LSP

Language in Special Populations

Reviews: ETIOLOGY ASSESSMENT INTERVENTION

POINTS OF INTEREST

· otitis media & language development

· cerebral palsy & communication skills

· language therapy programs

THE ISSUE    Clinicians are often presented with children whose difficulties are often very different from children with traditional speech and language problems. Their conditions include specific disorders such as autism spectrum disorder (ASD), cerebral palsy, otitis media, or fetal alcohol syndrome. Some children may have special needs due to social origins such as socio-economic factors or dual language learning. Specific clinical knowledge is often required to assess and treat these children. Children with autism learn language differently than children with specific language impairment, and require very different therapy goals and activities. To perform accurate assessments and set appropriate intervention goals, clinicians must be knowledgeable with respect to factors affecting language learning and development in specific populations.

THE REVIEWS    Thirteen reviews were identified for the category of language in special populations. Eight of these reviews focused on language intervention in areas such as autism, cerebral palsy, and bilingualism. Two reviews examined assessment: one examined issues associated with cross-cultural assessments of children’s speech and language skills, and the other examined early screening of children’s literacy skills including written language and phonological awareness, letter-name knowledge, and grapheme-morpheme correspondence. Finally, three reviews described the etiology of fetal alcohol syndrome, autism spectrum disorder, and otitis media.

WHAT THE REVIEWS CONCLUDE    It is a common belief amongst clinicians that otitis media has a significant negative impact on children’s speech and language development. One review concluded that there is little evidence to suggest that otitis media causes significant negative effects on children’s language development, and therefore challenged the use of medical interventions such as pressure-equalization tubes if language development is the only concern. The relationship between phonological development and otitis media was not addressed. Significant associations have been found between the degree of prenatal exposure to alcohol and cognitive impairment, learning disabilities, behavioural disorders, cranio-facial abnormalities (e.g., cleft palate), delays in language acquisition, receptive and expressive language deficits, otitis media with effusion, and conductive hearing loss. Prenatal exposure to cocaine results in more subtle cognitive deficits and fewer effects, if any, on speech and language development. The majority of research conducted in the area of autism has examined expressive language and prosody skills and not the receptive language skills of children with autism. Research on prosodic difficulties is often conflicting, which makes it difficult to determine whether prosodic disorders are generally characteristic of children with autism.

With respect to assessment, one review concluded that methods for developing cross-cultural speech and language assessment tools should include working with consultants to ensure that the words, terminology, and wording of questions and statements convey the appropriate message. Test materials that rely on images of normally-developing children may not be sufficiently valid as stimuli for testing special populations. The other review on assessment concluded that speech language clinics should be encouraged to design and implement early literacy screening protocols. Protocols should include tests of phonological awareness, letter/name knowledge, grapheme/morpheme correspondence, and so forth. The screening device can be used to identify children at risk for literacy difficulties and to determine whether children with literacy difficulties might benefit from the services of a speech-language pathologist. Two reviews examined assessment for children with autism. One provided early diagnostic indicators of ASD (e.g., pointing, showing objects, looking at another’s face, orienting to name). The review also suggested that children with autism can be reliably diagnosed by 24 months of age.

A range of intervention practices for children with autism were examined and a range of approaches (e.g., speech and language, functional communication training, increasing imitation, and social communication training) were found to be effective. Conclusions about which approach was most effective were not drawn. Clinicians can help facilitate treatment by providing interventions early in children’s natural environments, and by embedding intervention and goals in children’s daily routines. The other review found that early intervention that included parent training elicited better outcomes than other treatment approaches, however these results should be interpreted with caution as only two studies with small sample sizes were included in the review.

Reviews of intervention for children with cerebral palsy suggest that interaction training of the children’s conversational partners may not be the most effective method of treatment. Direct treatment of children may increase specific skills that are targeted in therapy; however, generalization across other skills was not often observed.

Language intervention with linguistically diverse preschoolers is facilitated by promoting language development in home and school. Parent training and peer intervention training were suggested as effective methods. One article reviewed early intervention programs for environmentally disadvantaged children in programs such as Head Start, the Carolina Abecedarian Project, and the Perry Preschool Project. Programs that were longer, started earlier, continued to provide support after entry into school, focused directly on the children, fostered social interaction, had specific goals, and placed an emphasis on cognitive and linguistic competencies were particularly beneficial. Finally, because gesture development has parallels in spoken language development, it was advanced as a method of facilitating language development for both normally developing children and children with significant delays and disorders.