Cognitive-Communicative Impairmentss.ppt

Cognitive communication lecture

1. Cognitive-Communicative
Impairments
Chapter Seven

2. Developmental Disability DD
•Broad definition applied to a wide range of
conditions
•Physical or mental impairment that begins
before age 22
•Impact 3 of the following areas: self care,
speaking, learning, motor skills, make
decisions, live on their own, earn/manage
an income

3. •IDEA allows states to use this Dx between
ages 3 – 9. Florida uses it until age 6,
when a more specific Dx is required to
obtain services for a child

4. Intellectual Disability
(Mental Retardation)
•MR as a term is not widely used – has gained a
negative connotation.
•IDEA 04 defines it as “significantly subaverage
general intellectual functioning existing
concurrently with deficits in adaptive behavior
and manifested during the developmental
period, that adversely affects a child’s
educational performance”
•DSM V will probably not use IQ to classify-rather
will focus on strengths on the individual

5. •Dx requires:
•Identification of limitations in two areas
• 1. intellectual functioning
• 2. adaptive behavior (limitation of
conceptual, social and practical adaptive
skills)
•Manifested during the developmental
period
•Appears before age 18

6. ID/MR Classification
•Mild Functional Limitations
•IQ of 50/55 to 70/75
•Adaptively can function close to same-
aged peers
•Sixth grade academic skills
•Fairly high degree of literate language use
•Hold job/live with minimal support

7. •Moderate Functional Limitations
•IQ of 35/40 to 50/55
•Moderately affected adaptive skills
•Academic skills around second grade level
•Possible to acquire literacy skills – use
targeted instruction
•Semiskilled work (general or workshops)
•Live with moderate degree of supervision

8. •Severe Functional Limitations
•IQ 20/25 – 35/40
•Adaptive behaviors severely affected
•Academic/language skills remain limited
•Often have comorbid conditions
•Can learn self-care in sheltered environments
•Perform some work tasks with close supervision

9. •Profound Functional Limitations
•IQ 20/25
•Adaptive behaviors profoundly affected
•Often havae comorbid sensory-motor
limitations
•Need comprehensive supervision &
assistance

10. Causal Factors Associated with
ID/MR
•Don’t always know the etiology
•Seizures can be indicator of CNS
impairment
•Medical risk factors such as high-risk
pregnancy, premature birth, low
birthweight, PKU (phenylketonuria)

11. Down Syndrome
•Etiology – genetic defect – trisomy 21
(extra chromosome 21)
•Associated with increased maternal age
•Physical characteristics: short fingers,
unusual palm creases, wide-spaced first
toes, epicanthal folds around the eyes,
colored speckles in the iris of the eye and
small ear, nose, and chin.

12. •Craniofacial morphology – short front to
back head dimensions and shortened oral
and pharyngeal structure with high vaulted
palate. Tongue appears large/difficult to
manipulate, increased risk of articulation
disorders and ear infections/conductive
hearing loss
•Has increased risk of abnormality in many
organ systems (heart)

13. •Language development delayed –
comparable to a much younger child (2 –
6)
•Studies support speech/language services
for articulation, vocabulary, syntax,
morphology
•Reading can be taught –difference of
opinion on best strategies (sound/letter, or
phonological awareness)

14. Fragile X Syndrome
•Most frequent inherited cause of ID
•Second most frequent genetic cause of ID
•One gene involved – FMRI – which is
critical to early brain development
(proliferation and pruning of dendrites –
impairs maturation and plasticity))
•Affects many more males than females
since they only have one X chromosome

15. •20-25% meet the criteria for ASD
•Communication characteristics – echolalia,
jargon, perseveration on words, phrases or
topics of conversation and comments that are
tangential or irrelevant
•Impaired articulation, telegraphic speech,
missing morphology
•Social skills – problems with eye gaze, gestures,
•Behaviors – anxiety, poor transitioning, sensory
defensiveness, temper tantrums

16. Prader-Willi Syndrome
•Chromosomal disorder – deletion of 15 from the
father or duplication from mother
•Males and females equally
•Hypotonia, feeding problems
•Micrognathia (small lower jaw) , narrow palatal
vault, hypo or hypernasality
•Speech/Language: articulation difficulty, short
MLU, limited vocabulary, difficulty with narrative
& conversational discourse, impaired social skills

17. Angelman Syndrome
•Chromosome 15 deleted from the mother
or duplicated from the father
•Appear normal at birth – most common
age of diagnosis is ages 3 – 7
•MRI’s and CT’s may appear normal or
show mild cortical atrophy (shrinkage) or
dysmyelination
•Delayed development/ not regression

18. •Characteristics: cognitive impairment with
severe functional limitations, ataxia of gait
and other movement disorders, appear
happy with laughter/smiling, easily
excitable, short attention span
•Verbal reception /nonverbal skills higher
than verbal – has few words

19. Williams Syndrome
•Number of genes missing due to the deletion of
the long arm of chromosome 7
•Appear “elfin”
•May have hyperacusis or an affinity to music
•Strength with sentence level language
production / comprehension may be
compromised (due to good auditory memory??)
•Uneven pattern of language skills

20. Autism Spectrum Disorder
•DX made if manifested prior to age three
in three primary domains:
• Social interaction (nonverbal/gestures)
• Failure to develop age-appropriate peer
relationships
• Absence of showing, pointing, sharing
• No social/emotional reciprocity

21. •Communication Impairment
• Delay or lack of spoken language
• Impaired initiation/sustained
conversation
• Idiosyncratic /stereotyped/repetitive use
of language
• Absence of make-believe/social play
•

22. •Repetitive Behaviors
• Preoccupation with
stereotyped/restricted patterns of interest
• Inflexible adherence to nonfunctional
routines/rituals
• Stereotyped/repetitive motor
mannerisms (hand flapping, body rocking)
• Preoccupation with parts of objects

23. •Etiology – genetics/neurobiological causal
factors now gaining acceptance
•Pre-frontal cortex, superior temporal
gyrus, amygdala, cerebellum (executive
function, social cognition – theory of mind)
•

24. •Other characteristics
• Lack of complex gestures
• Limited dramatic play/use of symbols
• Don’t compensate for lack of speech by using
other modalities (i.e. gestures)
• Can also have apraxia (planning, executing,
sequencing movements)
• If speech occurs prior to age 5, better
prognosis
Children who do talk often go through period
of echolalia (immediate/delayed) - Wetherby

25. Asperger Syndrome
•Have delays in two out of three of the
domains used to Dx ASD
•Severe and sustained impairment in social
interaction
•Restricted, repetitive patterns of behavior,
interests, and activities
• Have development of spoken
communication

26. Childhood Disintegrative Disorder
•According to DSM – “marked by
regression in functioning following at least
two years of apparently normal
development”
•Dx between ages of 2 and 10
•Loss of skills in 2/5 developmental
domains: receptive/expressive language,
social skills, bowel or bladder control, play,
motor skills

27. Rett Syndrome
•Only affects females
•Genetic causal factor
•Four stages
• I. 6 – 18 months early onset – subtle signs of reduced social
skills, head growth, gross motor skills
• II. 1 – 4 years rapid destruction stage – show head growth, loss
of spoken lang, social interaction, unsteady gait
• III. 2 – 10 years plateau stage Can last for most of child’s life.
Improvement in behavior, more interest in environment, better
attention span, communication skills, Prominent apraxia, motor,
and seizure difficulties.
• IV. Adulthood – late motor deterioration stage – reduced mobility,
spasticity, dystonia, scoliosis, cognition/communication stable

28. PDD-NOS
•Children who do not meet strict criteria for
ASD
•Later onset (after age 3)
•Atypical symptomatology
•Exclusion of other confounded Dx
(schizophrenia, avoidant personallity
disorder)

29. Acquired Brain Injury
TBI –Traumatic Brain Injury
OHI – open head injury – skull fractured and
meninges may be punctured
CHI – closed head injury – brain may swell
Ex: shaken baby syndrome

30. •TBI Classification Impact (moving) or Inertial
(stationary) forces
• Scalp and skull injury. Depressed skull fractures may
cause brain injury
• Brain contusion – bruising of the brain
• Concussion – mild injuries to the nerve fibers of the
brain
• Epidural hematoma – blood clot between skull and
meninges
Acute subdural hematoma –clot beneath dura but
above brain surface
Diffuse axonal injury – shears long fibers (white matter)

31. •TBI brain damage often diffuse and
bilateral
•Can cause motor, cognitive and sensory
deficits, seizures, language and literacy
difficulty.

32. Acquired Brain Injury
•Terms to know:
• Encephalopathy – brain injured by
disease or late effects of treatment of a
disease such as cancer
• Anoxia – deprivation of oxygen to the
brain

33. •Three groups of disease processes associated
with ABI
• Unilateral cerebrovascular lesions – usually
have good prognosis for language recovery
• Cerebral infections – (meningitis and
encephalitis) lesions may be focal or diffuse
• Cerebral tumors – depends on size and
location of tumor as well as effects of treatments
(radiation/chemotherapy)

34. •Other terms
• CVA – cerebral vascular accidents
(strokes) usually cause focal damage
• Occlusive embolism – blood clots - may
cause anoxia and damage to areas of the
brain

35. Acquired Seizure Disorders
Landau-Kleffner Syndrome
•Epilectic aphasia – etiology – repeated
convulsions
•Landau-Kleffner Syndrome (LKS) may be
preceded or followed by epilepsy Can’t process
phonetically encoded information receptively
(auditory agnosia) Expressive language can also
be impacted. Dx when sudden loss of receptive
language occurs.
•Usually Dx in children ages 3-7 with previous
normal development.
•Extremely rare

36. Other Potential Causes of
Language/Speech Delays
•Fetal Alcohol Spectrum Disorder
• Mother drank excessively/binge drinking
• Growth retardation for weight, height, or
head circumference
• Facial characteristics of absent or
indistinct philtrum, thin upper lip, small
space between eyes
• Evidence of damage to CNS

37. •Abuse and Neglect
• Physical
• Sexual
• Emotional
• Physical Neglect
• Emotional Neglect

38. •Failure to Thrive Syndrome
• Young child falls below the third
percentile on growth charts
• Potential etiologies: chronic disease,
congenital anomaly, child maltreatment
• Many have severe feeding problems

39. Interactive Disorders of Attention,
Emotion and Behavior
•ADD/ADHD-neurobiological in origin
•Selective Mutism
•Depression
•OCD
•Tourette’s Disorder- vocal/motor tics
•Schizophrenia-delusions, hallucinations
•Conduct Disorder-repetitive and persistent
patterns of behavior that violate rights of others
•ODD – Oppositional Defiant disorder – recurrent
pattern of negative, defiant, disobedient, and
hostile behavior toward authority figures