Language Disorders

Development of Language and
Literacy: Typical Milestones and
Childhood Language Disorders
Krista Stangel
Graduate Student Clinician - MS SLP
Lucas Steuber
MA Applied Linguistics
Graduate Student Clinician - MS SLP
What is Speech-Language Pathology?
 Responsible for “diagnosis, prognosis, prescription and
remediation” for children and adults with difficulty
speaking, listening, reading, writing, or swallowing.
 Speech, literacy, nonverbal communication,
assistive/augmentative communication, craniofacial
disorders (cleft palate), etc …
 Minimum of three years of graduate education
(including clinical fellowship)
The agenda for today
 Developmental Milestones in Normal Language
Acquisition – Lucas
 Signs of Childhood Language Disorders & Strategies
for Enhancing Language
 Q&A
Development – Krista
What is language?
 More than just speech
 More than just speech and writing
 Actually, more than just words
 Language is communication in all of its forms
 Language is how we interact with others and share
our ideas
What is language?
 Language learning and use is an interaction of
biological, cognitive, psychological, social, and
environmental factors
 Language must be seen in historical, cultural, and
social context
 Effective use of language requires a lot more than just
knowing the meaning of words
 Example of amelioration/pejorating
Domains of Language
 Syntax
 Semantics
 Phonology
 Morphology
 Pragmatics
Syntax
 “Grammar”
 The rules about how we combine words and
phrases to create sentences
 Different across languages
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English syntax is Subject-Verb-Object
“I told him”
French syntax can be Subject-Object-Verb
“Je lui ai dit” (“I him have told”)
Semantics
 Generally: Meaning
 Specifically: Vocabulary
 Our mental dictionary that we use to interpret
language and the world
 Contextual! “How many words do Eskimos have for
snow?”
 OED has 171,476 English words in use; 47,156
obsolete words (some obsolete)
George Washington
Having thus imparted to you my sentiments as they have been
awakened by the occasion which brings us together, I shall
take my present leave; but not without resorting once more to
the benign Parent of the Human Race in humble supplication
that, since He has been pleased to favor the American people
with opportunities for deliberating in perfect tranquility, and
dispositions for deciding with unparalleled unanimity on a form
of government for the security of their union and the
advancement of their happiness, so His divine blessing may be
equally conspicuous in the enlarged views, the temperate
consultations, and the wise measures on which the success of
this Government must depend.
George Bush
God bless you and God bless the United States of
America.
Phonology
 The sounds of language
 Also the rules that we use to determine what sounds
can go together in each language
 Ghoti = FISH (enough, women, nation)
 Sometimes has very little connection to orthography –
the way we spell in English
 Two main reasons for this:
 First, blame the French! (Norman invasion – 1066)
 Next, blame the “Great Vowel Shift” – 1350-1700
Morphology
 The system we use to change the form and
meaning of words
 Think “conjugation”
 Watch (N/V), Watches (N/V), Watched (V) …
 Some languages are agglutinative; syntax is
morphology
 Swahili: Nilimwambia “I told him”
 Ni – li – mwambi - a “I him tell (past tense)”
Pragmatics
 Language in use
 Specifically, appropriate use
 We all suffer from lapses in pragmatics
 I’m too loud and I talk too fast
 Children often learn some elements of pragmatics
before other parts of language
 Turn taking, reference (“deixis”), reciprocity of
smiling
Other Concerns
 Register: Talking to parent vs talking to friend
 Genre: Academic writing vs Facebook
 Dialect: Everyone has a dialect (and an accent)
 English as a Second Language
DIFFERENCE VS. DISORDER
Stages of Language
Acquisition
 Many people think about language and literacy
happening at school
 “Critical Period”
 In fact language learning starts much earlier and
continues much later
 Let’s look at phases of normal development in all
of the domains of language we just covered
Birth to Eight Months
 Phonology
 0-2mos: “Vegetative” noises
 2-4mos: Laughing, cooing, pleasure and displeasure
noises. May begin to cry differently for different
needs
 4-6mos: Some clear vowels; “vocal play”
 6-8mos: Babbling short repeating groups like
“mamamama bibibibi”
Birth to Eight Months
 Everything else
 Not much to point to in terms of production with
syntax, pragmatics, morphology, etc…
 Much “intentionality” on the part of young babies is
actually really attributed by caregivers
 However, the foundation of structure and meaning is
being laid
Eight Months to a Year
 Pragmatics
 Okay, NOW they start to mean it
 Intent shown by gesturing, refusing, games like
“peekaboo” understood
 Semantics
 Understanding of 3-50 words
 First words! Usually a name of a familiar person or object
 First words almost always have consonant-vowel shape
Eight Months to a Year
 Phonology
 Start to see babble that’s not just duplicated
 Contains “intonation contours” like normal speech
http://www.youtube.com/watch?v=_JmA2ClUvUY
12-18 Months
 Pragmatics
 Starts to use words to communicate things that
before were maybe communicated via gesture
 On average, five communicative actions per minute
during play
 Semantics
 Expressive vocabulary of 50-100 words
 Words communicate identity of people and objects,
rejection (no!), possession (mine)
18 months to 2 years
 Pragmatics
 New communicative intents include requesting
information (rather than just objects/activities) and
answering questions
 On average, 7-8 communicative actions during free
play
 Semantics
 Understanding of so-called “WH-” questions
 Who, what, where, when, how (but not yet why)
18 months to 2 years
 Syntax/Morphology
 “Brown’s Stage 1”
 Two-word utterances with consistent word order.
Few grammatical markers (-s, -ed, etc)
 Phonology
 Speech is 50% intelligible to familiar listeners
 Two-syllable words emerge, along with CVC
(consonant-vowel-consonant) words. “dog”
Literacy Check In!
 Before two years…
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Phonological awareness
“Meta-textual” skills like orientation and page turning
Scribbling with crayons etc
May pretend to read when others are reading
Two to Two and a Half Years
 Pragmatics
 Children start to say “please” (depending on the
parents!)
 Children start to LIE! Or, at least, to understand the
concept of lying/teasing.
 Children gain object permanence in their language;
will talk about things/people that aren’t present.
 “Symbolic play” – using one object to stand in for
another (a block for a truck, etc)
Two to Two and a Half Years
 Syntax/Morphology
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“Brown’s Stage 2”
Use of –ing, in, on, plural –s
Use of “no, not, can’t don’t” as negation of a verb
Questions formed with rising intonation
Verbs “gonna, wanna, gotta, hafta” appear
 Phonology
 Rhyming (highlight re: literacy)
 This is often the age when children with language
disorders may be identified
Two and a Half to Three Years
 Pragmatics
 Children will maintain a topic and ask for clarification
if needed
 Narratives start to take the form of a sequence rather
than a “heap” of disconnected events
 Semantics
 Understanding and use of “why” questions –
sometimes too much!
 Use of spatial pronouns like in, on, out, under, etc
Two and a Half to Three Years
 Syntax/Morphology
 “Brown’s Stage 3”
 So-called “helping” verbs like “can” and “will” are
used with basic verbs like be/go
 Past-tense overgeneralized (“I ranned there”)
 Phonetics
 Speech is 75% intelligible to familiar listeners
Three to Three and a Half Years
 Pragmatics
 Indirect requests (“can you...” “would you…”)
 Narratives start to take on thematic/temporal
organization. “At school I … and then I …”
 Semantics
 Color words
 Use of words like “and,” “or,” “then,” and “because” to
conjoin sentences
Three to Three and a Half Years
 Syntax/Morphology
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“Brown’s Stage 4”
First complex sentences (two sentences conjoined)
Irregular past tenses (“I ran”)
Use of articles (a, the) and possessive –s
 Phonology
 Some perceived articulation errors automatically
resolve (final consonant deletion, etc)
 “I can do a hantan!”
Three and a Half to Four Years
 Pragmatics
 New communication functions emerge, including:
Reasoning, predicting, empathy, creating imaginary
props during play
 Semantics:
 Full understanding of “when” and “how” Q’s
 Basic shape vocabulary (circle, square, triangle)
 Basic size vocabulary (big, small)
Three and a Half to Four Years
 Syntax
 “Brown’s Stage IV” continued
 Prepositional clauses (“in the house”)
 Phonology
 Decreased use of cluster reduction (“playing” for
“paying”)
 Overall articulation becoming much more clear
Four to Five Years
 Pragmatics
 Use of hints; like “those cookies look good!”
 Narratives now have a plot, but often no climax or
resolution
 Semantics
 Knowledge of letter names and their corresponding
sounds
 Knowledge of numbers and counting
Four to Five Years
 Syntax
 “Brown’s Stage 5”
 Regular past tense verbs and third person –s understood
and used (“He walks, he walked”)
 Gerunds! (“Playing is fun”)
 Phonology
 Speech 100% intelligible to familiar listeners
 Understanding of syllables within words
 Mild errors with s, r, l, and th may persist past this point
Literacy Check In!
 By age five…
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Learns order and format of print (left to right)
Recognizes own name
Recognizes some other familiar words
May invent spelling
Begins to write name
5-7 Years
 Pragmatics
 Narratives are true stories, with climax/resolution
 Semantics
 Average expressive vocabulary of 3-5,000 words
 So-called lexical “explosion” occurs
 Syntax
 Mastery of grammatical “exceptions” begins
 Phonology
 Last residual speech errors remediate spontaneously
7-9 Years
 Pragmatics
 Language used to establish/maintain social status
 Becomes more successful in persuasion
 Semantics
 Acquisition of “literate vocabulary”
 Can name synonyms in word definitions
 “Polysemy” understood; words with multiple
meanings
7-9 Years
 Syntax
 Begins to acquire/understand more complex syntax
required for academic interaction
 “in order to,” “if you,” “prior to …”
 Some errors in syntax still persist
 Phonology
 Articulation largely error-free
 Sound manipulation – “pig latin”
 Phonological knowledge used for spelling
More Literacy!
 By age 9 …
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Reads for pleasure (fiction and nonfiction)
May invent secret codes
Can “sound out” words
Some phonic patterns known (like silent e)
Begins to learn punctuation rules
Knows many conventional spellings
Can make errors in spelling due to phonological
correspondences
9-12 Years
 Pragmatics
 Use of jokes and riddles based on lexical ambiguity
 “what has four wheels and flies?”
 “where does Napoleon keep his armies?”
 Semantics
 Acquires and uses more abstract vocabulary from
school texts
 Common idioms are understood (“piece of cake”
“apple of my eye”)
9-12 Years
 Syntax
 Continues to acquire more complex syntax from
textbooks
 Word order can be varied creatively. “I drew a bear
for my art project” -> “For my art project, I drew a
bear”
 Phonology
 “Metaphonological” skills
Literacy Check!
 By age 12 …
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Reading is fluent
Comprehension is now the focus
Reads both for pleasure and to seek info
Fewer spelling errors
Begins to use persuasive and expository writing in
school curriculum
12-14 Years
 Pragmatics
 More use and understanding of humor and riddles
 Developing peer norms in social language use
 Semantics
 Can offer abstract, dictionary definitions for words
 Syntax
 Begins to use (and not just comprehend) more complex
syntax in writing
 Phonetics
 Proper rules of stress (“RECord, recORD”)
15-18 Years
 Pragmatics
 Ability to persuade and argue is near-adult
 Semantics
 Average expressive vocabulary of a high-school
graduate: 10,000 words
 Syntax
 Perfect aspect (“I had just finished, when …”)
 Able to write for an academic audience
 Passive construction of sentence
 Phonology
 Knowledge is now at adult level
18-21
 At this stage, phonology and pragmatics are often
near the end of their development.
 However, semantics and syntax continue to
develop if the individual continues to be engaged in
an academic environment
 Literacy also develops as the student reads
“beyond the high-school level”
… and beyond!
 We never stop learning about language!
 Discipline-specific information; “jargon”
 Technological advances change language
 Abbreviations
Communication and
Language Disorders
Let’s look at some common
communication disorders
 Articulation
http://www.youtube.com/watch?v=PYxM229pAzw
 Stuttering
http://www.youtube.com/watch?v=y1kGNUk_Hp0
Both communication disorders but different
from language disorders!
What is a Language Disorder?
 Remember, there is a WIDE range of normal!
 Language Disorder
 Difficulty understanding and/or using language
 Difference ≠ Disorder
 May involve deficits in any language domain
Impairment in one or more domains
 PHONOLOGY: how individual speech sounds can
be sequenced
 SYNTAX: word order and relationships between
words in sentences
 MORPHOLOGY: word structure and how the
meaning of words can be changed (plurals, past
tense)
 SEMANTICS: the meaning of words; vocabulary
 PRAGMATICS: how language is used socially
Language Disorders
No single cause
Primary Language Disorder:
 No other conditions or disorders; no known cause
 Often called specific language impairment (SLI)
Secondary Language Disorder:
 Language disorders often co-occur with
developmental, genetic, or acquired disorders
Specific Language Impairment
 Impairment specific to language
 No known cause
 May be slower starting to talk
 Varied language profile
Specific Language Impairment
 Phonology:
 May have co-occurring speech sound disorders
 May have difficulties with phonological
awareness
 Syntax & Morphology:
 Shorter length of utterance
 May omit grammatical elements and
morphemes (past tense, plurals, etc.)
 Pronoun errors
 Difficulty with wh- questions
Specific Language Impairment
 Semantics:
 Slower rate of vocabulary development
 May have smaller vocabularies
 May have difficulty with word retrieval
 Pragmatics:
 Pragmatic skills vary greatly
 May have difficulty with:
 Topic Initiation & Maintenance
 Repairing communication breakdowns
 Narrative skills
 Perspective taking
 Video
http://www.youtube.com/watch?v=UmLu8rzbHhE
Language & Literacy
 Strong connection between oral language abilities
and literacy skills
 Children with oral language disorders are at risk for
difficulties with reading and writing
 Impairments in any domain
can impact reading and writing
SLI & Dyslexia
 Dyslexia & SLI are distinct conditions but can cooccur
 Early signs of dyslexia and SLI may be similar in
some young children
 Possible delays in speaking
 Articulation errors may be present
 Difficulty with rhyming and phonological/phonemic
awareness
 Difficulty with word retrieval; imprecise language
Language Disorders
in Special Populations
 Language disorders commonly co-occur with many
genetic and developmental disorders
 A diagnosis does not predict an individual’s language
abilities
 Lots of variability
Let’s explore some possible language
characteristics in selected populations
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Intellectual Disabilities
Autism Spectrum Disorders
Traumatic Brain Injuries
ADHD
Complex Communication Needs
Intellectual Disabilities
 Significant limitations in cognitive functioning (IQ score
significantly below average) and adaptive skills
 IQ does not predict language skills
 Language development is delayed
 Different patterns of strengths/weaknesses
Intellectual Disabilities
 Phonology: May have speech sound disorders
 Syntax/Morphology:
 Shorter and less complex sentences
 Often omit morphemes and function words
 Semantics:
 Slower vocabulary growth
 Concrete vocabulary is a strength, difficulties
with abstract vocabulary
Intellectual Disabilities
 Pragmatics:
 Down Syndrome: generally considered a strength
 Williams Syndrome: overfriendliness, difficulties
providing appropriate/contingent responses
 Fragile X: Individuals who also have co-occurring ASD
will demonstrate significant pragmatic deficits
 Literacy:
 Variable
 Improving oral language abilities can provide a
foundation for literacy
Autism Spectrum Disorders (ASD)
 Deficits in social communication and social
interaction
 Often see early differences in social
communicative behaviors
 Delayed speech and language is common
 Pragmatic differences are universal
ASD
 Phonology
 Varies; may have very limited speech skills
 Syntax/Morphology
 Variable; can be completely intact
 May use short, simple sentences
 May use incorrect word order, omission of grammatical
morphemes
 Semantics
 Wide variability
 More difficulty with abstract vocabulary, figurative
language
ASD
 Pragmatics
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May lack interest in communication
Difficulty maintaining conversation
Use of language in perseverative manner
Difficulty with perspective taking
 Literacy
 Decoding may be a strength
 Comprehension may be more challenging
Traumatic Brain Injury
 Age, location, and severity of brain injury is related
to language and literacy outcomes
 Language impairments
from minimal
 Deficits in attention and
impact language & literacy
range
to severe
memory
ADHD
 Language can be typical
 Language & literacy challenges can include:
 Difficulties with complex grammar and vocabulary
 Pragmatic Difficulties
 Literacy outcomes may be influenced by processing
speed, attention, comprehension monitoring
Complex Communication Needs
 Some children may be unable to speak and use
verbal language
 Alternative and Augmentative Communication
(AAC) systems
language
can provide access to
Plus Many More!!
 Many other conditions or disorders may have cooccurring language disorders
 No matter what, individualized assessment and
intervention is key
Supporting Language Development
KEEP TALKING!
I’m Listening!
Supporting Language Development
 Model appropriate speech and language
 Respond to all attempts to communicate
 Offer choices
 Ask questions
 Read to your child to
vocabulary
increase
Zone of Proximal Development
 Build upon a child’s current language skills
 Scaffolding
 Example:
 If a child is saying two-word
sentences, we want to
model three-word sentences
(next developmental step)
Supporting Language Development
 Birth to 2 years
 Use language to describe what you are doing
 Self Talk
 Parallel Talk
 Use gestures when communicating
 Imitate facial expressions and sounds
 Expand upon the child’s babbling/words
 Explore written materials like books
Supporting Language Development
 2 to 4 years
Expand upon what the child says
Expansion: Repeating what child
says with adult-like grammar
Child: “Car go”
Adult: “Yes, the car is going”
Extension: Add new information
“The car is going fast”
Supporting Language Development
 2 to 4 years
Label objects/items to introduce new words
 Specific vocabulary (categories)
 20 introductions across different settings
Supporting Language Development
 4 to 6 years
Think about scaffolding and the zone of proximal
development
Give two- or three-step directions
 First sharpen your pencil, then get your notebook
 Sharpen your pencil, get your notebook, and then
sit down
Supporting Language Development
 4 to 6 years
Introduce new words, explain what they
mean, and use in multiple contexts
 Example: Combine and tractor
 Similarities and differences
 Functions
Supporting Language Development
 4 to 6 years
Play games involving
language
 I spy
 20 questions
Discuss opposites and attributes
 Size (big, small, heavy)
 Shape
 Color
Supporting Language Development
 School-Age
 Ask open-ended questions
 Make connections between school, home, and
other activities
 Follow the child’s lead in his/her interests and
preferences
 Use interest areas for vocabulary growth
THANK YOU!!!
ANY QUESTIONS?
References

American Speech-Language Hearing Association. (2013). Activities to encourage speech and
language development. Retrieved from: http://www.asha.org/public/speech/development/parent-stimactivities.htm.

American Speech-Language Hearing Association. (2013). Suggestions for parents. Retrieved from:
http://www.asha.org/public/speech/development/suggestions.htm.

Catts, H. W., Adlof, S. M., Hogan, T. P., & Weismer, S. E. (2005). Are specific language impairment
and dyslexia distinct disorders? Journal of Speech, Language, and Hearing Research, 48, 1378-1396.

Owens, R. (2010). Language disorders: A functional approach to assessment and intervention (5th
edition). Pearson Education, Inc.

Owens, R. (2012). Language development: An introduction (8th edition). Upper Saddle River, NJ:
Pearson Education, Inc.

Paul, R. & Norbury, C. (2012). Language disorders from infancy through adolescence: Listening,
speaking, reading, writing, and communicating (4th edition). St. Louis, Missouri: Elsevier Inc.

Roseberry-McKibbin, C. & Hegde, M. N. (2011). An advanced review of speech language pathology
(3rd edition). Austin, TX: Pro-Ed.

Shaywitz, S. (2003). Overcoming dyslexia: A new and complete science-based program for reading
problems at any level. New York: Vintage Books, Random House Inc.

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