Download - Bruce Tomblin slides - RCH
2/04/2012
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• Reflections on 40+ years of clinical
LANGUAGE IMPAIRMENT FROM INFANCY TO ADULTHOOD
and research experience
Bruce TomblinDepartment of Communication Sciences and DisordersUniversity of Iowa, USA
GOALS OF TALK
• Review how I came to be doing outcomes research.
• Outline the origins of the conceptual • Outline the origins of the conceptual model that I have used.
• Summarize the key findings from my research.
• Identify future directions.
A LONG TIME AGO IN A
PLACE FAR, FAR AWAY
• Language Science c. 1994• In psychology, language was
viewed as verbal behavior –a particular kind of human behavior that influenced others (tacts, mands etc).
• Development of language AS AN UNDERGRADUATE
PSYCHOLOGY MAJOR, I DISCOVERED CHILD LANGUAGE VIA AN INTEREST IN
AUTISM.
was largely the accrual of a collection of these behaviors.
• Learning involved general purpose learning systems.
• Abstract mental representations were rarely discussed.
• The notion of child language disorders was just emerging.• Assessment:
• Peabody Picture Vocabulary Test• Illinois Test of Psycholinguistic Ability
• Treatment• Operant principles used in discrete trials imitation
Speech Pathology 1964
p p ptraining.
• Childhood Aphasia –• A disorder of language arising from minimal brain
damage (focal?) with preserved intellect (Morley, McGinnis, Myklebust, Eisenson, Benton).
• Dissent: • Acquired aphasia is very different from childhood aphasia. There
is no direct evidence of brain damage. • Childhood aphasia is a form of mental retardation
• Language Science c. 1994• Linguistics was undergoing a massive
revolution. Chomsky.• Language was an abstract knowledge
system.• Symbols, rules and operations.• It was computational and algorithmic (inputs
to operations and outputs).• Language arose from a special cognitive
t i th i d d l itsystem in the mind - modularity• Language development was beginning to
be seen as a systematic unfolding of this computational system.• Uniformity• Universality• Innateness
• Speech Science• Categorical perception (Haskins
Laboratory): Speech is special
CHILD LANGUAGE MOVING AHEAD
• Speech Pathology and Child Language adopts a Linguistic Perspective.
• Childhood Aphasia becomes Specific Language Impairment (1980)• The term aphasia is dropped• The term aphasia is dropped.• The existence of an isolated impairment of language
becomes accepted.• Language development is viewed as a special
developmental process driven by its own principles.• Children with SLI have a defect in this process and this is why
we say they are impaired.• We will identify the nature of this defect by studying the details
of their language that can serve as markers of the impairment.
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At Iowa I discovered old records of children seen in our clinic with language and speech measures. 18 with Speech and Language Impairment
N l h i Normal hearing Normal nonverbal intelligence Language < 1 SD below mean Verbal IQ> 20 points below PIQ
18 with Speech only.
Contacted parents : obtained permission to get school records and updated the child’s educational status.
Iowa Tests of Basic Skills
Oral language skills, but not speech sound production difficulties, are associated with reading .
Formal Education
•Philosophy of Medicine: Health and Illness are socially defined rather than properties of nature.
•As natural phenomena, individual differences are all
1983 Symposium on Research in Child Language Disorders
pof equal value.
•The individual differences are not inherently normal or disordered.
•Social values dictate states of health and Illness
“If this is true then disorder isn’t real”
IndividualDifferences
In Language
ORIGINS OF DEVELOPMENTAL LANGUAGE DISORDER: Individual differences
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In nature individual differences of any type are neither “good” nor “bad”.
In modern biology, species variation is essential for survival and evolution.
Some forms of variation are better suited than others. Which variation serves these functions can only be known
after the fact.
ORIGINS OF DEVELOPMENTAL LANGUAGE DISORDER
IndividualDifferencesIn Language
Soci
al V
alues
+
-
+
+
-
-
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•Social groups form value systems (norms) that apply to the behavior of their members.
•These value systems establish what are “good” and “bad” forms of individual behavioral differences.
•Disordered (Ill health) forms of behavior reflect limitations in the person’s ability to accomplish socially expected and valued activities.
•Disorder or illness is an assigned status that reflects a relationship between the individual and the community.
•Language disorder is not found within the child but rather between the child and the functions served by language.
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ORIGINS OF DEVELOPMENTAL LANGUAGE DISORDER
IndividualDifferencesIn Language
ocia
l Val
ues-
+
+
-
-viro
nmen
tal
Sen
sory
Bio
logi
cal Cognitive
Neural Connectivity
Neuronal
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Individual differences do arise from systematic causal systems. The function of these systems are necessary but not sufficient for
explaining ill health. S
o
+En Neuronal
Genetic
UNDERSTANDING LANGUAGE DISORDER
• Developmental language disorder arises out of individual differences
• Societies may carve up these individual differences in different ways and is not necessarily a distinct type or form of these differences.
• The outcomes of individual differences in language are not by-g g yproducts of language disorder, but rather are grounds upon which we determine when language disorder occurs.
• An understanding of language disorder requires examining the pathways that run between social values and individual differences in speech and language.
• Direct pathway – values are applied directly on behavior
• Indirect pathway – values are applied indirectly via relationships between speech and language and functions that are valued.
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Individual DifferencesIn Speech and Language
Phonology/Speech Production
Pragmatics
Grammar
Semantics
Phonological Processing
Soc
ial V
alue
s
+
-
+
+
-
-
Academics
Friendships
Well Being
ARE VALUES PASSED
DIRECTLY ON
• 30 min language samples from 35 children between 36 and 78 months . (4 2 minute samples fro m each child).
• Samples played to 4 young adult listeners who were told these were children between 41/2 and 51/2 years old
JSHR, 1990
NTO INDIVIDUAL DIFFERENCES IN
LANGUAGE?
these were children between 41/2 and 51/2 years old.
• Child was rated (7 point scale) on 24 adjective pairs to form a semantic differential. superior/inferior; above average/below average; good/bad; big/small; relaxed/tense; bold/assertave; fast/slow; active/passive; mature/immature; dominant/submissive.
• Three factors:
• Dynamism
• Maturity (cognitive developmental status)
• Social appeal
ARE INDIVIDUAL DIFFERENCES IN SPEECH AND LANGUAGE ASSOCIATED WITH LISTENER
JUDGMENTS?
Dynamism R2
Conversational Participation .06+ Phonological Accuracy .10
MaturityPhonological Accuracy .36+Conversational Participantion .42+Speaking Rate .44+ Adherence to Gramm. .45
Social AppealConversational Participation .13+Dysfluency .16
INDIRECT EVIDENCE OF THE DIRECT EVALUATION OF SPEECH
• 1992-1995 Conducted a study of the prevalence of SLI in kindergarten children.• Screened 7000+ kindergarten children for poor
language.• Tested speech and language abilities in children • Tested speech and language abilities in children
who failed the screen (901) or passed screen (1,108).
• 10% of diagnosed children had received or were receiving speech-language intervention.
• Diagnosed language disorder based on EpiSLIstandard (2/5 subscores <10th percentile)
• Diagnosed speech disorder based on TOLD-2:P Word Artic (<-1.14 SD).
LSHSS, 2000
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•Poor speech sound skill is a stronger predictor of receipt of services than poor language
•Being male irrespective of your speech or language increases your likelihood of identification.
Social Values are Directly Applied to
Some Aspects of Communication but
O h
• The social values found in Western European cultures do seem to directly apply to speech behaviors.• Communication is a marker of cultural and
social backgrounds.• It is possible that we are attuned to speech
variation.• Pragmatic skills are also very likely to be
di tl li k d t i l lnot Others directly linked to social value.• Social values are less sensitive to
language differences (content and form).
• Does this mean that language variation unless large is not important?• Perhaps language variation inherits its
evaluation?
Individual DifferencesIn Speech and Language
Phonology/Speech Production
Pragmatics
Grammar ocia
l Val
ues-
+
+
-
-
How Can we Look at Pathways of Indirect Evaluation?
Grammar
Semantics
Phonological Processing
S
+
Academics
Friendships
Well Being
Social Valued Outcome as Competence
Fulfillment of social roles represents competence and failure represents incompetence (Masten et al. 1999)
Socially defined competence expectations
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Socially defined competence expectations change over development (Zigler & Gllick, 1986)
Earlier competence persists Earlier competence can influence later
competence in other domains (cascade) To the extent that language influences these
outcomes it will inherit their value.
COMMUNICATION AND COMPETENCE
Language & Communication
Academic
SocialIndependenceConduct
Academic Achievement
Close Friendships
Emerging Independence
Conduct
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Pre-school Years AdolescenceChildhood
Independence
Academic Achievement Friendships Conduct
ConductT i l C t l
Iowa Longitudinal Study
NLI SLI103 102
Typical Control372
N=577
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Mean Age 8.0 9.9
N= 604 575604 503
13.9
Age Range
5.9
7.1-9.0 9.1-10.9 13.1-15.4
541
15.8
14.9-17.4Age Range
Iowa Longitudinal Study
Measures Obtained• Spoken Language• Reading• Academic Perfomance• Psychosocial• Cognitive• DNA
ACADEMIC OUTCOMES
• Reading Outcomes• Parent and Teacher Rating of Performance
G d R t ti• Grade Retention• Need for Curriculum Adaptation and Special
Education
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LANGUAGE & READING CONNECTIONS
Few dispute the strong relationships between language and reading.Reading requires several coordinated skills, but most agree that functional reading comprises g g preading comprehension.Simple view of reading comprehension:
Reading comprehension=word reading*(listening) comprehension
How do children with poor language at school entry do with regard to reading?
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RATES OF POOR READING COMPREHENSION
High levels of poor reading are found persistently at high levels in children who enter school with poor spoken languageR t f 40
50
60
70
80
SLI NLI Normal
Rates of poor comprehension are 5 to 9 times as great as in children with normal languageRisk for poor comprehension is high even when non-verbal IQ is controlled.
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0
10
20
30
40
8 years 10 years 14 years 16 years
Reading < -1 SD
READING LESS THAN GRADE 5 (11 YEARS AT 16
22.8 %
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4.6 % PIQ Co-variate
IS EARLY SPEECH DISORDER ASSOCIATED WITH LATER RD?
253035404550
in 4
thG
rad
e
Recall in Hall and Tomblin the children with language and articulation problems had poorer reading than the artic only
05
10152025
ImpairedNormal
Perc
ent R
D
Status in Kindergarten
only.
Reading is believed to be tied to phonological processing and so we might expect SD to result in RD.
In fact, SD has only a weak effect.
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DOES LANGUAGE CONTRIBUTE TO ACADEMIC SUCCESS BEYOND READING?
• Learning to read is a important academic accomplishment.
• Reading also becomes an important tool for learning.
• However the role of language in classroom • However, the role of language in classroom learning is likely to go beyond reading – particularly if reading is viewed as word decoding.
• Reading comprehension at advanced levels is essentially equivalent to listening comprehension.
• Some and perhaps a great deal of learning is via listening.
WORD READING AND LISTENING COMPREHENSION CONTRIBUTION TO
READING COMPREHENSION
0 50.60.70.80.9
Word Reading
Listening
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00.10.20.30.40.5
2nd 4th 8th 10th
ListeningComprehension
Sum
Par
tial r
2
Reading ComprehensionWRMT Passage CompGORTDAB
Word ReadingWRMT Word IDWRMT Word Attack
Listening ComprehensionCELF-3
ROLE OF SPOKEN LANGUAGE AND READING IN RATED SCHOOL
PERFORMANCETeacher rating of reading
Teacher rating of writing
Teacher ratingC
.97
.92
88R di C h i 34
Word Recognition(2nd Grade)
.34
.64.25
Teacher rating of math
Parent rating of language, reading
Parent rating of Math
ClassroomPerformance
.88
.73
.63
Reading Comprehension(2nd Grade)
Language(kindergarten)
.34
.23.34
CFI: .95TLI: .97
.54
.31
SUMMING UP
• Social values need to be incorporated into our research and clinical thinking as these define health.
• Individual differences in some aspects of i ti di l d di tl d th communication are disvalued directly and others
indirectly.• The importance of communication as a tool for
learning is clear.• The role of listening comprehension in the classroom
remains under appreciated and a rich area for more research.
SOCIAL DEVELOPMENT
Social Participation Youth Self-Report (YSR)
CBCL Parent
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CBCL Social Skills Rating System Perceived Adequacy of Social
Relationships UCLA Loneliness Scale (Russel, 1996)
Parent
SOCIAL RELATIONSHIPS
• Both SLI and GD participated less than typical
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comparison grp. (η2=.05)
• Only GD were more lonely (affiliation) than comparison (η2=.03).
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SUBJECTIVE WELL-BEING
Modified Self Perception Scale for Adolescents (Harter, 1988)Mental CompetenceSelf WorthSocial Appearance
37Afasic Symposium 2007
Social Appearance
Satisfaction with Life (Pavot & Diener, 1993)
Positive Affect/DepressionYSR
HARTER SCALING METHOD
Some students get kind of lonely because they don’t have a close friend to share things with.
Other students don’t usually get too lonely because they do have a close friend to share things with.
1 32 4
Mental CompetenceConfident in schoolwork
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Confident in schoolworkLike writing papersSmart Do well in school workWant to answer teacher’s questions
Global Self EsteemSatisfied with selfDon’t get lonely Get a long with parentsLike themselves
Social AppearanceLike physical appearanceRomantic relationshipGood at video gamesGood dancer
26 items
3 Principal Components
SUBJECTIVE WELL-BEING
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SATISFACTION WITH LIFE
“I am satisfied with life”“If I could live my life over, I would change almost nothing”
1 2 3 4 5
40Afasic Symposium 2007
SUMMARY OF RESEARCH
Individual differences in speech and language at the start of school have consequences.Speech impairments are able to receive direct evaluation by listeners that lead to negative social value (stigma)social value (stigma).Poor language skills place children at risk for socially significant difficulties via their indirect effects on important life functions particularly education.Language disorders may be like high blood pressure. Silent killers.
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