Language Disorders

Medical and Psychosocial Aspects of Disability 11/2/04

Communication
There are 3 elements in this exchange,

and all must be present:

1. Message

2. Message

must be expressed 3. Message must be understood

Speech and Language

Speech is the motor act of

communicating by articulating verbal expression Language is the knowledge of a symbol system used for interpersonal communication.

Four domains of language

Phonology
Grammar

Semantics
Pragmatics

Phonology
The ability to produce and

discriminate the specific sounds of a given language. Its unit, the phoneme, is characterized by distinctive features. Babies start discriminating phonemes during the first few months of life, and they produce them soon after.

Phonology
Phonological receptivity is pluripotential

at birth Starts to decay at around 10 months Reaches a rather general inability to acquire native phonology by preadolescence

Grammar
The underlying rules that organize

any specific language. The combinatorial rules that most native speakers of a language recognize as acceptable for that language and that allow a native speaker an infinite array of generative possibilities.

Grammar
Composed of both morphology and

syntax.

Semantics
The study of meaning
Includes the study of vocabulary

(lexicon).

Lexicon
Lexical entries are organized in the

mental dictionary according to welldefined rules Allows the young child to acquire a peak average of 10 new words per day. By 24 months the average child knows 50 words.

Lexicon Growth
The subsequent

exponential growth makes it difficult to determine vocabulary size with exactitude.

Environmental factors predicting large vocabularies

Reading and discussing children's stories
The quality of dinner table conversations Large mother-produced number of words

Higher socioeconomic status (SES)

Being the firstborn ( Hoff-Ginsberg, 1998 ) Quantity and sophistication of mother's

vocabulary ( Snow, 1998 ).

Pragmatics
A number of sub-domains reflecting

communicative competence.

Sub domains of Pragmatics

Rules of conversation (turn-taking, topic

maintenance, conversational repair) Politeness Narrative and extended discourse The implementation of communicative intents

Pragmatic disorders
Little variety in language use
May say inappropriate or unrelated

things during conversations May tell stories in a disorganized way Can often make demands, ask questions, and greet people Has trouble organizing language to talk about what happened in the past.

Pragmatic disorders
Appear to pull topics out of the air
May not use statements that signal a

change in topic, such as "That reminds me." Peers may avoid having conversations with such a child. Can lower social acceptance.

Language Developmental Trajectory

Telegraphic speech

Word combinations
Word production Word comprehension Canonical Babbling

 By age 3, most

normal children have mastered the basic structures of their native language

Language acquisition
Occurs with uniformity and rapidity
Supports the hypothesized existence of

innate, genetically determined Universal Grammars Recently proposed a combination of traditional learning and innate language modules.

Disfluencies in Children
Almost all children go through a stage of

frequent disfluency
usually

between the ages of 2 and 5.

Speech is produced easily in spite of

the disfluencies.

Etiology of Speech & Language Disorders

Mental retardation
Hearing loss Maturation delay

Bilingualism
Psychosocial

(developmental language delay) Expressive language disorder (developmental expressive aphasia)

deprivation Autism Elective mutism Receptive aphasia Cerebral palsy

Overview of major types of speech disorders

Definitions vary, but

generally agree that speech disorders involve deviations of sufficient magnitude to interfere with communication. They draw attention to the speaking act and away from the message

1. Fluency Disorders
Speech is characterized by repeated

interruptions, hesitations, or repetitions Stuttering is by far the most well-known fluency disorder

1. Fluency disorders Stuttering

Flow of speech is abnormally

interrupted by repetitions, blocking, or prolongations of sounds, syllables, words, or phrases Very familiar, but actually quite rare only 1-5% of the population. Articulation disorders actually occur much more frequently than stuttering

Stuttering -- Causes

1. 2.

3.

Still a mystery Three perspectives: Symptom of emotional disturbance Result of biological makeup Learned response

Stuttering
Disorder of speech fluency that

interrupts the forward flow of speech.

All

individuals are disfluent at times Differentiated by the kind and amount of the disfluencies

Characteristics-Repetition
Sounds
b-b-b-ball

Syllables
mo-mo-mommy

Parts of words
basket-basket-basketball

Whole words, and phrases

CharacteristicsProlongation
Stretching, of sounds or syllables
r-----abbit

Characteristics
Tense pauses, hesitations, and/or no

sound between words Speech that occurs in spurts

as

the child tries to initiate or maintain voice on the speaking situation

Variability in stuttering behavior

depending

Related behaviors
tense muscles in the lips, jaw, and/or

neck tremor of the lips, jaw, and/or tongue foot tapping eye blinks head turns

2. Articulation disorders
This is the largest category of all

speech problems DSM-IV calls these phonological disorders. abnormal speech-sound production, characterized by inaccurate or otherwise inappropriate execution of speaking

2. Articulation disorders
Great majority are functional articulation

disorders Might represent as much as 80% of the speech disorders diagnosed by speech clinicians Must be very careful to distinguish true problems from delay. E.g., r, s, th problems may largely disappear naturally after 5 years of age

2. Articulation disorders
1. Omissions
2. Substitutions 3. Additions 4. Distortions

3. Voice disorders
Unusual or abnormal acoustical

qualities in the sounds made when a person speaks Very little research here What is a normal sounding voice? Nasality, hoarseness, breathiness

Normal Speech Development

4. Delayed speech
Failure to develop speech at the

expected age Somewhat subjective Usually associated with other maturational delays May also be associated with a hearing impairment, mental retardation, emotional disturbance, or brain injury Often the result of environmental deprivation

Epidemiology of Speech Delay

Common childhood problem
Affects 3 to 10 percent of children. 3-4X more common in boys than in

girls.

Most common causes of speech delay

Mental retardation
Hearing loss

Maturation delay

Overview of major types of language disorders

Need to understand normal language

and prelanguage development See Table 10.1 on 320 May involve comprehension (understanding) or expression in written or spoken language These are very complex to diagnose and treat

Language and Brain

Language disorders
1. Expressive language disorders
2. Receptive language disorders 3. Aphasia loss of the ability to speak

or comprehend language because of an injury or developmental abnormality in the brain

EXPRESSIVE LANGUAGE DISORDER

(developmental expressive aphasia)

Fail to develop the use of speech at the

usual age.

EXPRESSIVE LANGUAGE DISORDER

Normal intelligence
Normal hearing Good emotional relationships Normal articulation skills. Comprehension of speech is

appropriate to the age of the child

EXPRESSIVE LANGUAGE DISORDER

Brain dysfunction

that results in an inability to translate ideas into speech.

EXPRESSIVE LANGUAGE DISORDER

The child is at risk for language-based

learning disabilities (dyslexia). May use gestures to supplement their limited verbal expression .

Maturation Delay vs. Expressive Language Disorder? The late bloomer will
eventually develop normal speech The child with an expressive language disorder will not do so without intervention.

Maturation Delay vs. Expressive Language Disorder?

It is sometimes difficult, if not

impossible, to distinguish at an early age a late bloomer from a child with an expressive language disorder.

BILINGUALISM
A bilingual home

environment may cause an apparent temporary delay in the onset of both languages.

BILINGUALISM
The bilingual child's comprehension of

the two languages is normal for a child of the same age. Usually becomes proficient in both languages before the age of five years.

Interference or transfer
An English error due to the direct

influence of the primary language structure. This is a normal phenomenon

Silent period
Common second-language acquisition

phenomenon Often very quiet, speaking little Focus on understanding the new language The younger the child, the longer the silent period tends to last.

Code switching
Changing languages over phrases or

sentences. Normal phenomenon

Benefits of Bilingualism
Children who are fluent bilinguals

actually outperform monolingual speakers on tests of metalinguistic skill.

Benefits of Bilingualism
Our world is shrinking and business

becomes increasingly international Children who are fluent bilingual speakers are potentially a tremendously valuable resource for the U.S. economy.

Language Disorders
Egyptians reported

speech loss after blow to head 3000 years ago Broca (1861) finds damage to left inferior frontal region (Brocas area) of a language impaired patient, in postmortem analysis

Language Disorders (2)

In language disorders 90-95% of cases, damage is to the left hemisphere 5-10% of cases, to the right hemisphere
Wada test is used to determine the

hemispheric dominance

Sodium amydal is injected to the carotid artery First to the left and then to the right

Language Disorders (3)

Paraphasia: Substitution of a word by a sound, an incorrect word, or an unintended word Neologism: Paraphasia with a completely novel word Nonfluent speech: Talking with considerable effort Agraphia: Impairment in writing Alexia: Disturbances in reading

Three major types of Aphasia

Rosenzweig: Table 19.1, p. 615

Brocas aphasia Nonfluent speech

Wernickes aphasia Fluent speech but unintelligible Global aphasia Total loss of language Others: Conduction, Subcortical, Transcortical Motor/Sensory (see also Kandel, Table 59-1)

Brain areas involved in Language

Brocas Aphasia
Brodmann 44, 45

Lesions in the left inferior frontal region

(Brocas area) Nonfluent, labored, and hesitant speech Most also lost the ability to name persons or subjects (anomia) Can utter automatic speech (hello) Comprehension relatively intact Most also have partial paralysis of one side of the body (hemiplegia) If extensive, not much recovery over time

Wernickes Aphasia
Brodmann 22, 30

Lesions in posterior of the left superior

temporal gyrus, extending to adjacent parietal cortex Fluent speech But contains many paraphasias

girl-curl, bread-cake

Syntactical but empty sentences

Cannot repeat words or sentences

Unable to understand what they read or hear Usually no partial paralysis

Wernicke-Geschwind Model
1. Repeating a spoken word

Arcuate fasciculus is the bridge from the

Wernickes area to the Brocas area

Wernicke-Geschwind Model
2. Repeating a written word

Angular gyrus is the gateway from visual cortex to

Wernickes area This is an oversimplification of the issue: not all patients show such predicted behavior (Howard,
1997)

Sign Languages
Full-fledged languages, created by hearing-

impaired people (not by Linguists):

Dialects, jokes, poems, etc. Do not resemble the spoken language of the same area (ASL resembles Bantu and Navaho) Pinker: Nicaraguan Sign Language Another evidence of the origins of language (gestures)

Most gestures in ASL are with right-hand, or

else both hands (left hemisphere dominance) Signers with brain damage to similar regions show aphasia as well

Signer Aphasia
Young man, both spoken and sign language: Accident and damage to brain Both spoken and sign languages are affected Deaf-mute person, sign language: Stroke and damage to left-side of the brain Impairment in sign language
3 deaf signers: Different damages to the brain with different impairments to grammar and word production

Spoken and Sign Languages

Neural mechanisms are similar
fMRI studies show similar activations for

both hearing and deaf But in signers, homologous activation on the right hemisphere is unanswered yet

Dyslexia
Problem in learning to read
Common in boys and left-handed High IQ, so related with language only

Postmortem observation revealed anomalies

in the arrangement of cortical cells

Micropolygyria: excessive cortical folding Ectopias: nests of extra cells in unusual location

Might have occurred in mid-gestation, during

cell migration period

Acquired Dyslexia = Alexia

Disorder in adulthood as a result of

disease or injury Deep dyslexia (pays attn. to wholes):

cow -> horse, cannot read abstract words Fails to see small differences (do not read each letter) Problems with nonsense words

Surface dyslexia (pays attn. to details): Nonsense words are fine Suggests 2 different systems: One focused on the meanings of whole words The other on the sounds of words

Electrical Stimulation
Penfield and Roberts (1959): During epilepsy

surgery under local anesthesia to locate cortical language areas, stimulation of:

Large anterior zone:

stops speech
misnaming, impaired imitation of words unable comprehend auditory and visual semantic material, inability to follow oral commands, point to objects, and understand written questions

Both anterior and posterior temporoparietal cortex:

Brocas area:

Studies by Ojemann et al.

Stimulation of the brain of an English-

Spanish bilingual shows different areas for each language Stim of inferior premotor frontal cortex:

Arrests speech, impairs all facial movements

Stim of areas in inferior, frontal,

temporal, parietal cortex:

Impairs sequential facial movements, phoneme identification

Stim of other areas: lead to memory errors and reading errors Stim of thalamus during verbal input: increased accuracy of subsequent recall

Williams Syndrome
Caused by the deletion of a dozen genes

from one of the two chromosomes numbered 7 Shows dissociation between language and intelligence, patients are:

Fluent in language But cannot tie their shoe laces, draw images, etc.

Developmental process is altered: Number skills good at infancy, poor at adulthood Language skills poor at infancy, greatly improved in adulthood

Lateralization of the Brain

Human body is asymmetrical: heart,

liver, use of limbs, etc. Functions of the brain become lateralized Each hemisphere specialized for particular ways of working Split-brain patients are good examples of lateralization of language functions

Lateralization of functions
(approximate)

Left-hemisphere: Sequential analysis

Right-hemisphere: Simultaneous analysis

Synthetic Cognitive maps Personal space Facial recognition Drawing

Analytical Problem solving

Visual-Spatial skills

Language

Emotional functions

Recognizing emotions Expressing emotions

Music

Split-brain
Epileptic activity spread from one hemisphere

to the other thru corpus callosum Since 1930, such epileptic treated by severing the interhemispheric pathways At first no detectible changes (e.g. IQ) Animal research revealed deficits:

Cat with both corpus callosum and optic chiasm severed Left-hemisphere could be trained for symbol:reward Right-hemisphere could be trained for inverted symbol:reward

Left vs. Right Brain

Pre and post operation studies showed that: Selective stimulation of the right and left hemisphere was possible by stimulating different parts of the body (e.g. right/left hand):

Thus can test the capabilities of each hemisphere

Left hemisphere could read and verbally communicate Right hemisphere had small linguistic capacity: recognize single words Vocabulary and grammar capabilities of right is far less than left Only the processes taking place in the left hemisphere could be described verbally