Developmental language disorders: Organization and ...
Transcript of Developmental language disorders: Organization and ...
Developmental language disorders: Organization and management in
Belgium
Prof.dr.PhilippeF.Paquier Dr.StefanieKeulenUniversité LibredeBruxelles(ULB) Université LibredeBruxelles(ULB)VrijeUniversiteitBrussel(VUB) VrijeUniversiteitBrussel(VUB)UniversiteitAntwerpen(UA)
DNPS Annual MeetingHindsgavl Slot
3-4 November 2017
DEVELOPMENTAL LANGUAGE DISORDERS
Speech vs. LanguageSpeech• Themotorexecutionoforallanguagecommunication(theactof
speaking).• Speechisproducedthroughcomplexandcoordinatedrespiratory,
laryngeal,velopharyngeal,andarticulatorymovements(Sharp&Hillenbrand,2008):– Respirationprovidestheairpressuretoinitiatesoundproduction
throughvocalfoldvibrationatthelarynx;– Airflowandlaryngealsoundsaredirectednasallyororallybythe
velopharynx;– Articulators(e.g.,tongue,lips,teeth,jaw)shapelaryngealsoundsand
airflowtocreatevowelsandconsonants(phonemes).• Speechproductionencompassestheareasofvoice,fluency,and
intelligibility(articulation+resonance).
DEVELOPMENTAL LANGUAGE DISORDERS
Language• Asociallyagreedon,rule-governedsystemofsymbolsthatisusedto
representideasabouttheworld(Sharp&Hillenbrand,2008).• Languageincludesthefollowinglinguisticcomponents:
– Phonology:theabilitytoanalyzewordsintoseparatewordsounds(phonemes)andtoassemblephonemestoformwords.
– Semantics:theknowledgeofwordmeaning.– Morphology:thecapacitytochangewordsbymeansofinflections,
conjugations,andderivations.– Syntax:rulesthatgovernwordorderinasentence.– Pragmatics:theuseoflanguageasasocialtool,andthecapacityto
dealwithlanguageinitssituationalcontext,includingtheinteractionsbetweenthespeaker’sandtheinterlocutor’sknowledgeandbeliefs(e.g.,theirinferredintents).
Speech vs. Language
DEVELOPMENTAL LANGUAGE DISORDERS
Speech disorder vs. Language disorder
• Animpairmentofoneorseveralofthebasicspeechproductionmechanismsiscalledaspeech disorder.
• Animpairmentofoneorseveraloftheaforementionedlinguisticcomponents(phonology,semantics,morphology,syntax,pragmatics)iscalledalanguage disorder.
DEVELOPMENTAL LANGUAGE DISORDERS
Factors influencing the acquisition of speech and language
• Speechandlanguageacquisition:anaturalandself-evidentprocess?
Yes,ontheconditionthat(a)thechildpossessestherequiredphysicalandintellectualabilities,and(b)his/herenvironmentissufficientlystimulating.
Learningbyimitatingiscruciallyinvolvedinthisprocess(roleofmirrorneurons?).
DEVELOPMENTAL LANGUAGE DISORDERS
Factors influencing the acquisition of speech and language
• Mirrorneuron:aspecifictypeofvisuo-motorneuronthatdischargesbothwhenamonkeyexecutesamotoractandwhenitobservesasimilarmotoractperformedbyanotherindividual.
• Inasense,amirrorneuronreflectsanotherprimate’sbehavior,andisequallyactiveasifexecutingitselfthesamemotoract.
• Inhumans,themirrorneuronsystemhasbeenidentifiedinpremotorandparietalcortices.
• In2010,mirrorneuronswerealsoreportedinthehumanhippocampus.
Giacomo Rizzolatti
DEVELOPMENTAL LANGUAGE DISORDERS
Factors influencing the acquisition of speech and language
• Mirrorneuronsplayakeyroleinperceiving,understanding,andinterpretingothers’actions,andinlearningnewskillsbyimitation.
• Mirrorneuronsarethoughttoplayaroleintheanticipationofactionoutcomesinothersandintheapprehensionofothers’intentions(theoryofmind),intheabilitytoenterintoothers’emotionalfeelings(empathy),andintheacquisitionoflanguage–morespecifically,theemergenceandfurtherdevelopmentoflanguageproduction(speech).
DEVELOPMENTAL LANGUAGE DISORDERS
Factors influencing the acquisition of speech and language
Languageacquisitionprocess=processofinteractionbetweenthechildandhis/hersocialenvironment,determinedby:
– Thechild’shealthandtemperament;– Materialcircumstances(e.g.,housingconditions,familycomposition);
– Thegeneralsocialandemotionalfamilyconditions.
DEVELOPMENTAL LANGUAGE DISORDERS
Factors influencing the acquisition of speech and language
• Medicalfactors
• Cognitivefactors
• Psychosocialfactors
DEVELOPMENTAL LANGUAGE DISORDERS
Factors influencing the acquisition of speech and language
Medicalfactors:
• Hearing• Morphologyofthespeechapparatus• Motilityofthespeechapparatus• Neurologicaland/orpsychiatricstate
DEVELOPMENTAL LANGUAGE DISORDERS
Factors influencing the acquisition of speech and language
Cognitivefactors:
• Globallearningability• Languagesensitivity(“talentforlanguages”)
DEVELOPMENTAL LANGUAGE DISORDERS
Factors influencing the acquisition of speech and language
Psychosocial factors:
• Stimulating familyand schoolenvironment(parent-childinteraction;homelanguage and schoollanguage)
• Housingconditions,familycompositionandconditions• Emotional and behavioral development
DEVELOPMENTAL LANGUAGE DISORDERS
Classification of pediatric speech and language disorders
Childhoodspeechandlanguagedisorderscanbeclassifiedinto:
ü Developmental speechandlanguagedisorders
• specific (orprimary):noevident,detectablecause.• non-specific (orsecondary):resultingfroma
demonstrable,unfavorablefactor.
ü Acquired (neurological)speechandlanguagedisorders
DEVELOPMENTAL LANGUAGE DISORDERS
Classification of pediatric speech and language disorders
DevelopmentalspeechandlanguagedisordersAdisorderofspeechproductionand/orlinguisticfunctionsresultingfromademonstratedorassumedpathologicalconditionalreadypresentbeforetheemergenceoflanguage.
Acquired(neurological)speechandlanguagedisordersAspeechand/orlanguagedisordercausedbyalesionthatissustainedafteronsetoflanguageacquisition,andthatdisruptsalreadydevelopedspeech/languageskills.Thepathologicalprocesswhichcompromisesthefunctioningofspeechand/orlanguageissustainedafteraperiodoflanguagedevelopment.
DEVELOPMENTAL LANGUAGE DISORDERS
Classification of pediatric speech and language disorders
Primary (specific) Secondary (non-specific)
Speech • Verbal dyspraxia (childhood apraxiaofspeech)
• Developmental stuttering• Dyslalia (incorrectplacing ofphono-
articulatory organs)
Language
DEVELOPMENTAL LANGUAGE DISORDERS
Classification of pediatric speech and language disorders
Primary (specific) Secondary (non-specific)
Speech • Verbal dyspraxia (childhood apraxiaofspeech)
• Developmental stuttering• Dyslalia (incorrectplacing ofphono-
articulatory organs)
• Congenital /acquired dysarthria• Congenital /acquired apraxia ofspeech• Acquired stuttering• Articulation defects(speechapparatus
anomalies)
Language
DEVELOPMENTAL LANGUAGE DISORDERS
Classification of pediatric speech and language disorders
Primary (specific) Secondary (non-specific)
Speech • Verbal dyspraxia (childhood apraxiaofspeech)
• Developmental stuttering• Dyslalia (incorrectplacing ofphono-
articulatory organs)
• Congenital /acquired dysarthria• Congenital /acquired apraxia ofspeech• Acquired stuttering• Articulation defects(speechapparatus
anomalies)
Language • Dysphasia (SLI)
DEVELOPMENTAL LANGUAGE DISORDERS
Classification of pediatric speech and language disorders
Primary (specific) Secondary (non-specific)
Speech • Verbal dyspraxia (childhood apraxiaofspeech)
• Developmental stuttering• Dyslalia (incorrectplacing ofphono-
articulatory organs)
• Congenital /acquired dysarthria• Congenital /acquired apraxia ofspeech• Acquired stuttering• Articulation defects(speechapparatus
anomalies)
Language • Dysphasia (SLI) • Congenital /acquired aphasia• Other developmental language
disordersdue to identified causes:• Chromosomal anomalies• Neurodevelopmental disorders• Precarious physical condition• Detrimental environment• Hearing loss• …
DEVELOPMENTAL LANGUAGE DISORDERS
Classification of pediatric speech and language disorders
ExamplesofsecondaryS/Ldisorders(resultingfromademonstrable,unfavorablefactor):
Pre-,peri- orearlypostnatalbraindamage(cf.congenitaldysarthria).
Jansen A, Andermann E. J Med Genet 2005: 42: 369-378.© 2005 by BMJ Publishing Group Ltd
DEVELOPMENTAL LANGUAGE DISORDERS
Classification of pediatric speech and language disorders
ExamplesofsecondaryS/Ldisorders(resultingfromademonstrable,unfavorablefactor):
Pre-,peri- orearlypostnatalbraindamage(cf.congenitalaphasia).
Pizzamiglio MR et al.Neurocase 2004: 10: 308-315.
DEVELOPMENTAL LANGUAGE DISORDERS
Classification of pediatric speech and language disorders
ExamplesofsecondaryS/Ldisorders(resultingfromademonstrable,unfavorablefactor):
Chromosomalanomaliesassociatedwithneurologicaldeficits.
Down Syndrome
DEVELOPMENTAL LANGUAGE DISORDERS
Classification of pediatric speech and language disorders
ExamplesofsecondaryS/Ldisorders(resultingfromademonstrable,unfavorablefactor):
Neurodevelopmentaldisorders.
J Commun Disord 2000: 33: 227-240.
DEVELOPMENTAL LANGUAGE DISORDERS
Classification of pediatric speech and language disorders
ExamplesofsecondaryS/Ldisorders(resultingfromademonstrable,unfavorablefactor):
Neurodevelopmentaldisorders,suchasautismandADHD.
DEVELOPMENTAL LANGUAGE DISORDERS
Classification of pediatric speech and language disorders
ExamplesofsecondaryS/Ldisorders(resultingfromademonstrable,unfavorablefactor):
Extremelyillphysicalcondition(anemia,metabolicdisorders).
In: Murdoch BE (ed.), Acquired neurological speech/languagedisorders in childhood. London: Taylor & Francis: 1990; 199-
215.
J Speech Lang Hear Res 2011: 54: 487-519.
DEVELOPMENTAL LANGUAGE DISORDERS
Classification of pediatric speech and language disorders
ExamplesofsecondaryS/Ldisorders(resultingfromademonstrable,unfavorablefactor):
Detrimentalenvironmentalfactors(deprivation,abuseandneglect,adversefamilyorsocialbackground).
Dev Med Child Neurol 1992: 34: 943-948.
DEVELOPMENTAL LANGUAGE DISORDERS
Classification of pediatric speech and language disorders
ExamplesofsecondaryS/Ldisorders(resultingfromademonstrable,unfavorablefactor):
Morphologyandmotilityanomaliesofthespeechapparatus.
Palatoschisis
DEVELOPMENTAL LANGUAGE DISORDERS
Classification of pediatric speech and language disorders
ExamplesofsecondaryS/Ldisorders(resultingfromademonstrable,unfavorablefactor):
Morphologyandmotilityanomaliesofthespeechapparatus.
Am J Speech Lang Pathol 2000: 9: 202-213.
Beckwith-Wiedemann Syndrome
DEVELOPMENTAL LANGUAGE DISORDERS
Classification of pediatric speech and language disorders
ExamplesofsecondaryS/Ldisorders(resultingfromademonstrable,unfavorablefactor):
Hearingloss.Auditoryprocessingdisorder.
DEVELOPMENTAL LANGUAGE DISORDERS
Classification of pediatric speech and language disorders
Primary(specific)S/Ldisorders
DEVELOPMENTAL LANGUAGE DISORDERS
Classification of pediatric speech and language disorders
• Delayedlanguagedevelopment:Thechild’slanguagesystemdoesnotmatchhis/herchronologicalage,butisconsistentwiththatofayoungerchild.
• Deviantlanguagedevelopment(specificS/Ldisorders):Thechild’slanguagesystemshowscharacteristicsthatdonotmatchanyphaseofnormallanguageacquisition.
DEVELOPMENTAL LANGUAGE DISORDERS
Classification of pediatric speech and language disorders
Primary(specific)S/Ldisorders
Anomaliesinspeechand/orlanguageacquisitionanddevelopment,intheabsenceofanevident,detectablecause(i.e.,unfavorablefactorscannotbedemonstrated).
Ageneticpredispositiontopoorlanguageperformancemightbeinvolved.
DEVELOPMENTAL LANGUAGE DISORDERS
Classification of pediatric speech and language disorders
Primary (specific) Secondary (non-specific)
Speech
Language
DEVELOPMENTAL LANGUAGE DISORDERS
Classification of pediatric speech and language disorders
Primary (specific) Secondary (non-specific)
Speech • Verbal dyspraxia (childhood apraxiaofspeech)
Language
DEVELOPMENTAL LANGUAGE DISORDERS
Classification of pediatric speech and language disorders
Primary (specific) Secondary (non-specific)
Speech • Verbal dyspraxia (childhood apraxiaofspeech)
• Developmental stuttering
Language
DEVELOPMENTAL LANGUAGE DISORDERS
Classification of pediatric speech and language disorders
Primary (specific) Secondary (non-specific)
Speech • Verbal dyspraxia (childhood apraxiaofspeech)
• Developmental stuttering• Dyslalia (incorrectplacing ofphono-
articulatory organs)
Language
DEVELOPMENTAL LANGUAGE DISORDERS
Classification of pediatric speech and language disorders
Primary (specific) Secondary (non-specific)
Speech • Verbal dyspraxia (childhood apraxiaofspeech)
• Developmental stuttering• Dyslalia (incorrectplacing ofphono-
articulatory organs)
Language • Dysphasia (SLI)
DEVELOPMENTAL LANGUAGE DISORDERS
Classification of pediatric speech and language disorders
Primary (specific) Secondary (non-specific)
Speech • Verbal dyspraxia (childhood apraxiaofspeech)
• Developmental stuttering• Dyslalia (incorrectplacing ofphono-
articulatory organs)
Language • Dysphasia (SLI)
DEVELOPMENTAL LANGUAGE DISORDERS
Classification of pediatric speech and language disorders: dysphasia
Dysphasia (synonyms:developmentalaphasia;SpecificLanguageImpairment[SLI])referstoabnormallanguageperformancethatdoesnotmatchanyexpectedagenorms,andhasnevershownanarrestatnoradeclinefromanearlierleveloflanguagefunctioning.
Thedisorderthathindersthenormaldevelopmentoflanguagefunctionsisnotadequatelyaccountedforby:- Intellectualdisability- Motororsensorydefects(e.g.deafness)- Frankneurologicalproblems- Severeemotionaland/orbehavioraldisturbances- Majorenvironmentaland/orlanguagedeprivation
DEVELOPMENTAL LANGUAGE DISORDERS
Classification of pediatric speech and language disorders: dysphasia
“Theterminologyusedtorefertosuchchildrenhasvariedoverthepastfewdecades:‘developmentalaphasia’and‘developmentaldysphasia’(…)Moreneutraldiagnostictermswithfewermedicalovertones,suchas‘developmentallanguagedisorder’or‘specificlanguageimpairment’(SLI)arenowusuallypreferred.”(Bishop,1994).
Phil Trans R Soc Lond B 1994: 346: 105-111.
DEVELOPMENTAL LANGUAGE DISORDERS
Classification of pediatric speech and language disorders: dysphasia
Prevalence
Morley (1972) 3-yr-old7-yr-old
± 10-20 %± 1.5-3 %
Silva (1980)
Beitchman et al. (1986)
3-yr-old
< 6-yr-old
± 8%
± 3-10%
• Dysphasiaisnotadelayedbutadeviant developmentoflanguage.• Isdifficulttodifferentiatefromadelayedlanguagedevelopmentata
youngerage.• Latetalkingtoddlers–whoerroneouslyreceivedadiagnosisofdysphasia
atayoungerage– naturallycatchupwiththeirpeersatalaterage(delayedlanguagedevelopment).
DEVELOPMENTAL LANGUAGE DISORDERS
Classification of pediatric speech and language disorders: dysphasia
In: F. Plum (Ed.), Language, communication, and the brain. New York: Raven Press, 1988; pp. 57-75.
Updates:Rapin I.JChildPsychol Psychiat 1996:37:643-655.Rapin I.&DunnM.BrainDev2003:25:166-172.Rapin I.etal.DevNeuropsychol 2009:34:66-84.
DEVELOPMENTAL LANGUAGE DISORDERS
Classification of pediatric speech and language disorders: dysphasia
DEVELOPMENTAL LANGUAGE DISORDERS
Classification of pediatric speech and language disorders: dysphasia
DEVELOPMENTAL LANGUAGE DISORDERS
Classification of pediatric speech and language disorders: dysphasia
DEVELOPMENTAL LANGUAGE DISORDERS
Classification of pediatric speech and language disorders: dysphasia
Semanticpragmaticsubtype:• E.g.,autismspectrumdisorder(ASD),Aspergersyndrome,
Williamssyndrome,hydrocephalus+/- spinabifida(cocktailpartysyndrome),non-verballearningdisorder(+hyperlexia),…Ø butremember:primary vs.secondary S/Ldisorders!
• Fluent,verboseandscripted,grammaticallycomplexlanguage,butwithpoorsensitivitytothecommunicativesituation.
• Difficultyunderstandingironyandempathy.• Difficultycomprehendinginferentialmeaning.• PragmaticdeficitsmildinSLI,universalandoftenblatantin
ASD.
DEVELOPMENTAL LANGUAGE DISORDERS
Classification of pediatric speech and language disorders: verbal dyspraxia
DEVELOPMENTAL LANGUAGE DISORDERS
Verbaldyspraxia(synonyms:developmentalapraxiaofspeech;childhoodapraxiaofspeech) isaneurologicallybasedspeechdisorderthatcanbeunderstoodasadeficitinplanningandregulatingmotoractionsofvoluntaryandcomplexsequentialspeechmovements,intheabsenceofdysarthria,mentalretardation,hearingloss,receptivelanguageimpairments,andorofacialmalformation.Itsdefiningcharacteristicsare:unintelligiblespeechduetoalargenumberofconsonanterrors(especiallysubstitutionsandomissions),inconsistencyofspeecherrors,articulatoryabnormalitieslikegropingbehavior,andabnormalprosody.
Nijland L. Developmental apraxia of speech: deficits in phonetic planning and motor programming. Catholic UniversityNijmegen, PhD dissertation, 2003.
Classification of pediatric speech and language disorders: verbal dyspraxia
DEVELOPMENTAL LANGUAGE DISORDERS
• Characterizedbydeficitsintimingandsequencingthemovementsrequiredforspeechproduction.
PhD dissertation, KU Nijmegen, 2003.
Classification of pediatric speech and language disorders: verbal dyspraxia
§ EarlyvisualprocessingÞ recognitionofthepicture;
§ Accessingthesemanticrepresentation(ormeaning);
Hillis AE, Course N° 2DS.008, American Academy of Neurology, 53rd Annual Meeting, 2001.
Structural Representation
Semantics
Auditory Word Form
Motor Planning
Articulation
« horse »
DEVELOPMENTAL LANGUAGE DISORDERS
Classification of pediatric speech and language disorders: verbal dyspraxia
§ EarlyvisualprocessingÞ recognitionofthepicture;
§ Accessingthesemanticrepresentation(ormeaning);
§ Accessingthephonological(orauditory)formoftheword;
§ Programmingthearticulatorymovements(lips,tongue,jaw,palate,etc)andtheirsequence;
§ Articulatingthewordbyimplementingtheplannedmovements.
Hillis AE, Course N° 2DS.008, American Academy of Neurology, 53rd Annual Meeting, 2001.
Structural Representation
Semantics
Auditory Word Form
Motor Planning
Articulation
« horse »
DEVELOPMENTAL LANGUAGE DISORDERS
Classification of pediatric speech and language disorders: verbal dyspraxia
§ EarlyvisualprocessingÞ recognitionofthepicture;
§ Accessingthesemanticrepresentation(ormeaning);
§ Accessingthephonological(orauditory)formoftheword;
§ Programmingthearticulatorymovements(lips,tongue,jaw,palate,etc)andtheirsequence;
§ Articulatingthewordbyimplementingtheplannedmovements.
Hillis AE, Course N° 2DS.008, American Academy of Neurology, 53rd Annual Meeting, 2001.
Structural Representation
Semantics
Auditory Word Form
Motor Planning
Articulation
« horse »
DEVELOPMENTAL LANGUAGE DISORDERS
Classification of pediatric speech and language disorders: verbal dyspraxia
Þ Apraxia of Speech
§ EarlyvisualprocessingÞ recognitionofthepicture;
§ Accessingthesemanticrepresentation(ormeaning);
§ Accessingthephonological(orauditory)formoftheword;
§ Programmingthearticulatorymovements(lips,tongue,jaw,palate,etc)andtheirsequence;
§ Articulatingthewordbyimplementingtheplannedmovements.
Hillis AE, Course N° 2DS.008, American Academy of Neurology, 53rd Annual Meeting, 2001.
Structural Representation
Semantics
Auditory Word Form
Motor Planning
Articulation
« horse »
DEVELOPMENTAL LANGUAGE DISORDERS
Classification of pediatric speech and language disorders: verbal dyspraxia
Þ Dysarthria
DEVELOPMENTAL LANGUAGE DISORDERS
Classification of pediatric speech and language disorders: dysphasia = SLI
“Specificlanguageimpairment (SLI)isdiagnosedwhenfornoobviousreasonachildfailstodevelopnormallanguagebuthasadequatenonverbalintelligence,physicalability,andhearing.”(Bishop&Adams,1992).
DEVELOPMENTAL LANGUAGE DISORDERS
Classification of pediatric speech and language disorders
• Dysphasiaistypicallydefinedasadevelopmentallanguagedisorderthatisassociatedwithnoknownsensory,neurological,intellectual,oremotionaldeficits.
• Verbaldyspraxiaisaneurologicallybasedspeechdisorder(…)intheabsenceofdysarthria,mentalretardation,hearingloss,receptivelanguageimpairments,andorofacialmalformation.
DEVELOPMENTAL LANGUAGE DISORDERS
Dysphasia (SLI): No (known) neurological disorder?
DEVELOPMENTAL LANGUAGE DISORDERS
Dysphasia (SLI): No (known) neurological disorder?
DEVELOPMENTAL LANGUAGE DISORDERS
Dysphasia (SLI): No (known) neurological disorder?
Electrical StatusEpilepticusduring slowSleep(ESES)Continuous Spikesand Wavesduring slowSleep(CSWS)
DEVELOPMENTAL LANGUAGE DISORDERS
Dysphasia (SLI): No (known) neurological disorder?
Epilepsia 2009:50(Suppl.7):21-24.
DEVELOPMENTAL LANGUAGE DISORDERS
Dysphasia (SLI): No (known) neurological disorder?
Epilepsy &Behavior 2010:19:550-558.
“Wesuggestaspectrumorcontinuumofnocturnalepileptiform activityandlanguageimpairmentthatrangesfromSLIatoneendtoLKSandESESatthemostaffectedend”.
DEVELOPMENTAL LANGUAGE DISORDERS
Dysphasia (SLI): No (known) neurological disorder?
Pediat Neurol 1994: 10: 20-26.
Pediat Neurol 1999: 21: 745-748.
DEVELOPMENTAL LANGUAGE DISORDERS
Dysphasia (SLI): No (known) neurological disorder?
Normal controls: Left-sided IFG > Right-sided IFG and Right-sided cerebellar lobule VIIIA > Left-sided cerebellar lobule VIIIA.
SLI subjects: opposite pattern = larger Right-sided IFG and Left-sided VIIIA → reversed asymmetry.
DEVELOPMENTAL LANGUAGE DISORDERS
Verbal dyspraxia: No (known) neurological disorder?
DEVELOPMENTAL LANGUAGE DISORDERS
Verbal dyspraxia: No (known) neurological disorder?
• KEfamily,largethree-generationpedigree.
• Halfofthemembersareaffectedbyaseverespeech/languagedisorder.
• Transmittedasanautosomaldominantmonogenictrait.
• Responsiblegene(FOXP2)onlongarmofchromosome7(7q31).
Brain 2002: 125: 465-478.
DEVELOPMENTAL LANGUAGE DISORDERS
Verbal dyspraxia: No (known) neurological disorder?
Childhoodapraxiaofspeechisararemotorspeechdisorderthataffectstheproduction,sequencing,andtimingofsounds,syllables,andwords.Itisdistinctfromotherspeech(e.g.,stuttering)andlanguage(e.g.,SLI)disorders.
Theneedforamultidisciplinarydiagnosticandtherapeuticapproach:
• Medicalfactors:hearing;morphologyandmotilityofthespeechapparatus;neurologicaland/orpsychiatricstate.
• Cognitivefactors:globallearningability;languagesensitivity(“talentforlanguages”).
• Psychosocialfactors:stimulating familyand schoolenvironment(parent-child interaction;homelanguage and schoollanguage);housingconditions,familycompositionandconditions;emotional and behavioraldevelopment.
Management of pediatric speech and language disorders in Belgium
DEVELOPMENTAL LANGUAGE DISORDERS
Referraltohealthandsocialcarestakeholdersvia:Management of pediatric speech and language disorders in Belgium
DEVELOPMENTAL LANGUAGE DISORDERS
Parents >>
school;schooladvisoryservicesGP
School > schooladvisoryservicesGP;schooladvisoryservices >
>multidisciplinarydiagnostic center(pediatric)rehabilitationcenter
Multidisciplinarydiagnosticcenter;(pediatric)rehabilitationcenter
> multidisciplinaryteamintramuros
Healthandsocialcarestakeholdersinvolvedinthediagnosticwork-up(firstlineormultidisciplinaryteam):
• GP/schooldoctor(schooladvisoryservices)• ENT/audiologist• Childneurologist• Childpsychiatrist• Speech/languagepathologist• Neurolinguist /clinicallinguist(Netherlands)• Child(neuro)psychologist• Remedialeducationalist/orthopedagogist• Socialworker
Management of pediatric speech and language disorders in Belgium
DEVELOPMENTAL LANGUAGE DISORDERS
Healthcarestakeholdersentitledtorefertorefundable*speech/languagetherapy:
• GP• ENTspecialist• Pediatrician• (Child)neurologist• (Child)psychiatrist
* Bythenationalhealthinsurance.
Management of pediatric speech and language disorders in Belgium
DEVELOPMENTAL LANGUAGE DISORDERS
Healthandsocialcarestakeholdersinvolvedinthe(multidisciplinary)speech/languagerehabilitation:
• Speech/languagepathologist• Neurolinguist /clinicallinguist(Netherlands)• Child(neuro)psychologist• Remedialeducationalist/orthopedagogist• Remedialteacher
Management of pediatric speech and language disorders in Belgium
DEVELOPMENTAL LANGUAGE DISORDERS
Organizationofspeech/languagerehabilitationforschool-agedchildren(typesrefertospecificspecialneeds):
• Regulareducation+remedialteaching(e.g.,type9:ASDwithoutintellectualdisability)
• Regulareducation+rehabilitationcenter(e.g.,mildformsofSLIorACA)• Specialneedseducation(9differenttypes,ofwhich7might(partially)
pertaintospeech/languageimpairments):– Types1&2:mildorseverementaldeficiency;– Type3:severeemotionalandbehavioraldisorderswithoutintellectualdisability;– Type5:protractedhospitalization,preventorium;– Type7:severehearingloss/severespeech/languagedisorderswithoutintellectual
disability;– Type8:severelearningdisabilitywithouthearingdeficitorintellectualdisability;– Type9(seeabove).
Management of pediatric speech and language disorders in Belgium
DEVELOPMENTAL LANGUAGE DISORDERS
Concluding vignette: current research into verbal dyspraxia (VD) at VUB
DEVELOPMENTAL LANGUAGE DISORDERS
• Investigation into feedbackdeficitsinverbal dypraxia:• DIVA-model(Tourville &Guenther 2011):role ofauditory and kinesthetic feedback• Investigation into intactness ofauditory and kinesthetic feedbackinchildren with VDà
therapeutic measures?
• Researchquestions/aims:• TowhatextentdoesarticulationofchildrenwithVDdeviatefrompeerswithnormal
speechdevelopment?(viarepetitionofaseriesofsyllablescontrolledforcomplexityandlength);
• Doauditory and kinesthetic feedbackmechanismsfunctionnormallyinVDchildren?(doescompensationresemblethatofhealthycontrols?);
• Doesthepresence/absenceofASDimpactonperformance?
• Participants (aged 8-17yrs;Dutch-speaking):• 10children with VDwithoutASD• 10children with VD+ASD• 20healthy controls
Concluding vignette: current research into verbal dyspraxia (VD) at VUB
DEVELOPMENTAL LANGUAGE DISORDERS
• Methods
Protocol3x15minute-run
1st:nofeedbackinterruption2nd:auditory feedbackinterruption3rd:kinesthetic feedbackinterruption
StimuliSeriesofrandomized syllables controlled for internal complexity and sequencecomplexity
Electromagneticarticulography
Ultrasound
Concluding vignette: current research into verbal dyspraxia (VD) at VUB
DEVELOPMENTAL LANGUAGE DISORDERS
Stimuluscode
Syllabletype Sequence type Example Amount
SS Simple Simple /ba-ba-ba-ba-ba-ba/ N=20
SC Simple Complex /fo-de-ro-fo-de-ro/ N=20
CS Complex Simple /kli-kli-kli-kli-kli-kli/ N=20
CC Complex Complex /bri-dre-klau-bri-dre-klau/ N=20