COMMUNICATION

DISORDERS

Psych for Exceptional Children

Group 1 Presentation
 Outline:

 Definitions
 Characteristics
 Causes
 Identification and Assessment
 Educational Approach
 Educational Placement and Alternatives
Communication
Communication is the interactive exchange of information,
ideas, feelings, needs, and desires. Each communication
interaction includes three elements:
(a) a message,
(b) a sender who expresses the message, and
(c) a receiver who responds to the message.

Includes:
 NARRATING
 EXPLAINING/INFORMING
 REQUESTING
 EXPRESSING
Language
A language is a formalized code used by a group
of people to communicate with one another. All
languages consist of a set of abstract symbols—
sounds, letters, numbers, elements of sign
language—and a system of rules for combining
those symbols into larger units. Languages are not
static; they grow and develop as tools for
communication as the cultures and communities of
which they are part change. Nearly 7,000 living
languages are spoken in the world (Lewis, 2009).
 FIVE DIMENSIONS OF LANGUAGE

Phonology- refers to the linguistic rules governing a language’s sound system. Phonological
rules describe how sounds are sequenced and combined.
Morphology- a language that is concerned with the basic units of meaning and how those
units are combined into words.
Syntax- is the system of rules governing the meaningful arrangement of words.
Semantics- concerns the meaning of words and combinations of words.
Pragmatics- govern the social use of language.
3 Kinds of Pragmatic
(a) using language for different purposes (e.g., greeting, informing, demanding, promising,
requesting);
(b) changing language according to the needs of a listener
or situation (e.g., talking differently to a baby than to an adult, giving background information
to an unfamiliar listener, speaking differently in a classroom than on a playground); and
(c) following rules for conversations and storytelling (e.g., taking turns, staying on topic,
rephrasing when misunderstood, how close to stand when someone is talking, how to use
facial expressions and eye contact)
Speech
Speech is the oral production of language. Although
speech is not the only vehicle for expressing language
(e.g., gestures, manual signing, pictures, and written
symbols are also used), it is the fastest, most efficient
method of communication by language.

Most languages begin in spoken form, the product of people

talking with each other. Writing is a secondary language form
that uses graphic symbols to represent the spoken form. There
is no one-to-one correspondence, however, between
graphemes (print symbols or letters) and phonemes.
 Typical Speech and Language Development

Birth to 6 months
• Infant first communicates by crying, which produces a reliable consequence
in the form of parental attention.
• Different types of crying develop—a parent can often tell from the baby’s
cry whether she is wet, tired, or hungry.
• Comfort sounds—coos, gurgles, and sighs—contain some vowels and
consonants.
• Comfort sounds develop into babbling, sounds that in the beginning are
apparently made for the enjoyment of feeling and hearing them.
• Vowel sounds, such as /i/ (pronounced “ee”) and /e/ (pronounced “uh”), are
produced earlier than consonants, such as /m/, /b/, and /p/.
• Infant does not attach meaning to words she hears from others but may react
differently to loud and soft voices.
• Infant turns eyes and head in the direction of a sound.
 Typical Speech and Language Development

7 to 12 months
• Babbling becomes differentiated before the end of the
first year and contains some of the same phonetic
elements as the meaningful speech of 2-year-olds.
• Baby develops inflection—her voice rises and falls.
• She may respond appropriately to “no,” “bye-bye,” or
her own name and may perform an action, such as
clapping her hands, when told to.
• She will repeat simple sounds and words, such as
“mama.”
 Typical Speech and Language Development

12 to 18 months
• By 18 months, most children have learned to say
several words with appropriate meaning.
• Pronunciation is far from perfect; baby may say
“tup” when you point to a cup or “goggie” when she
sees a dog.
• She communicates by pointing and perhaps saying a
word or two.
• She responds to simple commands such as “Give me
the cup” and “Open your mouth.”
 Typical Speech and Language Development

18 to 24 months
• Most children go through a stage of echolalia, in which they repeat, or echo, the
speech they hear. Echolalia is a normal phase of language development, and most
children outgrow it by about the age of 21⁄2.
• There is a great spurt in acquisition and use of speech; baby begins to combine
words
into short sentences, such as “Daddy bye-bye” and “Want cookie.”

• Receptive vocabulary grows even more rapidly; at 2 years of age she may under-
stand more than 1,000 words.

• Understands such concepts as “soon” and “later” and makes more subtle distinctions
between objects such as cats and dogs and knives, forks, and spoons.
 Typical Speech and Language Development

2 to 3 years
• The 2-year-old child talks, saying sentences such as “I
won’t tell you” and asking questions such as “Where my
daddy go?”
• She participates in conversations.
• She identifies colors, uses plurals, and tells simple stories
about her experiences.
• She can follow compound commands such as “Pick up the
doll and bring it to me.”
• She uses most vowel sounds and some consonant sounds
correctly.
 Typical Speech and Language Development

3 to 4 years
• The normal 3-year-old has lots to say, speaks rapidly, and asks many questions.
• She may have an expressive vocabulary of 900–1,000 different words, using sentences
of three to four words.
• Sentences are longer and more varied: “Cindy’s playing in water”; “Mommy went
to work”; “The cat is hungry.”
• She uses speech to request, protest, agree, and make jokes.
• She understands children’s stories; grasps such concepts as funny, bigger, and secret;
and can complete simple analogies such as “In the daytime it is light; at night it is . . . ”
• She substitutes certain sounds, perhaps saying “baf” for “bath” or “yike” for “like.”
• Many 3-year-olds repeat sounds or words (“b-b-ball,” “l-l-little”). These repetitions and
hesitations are normal and do not indicate that the child will develop a habit of stuttering.
 Typical Speech and Language Development

4 to 5 years
• The child has a vocabulary of more than 1,500–2,000 words and uses
sentences averaging five words in length.
• She begins to modify her speech for the listener; for example, she uses
longer and more
complex sentences when talking to her mother than when addressing a
baby or a doll.
• She can define words such as “hat,” “stove,” and “policeman” and can
ask questions such as “How did you do that?” or “Who made this?”
• She uses conjunctions such as “if,” “when,” and “because.”
• She recites poems and sings songs from memory.
• She may still have difficulty with consonant sounds such as /r/, /s/, /z/
and /j/ and with blends such as “tr,” “gl,” “sk,” and “str.”
 Typical Speech and Language Development

After 5 years

• Language continues to develop steadily, although less dramatically, after

age 5.
• A typical 6-year-old uses most of the complex forms of adult English
and has an
expressive vocabulary of 2,600 words and a receptive understanding of
more than
20,000 words.
• Most children achieve adult speech sound production by age 7.
• Grammar and speech patterns of a child in first grade usually match
those of her
family, neighborhood, and region.
Communication Disorders
Communication Disorders Defined

 The American Speech-Language-Hearing Association (ASHA) (1993) defines a

communication disorder as “an impairment in the ability to receive, send, process, and
comprehend concepts or verbal, nonverbal and graphic symbols systems. A
communication disorder may be evident in the processes of hearing, language, and/or
speech”

 To be eligible for special education services, a child’s communication disorder must have
an adverse effect on learning. The Individuals with Disabilities Education Act (IDEA)
defines speech or language impairment as “a communication disorder, such as stuttering,
impaired articulation, a language impairment, or a voice impairment that adversely affects
a child’s educational performance”

 Like all disabilities, communication disorders vary widely by degree of severity. Some
children’s speech and language deviate from those of most children to such an extent that
they have serious difficulties in learning and interpersonal relations. Children who cannot
make themselves understood or who cannot comprehend ideas spoken to them by others
experience a significant handicap in virtually all aspects of education and personal
adjustment. A severe communication disorder may lead others—teachers, classmates,
people in the community—to erroneously believe the child does not care about the world
around him or simply has nothing to say (Downing, 2005).
 SPEECH IMPAIRMENTS

A widely used definition considers speech to be impaired “when it

deviates so far from the speech of other people that it
(a) calls attention to itself,
(b)interferes with communication, or
(c) provokes distress in the speaker or the listener” (Van Riper &
Erickson, 1996, p. 110).

Three basic types of speech impairments

 are articulation disorders (errors in the production of speech sounds)
 fluency disorders (difficulties with the flow or rhythm of speech),
and
 voice disorders (problems with the quality or use of one’s voice).
 LAANGUAGE IMPAIRMENTS

A language disorder is “impaired comprehension and/or use of spoken, written,

and/or other symbol systems. The disorder may involve
(a) The form of language (phonology, morphology, and syntax),
(b) The content of language (semantics), and/or
(c) The function of language in communication (pragmatics) in any
combination” (ASHA, 1993, p. 40).
 A child with a receptive language disorder may struggle learning the days of the
week in proper order or following a sequence of commands such as “Pick up the
paint brushes, wash them in the sink, and then put them on a paper towel to dry.”
 A child with an expressive language disorder may have a limited vocabulary for
her age, say sounds or words in the wrong order (e.g., “hostipal,” “aminal,” “wipe
shield winders”), and use tenses and plurals incorrectly (e.g., “Them throwed a
balls”).
 Children with an expressive language disorder may or may not also have
difficulty in receptive language.
Communication Differences Are
Not Disorders
Speech-Sound Errors
Four basic kinds of speech-sound errors occur:

• Distortions. A speech sound is distorted when it sounds more like the

intended phoneme than another speech sound but is conspicuously wrong.
The /s/ sound, for example, is relatively difficult to produce; children may
produce the word “sleep” as “schleep,” “zleep,” or “thleep.” Some speakers
have a lisp; others a whistling /s/. Distortions can cause misunderstanding,
although parents and teachers often become accustomed to them.
• Substitutions. Children sometimes substitute one sound for another, as in
saying “train” for “crane” or “doze” for “those.” Children with this problem are
often certain they have said the correct word and may resist correction.
Substitution of sounds can cause considerable confusion for the listener.
• Omissions. Children may omit certain sounds, as in saying “cool” for
“school.” They may drop consonant s from the ends of words, as in “pos” for
“post.” Most of us leave out sounds at times, but an extensive omission
problem can make speech unintelligible.
• Additions. The addition of extra sounds makes comprehension difficult. For
example, a child might say “buhrown” for “brown” or “hamber” for “hammer.”
Traditionally, all speech-sound errors bychildren were
identified as articulation problems and thought to be
relatively simple to treat. Articulation refers to the
movement of muscles and speech organs necessary to
produce various speech sounds. Research during the
past two decades, however, has revealed that many
speech-sound errors are not simply a function of faulty
mechanical operation of the speech apparatus but are
directly related to problems in recognizing or
processing the sound components of language
(phonology)
(Schwartz & Marton, 2011).
 ARTICULATION DISORDERS

 An articulation disorder means that a child is at present not able to

produce a given sound physically; the sound is not in his repertoire
of sounds.

 A severe articulation disorder is present when a child pronounces

many sounds so poorly that his speech is unintelligible most of the
time; even the child’s parents, teachers, and peers cannot easily
understand him. The child with a severe articulation disorder may
say, “Yeh me yuh a da wido,” instead of “Let me look out the
window,” or perhaps “Do foop is dood” for “That soup is good.”

 The fact that articulation disorders are prevalent does not mean that
teachers, parents, and specialists should regard them as simple or
unimportant. On the contrary, as Haynes and Pindzola (2012)
observe, an articulation disorder severe enough to interfere
 PHONOLOGICAL DISORDERS

 A child is said to have a phonological disorder if she

has the ability to produce a given sound and does so
correctly in some instances but does not produce the
sound correctly at other times.
 Children with phonological disorders are apt to
experience problems in academic areas, and they are
especially at risk for difficulties in reading (Bishop &
Snowling, 2004) and writing (Dockrell, Lindsay,
Connelly, & Mackie, 2007).
 Determining whether a speech-sound error is
primarily an articulation or a phonological disorder
 DISTINGUISHING ARTICULATION
AND PHONOLOGICAL DISORDERS

Articulation Disorder Phonological Disorder

• Difficulty with only a few sounds, • Multiple sound errors with obvious
with limited effect on intelligibility impairment of intelligibility
• Consistent misarticulation of • Inconsistent misarticulation of
specific sounds sounds
• Sound errors are motoric • Can motorically produce sound but
not in appropriate places

• Co-existing communication • Errors consistent with a phonolog

disorders possible but not as likely ical process (e.g., final consonant
as with phonological disorders deletion, making an error on a sound
in one position but producing that
sound correctly in another position,
as in omitting “t” in “post” but
producing “t” in “time”)
• Other language delays likely
(because phonology is a component
Fluency Disorders
A fluency disorder is an “interruption in the
flow of speaking characterized by atypical rate,
rhythm, and repetitions in sounds, syllables,
words, and phrases. This may be accompanied
by excessive tension, struggle behavior, and
secondary mannerisms” (ASHA, 1993, p. 40).
 STUTTERING

 The best-known (and in some ways least understood) fluency disorder is stuttering,
a condition marked by rapid-fire repetitions of consonant or vowel sounds,
especially at the beginnings of words, prolongations, hesitations, interjections, and
complete verbal blocks (Ramig & Pollard, 2011).
 Developmental stuttering is considered a disorder of childhood. Its onset is usually
between the ages of 2 and 4, and rarely after age 12 (Bloodstein & Bernstein
Ratner, 2007).
 It is believed that 4% of children stutter for 6 months or more and that 70% to 80%
of children 2 to 5 years old who stutter recover spontaneously, some taking until
age 8 to do so (Yairi & Ambrose, 1999).
 Stuttering is far more common among males than females, and it occurs more
frequently among twins. It is believed that approximately 3 million people in the
United States stutter (Stuttering Foundation of America, 2011).
 The incidence of stuttering is about the same in all Western countries: regardless of
what language is spoken, about 1% of the general population has a stuttering
problem at any given time.
 The causes of stuttering remain unknown, although the condition has been
studied extensively with some interesting results. A family member of a
person who stutters is 3 to 4 times more likely to stutter than the family
member of a person who does not stutter. It is not known whether this is
the result of a genetic connection or an environment conducive to the
development of the disorder, or a combination of hereditary and
environmental factors (Yairi & Seery, 2011).
 Stuttering is situational; that is, it appears to be related to the setting or
circumstances of speech.
 A child may be more likely to stutter when talking with people whose
opinions matter most to him, such as parents and teachers, and in situations
such as being called on to speak in front of the class.
 Most people who stutter are fluent about 90% of the time; a child with a
fluency disorder may not stutter at all when singing, talking to a pet, or
reciting a poem in unison with others.
 Reactions and expectations of parents, teachers, and peers clearly have an
important effect on any child’s personal and communicative development.
 CLUTTERING

 A type of fluency disorder known as cluttering is

characterized by excessive speech rate, repetitions,
extra sounds, mispronounced sounds, and poor or
absent use of pauses.
 The clutterer’s speech is garbled to the point of
unintelligibility. “Let’s go!” may be uttered as “Sko!”
and “Did you eat?” collapsed to “Jeet?” (Yairi & Seery,
2011).
 Whereas the stutterer is usually acutely aware of his
fluency problems, the clutterer may be oblivious to his
disorder.
Voice Disorders
 Voice is the sound produced by the larynx. A voice disorder is
characterized by “the abnormal production and/or absences of vocal
quality, pitch, loudness, resonance, and/or duration, which is
inappropriate for an individual’s age and/or sex” (ASHA,1993, p.
40).
 A voice is considered normal when its pitch, loudness, and quality
are adequate for communication and it suits a particular person. A
voice—whether good, poor, or in between—is closely identified
with the person who uses it.
 Voice disorders are more common in adults than in children.
Considering how often some children shout and yell without any
apparent harm to their voices, it is evident that the vocal cords can
withstand heavy use. In some cases, however, a child’s voice may be
difficult to understand or may be considered unpleasant (Sapienza,
Hicks, & Ruddy, 2011).
 Dysphonia- describes any condition of poor or unpleasant voice
quality.
 The Two Basic Types of Voice Disorders
Phonation Disorder- causes the voice to sound breathy, hoarse, husky, or
strained most of the time. In severe cases, there is no voice at all.
-Phonation disorders can have organic causes, such as growths or
irritations on the vocal cords; but hoarseness most frequently comes from
chronic vocal abuse, such as yelling, imitating noises, or habitually talking
while under tension.
-Misuse of the voice causes swelling of the vocal folds, which in
turn can lead to growths known as vocal nodules, nodes, or polyps. A
breathy voice is unpleasant because it is low in volume and fails to make
adequateuse of the vocal cords.

Resonance Disorder- characterized by either too many sounds coming out

through the air passages of the nose ( hypernasality) or, conversely, not
enough resonance of the nasal passages ( hyponasality).
-The hypernasal speaker may be perceived as talking through her
nose or having an unpleasant twang (Hall et al.,2001).
-A child with hyponasality (sometimes called denasality) may
Language Disorders
 Language disorders involve problems in one or more of the five dimensions of
language: phonology, morphology, syntax, semantics, and/or pragmatics.
 Language disorders are usually classified as either receptive or expressive. As
described previously, a receptive language disorder interferes with the
understanding of language. A child may, for example, be unable to comprehend
spoken sentences or 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 speak at all, communicating only through gestures.
 A child may have good receptive language when an expressive disorder is
present or may have both expressive and receptive disorders in combination.
 Educators sometimes use the term language-learning disability (LLD) to refer
to children with significant receptive and/or expressive language disorders.
 To say that a child has a language delay does not necessarily mean that the
child has a language disorder. As Reed (2012) explains, a language delay
implies that a child is slow to develop linguistic skills but acquires them in the
same sequence as typically developing children do. Generally, all language
features are delayed at about the same rate.
 A language disorder, however, suggests a disruption in the usual rate and/or sequence in
which specific language skills emerge. For example, a child who consistently has difficulty
in responding to who, what, and where questions but who otherwise displays language skills
appropriate for her age would likely be considered to have a language disorder.

 Children with serious language disorders are almost certain to have problems in school and
with social development. They frequently play a passive role in communication.

 Children with impaired language are less likely to initiate conversations than are their peers.
When children with language disorders are asked questions, their replies rarely provide new
information related to the topic. It is often difficult to detect children with language
disorders; their performance may lead people to mistakenly classify them with disability
labels such as intellectual disabilities, hearing impairment, or emotional disturbance, when in
fact these descriptions are neither accurate nor appropriate.

 Young children with oral language problems are also likely to have reading and writing
disabilities (Catts et al., 2002; DeThorne, Petrill, Schatschneider, & Cutting, 2010). For
example, Catts (1993) reported that 83% of kindergarteners with speech-language delays
eventually qualified for remedial reading services. The problem is compounded because
children with speech-language delays are more likely than their typically developing peers to
be “treatment-resistors” to generally effective early literacy interventions (Al Otaiba, 2001).
Causes
Many types of communication disorders and
numerous possible causes are recognized.
 A speech or language impairment may be organic
—that is, attributable to damage, dysfunction, or
malformation of a specific organ or part of the
body.
 Most communication disorders, however, are not
considered organic but are classified as functional.
 A functional communication disorder cannot be
ascribed to a specific physical condition, and its
origin is not clearly known.
 Causes of Speech Impairments

 Examples of physical factors that frequently result in speech

impairments are cleft palate, paralysis of the speech muscles,
absence of teeth, craniofacial abnormalities, enlarged
adenoids, and traumatic brain injury.
Dysarthria refers to a group of speech disorders caused by
neuromuscular impairments in respiration, phonation,
resonation, and articulation.
 Lack of precise motor control needed to produce and
sequence sounds causes distorted and repeated sounds.
 An organic speech impairment may be a child’s primary
disability, or it may be secondary to other disabilities, such as
cerebral palsy or intellectual disabilities.
 Causes of Language Disorders
 Factors that can contribute to language disorders in children include developmental and
intellectual disabilities, autism, traumatic brain injury, child abuse and neglect, hearing
loss, and structural abnormalities of the speech mechanism (Bacon & Wilcox, 2011).
 Language is so important to academic performance that it can be impossible to
differentiate a learning disability from a language disorder (Silliman & Diehl, 2002).
 Some severe disorders in expressive and receptive language result from injury to the
brain.
 Aphasia describes a loss of the ability to process and use language.
 Aphasia is one of the most prevalent causes of language disorders in adults, most often
occurring suddenly after a cardiovascular event (stroke).
 Head injury is a significant cause of aphasia in children. Aphasia may be either expressive
or, less
commonly, receptive.
 Children with mild aphasia have language patterns very similar to those of typically
developing children but may have difficulty retrieving certain words and tend to need
more time than usual to communicate.
 Children with severe aphasia, however, are likely to have a markedly reduced storehouse
of words and language forms.
 Causes of Language Disorders
 Research indicates that genetics may contribute to communication
disorders (McNeilly, 2011).
 Scientists in Britain have discovered a gene area that affects speech
(Porterfield, 1998), and other researchers have reported genetic
links to phonological disorders (Uffen, 1997) and stuttering (Yairi,
1998).
 Environmental influences also play an important part in delayed,
disordered, or absent language. The communication efforts of some
children are reinforced; other children, unfortunately, are punished
for talking, gesturing, or otherwise attempting to communicate.
 A child who has little stimulation at home and few chances to
speak, listen, explore, and interact with others will probably have
little motivation for communicating and may well experience
delays in language development (Kang et al., 2010).
Identification and Assessment
 Screening and Teacher Observation
 Evaluation Components
 Case history and physical examination
 Articulation
 Hearing
 Phonological awareness and processing
 Overall language development and vocabulary
 Language samples
 Observation in natural settings
 Assessment of Communication Disorders in
Children Whose First Language Is Not English
or Who Use Nonstandard English
Educational Approaches
 Speech-language pathologist (SLP)
 Speech Therapist
 Speech Clinician
 Speech Teacher
INTERVENTION ACROSS COMMUNICATION
FUNCTIONS
 Language Function
Echoic (or imitation for sign language)—
repeating words spoken (or signs made) by others.
Mand —asking for desired items, actions,
properties, information, etc.
Tact —naming items, actions, properties, etc.
Listener —responding to the language of others.
Intraverbal —answering questions or verbally
responding to the words spoken by others.
Textual —reading
Transcription —spelling
Treating Speech-Sound Errors
 ARTICULATION ERRORS
 Discrimination activities
 Production
 PHONOLOGICAL ERRORS
 When a child’s spoken language problem includes one or more
phonological errors, the goal of therapy is to help the child identify
the error pattern(s) and gradually produce more linguistically
appropriate sound patterns (Barlow, 2001).
 Therapeutic tasks are constructed so that the child is rewarded for
following directions (e.g., “Pick up the seal card”) and speaking
clearly enough for the therapist to follow his or her directions (e.g.,
the child directs the SLP to give him the seat card). To respond
correctly, the child must attend to and use the information in the final
consonant sound.
 Sounds are not taught in isolation. Children with phonological
problems can often articulate specific sounds but do not use those
sounds in proper linguistic context.
Treating Fluency Disorders
 Throughout history, people who stutter have been subjected to
countless treatments— some of them unusual, to say the least. Past
treatments included holding pebbles in the mouth, sticking fingers into
a light socket, talking out of one side of the mouth, eating raw oysters,
speaking with the teeth clenched, taking alternating hot and cold baths,
and speaking on inhaled rather than exhaled air (Ham, 1986).

 For many years, it was widely thought that a tongue that was unable to
function properly in the mouth caused stuttering. As a result, it was
common for early physicians to prescribe ointments to blister or numb
the tongue or even to remove portions of the tongue through surgery!
 Lidcombe Program
 Audio recorders\
 an SLP working together.
 There is no single treatment for stuttering because the causation, type,
and severity of nonfluencies vary from child to child.
Treating Voice Disorders
 A thorough medical examination should always be sought for a child with a voice
disorder. Surgery or other medical interventions can often treat organic causes.

 In addition, SLPs often recommend environmental modifications; a person who is

consistently required to speak in a noisy setting, for example, may benefit from the use of
a small microphone to reduce vocal straining and shouting. 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.

 Voice therapy often begins with teaching the child to listen to his own voice and learn to
identify those aspects that need to be changed. Depending on the type of voice disorder
and the child’s overall circumstances, vocal rehabilitation may include activities such as
exercises to increase breathing capacity, relaxation techniques to reduce tension, vocal
hygiene (e.g., drink fluids, avoid excessive throat clearing, vocal rest), and procedures to
increase or decrease the loudness of speech (Sapienza et al., 2011).

 Because many voice problems are directly attributable to vocal abuse, techniques from
applied behavior analysis can be used to help children and adults break habitual patterns
of vocal misuse. For example, a child might self-monitor the number of abuses he
commits in the classroom or at home, receiving rewards for gradually lowering the
number of abuses over time.
Treating Language Disorders
 Children with language impairments might develop written language skills by
exchanging e-mail letters with pen pals (Harmston, Strong, & Evans, 2001).
 VOCABULARY BUILDING Vocabulary has been called the building block of
language (Dockrell & Messer, 2004).
 Children with language disorders have a limited store of words to call upon.
Speech-language pathologists and classroom teachers use a wide variety of
techniques to build students’ vocabulary, including graphic organizers,
mnemonics, and learning strategies described in Chapter 5 . Foil and Alber
(2003) recommend that teachers use the following sequence to help students
learn new vocabulary:
1. Display each new word, pronounce it, give the meaning of the word, and have
students repeat it.
2. Provide and have students repeat multiple examples of the word used in
context.
3. Connect the word and its meaning to students’ current knowledge, and prompt
students to describe their experiences related to the word.
4. Provide multiple opportunities for students to use the word in context during
guided practice, and provide feedback on their responses.
5. Help students discriminate between words with similar
meanings but subtle differences (e.g., separate and
segregate).

6. Assign independent practice activities; challenge students

to select new vocabulary words to learn independently.

7. Promote generalization and maintenance by prompting

students to use their new vocabulary, providing praise and
other forms of reinforcement when students’ speech and
writing contain new vocabulary, and having students self-
record how often they use new vocabulary.
 NATURALISTIC STRATEGIES Speech-language
pathologists are increasingly employing naturalistic
interventions to help children develop and use
communication skills.
 Naturalistic approaches were developed as an alternative to
didactic language interventions because children often
experienced difficulties in generalizing new skills from
structured teaching settings to everyday contexts.
 In contrast to didactic teaching approaches, which use
contrived materials and activities (e.g., pictures, puppets)
and massed trials to teach specific skills, naturalistic
interventions, often called milieu or incidental teaching,
take advantage of naturally occurring activities throughout
the day to provide motivation and opportunities for a child
to use language skills (Downing, 2011).
 Kaiser and Grim (2006) make the following recommendations about
naturalistic interventions:
• Teach when the child is interested.
• Teach what is functional for the student at the moment.
• Stop while both the student and the teacher are still enjoying the
interaction.

 Naturalistic interventions involve structuring the environment to create

numerous opportunities for desired child responses (e.g., holding up a
toy and asking, “What do you want?”) and structuring adult responses
to a child’s communication (e.g., the child points outside and says, “Go
wifth me,” and the teacher says, “Okay, I’ll go with you”).

 However, good naturalistic teaching does not mean the teacher should
wait patiently to see whether and when opportunities for meaningful
and interesting language use by children occur.
 SIX STRATEGIES FOR INCREASING
NATURALISTIC
OPPORTUNITIES FOR LANGUAGE
TEACHING

1. Interesting materials
2. Out of reach
3. Inadequate portions
4. Choice-making
5. Assistance
6. Unexpected situations
Augmentative and Alternative
Communication
Augmentative and alternative communication (AAC) refers to a diverse
set of strategies and methods to assist individuals who cannot meet
their communication needs through speech or writing. AAC entails
three components (Kangas & Lloyd, 2011):
• A representational symbol set or vocabulary
• A means for selecting the symbols
• A means for transmitting the symbols

Beukelman and Miranda (1998) suggest that decisions about what to

include in a student’s augmentative vocabulary should take into
account the following:
• Vocabulary that peers in similar situations and settings use
• What communication partners (e.g., teachers, parents) think will be
needed
• Vocabulary the student is already using in all modalities
• Contextual demands of specific situations
 SYMBOL SETS AND SYMBOL SYSTEMS
Symbol sets are graphic, which means that the symbols look
like the object or concept they represent as much as possible.
Numerous symbol sets are available both commercially and
free. These sets are a collection of pictures or drawings in
which each symbol has one or more specified meanings, from
which a person’s AAC vocabulary might be constructed.
Symbol Systems
structured around an internal set of rules that govern how new
symbols are added to the system. One of the best-known
symbol systems is Blissymbolics, an international graphical
language of over 4,000 symbols, first developed for use by
people with physical disabilities. (Blissymbolics
Communication International, 2011).
 SELECTING THE SYMBOLS
• Students select symbols in augmentative communication by direct
selection, scanning, or encoding responses (Kangas & Lloyd, 2011).
• Direct selection involves pointing to the symbol one wishes to express
with a finger or fist or sometimes with a wand attached to the head or chin.
With a limited number of selections widely spaced from one another, the
user can select symbols by “eye pointing.”
• Scanning techniques present choices to the user one at a time, and the user
makes a response at the proper time to indicate which item or group of
selections she wants to communicate. Scanning can be machine or listener
assisted.
TRANSMITTING THE SYMBOLS
• After meaningful vocabulary and an appropriate symbol set have been
determined, a method of transmitting the symbols must be considered.
• An ever-more sophisticated variety of AAC devices offer a wide range of
alternatives for transmitting communication symbols. Software developers
have created numerous AAC apps for smart phones, such as the iPhone and
Android, and for portable tablets, such as the iPad.
 Using PECS to
Teach Functional Communication Skills
1. Conduct preference assessment
2. Create a set of pictures
3. Teach basic picture exchange
4. “Stretch” the lesson
5. Teach discrimination
6. Teach simple sentence structure
7. Teach attributes
8. Teach responding to questions
9. Teach commenting
Educational Placement Alternatives
 Monitoring
The SLP monitors or checks on the student’s speech and
language performance in the general education
classroom. This option is often used just before a
student is dismissed from therapy.
Pull-Out
The traditional and still most prevalent model of service
delivery is the pull-out approach, sometimes called
intermittent direct service. SLPs spend two-thirds of
their time working with a child individually or with
small groups of up to three children (ASHA, 2010).
Depending on the needs of the individual child, pull-out
may involve sessions of up to 1 hour 5 days per week.
 Collaborative Consultation
-Increasingly, communication disorders specialists serve as consultants for regular
and special education teachers (and parents) rather than spending most of their
time providing direct services to individual children (Dohan & Schulz, 1998).
-SLPs who work in school settings more often function as team members
concerned with children’s overall education and development. The SLP often
provides training and consultation for the general education classroom teacher,
who may do much of the direct work with a child with communication disorders.
The specialist concentrates on assessing communication disorders, evaluating
progress, and providing materials and techniques. Teachers and parents are
encouraged to follow the specialist’s guidelines.
Classroom or Curriculum Based
Increasingly, SLPs are working as educational partners in the classroom,
mediating between students’ communication needs and the communication
demands of the academic curriculum. SLPs report devoting about one-fourth of
time in helping teachers integrate language and speech goals into daily curriculum
activities. The advantage is that services are brought to the child and the teacher,
and communication connections with the curriculum are made more directly.
 Separate Classroom
Students with the most severe communication disorders are served in
special classrooms for children with speech or language impairments.
During the 2009–10 school year, approximately 1 in 20 children with
speech or language impairments were served in separate classes (U.S.
Department of Education, 2011).
Community Based
In community-based models, speech and language therapy is provided
outside the
school, usually in the home. This model is most often used with
preschoolers and
sometimes for students with severe disabilities, with an emphasis on
teaching functional communication skills in the community.
Combination
Variations of all these models exist, and many schools and SLPs serve
children using
combinations of two or more models.
Supporting Students with Language
Disorders
LANGUAGE IMPAIRMENTS
Although each student with a language
impairment presents a unique profile, teachers
can implement some general strategies when
working with these students.

• Thoroughly explain new vocabulary

• Embed new vocabulary across the curriculum
• Provide longer wait time
• Break multistep directions into smaller
components
ARTICULATION ERRORS
Although students in the primary grades exhibit
variability in speech-sound development, most
typically developing children consistently make
most speech sounds by the time they begin
kindergarten.

• Do not confuse typical speech-sound

development with serious articulation errors
• Consult with your school’s SLP if you have a
hard time understanding a child’s speech.
STUTTERING
Many teachers are unsure of what to do with a
student who
stutters. Here are a few general guidelines:

• Don’t anticipate what the student wants to say

and finish the utterance for her
• Consistently model a relaxed and unhurried
speaking style
• Ask the student what strategies she uses to
speak more fluently.
 A qualitative case study in the social capital of co-
professional collaborative co-practice for children with
speech, language and communication needs
Effective co-practice is essential to deliver services for children with
speech, language and communication needs (SLCN). The necessary
skills, knowledge and resources are distributed amongst
professionals and agencies. Co-practice is complex and a number of
barriers, such as ‘border disputes’ and poor awareness of respective
priorities, have been identified. However social–relational aspects of
co-practice have not been explored in sufficient depth to make
recommendations for improvements in policy and practice. Here we
apply social capital theory to data from practitioners: an analytical
framework with the potential to move beyond descriptions of socio-
cultural phenomena to inform change (McKean C. et al.,2016).
 Methods & Procedures
A qualitative case study of SLCN provision within one local
authority in England and its linked NHS partner was completed
through face-to-face semi-structured interviews with professionals
working with children with SLCN across the authority. Interviews,
exploring barriers and facilitators to interagency working and social
capital themes, were transcribed, subjected to thematic analysis
using iterative methods and a thematic framework derived.
 Outcomes & Results
McKean C. et al. (2016) identified a number of characteristics
important for the effective development of trust, reciprocity and
negotiated co-practice at different levels of social capital networks:
macro—service governance and policy; meso—school sites; and
micro—intra-practitioner knowledge and skills. Barriers to co-
practice differed from those found in earlier studies. Some negative
aspects of complexity were evident, but only where networked
professionalism and trust was absent between professions. Where
practitioners embraced and services and systems enabled more fluid
forms of collaboration, then trust and reciprocity developed.
 Conclusions & Implications
Highly collaborative forms of co-practice, inherently more complex
at the service governance, macro-level, bring benefits. At the meso-
level of the school and support team network there was greater
capacity to individualize co-practice to the needs of the child.
Capacity was increased at the micro-level of knowledge and skills to
harness the overall resource distributed amongst members of the
inter-professional team. The development of social capital, networks
of trust across SLCN support teams, should be a priority at all levels
—for practitioners, services, commissioners and schools.