Specific Language Impairment

Language is the blood of the soul into which thoughts run and out of which they grow.
– Oliver Wendell Holmes

We use language to share ideas and feelings to each other. In fact, we humans speak the most specialized and complicated language in the animal kingdom. However, not all of us can speak a language the way most people do.

Does this mean fluency?

No. It is more complicated than simple fluency. Language comprises of phonology (pronunciation), syntax (word order), semantics (meaning of words/phrases in a language), prosody (the rhythmic and intonational aspect of language[1]), pragmatics (what words mean in particular situations[1]), sarcasm (the use of words that mean the opposite of what you really want to say especially in order to insult someone, to show irritation, or to be funny[1]), humor, and body language. Not all of us can readily understand, interpret, and express language using all of these. The difficulties in language acquisition and usage are grouped as language disorders. The specific difficulty in receiving and sending language is called specific language impairment.

What is Specific Language Impairment?

Specific language impairment (SLI) is a type of communication/language disorder where a person affected with it cannot comprehend and express language. It is characterized by difficulty with language that is not caused by known neurological, sensory, intellectual, or emotional deficit. It can affect the development of vocabulary, grammar, and discourse skills, with evidence that certain morphemes may be especially difficult to acquire (including past tense, copula be, third person singular). Children with SLI may be intelligent and healthy in all regards except in the difficulty they have with language. They may in fact be extraordinarily bright and have high nonverbal IQs.[2]

Children with SLI are often called ‘late-talkers’ as they typically start to speak later than the typically developing children. While kids learn to talk simple words by 1 year, kids with SLI do the same in 3 years, making them delayed by 2 years against typocal children. Usually, parents and teachers see them as lazy, awkward, or not trying enough; actually, kids with SLI are eager to learn and talk but find it hard to ‘find the right words’ and express their ideas.

SLI has subtypes:

Expressive language disorder – also known as developmental verbal dyspraxia (DVD), where language expression is late and incomplete despite comprehension of language.[3]

Receptive language disorder – here, the child’s most obvious problems are a tendency to speak in short, simplified sentences, with omission of some grammatical features, such as past tense -ed.[3][4] Comprehension of language is affected.

Mixed receptive/expressive language disorder -a combination of both receptive and expressive language disorders.

Phonologic programming deficit syndrome – The child speaks in long but poorly intelligible utterances, producing what sounds like jargon.[3]

Lexical deficit disorder – The child has word finding problems and difficulty putting ideas into words. There is poor comprehension for connected speech.[3]

Pragmatic language impairment – The child speaks in fluent and well-formed utterances with adequate articulation; content of language is unusual; comprehension may be over-literal; language use is odd; the child may chatter incessantly, be poor at turn-taking in conversation and maintaining a topic.[3] Also known as social communication disorder or social (pragmatic) language disorder.

SLI is considered to be autism’s older brother, dyslexia’s younger brother, and dyspraxia’s twin because of its similiarities with these; however, SLI is one of the most difficult to recognize among learning disabilities. In fact, SLI remains very much a “hidden disability” within the community – poorly understood and rarely discussed.[5]

What causes SLI?

Genetics is one of the causes of SLI. One specific gene mutated for SLI is called CNTNAP2 gene (pronounced “catnap”) on chromosome 7q.[5]

But like autism, it’s unlikely that just one gene causes the majority of SLI cases. Rather, it’s probably the case that multiple gene variants that, when combined (and perhaps in conjunction with environmental factors), cause language difficulties.[5]

The effects of genes involved with SLI are likely to cause a different pattern of brain development. The enduring mystery of SLI is that no clear brain abnormality has been identified as a cause of language difficulties.[5]

How common is SLI?

SLI is so common it affects up to one child in every class and is as common as dyslexia and more common than autism but is barely heard of by the general public.[6]

What are the symptoms of SLI?

People with SLI have the following symptoms[7]:

Language:

Noticeably behind other students in speech and/or language skills development
May have a learning disability (difficulties with reading or written language) with average intelligence
Improper use of words and their meanings
Inability to express ideas
Inappropriate use of grammar when talking or writing
Inability to follow directions
Difficulties in understanding and/or using words in context, both verbally and nonverbally
May hear or see a word but not be able to understand its meaning
May have trouble getting others to understand what they are trying to communicate
Has difficulty remembering and using specific words during conversation, or when answering a question
Asks questions and/or responds to questions inappropriately
Has difficulty discriminating likenesses and differences
Has difficulty breaking words into sounds and syllable
Has difficulty with concepts of time, space, quantity, size, and measurement
Has difficulty understanding and using complex sentences
Has problems understanding rules and patterns for word and sentence formation
Cannot identify pronouns
Cannot retell the events in a story in order
Cannot make predictions, make judgments, draw conclusions
Difficulties with figurative language (such as alliteration, similes, metaphors, personification, and idioms)
Cannot give clear directions
Cannot summarize essential details from hearing or reading a passage, nor distinguish relevant from irrelevant information
Has difficulty understanding and solving math word problems (one or multi-step)
Will not initiate conversations
Has difficulty reading what others communicate through facial expressions and body language
Repeats what is said or what is read, vocally or subvocally (under breath)
Uses gestures when talking or in place of talking
Is slow to respond during verbal interaction or following verbal cues
Cannot identify or use different language in written work (expository, descriptive or narrative)
Cannot write an organized paragraph

Speech:

Noticeably behind other students in speech and/or language skills development
Trouble forming sounds (called articulation or phonological disorders)
Difficulties with the pitch, volume, or quality of the voice
May display stuttering (dysfluency), an interruption in the flow of speech
Omits or substitutes sounds when pronouncing words
May have trouble getting others to understand what they are trying to say
May have trouble with the way their voice sounds
Is echolalic (repeats speech)
Does not use appropriate speaking volume (too loud or too soft)
May have breathy, harsh, husky or monotone voice
Continually sounds congested
Sounds nasal and voice may have a “whining” quality
Has abnormal rhythm or rate of speech
Frequently prolongs or repeats sounds, words, phrases and/or sentences during speech
Has unintelligible (cannot be understood) or indistinct speech

Academics and Behavior:

Overall academic achievement may be lower than expected
Word knowledge may be below expectancy
Word substitutions may occur frequently in reading and writing (when copying)
Hesitates or refuses to participate in activities where speaking is required
Is inattentive and has difficulty with concentration
May not initiate or maintain eye contact
May become easily frustrated
Has difficulty following directions
Must be “shown” what to do
Has trouble understanding information from what is seen, heard or felt
May be embarrassed by speech, regardless of age
Acts impulsively, and may respond before instructions are given out
May isolate themselves from social situations

Physical:

May be conditions in the student’s medical/developmental history, such as cleft lip and/or palate, cerebral palsy, muscular dystrophy, brain injury or disorder, aphasia, hearing loss, ear surgery, facial abnormalities, or congenital (present at birth) disorders
Has frequent allergy problems or colds
Has oral muscular coordination slower than normal
Displays clumsiness or seems to be uncoordinated

How is SLI diagnosed?

SLI is defined purely in behavioural terms: there is no biological test for SLI. There are three points that need to be met for a diagnosis of SLI:

The child has language difficulties that interfere with daily life or academic progress
Other causes are excluded: the problems cannot be explained in terms of hearing loss, general developmental delay, autism, or physical difficulty in speaking
Performance on a standardized language test (see Assessment, below) is significantly below age level.[3]

EpiSLI criterion is also used, based on five composite scores representing performance in three domains of language (vocabulary, grammar, and narration) and two modalities (comprehension and production). Children scoring in the lowest 10% on two or more composite scores are identified as having language disorder.[3][8]

Furthermore, specific language impairment does not involve global developmental delays; children with SLI function within the typical range in non-linguistic areas, such as nonverbal social interaction, play, and self-help skills (e.g., feeding and dressing themselves). Children with autism spectrum disorders have core impairments in social interaction and communication, including both nonverbal and verbal skills, as well as certain characteristic behaviors (e.g., repetitive movements, lack of pretend play, and inflexible adherence to routines) that are not found in youngsters with SLI.[9]

How is SLI managed?

Intervention is usually carried out by speech and language therapists, who use a wide range of techniques to stimulate language learning.[3] The intervention is interwoven into natural episodes of communication, and the therapist builds on the child’s utterances, rather than dictating what will be talked about. In addition, there has been a move away from a focus solely on grammar and phonology toward interventions that develop children’s social use of language, often working in small groups that may include typically developing as well as language-impaired peers.[3][10]

Fast ForWord[11] is also used as a therapy for children with SLI. Fast ForWord is a family of educational software products intended to enhance cognitive skills of children, especially focused on developing “phonological awareness.”[11][12] Here, Fast ForWord uses computerized exercises in which children identify computer-generated speech sounds (although the latest versions of the product apparently includes others kinds of computerized training as well). In the speech-sound drills, the training program starts off with sounds that have been altered by computer processing. These processed sounds preserve the frequency content of normal speech sounds, but are slowed down and have artificially exaggerated differences. These changes make the task easier for children with slower than normal temporal processing, but paradoxically are more difficult to discriminate for temporal processing normals. As the subject progresses, these differences are reduced to make the games more challenging.[11]

What happens if SLI is not managed?

Complications arise when SLI is not identified and intervened. Primarily, a child’s academic and social life will be adversely affected. Children with SLI are less likely to complete secondary school, and are more likely to experience long periods of unemployment during adulthood. What’s more, individuals with SLI have greater difficulties forming close friendships and romantic relationships.[5]

The impact on mental health is significant, and adults with SLI are at a disturbingly high risk (around 50%) for depressive and anxiety disorders.[5]

Early identification and intervention is very important so as to address the very specific problems children with SLI.

And remember, if you see a person who talks erratically, that doesn’t necessarily mean he or she is dumb, liar, or immature. Maybe he or she has specific language impairment.

References:
1. Merriam-Webster Dictionary 2015.
2. http://www.asha.org/Publications/leader/2001/010626/sli.htm
3. http://en.m.wikipedia.org/wiki/Specific_language_impairment
4. Leonard, Laurence B. (1998). Children with specific language impairment. Cambridge, Mass: The MIT Press. ISBN 0-585-27859-8. OCLC 45728290.
5. http://theconversation.com/autisms-hidden-older-brother-specific-language-impairment-6295
6. http://www.huffingtonpost.co.uk/claire-mitchell/specific-language-impairm_b_1576898.html
7. http://www.do2learn.com/disabilities/CharacteristicsAndStrategies/SpeechLanguageImpairment_Characteristics.html
8. Tomblin JB, Records NL, Zhang X (December 1996). “A system for the diagnosis of specific language impairment in kindergarten children”. J Speech Hear Res 39 (6): 1284–94. doi:10.1044/jshr.3906.1284. PMID 8959613.
9. http://www.gemmlearning.com/can-help/speech-language/delay-info/specific-language-impairment/
10. Gallagher, T. (1996). Social-interactional approaches to child language intervention. In J. Beitchman, N. J. Cohen, M. M. Konstantareas & R. Tannock (Eds.), Language, Learning and Behavior Disorders: Developmental, Biological and Clinical Perspectives (pp. 493–514). New York: Cambridge University Press.
11. http://en.m.wikipedia.org/wiki/Fast_Forword
12. Begley, S.; Check, E. (1 Jan 2000). “Rewiring your gray matter”. Newsweek: 63. Retrieved 2010-02-05.

Advertisements

3 thoughts on “Specific Language Impairment

  1. Pingback: Neurodivergent Sexuality, Part 2 | Aegyo Kawaii's Neurodiversity Blog

  2. Pingback: Little Bookworms (Hyperlexia) | Aegyo Kawaii's Neurodiversity Blog

  3. Pingback: Pragmatic Language Impairment | Aegyo Kawaii's Neurodiversity Blog

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s