Communication Disabilities

1. Communication Disabilities Presented by Jennifer Tinson EEX5051 Summer 2009

2. Video Clip • http://www.youtube.com/watch?v=JnylM1hI2jc Group Discussion 10-15 mins. Jennifer Tinson

3. What is Meant by Communication Disorders Communication disorders include problems related to speech, language and auditory processing. Communication disorders may range from simple sound repetitions such as stuttering to occasional misarticulating of words to complete inability to use speech and language for communications (aphasia). Jennifer Tinson

4. Language Development Chart http://www.childdevelopmentinfo.com/development/language_development.shtml Jennifer Tinson

5. What are the causes of Communication Disorders? • The brain is complex and our understanding is very limited. For the majority of communication disorders we do not yet understand the cause. However, we do have an understanding of how to help many children to maximize their speech and language development. A few known causes of communication disorders are: • Hearing impairment - full or partial hearing impairment may cause difficulty in speech and language development. An assessment of hearing is one of the first steps in the investigation of speech and language problems. • Physical disability - cleft lip and palate, or malformations of the mouth or nose may cause communication disorders. More involved disabilities, such as severe cerebral palsy, may preclude any speech at all and for these non-verbal children augmentative communication methods must be used. • Developmental disability - some children (not all) with a developmental disability or Down's Syndrome may be slower to learn to talk and may need extra assistance. • Children with learning disabilities may have communication disorders. Many learning disabled children have difficulty with receptive or expressive language. Without appropriate intervention children with communication disorders are at high risk for educational failure. • Children with Pervasive Development Disorders (P.D.D.), or Autism spectrum disorders will also have communication disorders. Many children with PDD or Autism have difficulty with social skills and their behaviour and conversation skills may be limited or inappropriate. Often there is an associated language disorder. • Children with significant behaviour or emotional problems may also have a communication disorder. In some cases the behaviour problems are extreme and the focus on the safety and security of the child is the priority. However, evaluation by qualified professionals, including Speech-Language Pathologist, often reveal language disorders which have not been recognized or treated. Jennifer Tinson

6. Causes Cont’d • There are many potential causes of communication impairment; the most common is mental retardation. Other causes include: • Hearing impairment • ADD • Learning disabilities • Autism • Schizophrenia • Cerebral palsy • Physical disability: cleft lip and palate, or malformations of the mouth or nose • Significant behavior or emotional problems, including deficits in social skills • Vocal cord injury • Cri-du-chat syndrome • Gilles de la Tourette syndrome • Ill-fitting dentures • Alcohol intoxication • Neurological disorders and diseases • Head trauma • Alzheimer's disease • Stroke • Transient ischemic attack (TIA) Jennifer Tinson

7. Interesting Fact: Agree or Disagree • Studies show that although teachers are often aware of the importance of communication and concerned about levels of children’s language, many express anxiety and lack of knowledge in their ability to support them. A recent investigation into levels of teacher knowledge about communication development and disability showed that over 60% lacked confidence in their ability to meet children’s needs. • Locke A Ginsborg J and Peers I (2002) Development and Disadvantage: Implications for the early Years IJCD 2002 Vol 27 No 1 • Sadler J (2005) Knowledge, attitudes and beliefs of the mainstream teachers of children with a preschool diagnosis of speech/language impairment Child Language Teaching and therapy Vol 21 No.2 Child Language Teaching and Therapy’, Volume 21, Number 2, Jennifer Tinson

8. Assessment and Diagnosis • Speech-language pathologists (speech therapists) diagnose and treat or remediate communication disorders in children. In the United States, they are licensed by the American Speech-Language Hearing Association. In Canada, they are licensed by the Canadian Association of Speech-Language Pathologists and Audiologists. Developmental pediatricians and pediatric neurologists will also sometimes diagnose a speech or language disorder and refer you to a speech therapist for treatment. The assessment is made by using a combination of parent input, looking at the child's physical oral motor structures, and engaging the child in communication. Recommendations of frequency of speech therapy are made based upon the severity of the speech disorder and typically range from speech therapy once a week for a half hour to speech therapy four or five times per week for an hour per session. Jennifer Tinson

9. Prevalence • As many as 10% of children and young people have some level of communication disability. Children with a communication disability may have problems with production or comprehension of spoken language, with using or processing speech sounds, or with understanding and using language in social contexts. A growing number of studies show that a very significant proportion of language difficulties can be long-term. Jennifer Tinson

10. How Many Children Have Communication Disorders? • The overall estimate for speech and language disorders is widely agreed to be 5% of school-aged children. This figure includes voice disorders (3%) and stuttering (1%). The incidence of elementary school children who exhibit delayed phonological (articulation) development is 2% to 3%, although the percentage decreases steadily with age. Estimates of hearing impairments vary considerably, with one widely accepted figure of 5% representing the portion of school-aged children with hearing levels outside the normal range. Of this number, 10% to 20% require some type of special education. Approximately one-third of students who are deaf attend residential schools. Two-thirds attend day programs in schools for students who are deaf or day classes located in regular schools. The remainder are mainstreamed into regular school programs. Jennifer Tinson

11. What Are Some Characteristics of Children with Communication Disorders? • A child with speech or language delays may present a variety of characteristics including the inability to follow directions, slow and incomprehensible speech, and pronounced difficulties in syntax and articulation. SYNTAX refers to the order of words in a sentence, and ARTICULATION refers to the manner in which sounds are formed. Articulation disorders are characterized by the substitution of one sound for another or the omission or distortion of certain sounds. Stuttering or dysfluency is a disorder of speech flow that most often appears between the ages of 3 and 4 years and may progress from a sporadic to a chronic problem. Stuttering may spontaneously disappear by early adolescence, but speech and language therapy should be considered. Typical voice disorders include hoarseness, breathiness, or sudden breaks in loudness or pitch. Voice disorders are frequently combined with other speech problems to form a complex communication disorder. A child with a possible hearing problem may appear to strain to hear, ask to have questions repeated before giving the right answer, demonstrate speech inaccuracies (especially dropping the beginnings and endings of words), or exhibit confusion during discussion. Detection and diagnosis of hearing impairment have become very sophisticated. It is possible to detect the presence of hearing loss and evaluate its severity in a newborn child. Students who speak dialects different from standard English may have communication problems that represent either language differences or, in more severe instances, language disorders. Jennifer Tinson

12. Developmental Affects: • Children with communication disorders engage in fewer conversations than their typical peers, have lower rates of positive social behavior, and are less successful when they make social overtures to their peers. Jennifer Tinson

13. What are the Educational Implications of Communication Disorders? • Many speech problems are developmental rather than physiological, and as such they respond to remedial instruction. Language experiences are central to a young child's development. In the past, children with communication disorders were routinely removed from the regular class for individual speech and language therapy. This is still the case in severe instances, but the trend is toward keeping the child in the mainstream as much as possible. In order to accomplish this goal, teamwork among the teacher, speech and language therapist, audiologist, and parents is essential. Speech improvement and correction are blended into the regular classroom curriculum and the child's natural environment. Amplification may be extremely valuable for the child with a hearing impairment. Students whose hearing is not completely restored by hearing aids or other means of amplification have unique communication needs. Children who are deaf are not automatically exposed to the enormous amounts of language stimulation experienced by hearing children in their early years. For deaf children, early, consistent, and conscious use of visible communication modes such as sign language, finger spelling, and cued speech and/or amplification and aural/oral training can help reduce this language delay. Some educators advocate a strict oral approach in which the child is required to use as much speech as possible, while others favor the use of sign language and finger spelling combined with speech, an approach known as TOTAL COMMUNICATION. There is increasing consensus that whatever system works best for the individual should be used. Many children with hearing impairments can be served in the regular classroom with support services. In addition to amplification, instructional aids such as captioned films and high interest/low vocabulary reading materials are helpful. For most children with hearing impairments, language acquisition and development are significantly delayed, sometimes leading to an erroneously low estimate of intelligence. Students whose physical problems are so severe that they interfere with or completely inhibit communication can frequently take advantage of technological advances that allow the individual to make his or her needs and wants known, perhaps for the first time. Jennifer Tinson

14. Treatment/Therapy • Specific treatment for communication disorders is determined by an individual’s physician, special education teachers, and speech/language and mental health professionals based on: • age, overall health, and medical history • extent of the disorder • type of disorder • tolerance for specific medications or therapies • expectations for the course of the disorder • your opinion or preference • A coordinated effort between parents, teachers, and speech/language and mental health professionals provides the basis for individualized treatment strategies that may include individual or group remediation, special classes, or special resources. Two approaches are usually considered. Remedial techniques are used to increase communication skills in the areas of the deficit. A second approach helps to build on his/her strengths to circumvent his/her communication deficit. Jennifer Tinson

15. Modifications and Adaptations for inside and outside of the classroom Jennifer Tinson

16. Computer Accessibility • An accessibility option in Windows allows accessibility features for mobility impairments, hearing loss or vision loss. To view these features, go to: • start » programs » accessories » accessibility wizard » configure • This option can also be accessed by going to: • start » settings » control panel » accessibility options • Computer Screen Modifications Glare Protection a screen is put in front of the monitor to reduce visual fatigue from the computer screen. • Large Monitors offer crisper, sharper visuals, so eye fatigue is reduced. This may be especially beneficial for students with low vision. • The computer itself can be especially set up for accessibility features involving contrasting colors and font sizes. To view such accessibility features, go to: • start » programs » accessories » accessibility wizard » configure • This option can also be accessed by going to: • start » settings » control panel » accessibility options Jennifer Tinson

17. Computer Accessibility Cont’d • Resources for Web site Accessibility • Watchfire: WebXact • World Wide Web Consortium W3Cguidelines • Center for Applied Special Technology (CAST): Universal Design for Learning • Accessibility and Disability, Information and Resources in Psychology Training and Practice: Seven Easy Steps Towards Web site Accessibility • Things to consider when designing web sites • Description of photos/pictures • Captioning of video • High contrasting colors on screen • Site organization for easy navigation • Non-complex language on the screen (easy to read) Jennifer Tinson

18. Keybaord Modifications • There are a variety of modifications that can be used to make a computer keyboard more accessible to its users. • Some common modifications will be discussed here, but this list is not all-inclusive. • Keyboard Overlays • Braille: There are specialized Braille stickers or keyboard overlays that contains Braille. These can be put on the keyboard so a student who is blind can feel the Braille and type on the computer. • Keys: There are specialized keys or keyboard overlays that have larger numbers and letters that can be made to fit over the existing keys on a keyboard. Most of these overlays work with screen readers and software for people who are blind/low vision. • Sticky Keys or Keylocks: If a student has little to no use of one hand, specific mice can facilitate typing on the computer while simultaneously using the mouse. • Sticky keys eliminate the need to hold two or more keys at one time. Sticky keys are designed to hold down one key and type another key at the same time. Sticky keys can be helpful for those who cannot type a combination of keys at the same time. Sticky keys can be accessed by going to: • start » programs » accessories » accessibility wizard » configure • or start » settings » control panel » accessibility options • Keylocks, which attach to a keyboard itself, are available so the student can push the keylock down on a key and then press more than one key at once. The keylock can "stay" on a key so a function can be performed (such as control + alt + delete). Keylocks "pivot" onto a key and hold it so another key can be pushed. However, with keylocks, one would need to disable the auto repeat function or the same letter may repeat until the keylock is taken off a particular key.1 • One Handed Keyboard: These keyboards are available for students who have the use of only one hand. They are designed to allow the student to type at a faster rate than they would on a traditional keyboard. Jennifer Tinson

19. One Handed Keyboard: These keyboards are available for students who have the use of only one hand. They are designed to allow the student to type at a faster rate than they would on a traditional keyboard. Keyguards: These overlays can be used to prevent accidental pressing of keys on the keyboard and stabilizes the computer user's hand for better accuracy and stabilizes the computer user's hand for better accuracy. Alternative layout of keys on the keyboards may be helpful for those with disabilities if the standard layout of the keys on the keyboard is are not beneficial. This can include right or left-handed keyboards or alternative key placement keyboards. Alternative size keyboards are available which are smaller than standard keyboards. These mini keyboards can be made so students do not have to move their hands or fingers as much to type. Numerical keypads can be purchased separately as needed. Alternately, there are larger (expanded) keyboards and keypads that are designed to accommodate students who need more room when typing and the keyboard can expand as needed. Chord keyboards are keyboards where one key represents more than one letter. This makes it easier for some students to type because they do not have to navigate the keyboard as much. Onscreen keyboards: The computer display can be configured to display the keyboard contents on the monitor display. These onscreen keyboards can be manipulated by use of a pointer, finger, stick or pointer. There is a basic, built in onscreen keyboard with IBMs. To activate this feature click on: programs » accessories » accessibility » onscreen keyboard Split keyboards: Physically split keyboards are available so that the student position the two keyboard pieces separately in a way that is most comfortable for that user. Keyboard Modifications cont’d Jennifer Tinson

20. Text to Speech • Text to speech programs read the text and other graphics on the computer screen out loud. Text to Speech can also read scanned materials. There are a variety of voices that can read the text, depending on the computer program purchased. This product is able to voice what is in a word document, while other screen readers are web-based only.  Jennifer Tinson

21. Alternative Communication • Augmentative, sometimes referred to as alternative communication (AAC) is a method of communication used by individuals with severe speech and language disabilities, those who have Cerebral Palsy,Autism, ALS, suffered from a stroke, etc. AAC is for those individuals who are unable to use verbal speech yet are cognitively able or when speech is extremely difficult to understand. These individuals will use gestures, communications boards, pictures, symbols, drawings or a combination of all of these. An individual would point to a single meaning picture - for instance if the individual was hungry, the picture may look like somebody eating. If the individual is also physically impaired, a head pointer may be worn to indicate the picture which would relay the feeling. The methods of AAC will vary and be personalized to meet the needs of the individual. Many forms of AAC with have an assistive technology component which will come in both high tech or low tech strategies. You don't need special skills for understanding an individual who is using ACC as the processes are self-explanatory. Jennifer Tinson

22. Visual Supports Jennifer Tinson

23. Assistive Technology Devices: For a complete list of assistive technology devices please visit http://www.abledata.com/abledata.cfm?pageid=19327&ksectionid=19327 Jennifer Tinson

24. Assistive Technology Demonstration Chat PC 10-15 mins. Jennifer Tinson

25. For a complete list of accommodations please view the website found at http://www.disabilityresource.uic.edu/viewer.asp?tab=6 Jennifer Tinson

26. Communication Disabilities seen in students with autism • Echolalia • Delayed Speech • One word utterances • Speaking in third person Jennifer Tinson

27. Echolalia • Some children repeat what they hear, either as an automatic response to hearing language or as an unusual form of communication. This repeating is called "echolalia." Children with echolalia may repeat what they hear immediately (immediate echolalia) or some time after they have heard it (delayed echolalia). Jennifer Tinson

28. Tips for teaching students with communication disabilities: • Use a variety of materials to communicate with the child including sign language, pictures, visual cues, etc. • Respond to the child’s attempts at communication • Use appropriate pacing and rate of speaking • Use repetition in your activities • Label objects and actions in the child’s environment • Keep sentences short and use single words when necessary • Model appropriate responses Jennifer Tinson

29. Transition Into Adulthood • Although there is not a known “cure” for communication disabilities, there are therapies and other techniques that can help foster communication. • With the help of intensive therapy and the use of visual supports and assistive devices, many individuals are able to communicate well with others in the work environment, as well as in higher education settings. Jennifer Tinson

30. How Well Do You Communicate? • Assessment _Use an alternative form of communication to communicate a need or want to the class. Jennifer Tinson

31. Additional Links to websites for Communication Disabilities http://asha.org/public/speech/http://www.disabilityresource.uic.edu/viewer.asp?tab=6 http://www.brighttots.com/Echolalia_Child_Autism https://www.ocps.net/cs/ese/programs/sl/Pages/default.aspx https://www.scps.k.12.fl.us/esss https://www.faast.org Jennifer Tinson

32. References: • Children with Communication Disorders.1990. From the ERIC database Children with Communication Disorders. ERIC Digest #E470 (Revised #419). http://ericae.net/edo/ED321504.htm • Psychology Today 2008 retrieved on may 26, 2009 from http://www.psychologytoday.com/conditions/commdisorder.html • http://www.disabilityresource.uic.edu/viewer.asp?tab=6 • http://specialed.about.com/od/assistivetechnology/a/aac.htm • http://www.thewatsoninstitute.org/resources.jsp?pageId=0690200091781087595880192 • http://www.speechville.com/speech-therapy/who-diagnoses.html • http://www.oafccd.com/factshee/fact8.htm • http://www.ican.org.uk/upload2/i%20can%20talk%20%20communication%20disability%20and%20%20literacy%20difficulties.pdf • http://www.healthsystem.virginia.edu/uvahealth/peds_mentalhealth/commdis.cfm • http://www.education.com/reference/article/social-emotional-disabilities/ • http://www.communityconnections.umd.edu/tipsheets/ChildrenwithCommunicationDisabilities.pdf Jennifer Tinson