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This 2-year-old girl displays skills of varying age levels. She plays alongside other children and uses a spoon well, which are appropriate social and adaptive skills for her age. She follows two-step commands, points to named pictures, and sorts objects by color, all which are appropriate receptive language skills for a 24-month-old child. However, speaking only 10 words is more characteristic of a 16- to 18-month-old child. Therefore, there should be concern for her expressive language skills.
Delayed language skills may have many different causes. Major diagnoses that should be considered in a child who exhibits language delay include hearing impairment, motor disability that impairs the child’s ability to form speech (cerebral palsy, brain injury), mental retardation, autism, and language disorders. Children who have mental retardation have delays in both nonverbal and verbal skills. Children who have autism have disordered language (eg, echolalia, stereotypic phrases) as well as impaired social skills and atypical behaviors (eg, repetitive behaviors, lack of imaginative play). Children who have language delay may have expressive language delay, a mix of receptive and expressive delay, or delays in higher order processing. An example of expressive language delay is verbal apraxia, which is due to a deficit in motor praxis or the ability to coordinate motor movements to produced coordinated speech. Children who have verbal apraxia may have associated motor delays. An example of a mixed receptive and expressive language disorder is verbal auditory agnosia or word deafness in which children have difficulty decoding spoken language and, therefore, have difficulty with spoken language.
Monica has a delay in spoken language and should be referred to a speech and language pathologist for further evaluation. Her use of a spoon implies that she has adequate fine motor skills. Because her receptive language skills are intact, it is unlikely that she has a hearing impairment. Her social skills (parallel play) are appropriate for age, obviating the need for increase social interaction with other children

What is a speech or language impairment?
A “speech or language impairment” means a communication disorder, such as stuttering, impaired articulation, a language impairment, or a voice impairment, that adversely affects a child’s educational performance.

There are three areas to consider for the prevalence of this disorder and they are voice, speech and language. Head trauma can have an adverse effect on all three of these areas so remember to check out the info about traumatic brain injury too.
· Voice: Approximately 7.5 million people in the United States have trouble using their voices.
· Speech: The prevalence of speech sound disorder in young children is 8 to 9 percent. By the first grade, roughly 5 percent of children have noticeable speech disorders; the majority of these speech disorders have no known cause. It is estimated that more than 3 million Americans stutter. Stuttering affects individuals of all ages but occurs most frequently in young children between the ages of 2 and 6 who are developing language. Boys are 3 times more likely to stutter than girls. Most children, however, outgrow their stuttering, and it is estimated that fewer than 1 percent of adults stutter.
· Language: Between 6 and 8 million people in the United States have some form of language impairment. Research suggests that the first 6 months are the most crucial to a child's development of language skills. For a person to become fully competent in any language, exposure must begin as early as possible, preferably before school age.

Characteristics of Students http://www.education.com/reference/article/Ref_Speech_Language/
· Overall achievement may be below expectancy in relation to chronological age, mental age or both.
· Achievement in reading, spelling, written composition, grammatical usage or math processes may be below expected levels, often with delay or difficulty in acquisition of pre-reading or other readiness skills.
· Word knowledge may be below expectancy.
· Word substitutions may occur frequently in reading and in writing from a copy or reproducing from recall.
· Hesitates or refuses to participate in verbal activities.
· Is inattentive, distractible; exhibits poor concentration; has difficulty “tuning in” to tasks or switching tasks.
· Displays refusal behavior and/or low frustration tolerance.
· Perseverates verbally and/or motorically.
· Cannot identify or use expository, descriptive or narrative language in written work.
· Cannot write an organized paragraph using related sentences of varying length and grammatical complexity.
· Has problems interpreting and/or using vocal pitch, intensity, and timing for purposes of communicating subtle distinctions in emotion and intention.
· Has inappropriate vocal pitch for age and sex.
· Does not use appropriate vocal control, particularly in regulating speaking volume. (unusually loud or soft)
· Has breathy, harsh, husky or monotone voice.
· Continually sounds congested. (denasal)
· Sounds unusually nasal; voice has a “whining” quality.
· Has abnormal rhythm or rate of speech.
· Frequently prolongs or repeats sounds, words, phrases and/or sentences during speech.
· Has unintelligible or indistinct speech.
· Has difficulty articulating sounds within words.
· Conditions are indicated in the student’s medical/developmental history, such as cleft lip and/or palate, deviant palatal-pharyngeal structure, cerebral palsy, muscular dystrophy, brain injury, aphasia, vocal nodules or myringotomy or other aural surgery, orofacial abnormalities, congenital disorders.
· Has continuous allergy problems or frequent colds.
· Has deviant dental structure.
· Has oral muscular coordination slower than normal.
· Displays clumsiness or general motor incoordination.

How is this disability identified?
The two required screenings are hearing and vision. A formal assessment that is recommended is to gain information from school-wide, grade and/or class testing. There are several informal ways to assess this disability. Teachers can do observations in the classroom and keep notes on those. Check to see if there are existing records and available information to access and review. Other informal assessments include checklists, inventories and interviews. Once a child has been referred a speech-language pathologist must conduct a thorough and balanced speech, language, or communication assessment.

How do these learners receive their education?
Students are placed in the general classroom and provided with the necessary guidance of the trained professional in the student’s areas of need. This help could come from a speech-language pathologist, audiologist, psychologist, guidance counselor or special education teacher. Students may receive services individually or in a small group sessions. Speech-language pathologists integrate the students’ speech-language goals with academic outcomes and functional performance.

What are the best educational practices?
The general education teacher should work with the speech-language pathologist to incorporate strategies to help the student generalize strategies mastered in speech therapy. This may include corrective measures, helping with speech and language exercises, and providing the student with immediate feedback when the speech-language pathologist is not present. The general education and special education teacher should both collaborate with the speech-language pathologist for interventions and teaching strategies. The speech-language pathologist should provide the following services:
  • Helping children with articulation disorders to learn proper production of speech sounds
  • Helping children who stutter to speak more fluently
  • Assisting children with voice disorders to improve their voice quality
  • Helping individuals with aphasia to relearn speech and language skills
  • Assisting individuals who have difficulty swallowing as a result of illness, surgery, stroke, or injury
  • Evaluating, selecting, and developing augmentative and alternative communication systems
  • Enhancing communication effectiveness
· One-on-one presentations
· Small group settings
· Buddy Reader/helper
· Assignment modifications
· Computer access with a voice synthesizer
· Written papers or project instead of oral presentations
· Proper time given for student to express thoughts
Inclusive Practices
· Buddy Reading
· Encouraging peer interactions
· Bringing speech- language services to the child rather than taking the child to a separate treatment room
· Collaborating with speech-language pathologists, teachers, parents and others to achieve communication goals

Special Challenges for General Education
· School language differs from home language. Students must learn to rely on meanings that are more completely encoded linguistically. At home, routines are familiar and can be understood based on primarily nonverbal cues. In school, however, nonverbal context is provided less frequently as grade level increases and as instruction relies more heavily on written language activities.
· Language skills provide an important key to academic success! Children who do not have a firm language foundation lag further and further behind.
· The ability to read is perhaps the single most important skill children acquire in school. Therefore if a student struggles with reading this could impact their language or speech.
· Students have a hard time understanding social cues.
· Students may use poor judgment.
· Students have a hard time with a noisy or complex classroom.

Accommodations: Assistive Technology
For students with speech and language impairments, the major types of assistive technology can be divided into two areas.
First, students with speech and language impairments have an array of computer software packages available to develop their speech and language skills. An example is First Words, a language program that has a number of applications for teaching those who are developing or reacquiring language functions. The program uses graphic presentations combined with synthesized speech to teach high-frequency nouns, and is one of many software packages that can help develop both speech and language.
Secondly, students with speech and language impairments may use augmentative or alternative communication (AAC). AAC is the use of symbols, aids, strategies, and techniques to enhance the communication process. This includes sign language and various communication boards, both manual and electronic, that are used by individuals with impaired oral motor skills.
The most basic AAC devices are non-electronic communication boards. The boards usually are limited to a number of choices (two to four). The choices can be represented by real items, pictures of items, and symbols for items (including print). The objective of the communication board is to have the student make a choice, typically of food or activity. Electronic AAC devices range from very simple devices with few buttons (such as the Cheap Talk) to very elaborate systems that use a keyboard and synthesized speech (such as the Dyna Vox and Liberator).

Are there any wraparound services?

Yes. Requests for these services must be made by the student, parents or school. The child must be found eligible for wraparound services by the agency. The child will see our doctor and determine if there is medical necessity for wraparound services. This team includes parents, any lead teacher, a Behavior Specialist Consultant (BSC), any services coordinator, any therapist or counselor, and any person(s) the family wishes, including an advocate. If appropriate, your child is included. The plan includes goals, objectives, and treatments. Goals may target safety, functional, communication, social and classroom behavior and each member of the team is assigned responsibility to help meet the goals. Goals are individual to the needs of your child and family, and are updated as often as every three months.

Is this a school issue or a life issue?
This is definitely a school and life issue. Speech and language skills are needed wherever you go. These skills are used at school in almost everything you do and when you are not at school you still need these skills to interact with others and the environment.

How does this affect home?
Home is greatly impacted by this disability because the student tends to receive more help and at times may not be required to be independent and follow through with activities. The home atmosphere is familiar and parents tend to take over and do more for their children and not require them to be independent and try. Children may get what they want by making noises or only using a couple of words instead of being told to finish their sentences and speak clearly and correctly.

Name of someone who has achieved greatness.

king george vi
king george vi

King George VI--suffered from a speech impediment

What can you do to make a difference for the child?
Include the student in as much general education as possible. Here is a cool idea on using pictures to communicate, check it out!

What can you do to support parents?
Work as a team with the parents and support and encourage each other. Parents, teachers and the speech-language pathologist need to be on the same side which is the side of the student. A good parent website and organization is the NAPCSE which stands for National Association of Parents with children in Special Education. This website has loads of helpful exercises to do with your child in several areas of speech or language and a plethora of information.

· Bernstein & Tiegerman. Language and Communication Disorders in Children. Columbus, OH: Charles E. Merrill Publishing Co. 1985.
· Rhea Paul. Language Disorders From a Developmental Perspective. Mahwah, NJ: Lawrence Erlbaum Associates, Publishers. 2007.
· **www.asha.org** (American Speech Language Hearing Association)
· **www.interactivereadalouds.com**
· **www.classroomtoolkit.com/dol.html** (Daily Oral Language & other resources)
· **www.interventioncentral.org**
· See also the page on Oral Expression Disability