• orginally not thought to have a language imapirment because CA and LA are the same but when look t language system determined that strenghts and weakness in language exsist
• rarely will see kids with ID who have skills at a higher level then their CA

• Best utlized in terms of early intervention, stimulation, and working with the parents/teachers
• maximize language stimulation
• creat language learning opportunities in the classroom
• do behaviors that encourage language

• significant impairment in both intellectual functions and in adaptive behavior that orginates before the age of 18
• IQ below 70 expect there is a suggested range of 70 to 75
• each state sets their own guidelines so it depends where you live if you are eligibile for services

• the ability to act independently and responsibility
• conceptual skills: language, money
• practical skills: getting dressed, eating
• social skills: following rules, self esteem
• language skills
• need to do IQ test with adaptive behaviors as a better predictor of disability

• NVIQ between 70 and 85 (usually around 81)
• behind peers, not reading and writing at age level
• 13 to 14% of population fall into this category

• intermittent: get along in life but can't deal with crisis
• limited: need supports to on a more regular basis
• extensive: cared for individuals, can't participate in dailt acitvities
• pervasive: very severe

• Cognition: can't generalize across task
• don't remember something week to week
• routine approaches work best
• Attention
• attend to fewer stimulus items
• difficultly attending to and recognizing relevant task factors
• Memory:
• poor storage and retrival of info
• have to cue kids to retrieve known information

• Non syndromic and nonfamilial: damage to the fetus
• Non syndromic and familial: not a syndrome but runs in family
• Syndromes: down syndrome, fragil X, williams, FAS, prader-willi

• Better or worse with TOM
• ability to figure out what I know and what I don't know
• DS kids better with TOM skills
• Williams syndrome better with pragmatic and empathetic language skills
• DS bad with syntax

• as much alnguage as possible to enable the individual to function as independently as possible
• ultimate goal is to help the individual becomes as self sufficent as possible
• more matters

• Language problem exsisting in the absence of other conditions
• Language imapairment is the primary disability
• language difficulties interfere with academic or occupational achievement and social communication
• NSLI = IQ between 70 and 85
• Both definitions bring into play the concept of cognitive referencing so it requires for language to be very severe so only use definitions at certain times

• Once thought that could have normal receptive with poor expressive but this may not be that case
• Receptive language ability problems are more debilitating to a child then expressive language impairments
• Receptive lang is difficult to test in valid ways
• what a child knows about the world plays into comprehension

• SELD=Slow expressive language development
• ELD= early language delay

• SELD/ELD are BIG risk factors for SLI
• 50% of SELD kids have SLI

• exclusionary imapirment: only problem can be with language
• Hadley and Short: SLI is a condition characterized by extreme difficultly in language in the presence of otherwise typical development
• At or above -1SD
• usually the higher NVIQ the better SLI kids will fair because they have higher cognitive abilities to get around their language impairment

• adolescensed who were previously identified as SLI because of their normal NVIQ when retested may have low NVIQ and no longer receive the diagnosis of SLI
• this is because their peer group is doing more cognitive processing tasks to exposed them to things in life to help them deal with IQ tests which language impairment kids have missed

Tomblin and Colleagues

• -1.25 SD on a test provides the most sensativity and specificity
• did study on how kids were diagnosed after given TOLD-P2 versus how a SLP diagnoised them
• -1.25 is considered to be the cut off for significant limitations in language
• 7% of population has language impairments in the absences of othr conditions

Risk Factors for continuing language problems

-SELD

• 24 months with fewer then 50 single words and no 2 words combinations
• no obvious reason for language delay
• continuing language problmes with no obvious reasons likely to equal SLI

• is a huge risk factor for SLI
• teaching emotion regulation
• kids use language to regulate their emotion
• parent teach emotions regulation by explaining to child the state they are in
• if parents do not have language needed for emotional regulation dur to SLI they are disadvantaged in teaching their kids
• Parents with SLI will have lower SES
• have more family stressors and dont have alternative for them
• Family understanding of SLI may be limited so dont know what to do with child
• may not think child has a problem because act the same way parents do

• modeling and language literacy
• how many books are in the family
• reading time
• vocab and the family
• what vocab is the child exposed too
• Heritability/gentic link

• social adaptation issues
• problems with academics
• lower literacy level
• lower ses
• carry the gene
• continuing cycle

• multiple gene effects on language and related abilities
• Reading disability has high heritability
• may be a manisfistation of the same thing

• Vocab Delays
• Comprehension problem- huge problems
• Consider types of words child is using
• GAP verbs vs other verbs
• not learning abstract verbs
• not learning multiple meaning words
• no figurative language
• very literal in language usage
• poor metalinguistic ability
• Syntax and morphology delay
• slow development of complex sentences
• more issues with morphology

• Is the issues of not having good peer relationships a part of the syndrome of SLI (emotional impairment)
• Or are the problems in social interactions an adaptive behavior
• because they can't communicate they aren't involved with their peers so develop maladaptive behaviors
• Reed believes is adaptive behaviors

• Profound language delays
• Below peers in reading and spelling
• behavior problems
• lower educational achievement
• fewer extracurricular activites
• social isolation
• poorer math scores
• anxiety disorder
• lower NVIQ
• poor TOM
• worse social adapatation

• social isolation leads to suicide
• need direct study on SLI and suicide
• Juvenile delinquents: in 2 studies it was found that they had not recieved language services before being incarcerated but a number of them had receievd special ed services
• language imapairment was not identified but failure in school was noted so got special ed services but not the services they needed to correct failure

• SLI lose support services in middle school which makes it less likely that they are going to graduate
• get moved to general ed so don't need SLP in middle school
• SLI is a life long disability
• should adopt a disability model that suggests it can't be cured
• impossible for a kid to have a language imapirment without having some type of educational impact
  
• Matthew effect

• At 5 yrs Paul found that 75% of these kids scored within the normal range on language assessment
• however, SELD kids scored at the lower range, around 86ish, while their ND peers were clustering around 100ish
• SELD kids have a bigger range, bigger standard deviation, more varibale

• Recovery we think we see is not a real language recovery because we are not testing the right areas
• ND children will take a break from learning to consolidate everything while this is occuring SLI kids continue learning and may seem to "catch up" however as soon as break is over SLI kids fall behind
• Also, during this period they are missing out on social interactions leading to maladaptive behaviors

• Big predictor of narrative success
  
• Children also have receptive problems

• LD is a educational term which SLI is not
• SLI considered to be a speech/language impairment
• SLI is the most prevalent disability in school age children 7%
• Kids can talk in sentence so the language impairment may not be obvious

• Likelyhood of received treatment at 2nd grade:
• speech imapirment
• expressive lang impairment
• receptive lang impairment
• Greatest association with poor academics
• receptive language impairment
• expressive lang impairment
• speech impairment
• Greatest association with social problems
• receptive impairment
• expressive impairment
• speech impairment
• kids whose communcation impairment that has the biggest impact on social/behavior function and academics are the least likely to get treatment
• Communication problems are masked by other things, like comprehensions

• struggle to access the content of the curriculum and interact with peers
• distort concepts learned in school because they have holes in what they learn and how they learn
• don't build cohesive pyramind of knowledge
• distorted concepts

• Kids with SLI have problems with:
• emotional regulation
• conflict regulation
• social adaptation
• conversational access/termination

• school requires higer level learning skills
• metalinguistic abilities
• word retrival
• discourse skills
• there are changes in academic expectations across grade lveles
• written language demands
• code switch for subjects and specific teachers

• ADHD: 30 to 60% also have language impairment but labeled ADHD so that is the only thing they are treated for
• LD: 50 to 90% co-morbility with LD and language impairment

• 50% of the children with LI (SLI and NSLI) could be considered to have a reading disability in 2nd and 4th grade
• about 6 times more then were found in ND kids
• Language impairment in kindergarten is a high risk for reading disability in 2nd and 4th grade
• 65% of children with NSLI had reading disability in 2nd and 4th grade
• 40% of children with SLI had reading disability in 2nd and 4th grade

• language impaired kids in kindergarten who improved their spoken language by 2nd and 4th grade had better reading outcomes
• children's literacy knowledge and experience in kindergarten is a predictor of their intial reading achievement in 2nd grade and of subsequent reading outcomes
• if take wait and see model kids will be destined to have problems

1. Develop a small sight vocab
2. Learn how to sound out words
• link site word to auditory vocab they already know
• auditory word in head and what is being seen on paper
3. Use sounding out to build a bigger site vocab
4. Give up sounding out and become a fast fluent reader
• sounding out makes reading slow, fail at irregular words, and can't use cognitive resources to grasp reading content

1. phonemic awareness
2. phonics
3. fluency
4. vocab instuction
5. comprehension

• learning content requires access to literacy skills
• use world knowledge to access the content and use content to build on world knowledge

• reading and test measurement
• low 0L and high 2000L
• how difficult a passage is to comprehend based on the frquency of the words in the passage and sentence length
• the aim is for the student's lexicle score to match the passge
• proper reading level, 75%

• 75% comprehension rate is called the "targeted" reading
• it is the point at which the reader will comprehend enough to understand but will also face some reading challenge

• federal law that leads to state regulation
• IEP: must be educational relevant for the kids; help the kid in handling the educational setting
• you need to know the natural progression of language impairment (outcomes)
• think about what is going to happen to this kid in future grades, make predicitons 
• observation of the child outside a formal assessment situation is essential
• If IEP changes you need flexibility to shift the services delivery models without having to do another IEP

• SOLs= standards of learning
• what kids need to achieve in different grade levels
• RTI = response to intervention
• not a special ed context

• Direct (with the child)
• individual pull out
• group pull out
• in classroom: integrated, least restrictive envio
• teach communcation course 
• Indirect (with another person)
• parent training
• team teach with the teachers
• consult with teacher to explain things

• students with literacy and language issues struggle with:
• accessing the academic curriculum
• developing positive interactions with peers
• problems emerge early and continue
• underpin everything that is going to happen to them in middle and high school

1. start out poo language user in elementary school
2. SLI kids
3. NSLI kids
4. kids with dvlp disabilities

• different teachers and each teacher is idiosyncratic
• different tecturing styles
• kids need to be able to adapt their language

• high quality evidence based education for all students
• evidence based instruction
• blurring the lines betwen special ed and general ed

1. Primary instruction

• implemented by classroom teacher
• screened for how they are learning
• consultation with other professionals like SLP
• language instruction needs to be matching the child's language abilities

2. Secondary Instruction

• address specific needs
• interventions supplement general instruction
• delivered in small groups (either in classroom or out of classroom)
• delivered by any relevant professional
• IEPs not required

3. tertiary instruction

• intensive basis
• targeted for specific academic needs
• may be within general edu or special ed
• may require IEP
• sometimes 4th tier exsists which is special ed intervention

• SLPs offer language expertise
• SLP work with general ed teachers
• help kids to learn metalinguistic startegies and foundation language skills necessary to access curriculum
• all of this goes with ASHAs roles and responsibilities
• Possibly change from a caseload model to a workload model

• Preschool: wait and watch? depends how heavy risk bag is
• Kindergarten: depends on risk bag
• 1st grade
• if wait kids may have social issues
• a lot of phonological awareness and literacy foundation skills take place now
• At signs of reading failure
• at any point where the kid is not keeping up with reading instruction you need to intervene
• In middle and high school
• if struggling previously will need to get treatment because material just continues to get harder

• Dismissal Process: tendency to dismiss at end of elementary school
• tests may not be sensative to language issues in middle and high school
• Limited Research on Adolescent language
• not a lot of professional awareness about the problem
• few assessments and intervention tools 
• insufficent info on language dvlp in adolescents
• Lack of professional awareness
• failure to recognize the neg effects of a language impairment on academics and social aspects
• Lack of professional preparation
• SLP may feel unprepared for their role of helping adolescents with language
• Early Intervention emphasis
• focus so much on early intervention that it takes away from attention on adolescents
• Levels of Services in Secondary schools
• less SLPs employed in secondary schools
• lack of info on effectiveness of services in secondary schools
• Misidentification/misdiagnosis
• diagnoised with learning disability when may be language impairment
• problems attributed to other things then language impairment

• wobbly and imcomplete knowledge
• problems with executive function and meta-abilities
• teachers trying to teach kids but their past knowledge is incomplete
• horrible metalinguistic and metacognitive skills
• need to learn strategy of paraphrasing
• don't understand mult ways of saying something

• can't use language to plan out their activities
• horrible at analogies
• info processing limitations
• especially with auditory mode
• transient auditory stimuli
• Respond impulsively: guess
• spend time guessing and learn that adult will help them if they are wrong
• educational system trains kids to guess because will get yelled at if don't respond
• Learned helplessness
• Dependent learning: fail to activate know strategies

• Dependent clause: good language users will increase the use and length of dependent clauses especially those embedded in the beginning of sentences
• embedding, left branching
• Adverbial and Noun clause gap between high and low learning is the same in 12th grade as it was in 1st
• Adjective clauses
• good language users will use a significant more adjective clauses in 12th grade then poor language uses
• poor language users will use more adverbial clauses

• dont outgrow verb morphology problems
• compensating with past tense marking on verbs by using progressive markings
• say "was washing" instead of "washed"
• how many mazes and fillers occur when trying to talk
• narratives bring out mazes that you miss in normal convo

• gain literacy and access to the content
• use the school curriculim: teach client strategies to decode
• team collaboration
• advocacy
• involve the adolesent
• explain the problem and promote self understanding
• typically kids who have services while young didnt even know why they were being seen
• Multi-modality
• teach metalinguistics
• early adolescents focus on academic
• middle and later also focus on social and vocational

• more does matter
• distributed trials are better
• seens for smaller periods of time more time per week
• 20 min 3 times a week
• mass trials: 1 hour once a week