SHRI VAISHNAV VIDYAPEETH VISHWAVIDYALAYA

(SVISSHA)

Topic:- Language disorders

SUBMITTED TO:- SUBMITTED

BY:-
Dr. Shubhi Vyas Garima Pathak
M.Sc.Clinical Psychology
Language Disorders
Communication
■ There are 3 elements in this exchange, and
all must be present:
1.Message
2.Message must be expressed
3.Message must be understood
Speech and Language
■ Speech is the motor act of communicating
by articulating verbal expression
■ Language is the knowledge of a symbol
system used for interpersonal
communication.
Four domains of language
■ Phonology
■ Grammar
■ Semantics
■ Pragmatics
Phonology
■ The ability to produce and discriminate
the specific sounds of a given language.
■ Its unit, the phoneme, is characterized by
distinctive features.
■ Babies start discriminating phonemes during
the first few months of life, and they produce
them soon after.
Phonology
■ Phonological receptivity is pluripotential at
birth
■ Starts to decay at around 10 months
■ Reaches a rather general inability to acquire
native phonology by preadolescence
Grammar
■ The underlying rules that organize any
specific language.
■ The combinatorial rules that most native
speakers of a language recognize as
acceptable for that language and that allow
a native speaker an infinite array of
generative possibilities.
Grammar
■ Composed of both morphology and syntax.
Semantics
■ The study of meaning
■ Includes the study of vocabulary (lexicon).
Lexicon
■ Lexical entries are organized in the mental
dictionary according to well-defined rules
■ Allows the young child to acquire a peak
average of 10 new words per day.
■ By 24 months the average child knows 50
words.
Lexicon Growth
■ The subsequent
exponential growth
makes it difficult to
determine
vocabulary size with
exactitude.
Environmental factors
predicting large vocabularies
■ Reading and discussing children's stories
■ The quality of dinner table conversations
■ Large mother-produced number of words
■ Higher socioeconomic status (SES)
■ Being the firstborn ( Hoff-Ginsberg, 1998 )
■ Quantity and sophistication of mother's
vocabulary ( Snow, 1998 ).
Pragmatics
■ A number of sub-domains reflecting
communicative competence.
Sub domains of Pragmatics
■ Rules of conversation (turn-taking, topic
maintenance, conversational repair)
■ Politeness
■ Narrative and extended discourse
■ The implementation of communicative
intents
Pragmatic disorders
■ Little variety in language use
■ May say inappropriate or unrelated things
during conversations
■ May tell stories in a disorganized way
■ Can often make demands, ask questions,
and greet people
■ Has trouble organizing language to talk
about what happened in the past.
Pragmatic disorders
■ Appear to pull topics out of the air
■ May not use statements that signal a
change in topic, such as "That reminds me."
■ Peers may avoid having conversations with
such a child.
■ Can lower social acceptance.
Language Developmental
Trajectory

Telegraphic speech

Word combinations

Word production

Word comprehension

Canonical
Babbling
■ By age 3, most
normal children
have mastered the
basic structures of
their native
language
Language acquisition
■ Occurs with uniformity and rapidity
■ Supports the hypothesized existence of
innate, genetically determined Universal
Grammars
■ Recently proposed a combination of
traditional learning and innate language
modules.
Disfluencies in Children
■ Almost all children go through a stage of
frequent disfluency
■ usually between the ages of 2 and 5.
■ Speech is produced easily in spite of the
disfluencies.
Etiology of Speech &
Language Disorders
■ Mental retardation ■ Bilingualism
■ Hearing loss ■ Psychosocial
■ Maturation delay deprivation
(developmental
■ Autism
language delay)
■ Expressive ■ Elective mutism
language disorder ■ Receptive aphasia
(developmental ■ Cerebral palsy
expressive aphasia)
Overview of major types of
speech disorders
■ Definitions vary, but
generally agree that
speech disorders involve
deviations of sufficient
magnitude to interfere
with communication.
■ They draw attention to
the speaking act and
away from the message
1. Fluency Disorders
■ Speech is characterized by repeated
interruptions, hesitations, or repetitions
■ Stuttering is by far the most well-known
fluency disorder
1. Fluency disorders - Stuttering
■ Flow of speech is abnormally interrupted by
repetitions, blocking, or prolongations of
sounds, syllables, words, or phrases
■ Very familiar, but actually quite rare – only 1-
5% of the population.
■ Articulation disorders actually occur much
more frequently than stuttering
Stuttering -- Causes
■ Still a mystery
■ Three perspectives:
1. Symptom of emotional
disturbance
2. Result of biological
makeup
3. Learned response
Stuttering
■ Disorder of speech fluency that interrupts
the forward flow of speech.
■ All individuals are disfluent at times
■ Differentiated by the kind and amount of the
disfluencies
Characteristics-Repetition
■ Sounds
■ b-b-b-ball
■ Syllables
■ mo-mo-mommy
■ Parts of words
■ basket-basket-basketball
■ Whole words, and phrases
Characteristics-Prolongation
■ Stretching, of sounds or syllables
■ r-----abbit
Characteristics
■ Tense pauses, hesitations, and/or no sound
between words
■ Speech that occurs in spurts
■ as the child tries to initiate or maintain voice
■ Variability in stuttering behavior
■ depending on the speaking situation
Related behaviors
■ tense muscles in the lips, jaw, and/or neck
■ tremor of the lips, jaw, and/or tongue
■ foot tapping
■ eye blinks
■ head turns
2. Articulation disorders
■ This is the largest category of all speech
problems
■ DSM-IV calls these “phonological
disorders.”
■ “abnormal speech-sound production,
characterized by inaccurate or otherwise
inappropriate execution of speaking”
2. Articulation disorders
■ Great majority are functional articulation
disorders
■ Might represent as much as 80% of the speech
disorders diagnosed by speech clinicians
■ Must be very careful to distinguish true problems
from delay.
■ E.g., r, s, th problems may largely disappear
naturally after 5 years of age
2. Articulation disorders
1.Omissions
2.Substitutions
3.Additions
4.Distortions
3. Voice disorders
■ Unusual or abnormal acoustical qualities in
the sounds made when a person speaks
■ Very little research here
■ What is a “normal” sounding voice?
■ Nasality, hoarseness, breathiness
Normal Speech Development
4. Delayed speech

■ Failure to develop speech at the

expected age
■ Somewhat subjective
■ Usually associated with other
maturational delays
■ May also be associated with a hearing
impairment, mental retardation,
emotional disturbance, or brain injury
■ Often the result of environmental
deprivation
Epidemiology of Speech Delay
■ Common childhood problem
■ Affects 3 to 10 percent of children.
■ 3-4X more common in boys than in girls.
Most common causes of speech
delay
■ Mental retardation
■ Hearing loss
■ Maturation delay
Overview of major types of
language disorders
■ Need to understand normal language and
prelanguage development
■ See Table 10.1 on 320
■ May involve comprehension
(understanding) or expression in written or
spoken language
■ These are very complex to diagnose and
treat
Language and Brain
Language disorders
1.Expressive language disorders
2.Receptive language disorders
3.Aphasia – loss of the ability to speak or
comprehend language because of an injury
or developmental abnormality in the brain
EXPRESSIVE LANGUAGE
DISORDER
(developmental expressive aphasia)

■ Fail to develop the use of speech at the

usual age.
EXPRESSIVE LANGUAGE DISORDER

■ Normal intelligence
■ Normal hearing
■ Good emotional relationships
■ Normal articulation skills.
■ Comprehension of speech is appropriate to
the age of the child
EXPRESSIVE LANGUAGE DISORDER

■ Brain dysfunction
that results in an
inability to
translate ideas
into speech.
EXPRESSIVE LANGUAGE DISORDER

■ The child is at risk for language-based

learning disabilities (dyslexia).
■ May use gestures to supplement their
limited verbal expression .
Maturation Delay vs.
Expressive Language
Disorder?
■ The late bloomer will
eventually develop
normal speech
■ The child with an
expressive language
disorder will not do
so without
intervention.
Maturation Delay vs.
Expressive Language
Disorder?
■ It is sometimes difficult, if not
impossible, to distinguish at
an early age a late bloomer
from a child with an
expressive language disorder.
BILINGUALISM
■ A bilingual home
environment may
cause an apparent
temporary delay in
the onset of both
languages.
BILINGUALISM
■ The bilingual child's comprehension of the
two languages is normal for a child of the
same age.
■ Usually becomes proficient in both
languages before the age of five years.
Interference or transfer
■ An English error due to the direct influence
of the primary language structure.
■ This is a normal phenomenon
Silent period
■ Common second-language acquisition
phenomenon
■ Often very quiet, speaking little
■ Focus on understanding the new language
■ The younger the child, the longer the silent
period tends to last.
Code switching
■ Changing languages over phrases or
sentences.
■ Normal phenomenon
Benefits of Bilingualism
■ Children who are fluent bilinguals actually
outperform monolingual speakers on tests
of metalinguistic skill.
Benefits of Bilingualism
■ Our world is shrinking and business
becomes increasingly international
■ Children who are fluent bilingual speakers
are potentially a tremendously valuable
resource for the U.S. economy.
Language Disorders

■ Egyptians reported
speech loss after
blow to head 3000
years ago
■ Broca (1861) finds
damage to left inferior
frontal region (Broca’s
area) of a language
impaired patient, in
postmortem analysis
Language Disorders (2)
■ In language disorders
■ 90-95% of cases, damage is to the left hemisphere
■ 5-10% of cases, to the right hemisphere
■ Wada test is used to determine the hemispheric
dominance
■ Sodium amydal is injected to the carotid artery
■ First to the left and then to the right
Language Disorders (3)
■ Paraphasia:
■ Substitution of a word by a sound, an incorrect
word, or an unintended word
■ Neologism:
■ Paraphasia with a completely novel word
■ Nonfluent speech:
■ Talking with considerable effort
■ Agraphia:
■ Impairment in writing
■ Alexia:
■ Disturbances in reading
Three major types of Aphasia
Rosenzweig: Table 19.1, p. 615

■ Borca’s aphasia
■ Nonfluent speech
■ Wernicke’s aphasia
■ Fluent speech but unintelligible
■ Global aphasia
■ Total loss of language
Others: Conduction, Subcortical, Transcortical
Motor/Sensory (see also Kandel, Table 59-1)
Brain areas involved in Language
 Broca’s Aphasia
Brodmann 44, 45
■ Lesions in the left inferior frontal region (Broca’s
area)
■ Nonfluent, labored, and hesitant speech
■ Most also lost the ability to name persons or
subjects (anomia)
■ Can utter automatic speech (“hello”)
■ Comprehension relatively intact
■ Most also have partial paralysis of one side of the
body (hemiplegia)
■ If extensive, not much recovery over time
 Wernicke’s
Aphasia
■ Lesions in posterior
Brodmann 22, 30 of the left superior temporal
gyrus, extending to adjacent parietal cortex
■ Fluent speech
■ But contains many paraphasias
■ “girl”-“curl”, “bread”-“cake”
■ Syntactical but empty sentences
■ Cannot repeat words or sentences
■ Unable to understand what they read or hear
■ Usually no partial paralysis
Wernicke-Geschwind Model
1. Repeating a spoken word

■ Arcuate fasciculus is the bridge from the

Wernicke’s area to the Broca’s area
Wernicke-Geschwind Model
2. Repeating a written word

■ Angular gyrus is the gateway from visual cortex to

Wernicke’s area
■ This is an oversimplification of the issue:
■ not all patients show such predicted behavior (Howard,
1997)
Sign Languages
■ Full-fledged languages, created by hearing-
impaired people (not by Linguists):
■ Dialects, jokes, poems, etc.
■ Do not resemble the spoken language of the same
area (ASL resembles Bantu and Navaho)
■ Pinker: Nicaraguan Sign Language
■ Another evidence of the origins of language (gestures)
■ Most gestures in ASL are with right-hand, or
else both hands (left hemisphere dominance)
■ Signers with brain damage to similar regions
show aphasia as well
Signer Aphasia
■ Young man, both spoken and sign language:
■ Accident and damage to brain
■ Both spoken and sign languages are affected
■ Deaf-mute person, sign language:
■ Stroke and damage to left-side of the brain
■ Impairment in sign language
■ 3 deaf signers:
■ Different damages to the brain with different
impairments to grammar and word production
Spoken and Sign Languages
■ Neural mechanisms are similar
■ fMRI studies show similar activations for
both hearing and deaf
■ But in signers, homologous activation on the
right hemisphere is unanswered yet
Dyslexia
■ Problem in learning to read
■ Common in boys and left-handed
■ High IQ, so related with language only
■ Postmortem observation revealed anomalies in
the arrangement of cortical cells
■ Micropolygyria: excessive cortical folding
■ Ectopias: nests of extra cells in unusual location
■ Might have occurred in mid-gestation, during cell
migration period
 Acquired Dyslexia = Alexia
■ Disorder in adulthood as a result of
disease or injury
■ Deep dyslexia (pays attn. to wholes):
■ “cow” -> “horse”, cannot read abstract words
■ Fails to see small differences (do not read each
letter)
■ Problems with nonsense words
■ Surface dyslexia (pays attn. to details):
■ Nonsense words are fine
■ Suggests 2 different systems:
■ One focused on the meanings of whole words
■ The other on the sounds of words
Electrical Stimulation
■ Penfield and Roberts (1959): During epilepsy
surgery under local anesthesia to locate cortical
language areas, stimulation of:
■ Large anterior zone:
■ stops speech
■ Both anterior and posterior temporoparietal cortex:
■ misnaming, impaired imitation of words
■ Broca’s area:
■ unable comprehend auditory and visual semantic material,
■ inability to follow oral commands, point to objects, and
understand written questions
Studies by Ojemann et al.
■ Stimulation of the brain of an English-
Spanish bilingual shows different areas
for each language
■ Stim of inferior premotor frontal cortex:
■ Arrests speech, impairs all facial movements
■ Stim of areas in inferior, frontal,
temporal, parietal cortex:
■ Impairs sequential facial movements,
phoneme identification
■ Stim of other areas:
■ lead to memory errors and reading errors
■ Stim of thalamus during verbal input:
■ increased accuracy of subsequent recall
Williams Syndrome
■ Caused by the deletion of a dozen genes
from one of the two chromosomes
numbered 7
■ Shows dissociation between language
and intelligence, patients are:
■ Fluent in language
■ But cannot tie their shoe laces, draw images,
etc.
■ Developmental process is altered:
■ Number skills good at infancy, poor at
adulthood
■ Language skills poor at infancy, greatly
improved in adulthood
Lateralization of the Brain
■ Human body is asymmetrical: heart, liver,
use of limbs, etc.
■ Functions of the brain become lateralized
■ Each hemisphere specialized for particular
ways of working
■ Split-brain patients are good examples of
lateralization of language functions
Lateralization of functions
(approximate)

■ Left-hemisphere: ■ Right-hemisphere:
■ Simultaneous analysis
■ Sequential analysis ■ Synthetic
■ Analytical ■ Visual-Spatial skills
■ Problem solving ■ Cognitive maps
■ Personal space
■ Language
■ Facial recognition
■ Drawing
■ Emotional functions
■ Recognizing emotions
■ Expressing emotions
■ Music
Split-brain

■ Epileptic activity spread from one hemisphere

to the other thru corpus callosum
■ Since 1930, such epileptic treated by
severing the interhemispheric pathways
■ At first no detectible changes (e.g. IQ)
■ Animal research revealed deficits:
■ Cat with both corpus callosum and optic chiasm
severed
■ Left-hemisphere could be trained for
symbol:reward
■ Right-hemisphere could be trained for inverted
symbol:reward
Left vs. Right Brain
■ Pre and post operation studies showed that:
■ Selective stimulation of the right and left hemisphere
was possible by stimulating different parts of the body
(e.g. right/left hand):
■ Thus can test the capabilities of each hemisphere
■ Left hemisphere could read and verbally
communicate
■ Right hemisphere had small linguistic capacity:
recognize single words
■ Vocabulary and grammar capabilities of right is far
less than left
■ Only the processes taking place in the left
hemisphere could be described verbally