes) or
building blocks that compose the words of their language. Research has shown that by six
months of age, most children recognize the basic sounds of their native language.

As the speech mechanism (jaw, lips, and tongue) and voice mature, an infant is able to
make controlled sound. This begins in the first few months of life with “cooing,” a quiet,
pleasant, repetitive vocalization. By six months of age, an infant usually babbles or produces
repetitive syllables such as “ba, ba, ba” or “da, da, da.” babbling soon turns into a type of
nonsense speech (jargon) that often has the tone and pace of human speech but does not contain
real words. By the end of their first year, most children have mastered the ability to say a few
simple words. Children are most likely unaware of the meaning of their first words, but soon
learn the power of those words as others respond to them.

By eighteen months of age, most children can say eight to ten words. By age two, most
are putting words together in crude sentences such as “more milk.” During this period, children
rapidly learn that words symbolize or represent objects, actions, and thoughts. At this age they
also engage in representational or imaginary play. At ages three, four, and five, a child’s
vocabulary rapidly increases, and he or she begins to master the rules of language.

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Language and Speech Developmental Milestones

Children vary in their language and speech development. There is, however, a natural
progression or “timetable” for mastery of these skills for each language. The milestones are
identifiable skills that can serve as a guide to normal development. Typically, simple skills need
to be reached before the more complex skills can be learned. There is a general age and time
when most children pass through these periods. These milestones help doctors and other health
professionals determine when a child may need extra help to learn to speak or to use language.

Hearing and Understanding Talking

Birth-3 Months Birth-3 Months

 Startles to loud sounds  Makes pleasure sounds (cooing, gooing)

 Quiets or smiles when spoken to  Cries differently for different needs
him/her
 Smiles when sees you
 Seems to recognize your voice and
quiets if crying

 Increases or decreases sucking

behavior in response to sound
4-6 Months 4-6 Months

 Moves eyes in direction of sounds  Babbling sounds more speech-like with

 Responds to changes in tone of your many different sounds, including p, b and
voice m
 Chuckles (laugh quietly) and laughs
 Notices toys that make sounds
 Vocalizes excitement and displeasure
 Pays attention to music
 Makes gurgling (make bubbling water)
sounds when left alone and when playing
with you
7 Months-1 Year 7 Months-1 Year

 Enjoys games like touch/hit, cover  Babbling has both long and short groups
 Turns and looks in direction of sounds of sounds such as "tata upup bibibibi"
 Uses speech or non crying sounds to get
 Listens when spoken to

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  Recognizes words for common items and keep attention
like "cup", "shoe", "book", or "juice"
 Uses gestures to communication (waving,
 Begins to respond to requests (e.g. holding arms to be picked up)
"Come here" or "Want more?")  Imitates different speech sounds

 Has one or two words (hi, dog, dada,

mama) around first birthday, although
sounds may not be clear
One to Two Years
 Points to a few body parts when asked.  Says more words every month.

 Follows simple commands and  Uses some one- or two- word questions
understands simple questions ("Roll "Go bye-bye?" "What's that?").
the ball," "Kiss the baby," "Where's
your shoe?").  Puts two words together ("more cookie,"
"no juice," "mommy book").
 Listens to simple stories, songs, and
rhyme (eg ushururu…).  Uses many different consonant sounds at
the beginning of words.
 Points to pictures in a book when
named.
Two to Three Years

 Understands differences in meaning  Has a word for almost everything.

("go-stop," "in-on," "big-little," "up-
down").  Uses two- or three- words to talk about
and ask for things.
 Follows two requests ("Get the book
and put it on the table").  Uses k, g, f, t, d, and n sounds.

 Speech is understood by familiar listeners

 Listens to and enjoys hearing stories most of the time.
for longer periods of time
 Often asks for or directs attention to
objects by naming them.
Three to Four Years

 Hears you when you call from another  Talks about activities at school or at
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 room. friends' homes.
 Hears television or radio at the same  People outside of the family usually
loudness level as other family understand child's speech.
members.
 Uses a lot of sentences that have 4 or
 Answers simple "who?", "what?", more words.
"where?", and "why?" questions.
 Usually talks easily without repeating
words.
Four To Five Years

 Pays attention to a short story and  Uses sentences that give lots of details
answers simple questions about them. ("The biggest peach is mine").
 Tells stories that stick to topic.
 Hears and understands most of what is
said at home and in school.  Communicates easily with other children
and adults.

 Says most sounds correctly except a few

like l, s, r, v, z, ch, sh, th.

 Says rhyming words (with lines that end

in similar sounding words)

 Names some letters and numbers.

 Uses the same grammar as the rest of the

family.

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 2.1 Definition and Types of Language and Communication Disorders
There are two types of communication disorders: those that affect speech and, those that affect
language.

2.1.2 Speech Disorder/ Communication Disorders That Affect Speech

Speech Disorders Defined

Problems with producing speech sounds (articulation), controlling sounds that are produced (voice),
and controlling the rate and rhythm of speech (fluency) are generally considered speech disorders.

Types of Speech Disorder

1. Articulation disorder
Articulation disorder is defined as "the abnormal production of speech sounds". When a
youngster says, "The wabbit wan don the woad," for ―the Rabbit run down the road or
"poon" for "spoon, or "gog” for "dog. He or she may be using spoken language
appropriately but is not producing sounds correctly. Articulation refers to the speech sounds
that are produced to form the words of language. The articulating mechanism comprises the lips,
tongue, teeth, jaw, and palate.
There are many different types of errors in articulation. These include:
A. Omission
B. Substitution
C. Distortion
D. Addition of extra sound
A. Omission
What is Omission?
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From the name we understand that omission means when:
Certain speech sounds are omitted resulting in the production only part of a word.
Eg. ―oat for goat, po- y for ―pony‘
They may drop consonants from the ends of the words, as in Pos-” for “Post‖. Most people omit
sounds, but an extensive omission problems can made speech impossible to understand.

B. Substitution.
What is Substitution?
Substitution is the problems which includes errors such as substituting one phonemes with
another for example W for r, Wed for red, or b for v, ‘bery‘ for very‘. Children may
substitute one sound for another, as in saying ‘train‘for Crane or ‘doze’ for those. Substitution of
sounds can cause considerable confusions for the listeners, as in the case ―’the ball is wed’ for
―the ball is red.
C. Distortion
What is distortion?
Distortion is a kind of articulation disorder, it is when:-
 A distorted sound is a substitute sound which cannot be identified as any known consonant or
vowels in the language. Children may distort certain speech sounds while attempting to
produce them accurately. For instance, ‘nam’ for man. Distortion can cause misunderstanding.
D. Addition
What is addition of extra sound?
Addition means when:-
Children may add extra sounds (making comprehension different). For instance, they may say
‘buhrown’ for brown, ‘balack’ for black. Articulation problems vary in the degree of severity. It is
usually possible to understand their speech, but they may mispronounce certain words and use
immature speech like children. The majority of articulation errors, produced by young children, result
from lack of maturational development.

2. Voice disorder

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Voice disorder is defined as "the absence or abnormal production of vocal quality, pitch,
loudness, resonance, and/or duration". Individuals with voice disorders sometimes sound very
hoarse (irregular), or speak very loudly or in a very high or low pitch. These disorders occur
when the quality, loudness, or pitch of the voice is inappropriate or abnormal. The
appropriateness (quality) judged according to age, sex, physical status, and according to the
demands of the situation. Voice disorders are less common in children than in adults. In some
cases, a child‘s voice may be difficult to understand or may be considered unpleasant. A person‘s
voice may be considered disordered if it differs markedly from what is customary in the voices
of others of the same age, sex, and cultural background. It stated that voice disorder is a possible
error of pitch, loudness, voice flexibility, quality, and duration. But how do you understand
them? Define the following words in your own ways.
 Pitch of sound
 Loudness sound
 Voice flexibility
 Quality of sound
 Duration of sound
Pitch
It is the highness or lowness of the voice as relate to the musical scale. Some children use a
pitch level too high or too low for their age and sex. Such voices would be unpleasant and
be regarded as voice disorders involving pitch.
Loudness
It is the strengthen or weakness of the voice related to the amount of energy or volume used.
Too loud voice can be disturbing. A too weak voice can interfere with communication.
Voice Flexibility
It is the variability of pitch and loudness. It is a good tool for meaning. Many subtle
meanings of emotional states are expressed by flexible voice. When the voice is monotonous, the
message lacks precision.
Quality
It is the characteristics of voice and of pitch and loudness that provides the spice for
differentiating two voices. Four groups of voice quality disorders can be identified.
 Breathiness- similar to a low voice.
 Harshness – discordant, raspy, low pitched and lauder than normal.
 Hardness – typical of Laryngeal irritation resulting from excessive yelling and
throat infections.
 Nasality – too much of the sound passes through the nasal cavity and out through
the nose.
Duration
It refers to the total length of time the phonation exists. Disorder occur when phonation periods
are either too long or too short speech sounds, especially values may be distorted.
3. Fluency disorder
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Fluency disorder is defined as the abnormal flow of verbal expression, characterized by impaired
rate and rhythm which may be accompanied by struggle behavior. For instance, S-saying th-the
f-first s-sound o-of a-a w-word and th-then s-saying th-the w-word illustrates this problem.
It is clear that normal speech makes use or rhythm and timing words and phrases flow
easily with certain variations in speed, stress, and appropriate pauses. Fluency disorders
interrupt the natural, smooth flow of speech with inappropriate pauses, hesitation, or
repetition. Fluency disorder sometimes called disfluencies.
Fluency disorders include part of word repetition, whole word repetition, phrase repetitions,
introjections, reversions, tense pauses, prolongation of sounds and excessive muscle tension in
the formation of sounds. The most frequent types of fluency disorders are:-
I. Stuttering
II. Cluttering
I. Stuttering
What is stuttering?
There is no agreement on the definition of stuttering among speech-language pathologists.
The speech of children with this problem is characterized by disfluencies. They produce part
word repetitions (eg “cuh . . . . cuh . . . candy. They show prolongation (eg “s . . . . school‖).
They break words (eg teach . . . ing). Stuttering is the best known and probably least
understood fluency disorder. This condition is marked by rapid fire repetitions of
consonant or vowel sounds, especially at the beginning of words and complete verbal blocks.
Stuttering typically makes its appearance between the ages of 3 to 5 after the child has already
made great strides towards fluency. The trouble comes later just as speech is becoming less of a
feat and more of a habit. Stuttering is more common among males than females. Stuttering
occurs in about 1 percent of the population; it has been found to be most common in males,
twins, and left-handed persons. Stuttering is much more commonly reported among children than
adults, prevalence estimates in school age populations are in the 5% range. All children
experience some dysfluenceies-repetition and interruptions- in the course of developing
normal speech patterns. It is important not to over react to children‘s dysfluencies and
insist on perfect speech, some specialists believe that stuttering can be caused by pressures
placed on a child when parents and teachers react to normal hesitations and repetitions by
labeling the child a stutter.
Stuttering is situational, that is, it appears to be related to the setting or circumstances of speech.
A child may be likely to stutter when talking to the people whose opinions matter most to him
such as parents and teachers- and in situations like being called on to speak in front of the class.
Most people who stutter at all when singing, talking to his pet dog, or reciting a poem in unison
with others. The reactions and expectations of parents, teachers and peers clearly have an
important effect on any child‘s personal and communicative development.
Stuttering, speech disorder characterized by involuntary hesitations and rapid repetitions of
speech elements. Hesitations and repetitions in speech are normal from the ages of two to four,
as speech is developing; they are usually gone by the age of six, except for occasional episodes
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that may recur during times of stress. The temporary stuttering observed in early childhood may
be explained by the development of the child's mental ability to speak in advance of his or
her muscular powers to produce smooth speech. Beyond this period of speech development,
the ability of stutterers to produce smooth speech decreases.

II. Cluttering
Cluttering is the other type of fluency disorder. There is only little difference between
stuttering and cluttering. Cluttering involves speaking in an extremely fast, disorganized and
often unintelligible way. Cluttering is a condition in which speech is very rapid and
clipped, to the point of unintelligibility.
2.2 Language Disorder/ Communication Disorders that Affect Language
Problems with using proper forms of language (phonology, morphology, and
syntax), using the content of language (semantics), and using the functions of language
(pragmatics) are generally considered language disorders.
Language disorders are usually classified as either receptive or expressive. A receptive
language disorder interferes with the understanding of language. A child, for example,
may be unable to comprehend spoken sentences or to follow a sequence of directions. An
expressive language disorder interferes with the production of language. The child may
have a very limited vocabulary, may use incorrect words and phrases, or may not even speak
at all, communicating only through gestured. A child may have both expressive and
receptive disorders in combination.
In language disorder a child may have normal speech which means he has
acceptable voice, acceptable articulation and acceptable of fluency, but his talking may not
give sense and he may misinterpret the meaning of what he is heard or read.
Speech has to do with intelligible vocal encoding of message while language has to do with the
formulation and interpretation of meaning. Language involves listening and speaking,
reading and writing, as well as technical discourse and social interaction. Language
problems are basic to many of the disabilities especially mental retardation and learning
disabilities. Therefore, language disorder can also considered as problems in the recognition
and understanding of spoken language or in the ability to formulate well organized
grammatical sentences. That means the problem interferes either in the process of
comprehension or in the process of expression. Previously we said that language disorder
may be receptive or expressive. Receptive means problems related to hearing listening or
receiving language and Expressive problems of language related to producing or explaining
language.

Types of Language Disorder or different dimensions of Language

There are three kinds of language disorders, specifically problems related to form, content, and

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function.
1. Language form
Language form refers to the utterance or sentence structure of what is said. Form includes the
rule systems used in oral language. It also includes the linguistic elements that connect
sounds and symbols with meaning. It is characterized by three different rule systems these
are:-
I. Phonology
Phonology is concerned with the smallest units of language (phonemes or Speech sounds);
It is the system of the rules that govern sounds and their combination. It is the smallest linguistic
unit of speech that signals a difference in meaning.
E.g Bat, Pat, Hat
Language is a set of symbols and the rule for connecting those symbols. Graphemes (letters) are
the basic symbol unit of written language. Phonemes (sounds) are the basic symbols unit of
spoken language.
In the above three examples (bat, hat, and pat) they have different phonemes (sounds) and
different meanings. Phonemes are combined in specific way to form words. The phonology of
language varies according to language. That means each language has a finite number of
phonemes and specific rules for forming and combining phonemes. The speech sounds of
Spanish are different from those of English.

II. Morphology
Morphology is concerned with the smallest units of meaningful language (morphemes or
words and parts of words); Morphology refers to the rules that govern the parts of words that
form the basic elements of meaning and the structures of words. For instance, prefixes and
suffixes change the meaning of the roots of specific words as the case of unhappy
(prefixes), and tallest (suffixes). An ed at the end of a verb changes the tense to past like
played. Notice the difference in the meanings of cover and uncover, covered and uncovered,
etc. We understood the changes in these word‘s meanings, because we understand the
rules governing the structure of words.
III. Syntax.
Syntax is concerned with combining language units into meaningful phrases, clauses, or
sentences (grammatically correct language). It is the rule system that governs the structure of
sentences. Synthetically rules specify word order sentence organization and relationship
among words in order to have meaning. Syntax determines where a word is placed in
sentence. Like phonology rules syntax rules vary in different languages. The rules with in a
language determine the meaning of communication for instance in English language noun
generally precede verbs in a sentence. If the verb precedes the noun, the construction might be
a question. The placement of words in sentences can change their meaning. For example,
―The car hit the boy, has different meaning from
―The boy hit the car.
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Generally, form (proper use of phonemes, morphemes, and syntax is important in all
language (in oral, written, and sign language). This is because not all combinations are
acceptable. Form comprises the rules of language. In oral and written languages, letters and
letter combination are used to produce the words and word combinations (sentences) of
language. The uses of the letters (symbols) are words which are governed by the rules of
language.
Problems with form cause errors in letter formation, errors in sound formation, errors in using
correct grammatical structures and errors in sentence formation. Children who have
difficulty with the form of language also have problems recognizing sounds, sentence types
and sentence complexities. For instance, a child who has not mastered the rules of language
might not be able to tell the difference between these two sentences. Go to the school and Did
you go to the school?
2. Language Content
Language content refers to meanings of words and sentences, including abstract
concepts-semantics. Content involves knowledge about objects, events, people, and the
relationship among them. It includes semantics.
Semantics is concerned with word and message meanings (vocabulary, comprehension,
following directions). Problems with semantics are evident when students are unable to
identify appropriate pictures when word names are provided ("Find the grapes"), answer
simple questions ("Are apples fruits?"), follow directions ("Draw a line over the third
box"), tell how words or messages are similar or different ("How are apples,
oranges, and pears alike?"), or understand abstract concepts ("What is love?").
Semantics is the system that patterns the intent and meaning of words and sentence to
comprise the content of communication. The key words in statements the direct and
implied referents to these words, and order of the words used all affect the meaning of the
message. Hence, we have to be clear and precise in our use of words of sentences for the
meaningful communication. We use words like theses and those, here and there without being
exact when the sender of the message use indirect referents, the receivers might not understand
the message that intended. For instance, if a child comes home and tells his mother, ― I left at
school, she might be unclear about what the child left at school unless he is answering a direct
question like where is your jacket?
Children with problem in language content often do not understand the meaning of what is said
to them; choose inappropriate words for their oral language communication.
3. Language Function
Language function refers to the context in which language can be used and the purpose of
communication-pragmatics. It concerns the application of language in various communications
according to the social context of the situation. It includes pragmatics. Pragmatics deals with
appropriate language use in its communicative context, Pragmatics are rules that govern the use
of language in social context.

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 Pragmatics is concerned with the use and function of language in varying settings
(That is, following social conversational rules). Problems with pragmatics are
evident when students are unable to use language in social situations to express feelings,
create or understand images, give or request information, and/or control actions of listeners
criteria for identification.
There is different use of language in different social context. For instance, the
individual may request order, give, action, and information through a communication. Here, the
way we use language as home or with our friends is different from the way we speak to an
employer or people in authority.
To achieve competence in communication a person must be able to use language
correctly in social context. Problems with use (pragmatics) include problems in using
appropriate language in social contexts and conversations. This problems can be receptive
(related to hearing, listening to, or receiving language) and expressive (related to
producing or expressing language).

2.3 Causes of Communication Disorder

What are the major causes of communication disorders?
The causes of communication disorders are so many that one cannot exhaustively mention all.
According to Ysseldyke and Algozine (1995), Some causes of speech and language disorders
include hearing loss, neurological disorders, brain injury, mental retardation, drug abuse,
physical impairments such as cleft lip or palate, and vocal abuse or misuse. Frequently, however,
the cause is unknown.
In the known domain the major causes of communication disorder can be broadly divided into
two main categories.
I. Organic /physical/ cause
II. Non organic or functional cause
I. Organic /physical/ causes
Organic cause from its designation is means all causes of communication disorders which
have its own specific physical origin, i.e. there is anatomical problem which result a problem of
communication disorder because of physiological defect. They include physical factors such
as:
 Cleft palate,
 Brain damage
 Malfunction of the respiratory or speech mechanisms, or
malformation of the articulators
 Severely misaligned teeth
 Cleft lip
 Paralysis of speech muscles, and absence of teeth,
 Craniofacial abnormalities,

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  Enlarged adenoids, and neurological impairment
 Cognitive limitation or retardation
 Hearing impairment
Organic communication disorders maybe regarded as a child‘s primary handicapping
conditions or may be other secondary handicapping conditions.
II. Non – organic/Functional/
Some of the bad practices and psychological conditions could be undue abuse of the voice by
screaming, shouting, and straining can cause damage to the vocal cords and result in a voice
disorder.
Environments deprivation
 Lack of stimulation
 Lack of proper experiences for mental development and learning
language
 Inappropriate role model
 Punishment for speaking or being ignored trying to communicate
Stress that creates stuttering – lack of fluency in speaking may be characterized by severe
hesitation or the repetition of sounds and words

3 Major Characteristics Of Children with Language and Communication Disorders

3.1. Physical Characteristics

Individuals with certain condition like cerebral palsy, cleft palate or other kinds of oral facial
disorders, may result communication difficulties but for most students with speech and language
impairments there is no specific correspondence between physical appearance and speech or
language functioning.

3.2. Cognitive Characteristics

There is no clear agreement regarding the relationship between language and speech disorders
with cognitive development. However, scholars are in argument with two schools of thought.
According to one, some students do have cognitive difficulties; they perform poorly on
intelligence tests, particularly on verbal intelligence tests. Their development of cognitive skills
(identifying similarities among objects or concepts, understanding sentences and words) which is
heavily dependent on language is hampered by their language problems.

The competing view holds that students with communication disorders have normal or average
intellectual functioning.

The research is not clear on explaining whether difficulties in communication cause cognitive
difficulties or cognitive difficulties cause communication difficulties. However, it is believed
that the causation may run in either direction, depending on the individual student. Cognitive and
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linguistic development is related to each other in a more tightly interactive way and that both can
influence each other equally. The close relationship between communication and cognitive
development can make it difficult to determine a student’s actual needs.

3.3. Socio Emotional Characteristics

It can be difficult to separate psychosocial and emotional problems from problems with
language and communication. Children with language impairments had difficulty entering into
peer group conversations and were then excluded; giving them less opportunity to learn and
practice the social skills they needed for peer interaction. Failure to identify and treat such
problems can have serious consequences.

Children with language and speech disorders frequently play a passive role in
communication. They may show little tendency to initiate conversations. When a students’
speech or language is obviously different, his/her peers, teachers or adults, find to peers behave
differently toward him/her. They may pay more attention to the way in which the students says
something than to what he/she says. Others may ridicule an individual whose speech is
noticeably different and this can cause emotional problems.

As a result, students who have speech and language difficulties may withdraw from
social situations, be rejected in social situations and may ultimately suffer from a loss of
self-confidence.

3.4. Academic Characteristics

School is a verbal-symbolic environment. Throughout the school years, especially in

kindergarten and first grade, academic performance is highly dependent on students’ skill in
listening, following directions, and comprehending. Students are expected to understand and act
in response to verbal symbols and spoken language. Students who have speech and language
problems usually experience difficulties in reading, social studies, language arts and other
subjects that depend heavily on understanding verbal and written communication skills.

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4. Identification and Assessment of Children with language and communication Disorder

4.1. Identification of children with language and communication disorder

Because language is central to so many aspects of human life – cognition, social

interaction, education and vocation – valid identification, prevention, and treatment of language
disorders is a high priority for the therapeutic professions. Delay and/or difficulty in beginning to
use language is one of the most common causes of parental concern for young children brought
to pediatricians and other professionals.

The development of speech and language is a highly individualized process. No child

conforms exactly to precise developmental norms; some are advanced, some are delayed and
some acquire language in an unusual sequence. Unfortunately, some children deviate from the
normal to such an extent that they have serious difficulties in learning and in interpersonal
relations.

People who are not able to make themselves understood or who cannot comprehend ideas
that are spoken to them by others are likely to be greatly disadvantaged in virtually all aspects of
education and adjustment. They need specialized help. These kinds of problems occur frequently
among children in regular and special educational classes.

When does a communication difference become a communication disorder? A

communication difference / a language delay would be considered as a disorder when:

 The transmission and perception of message is faulty

 The person is placed at a learning disadvantage

 The person is placed at a social disadvantage

 When there is negative impact upon the emotional growth of the person

These things would be considered by the parents, teachers, and medical professional and
significant others depending on the nature and time of identification.

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To mention some symptoms of language disorders;

 Delayed language: marked slowness in the onset and development of language skills
necessary for expressing ideas and for understanding the thoughts and ideas one hears or
reads.

 Learning difficulty: something interfering with a child’s ability to understand the message
that his eyes and ears receive.

 Aphasia: loss of speech and language abilities following brain damage sometimes resulting
from a stroke or head injury.

Generally identification symptoms in the following four important areas can be used as a means
of referral:
Academically
 Overall achievement may be below expectancy in relation to chronological age, mental
age, or both
 Achievement in reading, spelling, written composition, grammatical usage or math
processes may be below expected levels, often with delay or difficulty in acquisition
of pre-reading or other readiness skills
 Word knowledge may be below expectancy
 Word substitutions may occur frequently in reading and in writing from copy or
reproducing from recall

Behavioral (socio-emotional)
 Hesitates or refuses to participate in verbal activities
 Is inattentive, distractible; exhibits poor concentration; has difficulty "tuning in" to tasks
or switching tasks
 Displays refusal behavior and/or low frustration tolerance
 Perseverates verbally and/or meteorically
 Has difficulty of following directions; must be "shown" what to do
 Has trouble analyzing/integrating information from what is seen, heard or felt
 Is embarrassed or disturbed by his speech, regardless of age
 Has difficulty interpreting emotions, attitudes and intentions others communicate
through nonverbal aspects of communication (facial expressions and body language)
 Responds inappropriately to subtle nonverbal social cues, often giving inappropriate
social responses
 May not establish or maintain eye contact
 Repeats what is said to him or what he is reading, vocally or sub vocally
 Uses gestures extensively while talking or in place of speech
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  Is slow to respond during verbal interaction or following verbal cues
 Is compulsive in actions or speech
 Acts impulsively, without forethought; often responds before instructions are completed
 Has difficulty of remembering and finding specific words to use during conversation or
when answering a question

Communicative Abilities: (abilities in the area of normal language and speech

development)
 Asks questions and/or responds to questions inappropriately (especially "why" and "how"
question forms)
 Has difficulty discriminating likenesses and differences
 Has difficulty analyzing and synthesizing sound sequences, forming stable
phoneme/grapheme associations, and segmenting words into smaller grammatical units
 Has difficulty learning and applying concepts of time, space, quantity, size, proportion
and measurement
 Has difficulty comprehending and using linguistically complex sentences
 Has problems acquiring and using grammatical rules and patterns for word and sentence
formation
 Cannot identify pronouns and their antecedents
 Cannot relate the events in a story or information in a report in sequential order
 Cannot predict outcomes, make judgments, draw conclusions or generate alternatives
after appropriate discussion
 Cannot give clear and appropriate directions
 Has difficulty interpreting or formulating (oral or written) compound or complex
sentences, and/or sentences which compare and contrast ideas or show cause-effect
relationships
 Cannot summarize essential details from hearing or reading a passage, nor distinguish
relevant from irrelevant information
 Will not initiate conversations
 Cannot identify or use expository, descriptive or narrative language in written work
 Cannot write an organized paragraph using related sentences of varying length and
grammatical complexity
 Has problems interpreting and/or using vocal pitch, intensity, and timing for purposes of
communicating subtle distinctions in emotion and intention
 Has inappropriate vocal pitch for age and sex
 Does not use appropriate vocal control, particularly in regulating speaking volume
(unusually loud or soft)

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  Has breathy, harsh, husky(rough) or monotone voice
 Continually sounds congested
 Sounds unusually nasal; voice has a "whining" quality
 Has abnormal rhythm or rate of speech
 Frequently prolongs or repeats sounds, words, phrases and/or sentences during speech
 Has unintelligible (cannot be understood) or indistinct speech
 Has difficulty articulating sounds within words
Physical
 Conditions are indicated in the student's medical/developmental history, such as cleft lip
and/or palate, deviant palatal-pharyngeal structure, cerebral palsy, muscular dystrophy,
brain injury, aphasia, vocal nodules or other pathology of the vocal mechanism, hearing
loss,aural-facial abnormalities, congenital disorders
 Has continuous allergy problems or frequent colds
 Has deviant dental structure
 Has oral muscular coordination slower than normal
 Displays clumsiness or general motor in coordination

Accordingly screening will be made on some relevant areas like hearing and vision. The child
will be referred for a formal comprehensive process of assessment.

4.2. Assessment Strategies of Children with language and communication Disorder

There are at least four purposes of assessment of children with language and communication
disorder:

1. To determine whether a child has a language learning problem

2. To identify the specific areas of deficit

3. To formulate hypotheses about the possible causes of the problem, and

4. To identify specific goals to target in a general management plan (IEP)

Assessments may vary based on the age of the child. For preschool children, observing
play behaviors and interactions with parents and siblings provides important information
about the child's social, cognitive, and interactive development; For school-age children,
language should be assessed not just with a clinician, but also with peers and in the classroom.
During this period, emergent literacy skills should be assessed (e.g., conventions of print, letter
names). Narrative abilities can be assessed by having young children retell a story using a
wordless picture book. A variety of discourse genres should be evaluated with spoken and
written samples of language. Figurative aspects of language should also be evaluated.

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 Most professional speech and language assessments begin with the collection of case history
information from the child and the parents. This typically involves completion a biographical
form that includes such diverse information as the child’s birth and developmental history,
illness, medication taken, scores on achievement and intelligence tests and adjustment to
school. The parent may be asked when the child first crawled, walked and uttered words.
Social skills, such as playing readily with other children may also be considered. A
comprehensive evaluation to detect the presence of a communication disorder would likely
include the following general components.

Articulation test

The speech errors the child is making are assessed. A record is kept of the sounds that are
defective, the way in which they are being mispronounced, and the number of errors made.

Hearing test

It is generally taken to determine whether a hearing problem is the cause of the speech disorder.

Language development test

This is administered to help determine the amount of vocabulary the child has acquired,
because vocabulary is generally a good indication of intelligence.

Understanding and Production Test

Assessing the child’s understanding and production of language structures is important in

evaluating the child’s communicative behavior.

Moreover, the way we seek information from children with language and communication
disorder will include the following approaches:

 A Thorough Case History

This will include information from parents on:

 The mothers pregnancy and the child’s birth and neonatal history

 History and composition of the family

 The child’s medical history

 The child’s developmental history, including motor, self-care and communicative

skills

 How the child uses receptive and expressive language at home; and

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  How the family has attempted to help.
 The Language Sample

Collect a sample of the child’s utterances which is representative of his/her problems. If the child
is completely nonverbal, the clinician tries to learn his gesture language.

 Evaluation of other related problems

These includes evaluation of hearing loss, (audiometric testing), organizing and processing
of information, inadequate cognitive skills, and impairments of motor coordination.

V.

5. Intervention Strategies for Children with Communication Strategies

Appropriate support and therapy can significantly accelerate the development of language
and cognitive skills and assist children to reach their potential. It is believed that the earlier
therapy begins, the better are the results that can be achieved. Treatment and therapy for children
with language disorders varies according to the extent and severity of each individual's pattern of
problems. Multi-disciplinary approach for the intervention of communication disorder
incorporates psychology, physiotherapy, speech pathology, occupational therapy, music therapy
and specialized teaching to help children reach their potential.

Parents have a great role in the treatment of the child with speech- language disorder. Parents
can be guided by professionals and provided with the detailed scheme of the language
development of the child. They can provide a back-up support at home to the child through
motivating the child to practice the required speech and/or language exercises or drills in their day
to day practices. Indeed, the arrangement of the setting of the home environment in a way that it is
receptive and responsive is very essential for promoting child’s language development.

5.1. Educational Intervention

5.1.1. Intervention of children with language impairment:

The process of improving a child’s ability to communicate generally refers to as Language

Intervention. In contrast, Language Management is the structuring of the child’s environment
so that the child can learn despite the language and speech disorders.

General considerations in the language intervention include selection of appropriate goals and
programs, the establishment of an environment that is conducive to language development,
and the use of language-facilitating techniques that enable the child to understand and use
language successfully.

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1. Selecting goal and program

The development of a program for a child with a language disorder should contain six basic
components:

a. The overall goal of the program and a series of intermediate goals expressed in terms of
behavioral objectives or targets

b. Selection of content

c. Specification of the content in terms of priority and hierarchy of tasks and procedures to
reach the objectives

d. Specification of instructional and motivational strategies

e. Identification of measures for evaluation of progress

f. Procedures for stabilization and generalization

From these basic components, it can be clearly seen that the development of a successful
language skill program involves analysis of a child’s specific communicative needs, detailed
planning of intervention procedures, and ongoing assessment to evaluate progress.

2. Structuring the program

Language intervention programs vary considerably in the degree of structure. Highly

structured programs incorporate specific directions for presenting stimuli, scheduling
reinforcement, and correcting errors that are based on a behavioral paradigm.

Other methods involve a more natural, conversational setting, with emphasis on using
language structures in a meaningful way. In comparison of the high and low structured programs,
not surprisingly, that no one approach is best for all children. The highly structured approach was
more successful with children who had limited cognitive ability or who had very poor syntax
skills. Conversely, the less structured program was more effective for children who had a higher
level of intellectual functioning and who were not so markedly delayed in syntax functioning.
While these are very broad guidelines, they emphasize the need to individualized language
intervention.

3. Facilitating communication

In order to use language effectively, children must practice their skills in a variety of
settings. All good teachers are also good communication facilitators who encourage children’s
communication skills and motivation. The effective teacher speaks with feeling and animation
and listens to children with genuine interest. Teachers will use these strategies in the classroom:

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  When a child makes an error, the teacher can correct it by naturally rephrasing it.

Example, Child: “them boys has football helmets.”

Teacher: “yes, those boys have football helmets.”

 Become Model correct language by identifying a specific target, e.g., irregular verbs, past
tense, and reflecting it back to the student after every incorrect use.
Example:
Student: "I writed my assignment" or "I drawed the diagram."
Teacher: "Oh, you wrote the assignment" or "I see, you drew the diagram."
 Expand on the student's utterance by adding form, content and attributes.
Example:
Student: " I saw the fight" or "They're fighting."
Teacher: "Where did you see the fight?" or "It's not a serious, violent fight." Discuss the
listeners' need for clarity, so the student may become more aware of the skills involved in
providing complete information.
 Barrier activities are useful exercises for students of any age. One barrier activity is to have
the student describe an item to someone who doesn't know what it is, e.g., an umbrella, a
calendar, a map, a baseball glove, a toaster.
 Discuss word associations, categories, similarities and differences, synonyms and
antonyms, attributes and multiple meanings. Use joke books and dictionaries. Make word
lists. Examine homonyms.
 Discuss abstract vocabulary, e.g., feelings, values, time.
 Focus on listening skills. The students should listen carefully to a comment or story and
associate what is said with their own experiences. They can listen for implied meaning and
significant clues. They can mentally summarize what the speaker is saying and listen for
direction-changing words, such as 'but'.
 It is also good to consider the following ideas when you are teaching:
- Add visual clues to verbal instructions (gestures, pictures)
- Highlight key words on a page with written instructions
- Keep your language familiar and predictable
- Make sure the students are paying attention. Are they looking at you?
- Ask students to repeat your instructions in their own words
- Give instructions in the right sequence.
For example, don't say: "Take the attendance before you start your group work, but be sure to get
the books you need first." Instead say: "Get the books you need, then take attendance, and then
you can start your group work."
Moreover, children often learn a specific language behavior in a classroom or clinical settings,
but fail to generalize the skill to other settings. The involvement of parents, siblings, and school

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personnel as participants in language training is one method of encouraging carryover of the
skill. In addition, teachers will use several other techniques for establishing generalization in
language training;
 Arrange the setting so the child is more likely to use language to meet needs

 Be responsive to attempts at communication

 Teach skills that are useful outside the classroom

 Vary the events and objects used in language training

 Use consequences that are varied and are related to the language being taught

 Reduce the rate of reinforcement as skills improve

 Avoid responding to needs before the child has an opportunity to use communication to
achieve needs (give the child time to respond)

The use of these general techniques, combined with the implementation of an organized
individual language intervention plan that involve the teacher, speech/language pathologist, and
parents, will help provide an environment in which the child with language-disorder can develop
greater proficiency in communication skills.

5.1.2. Intervention of children with speech disorders

Various approaches are employed in the treatment of speech disorders. Medical, dental or
surgical procedures can help many children whose speech problems result from organic causes.
The profession of speech-language pathology addresses both organic and non-organic causes and
encompasses practitioners with numerous points of view and a wide range of accepted
intervention techniques. Some specialists employ structured exercises and drills to correct speech
sounds. Others emphasize speech production in natural language contexts. Some prefer to work
with children in individual therapy sessions. Others believe that group sessions are advantageous
for language modeling and peer support. Some encourage children to imitate the therapist’s
speech. Others prefer to have the child listen to tapes of his/her own speech. Some specialists
follow a highly behavioral approach, in which target speech behavior are precisely promoted,
recorded and reinforced. Others favor less structured methods. Some speech-language therapists
focus their efforts exclusively on a child’s expressive and receptive communication. Others
devote attention to other aspects of the child’s behavior and environment, such as self-confidence
or interactions with parents and classmates.

Regarding articulation disorders, four models of treatment are widely used. In the
discrimination model emphasis is placed on developing the child’s ability to listen carefully and
detect the differences between similar sounds (such as “T” in take and “C” in cake). The child
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learns to match his speech to that of a standard model, using auditory, visual and tactual
feedback. The phonologic model seeks to identify the child’s pattern of sound production and to
teach him/her to produce gradually more acceptable sounds. A child who tends to omit final
consonants, for example, might be taught to recognize the difference between word pairs like
“two” and “tooth” and then to produce them more accurately. The sensori-motor model
emphasizes the repetitive production of sounds in various contexts, with special attention given
to the motor skills involved in articulation. Frequent exercises are employed to produce sounds
with differing stress patterns. The operant conditioning model: present specific stimuli and shape
articulator responses by providing reinforcing consequences

There is a generally consistent relationship between children’s ability to recognize sounds

and their ability to articulate them correctly. Whatever treatment models are used, the specialist
may have the child carefully watch how sounds are produced and then use a mirror to monitor
his/her own speech production. Children are expected to accurately produce problematic sounds
in syllables, words, sentences, and stories. They may tape record their own speech and listen
carefully for errors. It is sometimes helpful for children to learn to recognize the difference
between the way they produce a sound and the way other people produce it. As in all
communication training, it is important for the teacher, parent or specialist to provide a good
language model, to reward the child’s positive performance and to encourage the child to talk.

In the case of a child with a voice disorder, a medical examination should always be
sought. Organic causes often respond to surgery or medical treatment. In addition,
communication disorders specialists sometimes recommend environmental modifications. Most
remedial techniques, however, offer direct vocal rehabilitation, which helps the child with a
voice disorder gradually learn to produce more acceptable and efficient speech. Depending on
the type of voice disorder and the child’s overall circumstances, vocal rehabilitation may include
such activities as exercise to increase breathing capacity, relaxation techniques to reduce tension
or procedures to increase or decrease the loudness of speech.

The principles of applied behavior analysis have had a profound impact on the treatment
of voice disorders in recent years. Because many voice problems are directly attributable to vocal
abuse, behavioral principles are frequently used to pinpoint abusive vocal behaviors and then to
shape and modify them. Many children and adults have thus been able to break habitual patterns
of vocal misuse. The application of behavioral principles has strongly influenced recent practices
in the treatment of fluency disorders.

Reducing speech problems

The following tactics will be helpful in improving difficulties in speech production

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  Provide good models of appropriate speech. Speak clearly with appropriate pronunciation
and encourage students to demonstrate appropriate speech without calling attention to
classmate’s errors.

 Focus on quantity more than quality of speech

 Provide opportunities for practice.

Ten guidelines which is found to be helpful in talking with someone who has language and
communication disorder:

 The most important thing is to acknowledge your uncertainty and fear, and then try to
relax. Focus on the person rather than on your own nervousness. Remember, despite the
speech or language disorder, the individual is a person just like you. S/he has many
attributes besides the communication disorder.

 Maintain eye contact with the person. This is a basic non verbal way in which we bond
with others. It shows that we are “open for business”.

 Give the person enough time and opportunity to talk. It may take longer for the individual
to transmit a message. Speech is not an option for all persons who have communication
disorders. There are other systems (signs, symbol boards, electronic devices) to assist in
communication.

 You may have to listen more carefully than you usually do. Be aware that this requires
more effort-listening closely is hard work.

 Focus on what the person is saying rather that how he or she is saying it. The message is
what is important, not its form. In fact it is sometimes helpful to rephrase what was said
so that the speaker knows the intended message has been transmitted.

 If you don’t understand what the person is trying to say, tell him or her. Don’t pretend
that you understand when you don’t ask the person to repeat if necessary.

 Never fill in a word or assist an individual unless he or she asks for help offering
assistance before it is requested-simply assuming that help is needed-can be demeaning
and frustrating.

 Speak directly to the person, not to a companion, even if the individual is using an
interpreter. Never, under any circumstances, talk about the person in his/her presence.

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  In some instances, it may be helpful if you take more slowly and more simply. But don’t
talk down to the person or adopt a patronizing manner. It may also help to use gestures
along with your verbal message.

 Finally, let your language affirm the entire person, not just the communication disorder.
Put the person first, not the disability. The way we refer to individuals with disabilities
may shape our images of them- they become lispers, aphasics or clatterers.

Intervention takes place in various settings including speech and language specialty
clinics, home, and schools or classrooms. Direct therapy or group therapy provided by a
clinician, caretaker, or teacher can be child centered and/or include peer and family components.
The duration of the intervention varies. Intervention strategies focus on 1 or more domains
depending on individual needs, such as expressive language, receptive language, phonology,
syntax, and lexical (words) acquisition. Therapies can include naming objects, modeling and
prompting, individual or group play, discrimination tasks, reading, and conversation. Teachers
should need to provide intervention for children with language disorders through; Facilitating the
social use of language; Question-asking strategies; Teaching written language.

5.2. The influence of culture and families in the intervention of children with language and
communication disorders
“A good measure of the success of a society is how it treats its weakest members
similarly a good measure of the success of a school community is how it educates its most
vulnerable students”

How families could influence the practice of intervention of children with

communication disorder? How do interventionists would react to the negative influence of
parents in this process?
The acquisition of language is a dynamic and complex cultural act. Children acquire
communication skills within the cultural context of the family. Children’s language development
is influenced by cultural beliefs, family values, expectations, experiences and child–rearing
practices. An intervention program should be culturally sensitive and adaptive in order to provide
effective language and speech intervention.
Cross-cultural differences are not only present regarding communication interaction
patterns, but societies also differ with respect to what they consider to be normal or pathologic,
child rearing practices, beliefs regarding the nature of infants and perception of disability. These
differences necessitate professionals to develop cultural competence and become committed to
honoring cultural diversity through the services provided to families of children with speech and
language disorders. However, each family is unique and should be regarded as an individual unit
with its own values, beliefs, practices and needs. The recognized relationship between culture
and language reinforces the fact that cultural issues should be considered by speech-language
therapists when delivering intervention.
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5.2.1. Bilingual/Bicultural Issues
When working with bilingual/bicultural children when need to consider culturally/ linguistically
diverse groups.
5.2.2. The Need of Assistive Technology in the Process of Intervention
Assistive Technology is defined by IDEA (1997) "any item, piece of equipment, or
product system, whether acquired commercially “off the shelf”, modified, or customized, that is
used to increase, maintain, or improve the functional capabilities of a child with a disability".
Professionals further recommends the intervention team to consider whether the child needs
assistive technology devices and services or not, in the development of the Individual Education
Plan (IEP). Assistive technology may be helpful:
• increase student independence
• resolve transportation issues
• advance academic standing
• accomplish activities of daily living
• increase participation in classroom
activities • advance considerations for
continued training/education
• improve time-management skills
• improve job opportunities
• allow equal access to the school
environment • allow equal access to the workplace

• improve social interactions

Assistive technology considerations should center on the needs of the individual.

What does the disability prevent or impair the student from doing?
The most common technology used for children with language and speech disorders is
Augmentative (tending to increase) and Alternative Communication (AAC). AAC refers to aids,
strategies, and techniques designed to enhance a person’s existing communication skills. These
AAC systems may be simple displays (pictures or words printed on cardboard displays),
electronic devices (voice output devices with synthesized or digitized speech) or computer based
systems (voice output in addition to traditional computer functions). AAC systems can be
adapted to provide for the special needs of the individual.

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