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Deep Learning Technology: Sebastian Arnold, Betty van Aken, Paul Grundmann, Felix A. Gers and Alexander Löser. Learning Contextualized Document Representations for Healthcare Answer Retrieval. The Web Conference 2020 (WWW'20)
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Dyslexic children require special instruction for word analysis and spelling from an early age. While there are fonts that may help people with dyslexia better understand writing, this might simply be due to the added spacing between words. The prognosis, generally speaking, is positive for individuals who are identified in childhood and receive support from friends and family.
In 1983, Rapin and Allen suggested the term "semantic pragmatic disorder" to describe the communicative behavior of children who presented traits such as pathological talkativeness, deficient access to vocabulary and discourse comprehension, atypical choice of terms and inappropriate conversational skills. They referred to a group of children who presented with mild autistic features and specific semantic pragmatic language problems. More recently, the term "pragmatic language impairment" (PLI) has been proposed.
Rapin and Allen's definition has been expanded and refined by therapists who include communication disorders that involve difficulty in understanding the meaning of words, grammar, syntax, prosody, eye gaze, body language, gestures, or social context. While autistic children exhibit pragmatic language impairment, this type of communication disorder can also be found in individuals with other types of disorders including auditory processing disorders, neuropathies, encephalopathies and certain genetic disorders.
Treatment is usually carried out by speech and language therapists/pathologists, who use a wide range of techniques to stimulate language learning. In the past, there was a vogue for drilling children in grammatical exercises, using imitation and elicitation, but such methods fell into disuse when it became apparent that there was little generalisation to everyday situations. Contemporary approaches to enhancing development of language structure, for younger children at least, are more likely to adopt 'milieu' methods, in which the intervention is interwoven into natural episodes of communication, and the therapist builds on the child's utterances, rather than dictating what will be talked about. Interventions for older children, may be more explicit, telling the children what areas are being targeted and giving explanations regarding the rules and structures they are learning, often with visual supports.
In addition, there has been a move away from a focus solely on grammar and phonology toward interventions that develop children's social use of language, often working in small groups that may include typically developing as well as language-impaired peers.
Another way in contemporary remediation differ from the past is that parents are more likely to be directly involved, but this approach is largely used with preschool children, rather than those whose problems persist into school age.,
For school-aged children, teachers are increasingly involved in intervention, either in collaboration with speech and language therapists/pathologists, or as the main agents of delivery of the intervention. Evidence for the benefits of a collaborative approach is emerging, but the benefits of asking education staff to be the main deliverers of SLT intervention (the “consultative” approach) are unclear. When SLT intervention is delivered indirectly by trained SLT assistants, however, there are indications that this can be effective.
A radically different approach has been developed by Tallal and colleagues, who devised a computer-based intervention, FastForWord, that involves prolonged and intensive training on specific components of language and auditory processing. The theory underlying FastForword maintains that language difficulties are caused by a failure to make fine-grained auditory discriminations in the temporal dimension, and the computerised training materials are designed to sharpen perceptual acuity. However, a systematic review of clinical trials assessing FastForWord reported no significant gains relative to a control group.
In this field, Randomized controlled trial methodology has not been widely used, and this makes it difficult to assess clinical efficacy with confidence. Children's language will tend to improve over time, and without controlled studies, it can be hard to know how much of observed change is down to a specific treatment. There is, however, increasing evidence that direct 1:1 intervention with an SLT/P can be effective for improving vocabulary and expressive language. There have been few studies of interventions that target receptive language, though some positive outcomes have been reported.,
Through the use of compensation strategies, therapy and educational support, dyslexic individuals can learn to read and write. There are techniques and technical aids which help to manage or conceal symptoms of the disorder. Removing stress and anxiety alone can sometimes improve written comprehension. For dyslexia intervention with alphabet-writing systems, the fundamental aim is to increase a child's awareness of correspondences between graphemes (letters) and phonemes (sounds), and to relate these to reading and spelling by teaching how sounds blend into words. It has been found that reinforced collateral training focused on reading and spelling yields longer-lasting gains than oral phonological training alone. Early intervention that is done for children at a young age can be successful in reducing reading failure.
There is some evidence that the use of specially-tailored fonts may help with dyslexia. These fonts, which include Dyslexie, OpenDyslexic, and Lexia Readable, were created based on the idea that many of the letters of the Latin alphabet are visually similar and may, therefore, confuse people with dyslexia. Dyslexie and OpenDyslexic both put emphasis on making each letter more distinctive in order to be more easily identified. The benefits, however, might simply be due to the added spacing between words.
There have been many studies conducted regarding intervention in dyslexia. Among these studies one meta-analysis found that there was functional activation as a result.
There is no evidence demonstrating that the use of music education is effective in improving dyslexic adolescents' reading skills.
Children who demonstrate deficiencies early in their speech and language development are at risk for continued speech and language issues throughout later childhood. Similarly, even if these speech and language problems have been resolved, children with early language delay are more at risk for difficulties in phonological awareness, reading, and writing throughout their lives. Children with mixed receptive-expressive language disorder are often likely to have long-term implications for language development, literacy, behavior, social development, and even mental health problems. If suspected of having a mixed receptive-expressive language disorder, treatment is available from a speech therapist or pathologist. Most treatments are short term, and rely upon accommodations made within the environment, in order to minimize interfering with work or school. Programs that involve intervention planning that link verbal short term memory with visual/non-verbal information may be helpful for these children. In addition, approaches such as parent training for language stimulation and monitoring language through the "watch and see" method are recommended. The watch-and-see technique advises children with mixed receptive-expressive language disorder who come from stable, middle-class homes without any other behavioral, medical, or hearing problems should be vigilantly monitored rather than receive intervention. It is often the case that children do not meet the eligibility criteria established through a comprehensive oral language evaluation; and as a result, are not best suited for early intervention programs and require a different approach besides the "one size fits all" model.
Pragmatic language impairment (PLI), or social (pragmatic) communication disorder (SCD), is an impairment in understanding pragmatic aspects of language. This type of impairment was previously called semantic-pragmatic disorder (SPD). People with these impairments have special challenges with the semantic aspect of language (the meaning of what is being said) and the pragmatics of language (using language appropriately in social situations). It is assumed that those with autism have difficulty with "the meaning of what is being said" due to different ways of responding to social situations.
PLI is now a diagnosis in DSM-5, and is called social (pragmatic) communication disorder. Communication problems are also part of the autism spectrum disorders (ASD); however, the latter also show a restricted pattern of behavior, according to behavioral psychology. The diagnosis SCD can only be given if ASD has been ruled out.
In most cases the cause is unknown. However, there are various known causes of speech impediments, such as "hearing loss, neurological disorders, brain injury, intellectual disability, drug abuse, physical impairments such as cleft lip and palate, and vocal abuse or misuse."
There is no cure for the condition. Management is through therapy.
Developmental coordination disorder is a lifelong neurological condition that is more common in males than in females, with a ratio of approximately four males to every female. The exact proportion of people with the disorder is unknown since the disorder can be difficult to detect due to a lack of specific laboratory tests, thus making diagnosis of the condition one of elimination of all other possible causes/diseases. Approximately 5–6% of children are affected by this condition.
Specific language impairment (SLI) is diagnosed when a child has delayed or disordered language development for no apparent reason. Usually the first indication of SLI is that the child is later than usual in starting to speak and subsequently is delayed in putting words together to form sentences. Spoken language may be immature. In many children with SLI, understanding of language, or "receptive" language, is also impaired, though this may not be obvious unless the child is given a formal assessment.
Although difficulties with use and understanding of complex sentences are a common feature of SLI, the diagnostic criteria encompass a wide range of problems, and for some children other aspects of language are problematic (see below). In general, the term SLI is reserved for children whose language difficulties persist into school age, and so it would not be applied to toddlers who are late to start talking, most of whom catch up with their peer group after a late start.
The term developmental language disorder (DLD) was endorsed in a consensus study involving a panel of experts (CATALISE Consortium) in 2017... The study was conducted in response to concerns that a wide range of terminology was used in this area, with the consequence that there was poor communication, lack of public recognition, and in some cases children were denied access to services. Developmental language disorder is a subset of language disorder, which is itself a subset of the broader category of speech, language and communication needs (SLCN).
The terminology for children’s language disorders has been extremely wide-ranging and confusing, with many labels that have overlapping but not necessarily identical meanings. In part this confusion reflected uncertainty about the boundaries of DLD, and the existence of different subtypes. Historically, the terms ‘’developmental dysphasia’’ or ‘’developmental aphasia’’ were used to describe children with the clinical picture of DLD. These terms have, however, largely been abandoned, as they suggest parallels with adult acquired aphasia. This is misleading, as DLD is not caused by brain damage.
Although the term DLD has been used for many years, it has been less common than the term Specific language impairment (SLI), which has been widely adopted, especially in North America. The definition of SLI overlaps with DLD, but was rejected by the CATALISE panel because it was seen as overly restrictive in implying that the child had relatively pure problems with language in the absence of any other impairments. Children with such selective problems are relatively rare, and there is no evidence that they respond differently to intervention, or have different causal factors, from other children with language problems.
UK speech and language therapists widely use the term Speech, Language and Communication Needs (SLCN), but this is far broader than DLD, and includes children with speech and language difficulties arising from a wide range of causes.
The question of whether to refer to children's language problems as ‘disorder’ was a topic of debate among the CATALISE consortium, but the conclusion was that ‘disorder’ conveyed the serious nature and potential consequences of persistent language deficits. It is also parallel with other neurodevelopmental conditions and consistent with diagnostic frameworks such as DSM5 and ICD-11. Where there are milder or more transient difficulties, language difficulties may be a more appropriate term.
Nonverbal autism is a subset of autism where the subject is unable to speak. While most autistic children eventually begin to speak, there is a significant minority who will remain nonverbal.
Interventions include:
- Mastery model:
- Learners work at their own level of mastery.
- Practice
- Gain fundamental skills before moving onto the next level
- Note: this approach is most likely to be used with adult learners or outside the mainstream school system.
- Direct instruction:
- Emphasizes carefully planned lessons for small learning increments
- Scripted lesson plans
- Rapid-paced interaction between teacher and students
- Correcting mistakes immediately
- Achievement-based grouping
- Frequent progress assessments
- Classroom adjustments:
- Special seating assignments
- Alternative or modified assignments
- Modified testing procedures
- Quiet environment
- Special equipment:
- Word processors with spell checkers and dictionaries
- Text-to-speech and speech-to-text programs
- Talking calculators
- Books on tape
- Computer-based activities
- Classroom assistants:
- Note-takers
- Readers
- Proofreaders
- Scribes
- Special education:
- Prescribed hours in a resource room
- Placement in a resource room
- Enrollment in a special school for learning disabled students
- Individual education plan (IEP)
- Educational therapy
Sternberg has argued that early remediation can greatly reduce the number of children meeting diagnostic criteria for learning disabilities. He has also suggested that the focus on learning disabilities and the provision of accommodations in school fails to acknowledge that people have a range of strengths and weaknesses, and places undue emphasis on academic success by insisting that people should receive additional support in this arena but not in music or sports. Other research has pinpointed the use of resource rooms as an important—yet often politicized component of educating students with learning disabilities.
It is estimated that 25 to 50% of children diagnosed with Autism Spectrum Disorder (ASD) never develop spoken language beyond a few words or utterances. Despite the growing field of research on ASD, there is not much information available pertaining to individuals with autism who never develop functional language; that, in fact, individuals with nonverbal autism are considered to be underrepresented in all of autism research. Because of the limited research on nonverbal autism, there are not many validated measurements appropriate for this population. For example, while they may be appropriate for younger children, they lack the validity for grade-school aged children and adolescents and have continued to be a roadblock for nonverbal autism research. Often in autism research, individuals with nonverbal autism are sub-grouped with LFA, categorized by learning at most one word or having minimal verbal language.
Most of the existing body of research in nonverbal autism focuses on early interventions that predict successful language outcomes. Research suggests that most spoken language is inherited before the age of five, and the likelihood of acquiring functional language in the future past this age is minimal, that early language development is crucial to educational achievement, employment, independence during adulthood, and social relationships.
Specific language impairment (SLI) is diagnosed when a child's language does not develop normally and the difficulties cannot be accounted for by generally slow development, physical abnormality of the speech apparatus, autism spectrum disorder, apraxia, acquired brain damage or hearing loss. Twin studies have shown that it is under genetic
influence. Although language impairment can result from a single-gene mutation, this is unusual. More commonly SLI results from the combined influence of multiple genetic variants, each of which is found in the general population, as well as environmental influences.
A communication disorder is any disorder that affects an individual's ability to comprehend, detect, or apply language and speech to engage in discourse effectively with others. The delays and disorders can range from simple sound substitution to the inability to understand or use one's native language.
Mixed receptive-expressive language disorder (DSM-IV 315.32) is a communication disorder in which both the receptive and expressive areas of communication may be affected in any degree, from mild to severe. Children with this disorder have difficulty understanding words and sentences. This impairment is classified by deficiencies in expressive and receptive language development that is not attributed to sensory deficits, nonverbal intellectual deficits, a neurological condition, environmental deprivation or psychiatric impairments. Research illustrates that 2% to 4% of 5 year olds have mixed receptive-expressive language disorder. This distinction is made when children have issues in expressive language skills, the production of language, and when children also have issues in receptive language skills, the understanding of language. Those with mixed receptive-language disorder have a normal left-right anatomical asymmetry of the planum temporale and parietale. This is attributed to a reduced left hemisphere functional specialization for language. Taken from a measure of cerebral blood flow (SPECT) in phonemic discrimination tasks, children with mixed receptive-expressive language disorder do not exhibit the expected predominant left hemisphere activation. Mixed receptive-expressive language disorder is also known as receptive-expressive language impairment (RELI) or receptive language disorder.
Many researchers are investigating the characteristics of apraxia of speech and the most effective treatment methods. Below are a couple of the recent findings:
Sound Production Treatment:
Articulatory-kinematic treatments have the strongest evidence of their use in treating Acquired Apraxia of Speech. These treatments use the facilitation of movement, positioning, timing, and articulators to improve speech production. Sound Production Treatment (SPT) is an articulatory-kinematic treatment that has received more research than many other methods. It combines modeling, repetition, minimal pair contrast, integral stimulation, articulatory placement cueing, and verbal feedback. It was developed to improve the articulation of targeted sounds in the mid-1990s. SPT shows consistent improvement of trained sounds in trained and untrained words. The best results occur with eight to ten exemplars of the targeted sound to promote generalization to untrained exemplars of trained sounds. In addition, maintenance effects are the strongest with 1–2 months post-treatment with sounds that reached high accuracy during treatment. Therefore, the termination of treatment should not be determined by performance criteria, and not by the number of sessions the client completes, in order to have the greatest long-term effects. While there are many parts of SPT that should receive further investigation, it can be expected that it will improve the production of targeted sounds for speakers with apraxia of Speech.
Repeated Practice & Rate/Rhythm Control Treatments:
Julie Wambaugh’s research focuses on clinically applicable treatments for acquired apraxia of speech. She recently published an article examining the effects of repeated practice and rate/rhythm control on sound production accuracy. Wambaugh and colleagues studied the effects of such treatment for 10 individuals with acquired apraxia of speech. The results indicate that repeated practice treatment results in significant improvements in articulation for most clients. In addition, rate/rhythm control helped some clients, but not others. Thus, incorporating repeated practice treatment into therapy would likely help individuals with AOS.
Many of these types of disorders can be treated by speech therapy, but others require medical attention by a doctor in phoniatrics. Other treatments include correction of organic conditions and psychotherapy.
In the United States, school-age children with a speech disorder are often placed in special education programs. Children who struggle to learn to talk often experience persistent communication difficulties in addition to academic struggles. More than 700,000 of the students served in the public schools’ special education programs in the 2000-2001 school year were categorized as having a speech or language impediment. This estimate does not include children who have speech and language impairments secondary to other conditions such as deafness". Many school districts provide the students with speech therapy during school hours, although extended day and summer services may be appropriate under certain circumstances.
Patients will be treated in teams, depending on the type of disorder they have. A team can include SLPs, specialists, family doctors, teachers, and family members.
Deficits in any area of information processing can manifest in a variety of specific learning disabilities. It is possible for an individual to have more than one of these difficulties. This is referred to as comorbidity or co-occurrence of learning disabilities. In the UK, the term "dual diagnosis" is often used to refer to co-occurrence of learning difficulties.
Expressive language disorder is a communication disorder in which there are difficulties with verbal and written expression. It is a specific language impairment characterized by an ability to use expressive spoken language that is markedly below the appropriate level for the mental age, but with a language comprehension that is within normal limits. There can be problems with vocabulary, producing complex sentences, and remembering words, and there may or may not be abnormalities in articulation.
As well as present speech production, very often, someone will have difficulty remembering things. This memory problem is only disturbing for speech; non-verbal or non-linguistically based memory will be unimpaired. An example of a child with expressive language disorder can be seen here.
Expressive language disorder affects work and schooling in many ways. It is usually treated by specific speech therapy, and usually cannot be expected to go away on its own.
Expressive language disorder can be further classified into two groups: developmental expressive language disorder and acquired expressive language disorder. Developmental expressive language disorder currently has no known cause, is first observed when a child is learning to talk, is more common in boys than girls, and is much more common than the acquired form of the disorder. Acquired expressive language disorder is caused by specific damage to the brain by a stroke, traumatic brain injury, or seizures.
Care must be taken to distinguish expressive language disorder from other communication disorders, sensory-motor disturbances, intellectual disability and/or environmental deprivation (see DSM-IV-TR criterion D). These factors affect a person's speech and writing to certain predictable extents, and with certain differences.
Careful diagnosis is also important because "atypical language development can be a secondary characteristic of other physical and developmental problems that may first manifest as language problems".
Disorders and tendencies included and excluded under the category of communication disorders may vary by source. For example, the definitions offered by the American Speech–Language–Hearing Association differ from that of the Diagnostic Statistical Manual 4th edition (DSM-IV).
Gleanson (2001) defines a communication disorder as a speech and language disorder which refers to problems in communication and in related areas such as oral motor function. The delays and disorders can range from simple sound substitution to the inability to understand or use their native language.
In general, communications disorders commonly refer to problems in speech (comprehension and/or expression) that significantly interfere with an individual’s achievement and/or quality of life. Knowing the operational definition of the agency performing an assessment or giving a diagnosis may help.
Persons who speak more than one language or are considered to have an accent in their location of residence do not have speech disorders if they are speaking in a manner consistent with their home environment or a blending of their home and foreign environment.
Loss of language and skills related to social interaction and self-care are serious. The affected children face ongoing disabilities in certain areas and require long term care. Treatment of CDD involves both behavior therapy, environmental therapy and medications.
- Behavior therapy: The main aim of Applied Behavior Analysis (ABA) is to systematically teach the child to relearn language, self-care and social skills. The treatment programs designed in this respect "use a system of rewards to reinforce desirable behaviors and discourage problem behavior." ABA programs may be designed by a board-certified specialist in behavior analysis called a "BCBA" (Board Certified Behavior Analyst), but ABA is also widely used by a number of other health care personnel from different fields like psychologists, speech therapists, physical therapists and occupational therapists with differing levels of expertise. Parents, teachers and caregivers are instructed to use these behavior therapy methods at all times.
- Environmental Therapy: Sensory Enrichment Therapy uses enrichment of the sensory experience to improve symptoms in autism, many of which are common to CDD.
- Medications: There are no medications available to directly treat CDD. Antipsychotic medications are used to treat severe behavior problems like aggressive stance and repetitive behavior patterns. Anticonvulsant medications are used to control seizures.
Treatment of APD typically focuses on three primary areas: changing learning environment, developing higher-order skills to compensate for the disorder, and remediation of the auditory deficit itself. However, there is a lack of well-conducted evaluations of intervention using randomized controlled trial methodology. Most evidence for effectiveness adopts weaker standards of evidence, such as showing that performance improves after training. This does not control for possible influences of practice, maturation, or placebo effects. Recent research has shown that practice with basic auditory processing tasks (i.e. auditory training) may improve performance on auditory processing measures and phonemic awareness measures. Changes after auditory training have also been recorded at the physiological level. Many of these tasks are incorporated into computer-based auditory training programs such as Earobics and Fast ForWord, an adaptive software available at home and in clinics worldwide, but overall, evidence for effectiveness of these computerised interventions in improving language and literacy is not impressive. One small-scale uncontrolled study reported successful outcomes for children with APD using auditory training software.
Treating additional issues related to APD can result in success. For example, treatment for phonological disorders (difficulty in speech) can result in success in terms of both the phonological disorder as well as APD. In one study, speech therapy improved auditory evoked potentials (a measure of brain activity in the auditory portions of the brain).
While there is evidence that language training is effective for improving APD, there is no current research supporting the following APD treatments:
- Auditory Integration Training typically involves a child attending two 30-minute sessions per day for ten days.
- Lindamood-Bell Learning Processes (particularly, the Visualizing and Verbalizing program)
- Physical activities that require frequent crossing of the midline (e.g., occupational therapy)
- Sound Field Amplification
- Neuro-Sensory Educational Therapy
- Neurofeedback
However, use of a FM transmitter has been shown to produce significant improvements over time with children.
Hyperlexia is a syndrome characterized by a child's precocious ability to read. It was initially identified by Norman E. Silberberg and Margaret C. Silberberg (1967), who defined it as the precocious ability to read words without prior training in learning to read, typically before the age of 5. They indicated that children with hyperlexia have a significantly higher word-decoding ability than their reading comprehension levels. Children with hyperlexia also present with an intense fascination for written material at a very early age.
Hyperlexic children are characterized by having average or above-average IQs, and word-reading ability well above what would be expected given their age. First named and scientifically described in 1967 (Silverberg and Silverberg), it can be viewed as a superability in which word recognition ability goes far above expected levels of skill. Some hyperlexics, however, have trouble understanding speech. Some experts believe that most, or perhaps all children with hyperlexia, lie on the autism spectrum. However, one expert, Darold Treffert, proposes that hyperlexia has subtypes, only some of which overlap with autism. Between 5 and 20 percent of autistic children have been estimated to be hyperlexic.
Hyperlexic children are often fascinated by letters or numbers. They are extremely good at decoding language and thus often become very early readers. Some hyperlexic children learn to spell long words (such as "elephant") before they are two years old and learn to read whole sentences before they turn three.
An fMRI study of a single child showed that hyperlexia may be the neurological opposite of dyslexia.