In Relation To Autism: Vocabulary

A lot of terms are commonly heard in relation to autism, such as: classic autism, infantile autism, Pervasive Developmental Disorder (PDD), Atypical PDD, Autistic like, PDD-NOS, Asperger’s Syndrome and high functioning Autistic.

What Is It Exactly?

Basically, Autism is a neurological disorder. It is classified to be a Pervasive Developmental Disorder. The main characteristic of Autism is that it affects three major areas in relation to speech and language. This triad is the impairment of the child’s: social interaction, communication and imaginative play.

Pervasive Developmental Disorder is actually an umbrella term for Autistic Spectrum Disorders. With the use of the term ‘pervasive’, it is emphasized that the disability’s range of deficits is beyond psychological development. On the other hand, the term ‘developmental’ puts emphasis that the occurrence of the condition is during the child’s development rather than later in life.

Autism is actually only one condition under this umbrella. Other conditions include Rett’s Disorder, which is a neurodevelopmental disorder that begins to show its symptoms during early childhood or infancy.

Another is Childhood Disintegrative Disorder; it somewhat resembles Autism but the difference is the first two to four years of the child’s life is rather normal, then the symptoms start to show.

Asperger’s syndrome is also in this umbrella. It is sometimes called high functioning autism. Lastly, PDD-NOS or Pervasive Developmental Disordere-Not Otherwise Specified is also related to Autism. These are children that present symptoms similar to but don’t quite match the other conditions.

What Causes Autism?

Even though a lot of research has been done, there is no identified single factor that causes Autism. Several factors are said to play a part in the occurrence of Autism. One of these is brain disorder. Recent studies show that there is a difference in the brains of people with Autism. Their cerebellum seems to be smaller than normal, and their limbic system is impaired.

Chemical imbalances are also said to play a part here. It was found that in some cases, symptoms came from food allergies, chemical deficiencies, hormonal imbalances or elevated brain chemical levels.

Heredity is also an important factor. A lot of genetic disorders have Autism as a symptom. An example would be the fragile-X syndrome. Other factors include pre-, peri-, post-natal trauma, brain damage complications and MMR immunization.

Whatever the cause may be, the child with Autism should be given the same structured training in able to stimulate his learning, language and social skills.

Diagnosis

For a child to be diagnosed of having Autism, he should first qualify for the Diagnostic Criteria for Autistic Disorders according to the DSM-IV.

Treatment: Therapy And Others

Due to the triad of Autism effects on the child, speech therapy becomes a vital part of Autism management. However, other members of the team are also needed such as pediatrician, pediatric neurologist, child psychiatrist, psychologist, occupational therapist, behavior therapist, and educators like schoolteachers or Special Education teachers.

Role Of Speech Therapist In Autism Rehabilitation

The Speech Therapist assesses hearing. He also evaluates whether the speech and language difficulties of the child is really due to Autism or another disorder. This can be taken from analyzing the child’s expressive language, receptive language, oral-motor functions, voice quality, articulation and fluency, auditory processing and pragmatic skills.

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Benefits Of Obtaining Both Reading and Conversation Sample

It is more beneficial to obtain both reading and conversation sample from school children and adults because this would give more reliability and credibility to the samples taken.

Since stuttering varies in different situations, a reading and conversation sample would allow the clinician to see the behaviors of the person in two different tasks. A conversational speech sample is likely to have more variability, while a reading passage would likely have less variability.

Information To Assess Motivation

Through interview, a therapist can learn a lot from his client. In fact, insight about the client’s motivation could be seen by asking the following questions like “What do you believe caused you to stutter?”, “Has you stuttering changed or caused you more problems recently?, “Why did you come in for help at the present time?”, ” Are there times or situations when you stutter more? Less? What are they?”.

Benefits Of Continuing Evaluation

No individual could be understood in an hour or two; that’s why continuing of evaluation is recommended. The clinician might overlook an important element at times and some times a vital clue will not be present in the samples of behavior taken from the limited time of the evaluation period.

Note The Difference When Assessing Feelings and Attitudes

Assessing a school-age child’s feelings and attitudes would require the clinician to establish rapport and to get to know the child much better after some time, because the clinician’s judgment is also a fair measurement in the case of school-age children.

Talking to the child and observing his behaviors would be necessary. When the clinician has known the child much better, he could administer the A-19 Scale to the child. Other methods could also be used such as “Worry Ladder” and “Hands Down” that could be found in the workbook, The School-Age Child Who Stutters: Working Effectively with Attitudes and Emotions.

For adults and adolescents assessment of feelings and attitudes are usually done by administering tools such as, the Modified Erickson Scale of Communication Attitudes, the Stutterer’s Self-Rating of Reactions to Speech Situations, the Perceptions of Stuttering Inventory and the Locus of Control of Behavior Scale.

Remember The Role Of The IEP Team

An Individualized Education Program (IEP) team is appointed to a child to be the ones to consider reports by the clinician and other information. They decide if the child meets the state’s eligibility standards and if the child’s stuttering has a negative effect on his education.

If a child is eligible for services measurable, the IEP team sets goals and short-term objectives for the child. They also provide services needed by the child for improvement in the educational setting.

Goals Of Trial Therapy

Trial therapy for a school-age child is done to understand what approach might work and what might be difficult for him. This could increase the child’s motivation and positive outlook for the treatment. In the case of adults and adolescents, trial therapy is done for 3 main reasons.

First, is to get an idea of how a client would respond to different therapy approaches. Second, is to make a differential diagnosis between developmental, neurological or psychological stuttering. Third, it gives a preview to the client of what to expect during therapy sessions, in effect it would give them motivation to go on their treatment.

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Types Of Sound Source

There are mainly three types of sound source a patient can choose from. These are: external man-made prosthesis or artificial larynx; sphincter like junction of the pharynx and esophagus or esophageal speech; and lastly, surgically implanted device or transesophageal puncture and silicon prosthesis.

Artificial Larynx

The principle of artificial larynx is to have an external mechanical sound source that is substituted for the larynx. Anatomic structures for articulation and resonance are most of the time unaltered.

There are two general types of electrolarynges that are available: neck type and intra oral type. The neck type is placed flush to the skin on the side of the neck, under the chin, or on the cheek. Sound is conducted via the oropharynx and is articulated normally.

The intraoral type is used for patients that can’t conduct sound through skin adequately. A small tube is placed toward the posterior oral cavity, and the produced sound is then articulated. The tube has little effect on articulatory accuracy if the patient is taught properly and learns to use it well.

The advantage of artificial larynx is that voice is restored after surgery immediately and the maintenance of the hardware is minimal. The disadvantage however, is that the quality of sound may seem mechanical.

Esophageal Speech

The principle behind esophageal speech is that air is of greater pressure in one chamber (oral cavity) will flow to a chamber containing less pressure (esophagus), if these chambers are connected.

Goals of esophageal speech include: to be able to phonate upon demand, use a rapid method of air intake, short latency between air intake and phonation, produce four to nine syllables per air charge, achieve a speaking rate of 85-129 words per minute, and attain good speech intelligibility.

There are mainly three methods of esophageal speech. Injection is a method where air in the mouth/nose is compressed by lingual or labial movement and is injected into the esophagus. Swallowing method uses air that enters during oral opening when swallowing. The air is used to produce voice.

Inhalation method maintains a patent airway between the nose, lips and esophagus. The stoma is used for inhalation. Air enters the esophagus when the pharyngo-esophageal muscle is relaxed during inhalation.

The advantage of this kind of speech includes: no external devices, natural sounding speech, and the possibility of pitch and loudness control. Disadvantages on the other hand are: there is reduced length of utterance, is hard to learn and requires good articulation.

Transesophageal Speech

This is another approach to voice restoration. It requires a surgical/prosthesis procedure that makes use of a man-made device inserted into a surgically created midline transesophageal fistula.

Air is conducted from the trachea to the esophagus through the prosthesis to excite the pharyngo-esophageal segment for voice production.

Advantages include: rapid restoration, natural sound, normal utterance length, hands-free, minimal maintenance and intelligible tonal language. Disadvantages are: the need for surgery, puncture stenosis, candida growth, aspiration of foreign objects, and troubleshooting.

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Flexible Rate

Flexible rate is slowing down the production of a word, especially the first syllable. This technique is thought to allow more time for language planning and motor execution. In here, only those syllables on which stuttering is expected are slowed, not the surrounding speech.

Flexible rate is taught by having the clinician model production of words in which the first syllable and the transition to the second syllable are said in a way that slows all of the sounds equally. Vowels, fricatives, nasals, sibilants, and glides are lengthened, and plosives and affricates are produced to sound more like fricatives, without stopping the sound or airflow.

After the clinician’s model, the child produces the word with flexible rate, and successive approximations of the target are reinforced.

Easy Onsets

Easy onsets refer to an easy or gentle onset of voicing. Teaching easy onsets is like teaching flexible rate. The clinician models the target behavior by the use of a lot of different sounds and then he makes the child imitate the models. After the child tries to imitate, the therapist should reinforce the child’s successive approximations.

Some children, particular younger ones, may be helped to get the concept by performing an action, such as bringing their hands together slowly, as they produce an easy onset.

Light Contacts

Producing consonants with light contacts prevents the stoppage of airlow and/ or voicing that can trigger stuttering. Light contacts are taught by modeling a style of producing consonants with relaxed articulators and continuous flow of air or voice, depending on the consonant.

Plosives and affricates should be slightly distorted so that they sound like fricatives but are still intelligible. Modeling a variety of words with initial consonants and reinforcing the child’s successive approximations of the target accomplish teaching a child to use light contacts. The clinician can use a variety of games to make the concept of light contact more interesting.

Proprioception

Proprioception refers to sensory feedback from mechanoreceptors in muscles of the lips, jaw, and tongue. The effectiveness of teaching proprioception may be that it promotes conscious attention to sensory information from the articulators, perhaps bypassing inefficient automatic sensory monitoring systems and thereby normalizing sensory-motor control.

Children can be taught to use proprioception by having a child first hold a raisin in his mouth and report on its taste, shape, size, and other attributes. Children can also learn proprioception by picking a word from a list and then closing their eyes and silently moving their articulators for this word and being rewarded when the clinician guesses the word.

Children can be coached to feel the movements of their lips, tongue, and jaw as they say a word. Proprioceptive awareness can also be enhanced by using masking noise or delayed auditory feedback to interfere with self-hearing. In this, the clinician must look for slightly exaggerated, slow movements to verify that a child is trying to feel the movement of his articulators.

Scaffolding

It is useful with some children to “scaffold” their use of superfluency by letting the listener/s know that we are working on our speech and sometimes by coaching the child in that fluency-friendly environment. This can be exhibited for example telling a stranger in a mall that the child and the clinician are working on their speech and would like to ask him some questions, another example would be when the child makes telephone calls.

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Broca’s Aphasia

Broca’s Aphasia is also known as motor aphasia. You can obtain this, if you damage your brain’s frontal lobe, particularly at the frontal part of the lobe at your language-dominant side.

If Broca’s Aphasia is your case, then you may have complete mutism or inability to speak. In some cases you may be able to utter single-word statements or a full sentence, but constructing such would entail you great effort.

You may also omit small words, like conjunctions (but, and, or) and articles (a, an, the). Due to these omissions, you may produce a “telegraph” quality of speech. Usually, your hearing comprehension is not affected, so you are able to comprehend conversation, other’s speech and follow commands.

Difficulty in writing is also evident, since you may experience weakness on your body’s right side. You also get an impaired reading ability along with difficulty in finding the right words when speaking. People with this type of aphasia may be depressed and frustrated, because of their awareness of their difficulties.

Wernicke’s Aphasia

When your brain’s language-dominant area’s temporal lobe is damaged, you get Wernicke’s aphasia. If you have this kind of aphasia, you may speak in uninterrupted, long, sentences; the catch is, the words you use are usually unnecessary or at times made-up.

You can also have difficulty understanding other’s speech, to the extent of having the inability to comprehend spoken language in any way. You also have a diminished reading ability. Your writing ability may be retained, but what you write may seem to be abnormal.

In contrast with Broca’s Aphasia, Wernicke’s Aphasia doesn’t manifest physical symptoms like right-sided weakness. Also, with this kind of Aphasia, you are not aware of your language errors.

Global Aphasia

This kind of aphasia is obtained when you have widespread damage on language areas of your brain’s left hemisphere. Consequently, all your fundamental language functions are affected. However, some areas can be severely affected than other areas of your brain.

It may be the case that you have difficulty speaking but you are able to write well. You may also experience weakness and numbness on the right side of your body.

Conduction Aphasia

This kind is also known as Associative Aphasia. It is a somewhat uncommon kind, in which you have the inability to repeat sentences, phrases and words. Your speech fluency is reasonably unbroken. There are times that you may correct yourself and skip or repeat some words.

Even though you are capable of understanding spoken language, you can still have difficulty finding the right words to use to describe an object or a person. This condition’s effect on your reading and writing skills can also vary. Just like other types of aphasia, you can have sensory loss or right-sided weakness.

Nominal Or Anomic Aphasia

This kind of aphasia would primarily influence your ability to obtain the right name for an object or person. Consequently, rather than naming an object, you may resort to describing it. Your reading skills, writing ability, hearing comprehension, and repetition are not damaged, except by this inability to get the right name.

Your may have fluent speech, except for the moments that you pause to recall the correct name. Physical symptoms like sensory loss and one-sided body weakness, may or may not be present.

Transcortical Aphasia

This kind is caused by the damage of language areas on your left hemisphere just outside your primary language areas. There are three types of this aphasia: transcortical sensory, transcortical motor, and mixed transcortical. All of these types are differentiated from others by your ability to repeat phrases, words, or sentences.

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Autistic Disorder Criteria: Social Interaction

First off, a child should have impairment in social interaction. This could be manifested by at least two of the following behaviors. First is a marked impairment with the use of different non-verbal behaviors like facial expression, eye-to-eye gaze, and body posture.

Second is the child’s failure to develop peer relationship that is appropriate for his developmental level. In this case the child may seem to have difficulty gaining friends, or even just relating to other children within his age.

The child may also have the lack of spontaneity to share his emotions and thoughts. He may not share enjoyment, achievements, or interests to other people. In this case, the child doesn’t usually bring or point to objects that interest him.

The lack of emotional reciprocity is also possible. No matter how hard you try to connect or show your emotions and feelings to the child, he wouldn’t care less.

Autistic Disorder Criteria: Communication

The child also has communication impairment. Having at least one of the following conditions manifests this.

First is having a delay, or even total lack of spoken language development or expressive language. In this case, the child doesn’t even try to use of compensatory strategies to communicate or other means of communication like gestures.

For children that have adequate speech, the communication impairment is manifested by not being able to initiate or sustain a conversation with other people.

The child can also have stereotyped and repetitive use of language. This phenomenon is actually called idiosyncratic language, where what the child keeps on saying seems to me meaningless. He may keep on saying the word “blue” for countless of times, even for the whole duration of the day.

He can also lack the ability to have varied, spontaneous make-believe play or social imitative play that is appropriate for his developmental level. Play is one of the notable things that differentiate a child with Autism with normal children. For an Autistic child, play does not exist. The main concern is that play is an important factor for language development since it is a prerequisite or co-requisite of inner language.

Autistic Disorder Criteria: Repetitive And Stereotype Behavior Patterns

An Autistic child also manifests repetitive behavior. This criteria is judged by having at least one of the following conditions.

The child may have an encompassing preoccupation with one or more restricted and stereotyped patterns of interests that may seem abnormal in respect to focus and intensity. For example the child can sit and look at the ceiling fan for the whole day, and doesn’t care what is happening in his environment, all that matters is the fan.

The child also has fetish with routines and rituals. If he passes by a certain way to school, it has to be the same way. If you use the main stairs going to his classroom, then taking a different route like the elevator would definitely agitate him, make him angry and have tantrums.

The child may also have repetitive behaviors or mannerisms. Hand flapping, finger twisting, and complex body movements are examples of these.

Lastly, he can also be preoccupied with object parts like buttons, screws and other small details.

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Developing Auditory Awareness

Auditory awareness is the ability to be conscious of the fact that sound is present. During this period, the child is to learn to wear appropriate amplification. Therapy involves playing with toys that make sounds and listening to music.

Developing Auditory Attention or Listening

Auditory attention is the ability to give some real notice or interest to the sound that is heard.

The clinician focuses the child’s attention to the sound by saying two or three times: “Listen, I hear something. What is that?” The clinician pats his ears, but does not show the source of the sound until the child is listening. The clinician rewards the child’s attention by showing the source of the sound.

Developing Auditory Localization and Distance Hearing

Auditory localization is the ability to recognize the direction from which the sound is coming from. Distance hearing, on the other hand, is the ability to hear the sound even from afar.

The therapist shows the child how to respond whenever he hears a sound. Some of the activities are opening the door when someone knocks, dancing to music, clapping to music, building blocks when a sound is heard, marching to a drum and picking the phone up when it rings.

Developing Vocal Play

Vocal play is the ability to use the speech structures to produce various sounds that are not necessarily meaningful but are sound productions nonetheless. This stage requires making lots of sounds when playing with toys, especially animal and vehicle noises: growl for the teddy bear, meow for the cat, or click tongue for the horse.

Developing Auditory Discrimination

Auditory discrimination is the ability to identify one sound from another. Activities include reviewing vowel sounds and varying pitch, loudness and rhythm: oo— vs. oo-oo. For example, the therapist can build a train with blocks and say oo-oo or oo—, as the train is being pushed on the table. For older infants, they can look at books, making similar sounds for the pictures.

Developing Auditory Discrimination and Short-Term Memory

Activities include teaching discrimination of noise makers in audition and incorporation of phonemes into words in use.

Developing Auditory Processing

Auditory processing is the ability to associate sounds with memories of past events. Activities include naming of abstract ideas like sadness and joy. The therapist also starts to teach the child to call the names of the people that he has constant contact with.

Developing Auditory Processing of Patterns and Auditory Memory Span

Activities for the child’s audition include testing the child’s recognition of words and testing of auditory memory span. Auditory memory span is the ability of the child to remember in sequence the things that he has heard. An example would be the sequence of the instructions that the therapist gave to him.

Developing Auditory Figure-Ground Discrimination

Auditory figure-ground discrimination is the ability to choose among the sounds that are present in the environment and to focus on that one sound alone without being distracted by the rest of the surrounding sounds.

Activities for the child’s auditory skills include clapping or dancing to different rhythms, learning to count from one to ten, saying the alphabets, days of the week, nursery rhymes, holiday songs, prayers, his own address or telephone number, and also remembering two or three directions at a time.

Auditory Tracking

Auditory tracking is the act of listening closely to a material to be able to follow what is being stated in the said material. Auditory tracking using a tape recorder is included in the activities. Also included are reading aloud, practicing using the telephone, listening for information and using internal repetition.

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Management For Normal Developmental Disfluency

Developmental disfluency occurs during the critical period of speech and language development. A child is considered to have this condition if 5% or less of his overall speech-sample are repetitions and 1% or less are prolongations.

Etiologies of this condition could be: excitement while speaking, demands of Language Acquisition, Speech-Motor control is lagging, environmental factors like stress in the family (e.g. separation of parents) and the situations they are in, and daily pressures of competition.

Concerned parents still make their children with this kind of disfluency undergo therapy even if this could still possibly decline. These children are taught how to: decrease the rate of their speech, relieve other pressures that the therapist and parents mutually agree to change, and simplify their language.

Management For Stuttering

The onset of stuttering may occur between ages 1

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A Team Approach

Firs off, the management of laryngeal cancer requires a team approach. The patient gets to see a surgeon, radiologist, audiologist, speech-language pathologist, oncologist, physical therapist, maxillofacial prosthodontist, and a psychiatrist. All of these health care professionals work together to work on the management of the patient.

What Is Laryngectomy?

Laryngectomy is the total removal of the larynx. It is also the partition of the airway from the nose, mouth, and esophagus. A person that undergoes this kind of operation would have to breathe via an opening on the neck, called stoma.

Laryngectomy is done when a person has laryngeal cancer. It may be considered to be a traditional way of managing laryngeal cancer, since a lot of laryngeal cancer cases nowadays are treated with the use of chemotherapy, radiation, or other laser procedures. In severe cases that these don’t work, that is the only time laryngectomy is opted for.

Other than the larynx, other structures are also removed. These other structures includes Sternocleidomastoid, Omohyoid muscle, Internal Jugular vein, Spinal Accessory vein (CNXI), Submaxillary salivary gland. In most severe cases, the external carotid artery, strap muscles of the neck, Vagus nerve (CN X), Hypoglossal nerve (CN XII) and the lingual branch of the Trigeminal nerve (CN V) are also removed.

How Common Is Laryngectomy?

It is estimated by the American Cancer Society, in 2003, that around nine thousand five hundred people in the US were diagnosed of laryngeal cancer. This condition occurs about 4.4 times more predominantly with men than with women. Though, similar with lung cancer, laryngeal cancer is becoming increasingly frequent with women.

Tobacco smoking is so far the supreme risk factor in having laryngeal cancer. Other factors include radiation exposure, asbestos exposure, alcohol abuse, and genetic factors. In United Kingdom, laryngeal cancer is rather rare, since it only affects less than 3,000 people per year.

Possible Problems

After total Laryngectomy, possible problems may occur. These include having a scar tissue at the tongue base, narrowing of the esophagus, partial tongue base resection, dysphagia, Xerostomia, mouth sores and changes in smell, taste, appetite and weight.

Effects And Impacts Of Laryngectomy

Laryngectomy has two mechanistic effects. One, it separates respiration from speech. Two, it keeps the pharyngoesophageal region intact.

There are also impacts that Laryngectomy brings about. The main impact would be the loss of voice for communication. You may also lose the ability to express emotions such as laughing. You also get physical problems with regard to tasting and feeding.

Laryngectomy is frequently successful in treating early-staged cancers. Still, undergoing through the procedure would require major lifestyle change. There is also a risk of having severe psychological stress due to unsuccessful adaptations.

After The Procedure: Voice Replacement And Care

After the patient’s larynx is removed, voice prosthetics is used. This serves as a replacement for the lost larynx, so that the person will still be able to communicate and speak. In this case, Laryngectomees would have to learn new methods of speaking.

They should also be constantly concerned in taking care and cleaning their stoma. Severe problems can arise if foreign materials and water enter their lungs via their unprotected stoma.

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Differentiating Speech And Language Therapy

The truth of the matter is, that speech therapy and language therapy differ in some key areas. First off, they differ on the problems that they are targeting. The techniques and activities used during therapy are also different. Although there are times that these activities are done simultaneously, to target two problems at a time.

Speech Therapy

Speech therapy is done to treat speech problems. Such speech problems deal with how or the manner a person speaks. These speech problems are categorized into three general kinds. First, is voice or resonation disorders. Second, is articulation disorders. And, lastly, fluency disorders.

Voice disorders mainly deals on problems with the voice box or the larynx itself. These may be due to physiological malfunction, anatomical differences, fatigue, or neurological problems. Some voice disorders present problems in pitch, volume, and tone. The presence of breathy, raspy, nasal and weak voice is viable too.

Articulation disorders, on the other hand, deal with the manner a person speaks. The problem is rooted from the articulators themselves. Articulators are composed of the tongue, teeth, hard palate, soft palate, jaw, and cheeks. Articulation disorders may be due to weakness or physiological malfunction in any of the articulators, which results to distorted or incomprehensible speech.

Fluency disorders would deal on problems regarding the fluency of the person. It may be the case that he talks too fast or too slow. Stuttering and Cluttering are two of the major fluency problems that speech therapists deal with.

Speech therapy activities would likely include different exercises to practice speaking. Since most of the time, weak muscles are present; the therapy proper would usually include activities that can help strengthen these muscles. Different compensatory strategies are also taught, so that the patient can compensate for lost speaking skills.

Language Therapy

Language therapy mainly deals with problems regarding your inner language, receptive language and expressive language. Cognition skills can be the main cause of language problems. Unlike speech disorders, that manifest physical differences, most language disorders are due to problems the brain’s language processing.

Receptive language problems mainly deals on difficulties understanding received language, like what other people are telling you and comprehending written data. Expressive language problems on the other hand are difficulties on expressing oneself. You may have a hard time knowing which words to use verbally or even through writing.

Language based problems are usually treated through mental exercises. Workbooks are often used to practice and develop language skills. For very young children, play therapy is used to develop inner language, so that the therapist could later on target improving receptive and expressive language, respectively.

In some cases, speech and language problems are both present. This is especially true for individuals that had traumatic brain injuries or accidents that had an effect on the brain. They may manifest physiological problems due to damaged nerves that result to articulation or voice problems.

The can also have language problems like aphasia, especially if their brain was hit on its language areas.

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