Communication Disorder

“
Communication disorders an impairment in the ability to receive, send,
process, and comprehend concepts or verbal, nonverbal and graphic
symbol systems.

2
 “
Narrating
Children need to be able to tell (and follow the telling of) a story—a
sequence of related events connected in an orderly, clear, and interesting
manner.

▹ Five-year-old Cindy tells her teacher, “I had a birthday party. I wore a

funny hat. Daddy made a cake, and Mommy took pictures.”

▹ Fourteen-year-old Ian tells the class about the events leading up to

the Selma-to-Montgomery marches.
3
 “
Explaining and Informing
Teachers expect children to interpret the explanations of others in
speech and writing and to put what they understand into words so their
listeners or readers will be able to understand it.

▹ In a typical classroom, children must frequently respond to teachers’

questions: “Which number is larger?” “How do you suppose the story
will end?” “Why do you think George Washington was a great
president?”
4
 “
Requesting

Children are expected to communicate their wishes and desires to others

in socially appropriate ways. A child who has learned to state requests
clearly and politely is more likely to get what she wants and less likely to
engage in inappropriate behavior to communicate
her needs.

5
 “
Expressing
It is important for children to express their personal feelings and opinions
and to respond to the feelings of others. Speech and language can
convey joy, fear, frustration, humor, sympathy, and anger.

▹ A child writes, “I have just moved. And it is hard to find a friend

because I am shy.” Another tells her classmates, “Guess what? I have
a new baby brother!”

6
LANGUAGE DISORDER
 “
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.

8
 “
Language disorder consists of difficulties in the acquisition and use of
language across many modalities, including spoken and written, due to
deficits in comprehension or production based on both expressive and
receptive skills. These deficits include reduced vocabulary, limited abilities
in forming sentences using the rules of grammar, and impairments in
conversing based on difficulties using vocabulary to connect sentences in
descriptive ways.

9
 Etiology

▹ Limited magnetic resonance imaging (MRI) studies suggest that language disorders are associated with
diminished left–right brain asymmetry and results of one small MRI study suggested possible inversion
of brain asymmetry (right > left).
▹ Evidence shows that language disorders occur more frequently within some families, and several
studies of twins show significant concordance for monozygotic twins with respect to language
disorders.
▹ Environmental and educational factors are also postulated to contribute to developmental language
disorders.
10
LA󰈰󰉁󰈖󰉚GE 󰉍󰈾󰈟󰈭R󰉍E󰈣
Di󰈀g󰈝󰈢󰈼ti󰇹 C󰈹󰈎t󰇵󰈸i󰈀 & Sy󰈚󰈦to󰈚󰈼
A. Per󰈻󰈎󰈼t󰇵󰈝󰉄 diffi󰇹󰉉󰈘t󰈏e󰈻 in 󰉃󰈋󰈩 ac󰈫󰉉󰈏󰈼it󰈎󰈢󰈝 a󰈞d 󰉉󰈻󰇵 o󰇿
la󰈝󰈈󰉉󰇽ge 󰈀󰇹󰈹󰈢s󰈻 󰈛od󰈀󰈗󰈏󰉄i󰈩s (i.󰈩., s󰈥󰈢󰈕en, 󰉒󰈹󰈎󰉅󰇵n, 󰈻i󰈈n
la󰈝󰈈󰉉󰇽ge, 󰈡󰈸 󰈢󰉄he󰈸) 󰇶󰉉󰇵 to 󰇷󰈩fi󰇸󰈏t󰈻 i󰈞 c󰈡󰈚󰈦r󰇵󰈊e󰈞s󰈎󰈢󰈝 o󰈹
p󰈸o󰇶󰉉c󰉃󰈏o󰈞 t󰈊󰈀󰉄 󰈏n󰇹󰈘ud󰈩 󰉃󰈋󰇵 fo󰈗󰈘󰈡w󰈏󰈝󰈈:
1. Red󰉉󰇹󰇵󰇶 vo󰇹󰈀󰇻󰉊la󰈸󰉙 (w󰈡󰈸󰇶 k󰈝󰈢󰉓le󰇷󰈈󰈩 󰇽n󰇷 u󰈼󰈩)
2. Lim󰈎󰉃󰇵󰇶 se󰈝󰉄󰈩n󰇹󰇵󰈼 s󰉃󰈹uc󰉃󰉉󰈹󰇵
3. Im󰈥a󰈎󰈹m󰇵󰈝󰉄s i󰈝 󰇶󰈎s󰇹󰈢u󰈹s󰈩
B. Lan󰈇󰉉󰇽󰈈e 󰈀b󰈏󰈗i󰉄󰈎󰇵s a󰈸󰈩 su󰇼󰈼t󰈀󰈝󰉄󰈏al󰈗󰉙 󰈀n󰇷 󰈬󰉊an󰉃󰈎fi󰇽󰇻l󰉘
be󰈗󰈡󰉓 t󰈊󰈢󰈼e 󰈩x󰈥󰇵󰇸te󰇷 󰇿󰈡r 󰇽󰈇e, re󰈻󰉉󰈘t󰈏󰈝󰈈 in 󰇾󰉉󰈞c󰉃󰈏o󰈞󰈀l
li󰈚󰈎󰉄󰇽ti󰈡󰈝󰈼 󰈏n eff󰈩󰇹󰉄󰈏ve 󰇹󰈡󰈛m󰉊󰈝i󰇸󰈀t󰈏o󰈝, 󰈼󰈡c󰈏a󰈗
pa󰈸󰉄󰈎c󰈏󰈥a󰉄󰈎󰈢n, a󰇹󰈀󰇶󰇵mi󰇹 󰈀󰇸h󰈏e󰉏󰈩󰈛󰇵n󰉃, o󰈹 󰈡c󰇹󰉊󰈦at󰈎󰈢󰈝a󰈘
pe󰈸󰇿󰈡r󰈚󰇽󰈞ce, 󰈎󰈝󰇶󰈏vi󰇷󰉉󰇽󰈘l󰉘 o󰈹 󰈎n 󰇽󰈝󰉙 co󰈚󰇻󰈎n󰇽󰉃i󰈡󰈞.
C. On󰈻e󰉄 󰈡f 󰈻󰉙m󰈥󰉄om󰈻 󰈎󰈼 󰈏n 󰉃󰈋e 󰈩󰇽r󰈗󰉙 de󰉏󰈩󰈘󰈢p󰈚e󰈞t󰈀󰈗
pe󰈸󰈎󰈢󰇶.

“We cannot diagnose immediately the child showing

symptoms of language disorder, instead we continue
monitoring them and take note of their deficits.”
D. The 󰇷󰈎ffi󰇸󰉊l󰉃i󰈩󰈼 󰇽re no󰉃 󰈀󰉅󰈹󰈏bu󰉃󰈀󰇻l󰇵 to 󰈊󰈩󰇽󰈹in󰈇 󰈡󰈹 󰈢t󰈊e󰈹
se󰈝󰈼󰈡r󰉘 󰈏󰈛pa󰈎󰈸󰈛󰇵n󰉃, 󰈛ot󰈡󰈸 󰇶y󰈻󰇿un󰇹󰉄󰈎󰈢n, o󰈸 󰈀󰈞󰈢t󰈊e󰈹 m󰈩󰇷󰈏󰇸al
or 󰈝󰈩󰉊󰈹ol󰈡󰈇󰈏󰇸al 󰇹󰈡󰈞d󰈏󰉃i󰈡󰈞 󰇽n󰇷 a󰈹󰈩 n󰈢󰉃 󰇻e󰉅󰈩r 󰇵󰉕󰈦la󰈎󰈝󰇵󰇶 b󰉘
in󰉃󰈩󰈘l󰇵󰇹󰉄u󰈀l 󰇷󰈏󰈼ab󰈎󰈗󰈏󰉄y (i󰈝󰉄󰈩l󰈗󰇵󰇸tu󰈀󰈗 󰇶󰇵ve󰈗󰈡󰈦m󰇵󰈝󰉄 di󰈻󰈡󰈹d󰇵󰈸) o󰈹
g󰈗o󰇻󰈀l 󰇷󰇵󰉐el󰈡󰈥󰈛󰇵n󰉃 󰇶el󰈀󰉘.
Language Disorder
Diagnostic Feature
▹ Language Disorder has two core diagnostic
features:
Acquisition and use of Language

▹ The language deficits are evident in spoken

communication, written communication, or sign
language.
▹ Language learning and use is dependent on both
Receptive and Expressive skills.
▹ Expressive ability- The production of vocal,
gestural, or verbal signals.

▹ Receptive ability- The process of receiving and

comprehending language messages.

▹ Language skills need to b assessed in both

modalities as these may differ in severity.
▹ The child’s first words and phrases are likely
to be delayed in onset; vocabulary sizes is
smaller and less varied than expected; and
sentences are shorter and less complex with
grammatical errors, especially in past tense.

▹ Problems with remembering new words and

sentences.
▹ Difficulties following instructions of increasing
length, rehearsing strings of verbal information,
and difficulty remembering novel sound
sequences.

▹ Difficulty providing adequate information about

the key events and to narrate a coherent story.
▹ The language difficulty is manifest by abilities
substantially and quantifiably below the
expected for age and significantly interfering
with academic achievement , occupational
performance, effective communication , or
socialization.
 A diagnosis is made based on the:

▹ Synthesis of the individual’s history

▹ Direct clinical observation in different
contexts (i.e., home, school, or work)
▹ Scores from standardized tests of
language ability that can be used to
guide estimates of severity.
language disorder
Assessment
 Recommended in-depth assessment of young
children with possible speech language disorder
includes:
Standardized tests they offer objectivity and structure to the assessment
process.
Alternative approaches analysis of samples of the child's speech and
language .
Case History and Physical Examination information of the child’s birth and
developmental history, health record, scores on achievement and intelligence
tests, and adjustment to school.
Screening and Teacher Observation SLPs screen the spoken language
abilities of all kindergarten children. Screenings involve norm-referenced tests,
informal assessments developed by the SLP, and questionnaires or checklists
for parents and teachers.
Specific components to be included in an in-depth
assessment
✔ Standardized tests of expressive and receptive language It
is important that these tests be age-appropriate and include:
❑ norm-referenced measures compare the child's
performance to an appropriate peer group
❑ criterion-referenced measures compare the child's
performance with an established level or
pre-determined standard
❑ Wechsler Intelligence Scale for Children III (WISC-III)
use to identify a child with expressive language deficit.
✔ Samples of spontaneous speech collected in natural
contexts to determine the level of language development and
obtain a description of language form, content, and use.
 Specific components to be included in an in-depth
assessment
✔ Observations of communicative interactions observation of the caregiver can be use to
measure the effectiveness of the child's communication.
✔ Dynamic assessments help determine if a child is at a developmental level appropriate to
learning specific new language skills.
✔ Overall language development and vocabulary amount of vocabulary a child has acquired.
❑ Peabody Picture Vocabulary Test—4 (Dunn & Dunn, 2006)
❑ Comprehensive Receptive and Expressive Vocabulary Test (Wallace & Hammill, 2002
✔ Overall Language Test assesses the child’s understanding and production of language
structures.
❑ Test of Language Development (Hammill & Newcomer, 2008)
❑ Clinical Evaluation of Language Fundamentals (Semel, Wiig, & Secord, 2003)
 Specific components to be included in an in-depth
assessment
✔ Language samples obtaining accurate samples of the child’s expressive speech and language.
✔ Assessment of language function emphasized the various functions of communication (e.g.,
requesting, naming).
❑ Verbal Behavior Milestones Assessment and Placement Program (VB-MAPP) identifies a
student’s strengths and weaknesses across the different language functions and compares
them with the language and communication skills of typically developing children.
❑ Barriers Assessment identifies 24 possible barriers that might be preventing a child from
making progress (e.g., prompt dependency, weak motivation)
❑ Transition Assessment identify a child’s overall educational needs.
INTERVENTION
Language Disorder
 Treatment Strategies
Language therapy
o The common treatment for language disorder is
speech-language therapy.

Child may participate in

Speech-language therapist one-on-one treatment
will diagnose and treat the sessions with a
Treatment will depend
child according to their speech-language
on the age of the child
deficits. therapist or attend group
and the cause and
extent of the condition sessions.
Treatment Strategies
Language Intervention Activities
Intervention techniques
o Speech and language therapists commonly use a range of
behavioral techniques, including imitation, modelling, repetition and
extension.
Stimuli are commonly It is assumed that practice is
repeated many times to draw one of the cornerstones of Key to all intervention
the child's attention to the reinforcement and that is building the child's
correct form. repetition makes it easy for the motivation to speak.
child to learn what they have
not otherwise acquired.
Treatment Strategies
Language Intervention Activities

• The Speech-language therapist (SLP) will interact with a child by playing and
talking, using pictures, books, objects, or ongoing events to stimulate language
development. The therapist may model correct vocabulary and grammar, and use
repetition exercises to build language skills.
Treatment Strategies
Psychological therapy
o Having difficulty understanding and communicating with others can be
frustrating and may trigger episodes of acting out. Counseling may be
needed to address emotional or behavioral issues.

Medical exam
o The first course of action is to visit a doctor for a full physical exam.
This will help rule out or diagnose other conditions, such as a hearing
problems or other sensory impairment.
Parental Involvement in
Language Intervention
As a parent one should:
✔ Talk a lot to your child. This will help your child learn new words.
✔ Read to your child every day. Point out words you see.
✔ Point to signs in the grocery store, at school, and outside.
✔ Speak to your child in the language you know best.
✔ Listen and answer when your child talks.
✔ Get your child to ask you questions.
✔ Give your child time to answer questions.
✔ Set time limits for watching TV and using computers. Use the time for talking and reading
together.
34
SPEECH SOUND
DISORDER
 Children may say some sounds the wrong way as
they learn to talk. They learn some sounds earlier,
like p, m, or w. Other sounds take longer to learn,
like z, v, or th. Most children can say almost all
speech sounds correctly by 4 years old. A child who
does not say sounds by the expected ages may
have a speech sound disorder.
Children with speech sound disorder have difficulty
forming speech sounds — articulating individual
sounds, being understood, modulating speech —
and they may stutter or lisp.
 What is a Speech Sound
Disorder?

It is a communication disorder characterized by

persistent difficulties in producing speech sounds. It
can involve phonological problems, problems
controlling different parts of the vocal apparatus,
problems with the timing of speech, or difficulties
with speech such as stuttering or lisping.
 REMEMBER!

Children with speech sound disorder do not have

problems understanding language itself. Rather,
they have difficulties expressing language in
speech sounds at an age-appropriate level.
ETIOLOGY
Speech Sound Disorder
 Neurological Factor

• Nervous system disorders

such as cerebral palsy
It can affect a person's ability to
finely coordinate the muscles
around the mouth and tongue
that are needed for speech.
 Genetic Factors

• Family history of speech delay or immature

development.
• Genetic disorders such as
Down syndrome
Difficulty with grammar, tenses
and word endings and use
shorter sentences to
communicate.
 Biological Factors

• Frequent ear infections

•Physical problems such as a
cleft lip or palate
• Hearing loss
Problems with speech that
include sounding nasal which is
caused by the soft palate not being
able to properly close off the mouth
from the nose while speaking and
therefore letting air escape through
the nose
 Environmental Factor
•Lack of support in learning at home

Psychological Factors
• Too much thumb-sucking or pacifier use
• Developmental disorders such as autism
 SPEECH SOUND
DISORDER
(PHONOLOGICAL
DISORDER)
DIAGNOSTIC CRITERIA
Speech Sound Disorder

According to DSM-5, there are

certain criteria that must be met in
order for the diagnosis of Speech
Sound Disorder (American
Psychiatric Association, 2013).

46
 Criterion A

Persistent difficulty of speech

sound production that interferes
with speech intelligibility or prevents
verbal communication of
messages.

47
omissions/deletions—certain sounds are omitted or deleted
(e.g., "cu" for "cup" and "poon" for "spoon")

substitutions—one or more sounds are substituted, which may result in loss of phonemic contrast
(e.g., "thing" for "sing" and "wabbit" for "rabbit")

additions—one or more extra sounds are added or inserted into a word

(e.g., "buhlack" for "black")

sound distortions occur when a phoneme is not produced correctly, usually resulting in a “slushy”
sound. Children with SSD most frequently distort the /r/, /l/,/z/, /sh/, and /ch/ sounds.

syllable-level errors—weak syllables are deleted

(e.g., "tephone" for "telephone")
Saying only 1 syllable in a word (example: “bay” instead of “baby”)
Simplifying a word by repeating 2 syllables (example: “baba” instead of “bottle”)
Leaving out a consonant sound (example: “at” or “ba” instead of “bat”)
Changing certain consonant sounds (example: “tat” instead of “cat”)

4
8
 Criterion B

The disturbance causes limitations

in effective communication that
interfere with social participation,
academic achievement, or
occupational performance,
individually or in any combination.

49
 By 3 months Makes cooing sounds
Criterion C
By 5 months Laughs and makes playful sounds
Onset symptoms is in the early
developmental period. By 6 months Makes speech-like babbling
sounds like puh, ba, mi, da

By 1 year Babbles longer strings of sounds

like mimi, upup, bababa

By 3 years Says m, n, h, w, p, b, t, d, k, g, and f in

words
Familiar people understand the child's
speech

By 4 years Says y and v in words

May still make mistakes on the s, sh,
ch, j, ng, th, z, l, and r sounds
Most people understand the child’s
speech
50
 Criterion D

The difficulties are not attributes to

congenital or acquired conditions,
such as cerebral palsy, cleft palate,
deafness or hearing loss, traumatic
brain injury, or other medical or
neurological conditions.

51
DIAGNOSTIC FEATURES OF
SPEECH SOUND DISORDER
✔ The disorder results in errors in whole words because
of incorrect pronunciation of consonants, the
substitution of one sound for another, omission
(left out) of entire phonemes.

✔ In some cases, dysarthria slurred speech (poor

pronunciation of words or mumble) because of
incoordination of speech muscles) and related facial
musculature such as chewing, maintaining mouth
closure, and blowing the nose. or dyspraxia
difficulty planning and executing speech.

✔ The diagnosis of a speech sound disorder is made

by comparing the skills of a given child with the
expected skill level of others of the same age.
✔ Articulation deficits give the impression of “baby
talk.” Typically, these deficits are not caused by
anatomical, structural, physiological, auditory, or
neurological abnormalities.

✔ They vary from mild to severe and result in speech

that ranges from completely intelligible to
unintelligible.

✔ Language disorder, particularly expressive deficit,

may be found to co-occur with speech sound disorder.
a positive family history of the speech-language
disorder is often present.
 Developmental and Course
✔ Speech sound articulation follows a developmental
pattern, that is reflected in the age norms of standardized
tests.

✔ By age 3 years developing children are learning to talk

and it is not unusual for the child to talk in short words
and syllables. The progress of the child’s mastering speech
sound production should result mostly intelligible.

✔ Age 4 years, overall speech should be intelligible,

whereas, at age 2 years, only 50% may be
understandable.

✔ By age 7 tears, most speech sounds should be produced

clearly and most words should be pronounced.
 Developmental and Course

✔ By age 8 years, misarticulation could be considered

within normal limits especially when multiple sounds are
involved. Targeting those sounds is appropriate as part of
a plan to improve intelligibility prior to the age at which
almost all children can produce them accurately.

✔ Most children with speech sound disorder respond well to

treatment, and speech difficulties improve over time, and
thus the disorder may not be lifelong.

✔ However, when a language disorder is also present, the

speech disorder has a poorer prognosis and may be
associated with specific learning disorders.
Speech Sound
Disorder
Assessment
NORMATIVE DATA FOR SPEECH
SOUND ACQUISITION
• One of the primary means of
determining whether or not speech
sound production is delayed or
disordered is by comparison to
developmental norms.
• As a general developmental rule, vowels
emerge and become established prior
to consonants.
Templin (1957) has identified the ages
at which initial and final consonant
clusters were accurately produced by
75% of the participants in his study
(Certain Language Skills in Children:
Their Development and
Interrelationships) , ranging from 4 to 8
years old:
According to American
Speech-Language Association or
ASHA (2004), clinical indications for a
speech sound assessment are initiated
by referral (from a health or an
education professional), the client’s
medical status, or by failing a
speech-language screening.
The screening measure is used
to:
• Evaluate both strengths and
weaknesses in speech sound
discrimination and production.
• For the objective identification of
impairments or speech sound disorders.
• To make recommendations and
referrals for intervention.
Parameters to be assessed by formal
and informal means are as follows:

• A case history entailing information such as the

child’s medical history, birth and developmental
milestones (if a child), social history, academic
and previous therapy history.

• Conversational speech assessment in different

contexts.
• Measure overall intelligibility (the
understandability of speech) in isolated
and connected words and spontaneous
utterances, again noting the consistency
and frequency of sound production
errors.

• Stimulability (the ability to imitate a

target sound) of error sound productions.
Assessments for Speech Sound
Disorder
Name of Measure Description
Goldman-Fristoe Test of Articulation-2 & 3 Norm-Referenced Standardized Test of
Articulation and Stimulability for
ages 2- 11 years

Hodson Assessment of Phonological Norm-Referenced Standardized Test &

Processes-3 Criterion-Referenced Test of Phonological
Processes for ages 3-8 years.

The Entire World of /r/ Screener Criterion-Based Assessment of 21 variations

of /r/
Assessments for Speech Sound
Disorder
Name of Measure Description
The Arizona-3 Norm-Referenced, Standardized test for
Articulation, ages 1.5-18 years.

DEAP (Diagnostic Evaluation of Articulation Norm-Referenced Standardized Test of

and Phonology) Articulation and Phonology for Ages 3-8- 11
 Speech Sound
Disorder Intervention &
Treatments
Who facilitates the
intervention?
✗ Speech-Language Pathologists
✗ Family/Parents
✗ School teachers

69
In󰉃e󰈹v󰈩󰈝󰉄󰈏on 󰇷󰈩󰈦󰇵n󰇷󰈼 up󰈡󰈝 󰉄h󰇵 󰈝a󰉄󰉉r󰇵 o󰇾 󰉄h󰈩
s󰈥e󰈩󰇸h 󰈻󰈢u󰈞d 󰇷󰈎󰈼󰈢r󰇷e󰈹 󰈀n󰇷 󰉄h󰇵 󰈻󰈦ec󰈎fi󰇹
defi󰇹󰈎󰉄s 󰈢󰇾 󰉄he 󰇹󰈋󰈎l󰇷.

70
Early Intervention (Birth to Age 3)
When children are quite young, language intervention
typically is implemented through a family-centered approach.

It recognizes the influential role of caregivers and their

abilities and the home context in children’s communicative
development throughout everyday routines (Rush and Shelden,
2008).
 Tec󰈊󰈞󰈎q󰉊e󰈻 󰇿󰈡󰉊n󰇷 o󰈞 r󰈩󰈻󰇵a󰈹c󰈊󰈩󰈼
Expansion - The parent provided a model of a grammatically well-formed sentence by
expanding the child’s utterance.

Child: “See doggy,”

Parent may follow by saying, “Yes, see the doggy.”

Recast - A variant on expansion that entails reformulation of a child’s prior

well-formed utterance to include additional and more advanced
grammatical properties (Nelson et al., 1973).

Child: “The doggy is barking”

Parent: “Yes, the doggy is barking very loudly, isn’t he?”
 Pro󰈚󰈡󰉄󰈏n󰈇 󰇸ar󰈩󰈇󰈏󰉐er 󰈸󰈩󰈼p󰈢󰈝󰈼iv󰈩󰈝󰇵󰈼s 󰉃o 󰉄h󰈩 󰇹󰈋󰈏l󰇷 a󰈞d 󰉃󰈡 󰉄h󰇵
c󰈊i󰈘d’󰈻 󰈩ff󰈢󰈹t󰈻 󰉄o c󰈡󰈚󰈛󰉊ni󰇹󰈀󰉄󰇵 is 󰈀󰈝󰈢󰉄he󰈸 󰈦r󰈎󰈚󰇽󰈹y 󰈇o󰈀󰈘 󰈢f e󰈀󰈸󰈘y
in󰉃󰈩󰈹v󰇵󰈝󰉄i󰈡n.

Ways to enhance caregiver’s responsiveness:

• Parallel talk (e.g., describing in the moment what the child is
doing or experiencing) “You are swinging so high.”
• Asking open-ended questions. “What else do you want?”
• Reduce the use of overly directive and/or controlling. “Say it
this way, not that way.”
 3 Levels of Intervention (RTI
Approach)
Tier 1: The General Tier 2: Collaborative Tier 3: Individualized
Education Classroom Intervention Educational Services
✔ Provides a rich ✔ Teachers worked
language with SLP to plan
environment that can ✔ specifically designed
activities and
enhance the to meet the individual
strategies to address
communication skills needs of the student.
communication
✔ Promotes difficulties
conversations about
what is being learned
 Ar󰉃i󰇸󰉉l󰇽󰉃i󰈡󰈞 󰇽n󰇷 P󰈋on󰈡󰈗󰈢󰈈ic󰈀󰈗 D󰈏󰈼or󰇷󰈩󰈹s
Articulation Disorder Phonological Disorders

A child is not able to produce a given A child with a phonological disorder has the
sound physically because that sound is ability to produce a given sound but does so
not in his repertoire. inconsistently.

child pronounces so many sounds She produces the same sound correctly in
poorly that his speech is unintelligible some instances and incorrectly in others.
most of the time.
Common errors:
Common errors SODA: - Final Consonant Deletion
- substitution (“train” for “crane”) - Cluster reduction
- Omission (“cool” for “school”) - Velar fronting
- Distortion (“sleep” as “thleep”) - Stopping
- Addition (“buhrown” for “brown”) - Glides
 Tre󰈀󰉃󰈏󰈞g A󰈸󰉄ic󰉉󰈗󰇽󰉄i󰈡n E󰈸󰈹󰈢r󰈻

The goals of therapy for articulation problems are:

a) Acquisition of correct speech sound(s),

b) Generalization of the correct sound(s) to all settings and
contexts (especially the classroom), and
c) Maintenance of the correct sound(s) after therapy has ended
 Tra󰇷󰈎󰉄󰈏on󰈀󰈗
Ar󰉃i󰇸󰉉l󰇽󰉃i󰈡󰈞
The󰈸󰈀󰈦y
✔ It presents sequenced activities,
which teaches children target
sounds in successive stages.

✔ Therapy emphasizes the

repetitive production of sounds in
various contexts, with special
attention to the motor skills
involved in articulation.
Pho󰈝󰈡󰈘󰈢gi󰇹󰈀󰈘 C󰈢n󰉃󰈹as󰉃
Ap󰈥󰈹o󰈀c󰈊󰇵󰈼
Min󰈎󰈚󰇽󰈘 Op󰈥o󰈼󰈎t󰈏o󰈝 Max󰈎󰈚󰇽󰈘
(Min󰈎󰈚󰇽󰈘-Pa󰈎r 󰈜󰈊󰇵󰈹ap󰉘) Op󰈥o󰈼󰈎t󰈏o󰈝󰈼
They focus on improving phonemic
contrasts in the child's speech by
emphasizing sound contrasts Fo󰉉r 󰉑󰈢󰈝󰉄ra󰈻󰉄󰈎v󰇵
necessary to differentiate one word
from another.
Ap󰈥󰈹o󰈀c󰈊󰇵󰈼
Tre󰈀󰉃󰈛󰇵n󰉃 o󰇿 t󰈊󰈩 E󰈛p󰉃󰉙
Contrast approaches use contrasting word
Set Mul󰉃󰈎󰈦l󰇵
pairs as targets instead of individual
sounds. (Nul󰈗 󰈠󰈩󰉄) Op󰈥o󰈼󰈎t󰈏o󰈝󰈼
 1. Min󰈎󰈚󰇽󰈘 Op󰈥o󰈼󰈎t󰈏o󰈝 (M󰈎󰈞󰈏ma󰈗-P󰈀󰈏󰈹 󰈜he󰈸󰈀󰈦y)
This uses pairs of words that differ by only one phoneme or single
feature signaling a change in meaning.

Minimal pairs are used to help establish contrasts not present in the
child's phonological system.

Examples:

"door" vs. "sore,"

"key" vs. "tea";

(Blache, Parsons, & Humphreys, 1981; Weiner, 1981).

 2. Max󰈎󰈚󰇽󰈘 Op󰈥o󰈼󰈎t󰈏o󰈝󰈼
Uses pairs of words containing a contrastive sound that is maximally
distinct and varies on multiple dimensions (e.g., voice, place, and
manner) to teach an unknown sound.

Example:
"mall" and "call"

Maximal pair because /m/ and /k/ vary on more than one dimension—/m/ is
a bilabial voiced nasal, whereas /k/ is a velar voiceless stop.
***Refer to the table next slide.***

(Gierut, 1989, 1990, 1992).

 3. Tre󰈀󰉃󰈛󰇵n󰉃 o󰇿 t󰈊󰈩 E󰈛p󰉃󰉙 Set (󰈰󰉉󰈗󰈘 󰈟󰇵t)
Similar to the maximal oppositions approach but uses pairs of words
containing two maximally opposing sounds (e.g., /r/ and /d/) that
are unknown to the child.

We will refer to the inventory (during the assessment) to identify the

unknown sounds.

Example:
"row" vs. "doe"
"ray" vs. "day"

(Gierut, 1992).
 4. Mul󰉃󰈎󰈦l󰇵 O󰈥󰈦os󰈎󰉃󰈏o󰈞s
A variation of the minimal oppositions approach but uses pairs of
words contrasting a child's error sound with three or four strategically
selected sounds that reflect both maximal classification and maximal
distinction.

Example:
"door," "four," "chore," and "store,"
to reduce backing of /d/ to /g/

(Williams, 2000a, 2000b)

 Cor󰈩 󰈐󰈢󰇹a󰇻󰉉l󰇽󰈸󰉙 Ap󰈥󰈹o󰈀c󰈊
Focuses on whole-word production
For children with inconsistent speech sound
production who may be resistant to more traditional
therapy approaches.
Words for practice are those used frequently.
List is developed from observation, parent and
teacher reports.
Words from this list are selected each week for
treatment.
Words are practiced until consistently produced

(Dodd, Holm, Crosbie, & McIntosh, 2006).

 Spe󰈩󰇹󰈋 P󰇵r󰇹e󰈦t󰈎󰈢󰈝 I󰈞te󰈸󰉐󰈩n󰉃󰈏o󰈞
(Spe󰈩󰇹󰈋 S󰈢un󰇷 󰈪󰈩󰈹c󰇵󰈥󰉄i󰈡n T󰈸󰇽i󰈞󰈎n󰈇)
Is used to help a child acquire a stable perceptual representation
for the target phoneme or phonological structure.

RECOMMENDED PROCEDURES:

a) Auditory bombardment – listening activity in which the student hears the target
sound produced correctly multiple times in a short period of time. The child can
engage in a quiet activity while listening.
b) Discrimination - Identification tasks are provided in which the child identifies
correct and incorrect versions of the target (e.g., "rat" is a correct exemplar of the
word corresponding to a rodent, whereas "wat" is not).

(ASHA website)
85
 Nat󰉉󰈸󰇽󰈘is󰉃󰈎󰇸 Sp󰇵e󰇹󰈋 In󰉃e󰈘l󰈎󰈇󰈏󰇻il󰈎󰉃󰉙
an󰇷 A󰇸cu󰈸󰈀󰇸y T󰈸󰇽i󰈞󰈎n󰈇
Addresses the targeted sound in naturalistic activities that provide the
child with frequent opportunities for the sound to occur.

For example, using a McDonald's menu, signs at the grocery store, or

favorite books, the child can be asked questions about words that
contain the targeted sound(s).

The child's error productions are recast without the use of imitative
prompts or direct motor training. This approach is used with children
who are able to use the recasts effectively (Camarata, 2010).
Most children with Speech sound disorder respond
well to treatment and speech difficulties improve over
time.

However, when language disorder is also present, the

speech disorder has a poorer prognosis and may be
associated with specific learning disorder.
Childhood-Onset
Fluency Disorder
(Stuttering)
 Wha󰉃 󰈎󰈼 S󰈜U󰈙T󰉋󰈤󰈽󰈯G?
It is a condition characterized by disturbances in the normal
speech fluency and time patterning of speech that are inappropriate for
the individual’s age and language skills, and persist over time
(American Psychiatric Association, 2013; Birstein. 2015).
 CO󰈲󰇴󰈮N󰉈󰈰󰈙S O󰉇 󰈟P󰉋󰉈󰉑󰈿 F󰈴U󰉋󰈯C󰇳:

Rat󰈩 – 󰉃󰈋󰇵 s󰈥e󰈩󰇶 󰇽t 󰉒󰈋ic󰈊 󰈦󰈩󰈢p󰈗e 󰈼p󰈩󰇽󰈔

Dur󰈀󰉃󰈏o󰈞 – t󰈊e 󰈘󰈩n󰈇󰉄h 󰈢󰇾 󰉄im󰈩 󰈢󰇾 i󰈞d󰈎󰉏󰈏󰇶u󰈀l 󰈻󰈦󰇵ec󰈊
so󰉉󰈝󰇶s
Rh󰉘󰉄h󰈚 – 󰉄he 󰇾󰈘󰈡w 󰇽󰈝󰇶 f󰈗u󰈎󰇶󰈏t󰉘 o󰇿 s󰈡󰉊󰈝󰇶s
Seq󰉉󰇵󰈝󰇸e – t󰈊󰈩 󰈢󰈹de󰈸 󰈡󰇿 s󰈢u󰈝󰇶s
 Eti󰈡󰈗󰈢󰈈y
✗ Psycholinguistics theories and several other theories attempt to
explain causes of stuttering, but no single approach, theory, or
model is able to explain all cases of stuttering.

(Birstein, 2015)

92
 93

Stu󰉅󰈩󰈸󰈏󰈞g T󰈊e󰈡󰈹󰈏es

Genetics
Learning and
and Psycholinguistics
Emotion
Neurobiology
 Gen󰈩󰉃󰈏󰇸s a󰈝󰇶 N󰈩󰉊ro󰇼󰈎󰈢󰈘og󰉘
Stuttering is heritable.
28% have parents who stuttered as a child
43% have at least 1 immediate family member with history

71% at least 1 in extended family member with history

Approx. 67% chance the other twin will stutter if the other does (gene
contribution)
Functional differences in the brains of people who stutter and who do not.

Greater activation of left-hemisphere brain regions responsible for

language (Broca’s and Wernicke’s areas) when people speak; people
who stutter have excessive activity of the right (not left) hemisphere.
 Le󰈀r󰈝󰈏󰈞g a󰈝󰇶 Em󰈡󰉃󰈏o󰈞 t󰈊󰈩󰈢󰈹i󰈩s
Two-factor Theory of Stuttering

• Both classical and operant conditioning play roles in the onset

and maintenance of stuttering (Brutten & Shoemaker, 1967).

• Stuttering begins when normal speech disfluencies are paired

with parental disapproval (classical conditioning).

• Stuttering is reinforced by the reactions of others (operant

conditioning).

• Interruption, scolding, ridiculing, and punishing children when

they exhibit disfluencies can exacerbate the behavior.
 Le󰈀r󰈝󰈏󰈞g a󰈝󰇶 Em󰈡󰉃󰈏o󰈞 t󰈊󰈩󰈢󰈹i󰈩s
• Adolescents and adults who stutter report higher anxiety levels than individuals
who do not stutter.

• Nearly all older children and adolescents report intense feelings of anxiety,
apprehension, and psychological tension associated with speaking.

• Anticipatory-Struggle Theory of Stuttering - Older children and adolescents

with speech disfluencies expect speaking to be anxiety-provoking and difficult
(Garcia-Barrera & Davidow, 2015).

• The negative automatic thoughts and the anxiety may increase the severity of
the stuttering.
 Ps󰉘󰇸ho󰈗󰈎󰈞g󰉊i󰈻󰉄󰈎c󰈻
Based on the premise that fluency depends on three process:
• Conceptualization (children think about what they want to
communicate)

• Formulation (formulate appropriate mental representations for their

message: involves encoding the appropriate sounds and word order)

• Articulation (articulate these representations through manipulation of

the mouth, lips, tongue, and vocal cords.

Stuttering occurs when there is breakdown in one or more of these processes.

Childhood-Onset Fluency
Disorder (Stuttering)
Diagnostic Criteria
Criterion A
Disturbances in the normal fluency and time patterning of speech that
are inappropriate for the individual’s age and language skills, persist
over time, and are characterized by frequent and marked occurrences
of one (or more) of the following:
1. Sound and syllable repetitions.
2. Sound prolongations of consonants as well as vowels.
3. Broken words (e.g., pauses within a word).
4. Audible or silent blocking (filled or unfilled pauses in speech).
5. Circumlocutions (word substitutions to avoid problematic
words).
6. Words produced with an excess of physical tension.
7. Monosyllabic whole-word repetitions (e.g., “I-I-I-I see him”).
Criterion B
The disturbance causes anxiety about speaking or limitations in
effective communication, social participation, or academic or
occupational performance, individually or in any combination
Criterion C
The onset of symptoms is in the early developmental period. (Note:
Later-onset cases are diagnosed as 307.0 [F98.5] adult-onset fluency
disorder.)
Criterion D
The disturbance is not attributable to a speech-motor or sensory
deficit, dysfluency associated with a neurological insult (e.g., stroke,
tumor, trauma), or another medical condition and is not better
explained by another mental disorder.
 DIAGNOSTIC FEATURE
THE ESSENTIAL FEATURE OF CHILDHOOD-ONSET
FLUENCY DISORDER (STUTTERING) IS A
DISTURBANCE IN THE NORMAL FLUENCY AND
TIME PATTERING OF SPEECH THAT IS
INAPPROPRIATE FOR THE INDIVIDUAL’S AGE.
 DIAGNOSTIC FEATURES
▪ frequent repetitions or prolongations
of sounds or syllables and by other
types of speech dysfluencies,
including broken words.
▪ audible or silent blocking
▪ Circumlocutions
▪ words produced with an excess of
physical tension, and monosyllabic
whole-word repetitions
 Assessment of
Childhood-Onset
Fluency Disorder
(Stuttering)
 Comprehensive Assessment

Case History
It is essential to obtain background information related to
prenatal and birth circumstances, family structure, general motor
and speech-language history, medical history.

104
 Comprehensive Assessment

Interview
the interview provide clinicians/professionals with the
opportunity to review the case history.

105
 Speech Fluency
Assessment
The Stuttering Severity Instrument (SSI-4) is a
norm-referenced stuttering assessment.

It measures stuttering severity in both children and

adults in the four areas of speech behavior:
• frequency
• duration Another option is the Test of Childhood Stuttering
• physical concomitants (TOCS)
• naturalness of the individual’s speech.

Its main purposes are to (1) identify children who

stutter, (2) determine the severity of a child's stuttering,
and (3) document changes in a child's fluency
functioning over time. It can also be used as a tool in
research on childhood stuttering.

106
 Comprehensive Assessment

Informal Analysis (real-time analysis)

Experienced clinicians may be able to perform real-time

analysis of disfluency counts, suing prepared charts and forms
based on clinic-specific methods.

107
Childhood-Onset
Fluency Disorder
(Stuttering)
Intervention
Intervention and Treatment for
Stuttering
While there is no “cure” for stuttering,
there are various treatment options
that may help people who stutter.
Some methods focus on reducing
disfluency, while others focus on
accepting stuttering and decreasing
communication anxiety.
Treatment will depend one or
more of the following:
• How much the child stutters
• How the child reacts when stuttering
• How stuttering impacts the child's everyday
life
• How others react to the child when they
stutter
• Child's age
Fluency shaping
•A treatment for stuttering that
emphasizes reducing disfluent
speech.

•The goal of fluency shaping is to

eliminate all stuttering events and
speak fluently at all times.
Modification

• Involves identifying and adjusting

disfluencies when they occur.
• Stuttering modification includes education
and counseling for the person who stutters,
with the goal of decreasing anxiety when
speaking.
 Difference between Fluency
shaping and Modification
• Stuttering modification strategies include
techniques such as catching the stutter,
relaxing the stutter, easy stuttering and
cancellation.

• Fluency-enhancing strategies include skills

such as relaxed breath, slow stretched
speech, smooth movement, easy voice,
light contact, and stretched speech.
• Early intervention plays a crucial role.
• Addressing disfluencies early will also help
a child cope with the negative emotional
reactions, tension, and avoidance of
speaking situations that can make
stuttering more severe.
• Successful treatment should help people
who stutter overcome negative feelings,
reduce stress surrounding speaking,
participate in activities, and improve their
overall quality of life.
Important considerations:
• “Slow down how fast you talk” instead of saying “slow
down”. A child who is told to slow down a lot might get
frustrated or decide to talk less.
• Slowing down how fast you talk may help a student’s
stuttering because:

a) if you talk slower, it shows the child it is okay to take his or her
time
b) slower speech may be calming and relaxing (especially if
the child is excited, scared, angry, or upset)
c) talking slower may lessen the sense of competition while
having a conversation
Social (Pragmatic)
Communication
Disorder
Communication requires the use of linguistic context
(pragmatics), in which children are expected to
infer meaning or resolve ambiguities by integrating
the surrounding language with their prior knowledge
and experience.
What is Social Pragmatic Disorder?

•Social (Pragmatic) Communication Disorder (SCD)

is a diagnosis characterized by impairment in
communication for social purposes characterized
by persistent difficulties using verbal and nonverbal
communication for social purposes, in the absence
of restricted and repetitive interests and
behaviours.
•Social Communication Disorder (SCD) was
introduced to the Diagnostic and Statistical
Manual of Mental Disorders (DSM) for the first time
in the most recent update (DSM-5) in 2013.
Etiology

•Similar to other psychological and communication

disorders, the exact cause of Social
Communication Disorder (SCD) is not well
understood.
•Studies exploring genetic associations.
Etiology

•a family history of Autism Spectrum Disorder,

Communication Disorders, or Specific Learning Disorders
are more likely to have a SCD diagnosis.

•SCD isn’t related to intelligence.

•Diagnosis of SCD should not be made until children
are 4–5 years of age.

•Social communication disorder can co-occur with

other communication disorders in the DSM-5 (these
include language disorder, speech sound disorder,
childhood-onset fluency disorder, and unspecified
communication disorder.
Diagnostic Criteria
Social Pragmatic Communication Disorder
 DSM-5 Criteria: Social Pragmatic Communication
Disorder
Diagnostic Criteria 315.39 (F80.89)
A. Persistent di culties in the social use of verbal and nonverbal communication as manifested
by all of the following:
1. De cits in using communication for social purposes, such as greeting and sharing
information, in a manner that is appropriate for the social context.
2. Impairment of the ability to change communication to match context or the needs of the
listener, such as speaking di erently in a classroom than on a playground, talking di erently to a
child than to an adult, and avoiding use of overly formal language.
3. Di culties following rules for conversation and storytelling, such as taking turns in
conversation, rephrasing when misunderstood, and knowing how to use verbal and nonverbal
signals to regulate interaction.
4. Di culties understanding what is not explicitly stated (e.g., making inferences) and
nonliteral or ambiguous meanings of language (e.g., idioms, humor, metaphors, multiple
meanings that depend on the context of interpretation).
 DSM-5 Criteria: Social Pragmatic Communication
Disorder

B. The de cits result in functional limitations in e ective communication, social

participation, social relationships, academic achievement, or occupational
performance, individually or in combination.
C. The onset of the symptoms is in the early developmental period (but de cits may
not become fully manifest until social communication demand exceed limited
capacities).
D. The symptoms are not attributable to another medical or neurological condition
or to low abilities in the domains of word structure and grammar, and are not better
explained by autism spectrum disorder, intellectual disability (intellectual
developmental disorder), global developmental delay, or another mental disorder.
DIAGNOSTIC
FEATURES
Characterized by a primarily difficulty with
pragmatics, or the social use of language The deficits of social communication result

and communication, as manifested by in functional limitations in effective

deficits in understanding and following communication, social participation,

social rules of verbal and non verbal development of social relationships,

communication in naturalistic contexts, academic achievement, or occupational

changing language according to the needs performance.

of listener or situation, and following rules

for conversations and storytelling.
 Soc󰈎󰇽󰈗 (P󰈹ag󰈚󰈀󰉄󰈏c)
Com󰈚󰉉󰈞󰈏ca󰉃󰈎󰈢󰈞 Dis󰈡󰈸󰇶󰇵r
As󰈻e󰈼s󰈚󰈩󰈞t 󰇽󰈝󰇶 Tes󰉃󰈎󰈞g
 Sc󰈸e󰈩󰈞󰈏n󰈇 a󰈞d T󰈩󰇽󰇹󰈋er O󰇼󰈼󰈩r󰉏󰇽󰉄i󰈡n
It might involve norm-referenced tests, informal assessments
developed by the SLP, and questionnaires or checklists for parents and
teachers (Justice & Redle, 2014; Owens, Farinella, & Metz, 2015).

For Social pragmatic functioning, these are the areas that can be check
according to Elleseff (2015):
1. Narrative/Storytelling
2. Problem solving
3. Pragmatic Language
4. Social Emotional Development
5. Executive Functions
 Com󰈥󰈹󰈩h󰇵󰈝󰈼iv󰈩 E󰉏󰇽󰈘u󰈀t󰈏o󰈝
Generally, these are the components of the comprehensive evaluation:

1) case history and physical examination,

2) articulation test,
3) hearing test,
4) auditory discrimination test,
5) phonological awareness and processing,
6) vocabulary and overall language development test,
7) assessment of language function,
8) Language samples, and
9) Observation in natural settings.
 Lan󰈇󰉉󰇽󰈈e Us󰈩 󰈾󰈝󰉐󰇵n󰉃o󰈹y
• a parent questionnaire designed to
identify children, aged 18-47 months,
with delays in pragmatics or social
communication.

• It also identifies children whose

expressive language skills require further
evaluation.

• It examines gestural and verbal

communication, and child’s questions
and comments and their use of language
to interact with people.
 Chi󰈗󰇶r󰈩󰈝'󰈼 C󰈢m󰈚u󰈞󰈎c󰇽󰉃i󰈡󰈞 Ch󰇵󰇹󰈕li󰈻󰉄-2 | U.S. 󰉋di󰉃󰈎󰈢󰈞

• Is a 70-item questionnaire that rates a

child’s communication skills to
determine if further testing is required.

• Helps rate aspects of communication,

screens for general language, and
identifies pragmatic language
impairment.

• For ages 4-16

Soc󰈎󰇽󰈗 E󰈛ot󰈎󰈢󰈝a󰈘 Ev󰈀󰈗󰉊a󰉄󰈎󰈢n (SE󰉋)

• evaluates the social skills and higher-level

language that students need to interact
successfully in everyday situations at home,
school, and community.

• Includes five subtests for assessing social

language:
a. Recalling Facial Expressions
b. Identifying Common Emotions
c. Recognizing Emotional Reactions
d. Understanding Social Gaffes
e. Understanding Conflicting Messages

• For ages 6-12 years

 Tes󰉃 󰈡󰇿 Pr󰇽󰈇󰈛at󰈎󰇹 L󰇽󰈞gu󰈀󰈇󰇵-2 (TO󰈪󰈳-2)

• Evaluates social communication in context,

telling you how well students listen, choose
appropriate content, express feelings, make
requests, and handle other aspects of
pragmatic language

• Student responds to verbal prompts read by

examiner and color illustrations presented in a
convenient spiralbound flipbook

• For 6 to 11 years
Soc󰈎󰇽󰈗 La󰈞g󰉉󰇽󰈇e D󰈩󰉐󰇵lo󰈥󰈛󰈩n󰉃 T󰇵󰈼t – E󰈗e󰈛󰈩n󰉃󰇽󰈹y (S󰈴󰉌T-E) 󰈰󰈖

• Assesses language-based skills of social

interpretation and interaction with
friends, the skills found to be most
predictive of social language
development.

• 6 years to 11 years

• Features four subtests, which require

students to make inferences, interpret
photographed scenes, and explain how
they would resolve problems with peers.
 Cli󰈝󰈎󰇸󰇽l A󰈻󰈼es󰈻󰈛󰈩n󰉃 󰈢󰇿 Pra󰈇󰈛󰈀t󰈏󰇹󰈼

• Individually administered performance

tests based on digital video scenes.

• Sensitive to the assessment of social

rules, irony, sarcasm, figurative language
as well as comprehension and elicitation
of nonverbal body language.

• For ages 7 to 18 years old

 In󰇾o󰈹m󰈀󰈗 A󰈼s󰇵󰈻󰈼me󰈝󰉄 󰈡f S󰈢󰇹i󰈀󰈘 L󰇽n󰈇u󰈀󰈈󰇵 Com󰈥󰈩󰉄󰇵n󰇹e

• Sally-Anne: First Order False Belief Task (4-5 yo) These aimed at assessing the
• John Thinks that Mary Thinks Task (6+) client’s perspective taking
abilities, comprehension of
• John Thinks that Mary Feels (5-6 yo)
non-literal language, positive
• Social Dynamic Assessment Protocol (8+) and negative emotions,
• Informal Narrative Assessments (preschool, ability to produce coherent
and cohesive narratives, as
kindergarten, adolescent)
well as other abilities related
to social competence.
 SOCIAL (PRAGMATIC)
COMMUNICATION DISORDER
INTERVENTION
 TREATMENT STRATEGIES:
A randomized controlled trial of a social communication
intervention directed specifically at children with social
(pragmatic) communication disorder aimed at three areas of
communication:
1. social understanding and social interaction;
2. verbal and nonverbal pragmatic skills, including
conversation; and
3. language processing, involving making inferences, and
learning new words.
 TREATMENT STRATEGIES:
The main treatment for SCD is speech-language therapy.
Speech-language therapists can work with kids on conversation skills either
one-on-one or in small groups. They might use role-playing games or visuals like
comic books.
Clinician-directed interventions are useful for teaching new skills.
Group interventions are used in conjunction with one-on-one services to practice
skills in functional communication settings and to promote generalization.
School settings interventions often include environmental arrangements,
teacher-mediated interventions, and peer-mediated interventions (Timler, 2008).
 INTERVENTIONS TO INCREASE SOCIAL
COMMUNICATION SKILLS

✔ Comic Strip Conversations used for conflict

resolution, problem-solving, communicating
✔ Social Scripts teach children how to use
feelings and perspectives, and reflecting on
varied language during social
something that happened.
interactions.
✔ Score Skills Strategy focuses on five social
✔ Social Skills Groups intervention that
skills: (S) share ideas, (C) compliment others,
uses instruction, role play, and feedback
(O) offer help or encouragement, (R)
to teach ways of interacting
recommend changes nicely, and (E) exercise
appropriately with peers
self-control.
✔ Social Stories highly structured
✔ Social Communication Intervention Project
intervention that uses stories to explain
(SCIP) intervention that focuses on social
social situations to children and help
understanding and social interpretation
them learn socially appropriate
behaviors and responses.
 Speech and language treatments with
family engagement.
❑ Take turns. Participate in simple turn-taking ❑ Clue into pop culture. Introduce your child to
activities that mirror the flow of social popular, developmentally appropriate shows
interaction. and public figures so he can join related
❑ Read and discuss. Read a book with your child, conversations with friends and classmates.
asking and encouraging open-ended questions. ❑ Plan structured playdates. Begin with just one
❑ Talk about the feelings. Suggest why you think
friend at a time and have a planned activity
a character in a story is behaving or feeling a
with a time limit – say, 60 to 90 minutes to start.
particular way.
❑ Use visual supports. Visual supports can be
❑ Predict. Have your child try to predict what will
particularly useful in helping your child
happen next in a story.
understand expectations and schedules.
 Professional help is crucial
Children with SCD need professional intervention to develop their social
interaction skills.

Placing a child with SCD into socially demanding environments without

appropriate support can do more harm than good by leading to teasing and
isolation.

A therapist trained in social communication intervention can provide the child and
parents with the strategies needed to make these experiences rewarding and
beneficial.

It encourages parents to work closely with their child’s speech-language

pathologists to reinforce the new skills he’s learning in therapy.