Made by DATEXIS (Data Science and Text-based Information Systems) at Beuth University of Applied Sciences Berlin
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)
Funded by The Federal Ministry for Economic Affairs and Energy; Grant: 01MD19013D, Smart-MD Project, Digital Technologies
If assessed on the Wechsler Adult Intelligence Scale, for instance, symptoms of mixed receptive-expressive language disorder may show as relatively low scores for Information, Vocabulary and Comprehension (perhaps below the 25th percentile). If a person has difficulty with specific types of concepts, for example spatial terms, such as 'over', 'under', 'here' and 'there', they may also have difficulties with arithmetic, understanding word problems and instructions, or difficulties using words at all.
They may also have a more general problem with words or sentences, both comprehension and orally. Some children will have issues with pragmatics - the use of language in social contexts as well; and therefore, will have difficulty with inferring meaning. Furthermore, they have severe impairment of spontaneous language production and for this reason, they have difficulty in formulating questions. Generally, children will have trouble with morphosyntax, which is word inflections. These children have difficulty understanding and applying grammatical rules, such as endings that mark verb tenses (e.g. -"ed"), third-person singular verbs (e.g. I "think", he "thinks"), plurals (e.g. -"s"), auxiliary verbs that denote tenses (e.g. "was" running, "is" running), and with determiners ("the, a"). Moreover, children with mixed receptive-expressive language disorders have deficits in completing two cognitive operations at the same time and learning new words or morphemes under time pressure or when processing demands are high. These children also have auditory processing deficits in which they process auditory information at a slower rate and as a result, require more time for processing.
Individuals with PLI have particular trouble understanding the meaning of what others are saying, and they are challenged in using language appropriately to get their needs met and interact with others. Children with the disorder often exhibit:
- delayed language development
- aphasic speech (such as word search pauses, jargoning, word order errors, word category errors, verb tense errors)
- Stuttering or cluttering speech
- Repeating words or phrases
- difficulty with pronouns or pronoun reversal
- difficulty understanding questions
- difficulty understanding choices and making decisions.
- difficulty following conversations or stories. Conversations are "off-topic" or "one-sided".
- difficulty extracting the key points from a conversation or story; they tend to get lost in the details
- difficulty with verb tenses
- difficulty explaining or describing an event
- tendency to be concrete or prefer facts to stories
- difficulty understanding satire or jokes
- difficulty understanding contextual cues
- difficulty in reading comprehension
- difficulty with reading body language
- difficulty in making and maintaining friendships and relationships because of delayed language development.
- difficulty in distinguishing offensive remarks
- difficulty with organizational skills
Language disorders or language impairments are disorders that involve the processing of linguistic information. Problems that may be experienced can involve grammar (syntax and/or morphology), semantics (meaning), or other aspects of language. These problems may be receptive (involving impaired language comprehension), expressive (involving language production), or a combination of both. Examples include specific language impairment and aphasia, among others. Language disorders can affect both spoken and written language, and can also affect sign language; typically, all forms of language will be impaired.
Current data indicates that 7% of young children display language disorder, with boys being diagnosed twice as much as girls.
Preliminary research on potential risk factors have suggested biological components, such as low-birth weight, prematurity, general birth complications, and male gender, as well as family history and low parental education can increase the chance of developing language disorders.
For children with phonological and expressive language difficulties, there is evidence supporting speech and language therapy. However, the same therapy is shown to be much less effective for receptive language difficulties. These results are consistent with the poorer prognosis for receptive language impairments that are generally accompanied with problems in reading comprehension.
Note that these are distinct from speech disorders, which involve difficulty with the act of speech production, but not with language.
Language disorders tend to manifest in two different ways: receptive language disorders (where one cannot properly comprehend language) and expressive language disorders (where one cannot properly communicate their intended message).
Studies show that low receptive and expressive language at young ages was correlated to increased autism symptom severity in children in their early school years. Below is a chart depicting language deficits of children on the Autistic Spectrum. This table indicates the lower levels of language processing, receptive/expressive disorders, which is more severe in children with autism. When autistic children speak, they are often difficult to understand, their language is sparse and dysfluent, they speak in single, uninflected words or short phrases, and their supply of words is severely depleted. This leads to limited vocabulary while also having deficits in verbal short term memory.
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".
Examples of disorders that may include or create challenges in language and communication and/or may co-occur with the above disorders:
- autism spectrum disorder - autistic disorder (also called "classic" autism), pervasive developmental disorder, and Asperger syndrome – developmental disorders that affect the brain's normal development of social and communication skills.
- expressive language disorder – affects speaking and understanding where there is no delay in non-verbal intelligence.
- mixed receptive-expressive language disorder – affects speaking, understanding, reading and writing where there is no delay in non-verbal intelligence.
- specific language impairment – a language disorder that delays the mastery of language skills in children who have no hearing loss or other developmental delays. SLI is also called developmental language disorder, language delay, or developmental dysphasia.
Receptive language disorders can be acquired or developmental (most often the latter). When developmental, difficulties in spoken language tend to occur before three years of age. Usually such disorders are accompanied by expressive language disorders.
However, unique symptoms and signs of a receptive language disorder include: struggling to understand meanings of words and sentences, struggling to put words in proper order, and inability to follow verbal instruction.
Treatment options include: language therapy, special education classes for children at school, and a psychologist if accompanying behavioral problems are present.
Aphasia is loss of the ability to produce or comprehend language. There are acute aphasias which result from stroke or brain injury, and primary progressive aphasias caused by progressive illnesses such as dementia.
- Acute aphasias
- Expressive aphasia also known as Broca's aphasia, expressive aphasia is a non-fluent aphasia that is characterized by damage to the frontal lobe region of the brain. A person with expressive aphasia usually speaks in short sentences that make sense but take great effort to produce. Also, a person with expressive aphasia understands another person's speech but has trouble responding quickly.
- Receptive aphasia also known as Wernicke's aphasia, receptive aphasia is a fluent aphasia that is categorized by damage to the temporal lobe region of the brain. A person with receptive aphasia usually speaks in long sentences that have no meaning or content. People with this type of aphasia often have trouble understanding other's speech and generally do not realize that they are not making any sense.
- Conduction aphasia
- Anomic aphasia
- Global aphasia
- Primary progressive aphasias
- Progressive nonfluent aphasia
- Semantic dementia
- Logopenic progressive aphasia
Speech is the act of articulating sounds, and this can be impaired for all kinds of reasons – a structural problem such as cleft lip and cleft palate, a neurological problem affecting motor control of the speech apparatus Dysarthria, or inability to perceive distinctions between sounds because of Hearing loss. Some distortions of speech sounds, such as a Lisp, are commonly seen in young children. These misarticulations should not be confused with language problems, which involve the ability to select and combine linguistic elements to express meanings, and the ability to comprehend meanings.
Although speech disorders can be distinguished from language disorders, they can also co-occur. When a child fails to produce distinctions between speech sounds for no obvious reason, this is typically regarded as a language problem affecting the learning of phonological contrasts. The classification of and terminology for disorders of speech sound production is a subject of considerable debate. In practice, even for those with specialist skills, it is not always easy to distinguish between phonological disorders and other types of speech production problem.
Speech sound disorder (SSD) is a general term for problems with speech production arising from any cause.
Speech Sound Disorders of unknown cause that are not accompanied by other language problems are a relatively common reason for young children to be referred to speech-language therapy (speech-language pathology). These often resolve by around 4-5 years of age with specialist intervention, and so would not meet criteria for DLD. Where such problems continue beyond 5 years of age, they are usually accompanied by problems in broader language domains and have a poorer prognosis, so a diagnosis of DLD with SSD is then appropriate.
Developmental language disorder (DLD) is identified when a child has problems with language development that continue into school age and beyond. The language problems have a significant impact on everyday social interactions or educational progress, and occur in the absence of autism spectrum disorder, intellectual disability or a known biomedical condition. The most obvious problems are difficulties in using words and sentences to express meanings, but for many children, understanding of language (receptive language) is also a challenge, although this may not be evident unless the child is given a formal assessment.
People with aphasia may experience any of the following behaviors due to an acquired brain injury, although some of these symptoms may be due to related or concomitant problems such as dysarthria or apraxia and not primarily due to aphasia. Aphasia symptoms can vary based on the location of damage in the brain. Signs and symptoms may or may not be present in individuals with aphasia and may vary in severity and level of disruption to communication. Often those with aphasia will try to hide their inability to name objects by using words like "thing". So when asked to name a pencil they may say it is a thing used to write.
- Inability to comprehend language
- Inability to pronounce, not due to muscle paralysis or weakness
- Inability to speak spontaneously
- Inability to form words
- Inability to name objects (anomia)
- Poor enunciation
- Excessive creation and use of personal neologisms
- Inability to repeat a phrase
- Persistent repetition of one syllable, word, or phrase (stereotypies)
- Paraphasia (substituting letters, syllables or words)
- Agrammatism (inability to speak in a grammatically correct fashion)
- Dysprosody (alterations in inflexion, stress, and rhythm)
- Incomplete sentences
- Inability to read
- Inability to write
- Limited verbal output
- Difficulty in naming
- Speech disorder
- Speaking gibberish
- Inability to follow or understand simple requests
Although textbooks draw clear boundaries between different neurodevelopmental disorders, there is much debate about overlaps between them. Many children with SLI meet diagnostic criteria for developmental dyslexia, and others have features of autism.
Given the previously stated signs and symptoms the following behaviors are often seen in people with aphasia as a result of attempted compensation for incurred speech and language deficits:
- Self-repairs: Further disruptions in fluent speech as a result of mis-attempts to repair erred speech production.
- Speech disfluencies: Include previously mentioned disfluencies including repetitions and prolongations at the phonemic, syllable and word level presenting in pathological/ severe levels of frequency.
- Struggle in non-fluent aphasias: A severe increase in expelled effort to speak after a life where talking and communicating was an ability that came so easily can cause visible frustration.
- Preserved and automatic language: A behavior in which some language or language sequences that were used so frequently, prior to onset, they still possess the ability to produce them with more ease than other language post onset.
Even though most speech sound disorders can be successfully treated in childhood, and a few may even outgrow them on their own, errors may sometimes persist into adulthood rather than only being not age appropriate. Such persisting errors are referred to as "residual errors" and may remain for life.
The word hyperlexia is derived from the Greek terms "hyper" ("over") and "léxis" ("diction", "word").
AOS and expressive aphasia (also known as Broca's aphasia) are commonly mistaken as the same disorder mainly because they often occur together in patients. Although both disorders present with symptoms such as a difficulty producing sounds due to damage in the language parts of the brain, they are not the same. The main difference between these disorders lies in the ability to comprehend spoken language; patients with apraxia are able to fully comprehend speech, while patients with aphasia are not always fully able to comprehend others' speech.
Conduction aphasia is another speech disorder that is similar to, but not the same as, apraxia of speech. Although patients who suffer from conduction aphasia have full comprehension of speech, as do AOS sufferers, there are differences between the two disorders. Patients with conduction aphasia are typically able to speak fluently, but they do not have the ability to repeat what they hear.
Similarly, dysarthria, another motor speech disorder, is characterized by difficulty articulating sounds. The difficulty in articulation does not occur due in planning the motor movement, as happens with AOS. Instead, dysarthria is caused by inability in or weakness of the muscles in the mouth, face, and respiratory system.
There are three significant features that differentiate DVD/CAS from other childhood speech sound disorders. These features are:
- "Inconsistent errors on consonants and vowels in repeated productions of syllables and words
- Lengthened coarticulatory transitions between sounds and syllables
- Inappropriate prosody, especially in the realization of lexical or phrasal stress"
Even though DVD/CAS is a "developmental" disorder, it will not simply disappear when children grow older. Children with this disorder do not follow typical patterns of language acquisition and will need treatment in order to make progress.
The warning signs of early speech delay are categorized into age related milestones, beginning at the age of 12 months and continuing through early adolescence.
At the age of 12 months, there is cause for concern if the child is not able to do the following:
- Using gestures such as waving good-bye and pointing at objects
- Practicing the use of several different consonant sounds
- Vocalizing or communicating needs
Between the ages of 15 and 18 months children are at a higher risk for speech delay if they are displaying the following:
- Not saying "momma" and "dada"
- Not reciprocating when told "no", "hello", and "bye"
- Does not have a one to three word vocabulary at 12 months and up to 15 words by 18 months
- Is unable to identify body parts
- Displaying difficulties imitating sounds and actions
- Shows preference to gestures over verbalization
Additional signs of speech delay after the age of 2 years and up to the age of 4 include the following:
- Inability to spontaneously produce words and phrases
- Inability to follow simple directions and commands
- Cannot make two word connections
- Lacks consonant sounds at the beginning or end of words
- Is difficult to understand by close family members
- Is not able to display the tasks of common household objects
- Is unable to form simple 2 to 3 word sentences
The DSM-5 categorizes SCD as a communication disorder within the domain of neurodevelopmental disorders, listed alongside other disorders of speech and language which typically manifest in early childhood. The DSM-5 diagnostic criteria for social (pragmatic) communication disorder is as follows:
- A. Persistent difficulties in the social use of verbal and nonverbal communication as manifested by all of the following:
1. Deficits in using communication for social purposes, such as greeting and sharing information, in a manner that is appropriate for the social context.
2. Impairment of the ability to change communication to match context or the needs of the listener, such as speaking differently in a classroom than on a playground, talking differently to a child than to an adult, and avoiding use of overly formal language.
3. Difficulties following rules for conversation and storytelling, such as taking turns in conversation, rephrasing when misunderstood, and knowing how to use verbal and nonverbal signals to regulate interaction.
4. Difficulties understanding what is not explicitly stated (e.g., making inferences) and nonliteral or ambiguous meanings of language (e.g., idioms, humor, metaphors, multiple meanings that depend on the context for interpretation).
- B. The deficits result in functional limitations in effective communication, social participation, social relationships, academic achievement, or occupational performance, individually or in combination.
- C. The onset of symptoms is in the early developmental period (but deficits may not become fully manifest until social communication demands exceed limited capacities).
- D. The symptoms are not attributable to another medical or neurological condition or to low abilities in the domains of word structure and grammar, and are not better explained by autism spectrum disorder, intellectual disability (intellectual developmental disorder), global developmental delay, or another mental disorder.
Speech and language impairment are basic categories that might be drawn in issues of communication involve hearing, speech, language, and fluency.
A speech impairment is characterized by difficulty in articulation of words. Examples include stuttering or problems producing particular sounds. Articulation refers to the sounds, syllables, and phonology produced by the individual. Voice, however, may refer to the characteristics of the sounds produced—specifically, the pitch, quality, and intensity of the sound. Often, fluency will also be considered a category under speech, encompassing the characteristics of rhythm, rate, and emphasis of the sound produced
A language impairment is a specific impairment in understanding and sharing thoughts and ideas, i.e. a disorder that involves the processing of linguistic information. Problems that may be experienced can involve the form of language, including grammar, morphology, syntax; and the functional aspects of language, including semantics and pragmatics
An individual can have one or both types of impairment. These impairments/disorders are identified by a speech and language pathologist.
In some cases phonetic and phonemic errors may coexist in the same person. In such case the primary focus is usually on the phonological component but articulation therapy may be needed as part of the process, since teaching a child how to use a sound is not practical if the child does not know how to produce it.
Agraphia or impairment in producing written language can occur in many ways and many forms because writing involves many cognitive processes (language processing, spelling, visual perception, visuospatial orientation for graphic symbols, motor planning, and motor control of handwriting).
Agraphia has two main subgroupings: central ("aphasic") agraphia and peripheral ("nonaphasic") agraphia. Central agraphias include , phonological, deep, and semantic agraphia. Peripheral agraphias include allographic, apraxic, motor execution, hemianoptic and afferent agraphia.
Language-based learning disabilities or LBLD are "heterogeneous" neurological differences that can affect skills such as listening, reasoning, speaking, reading, writing, and maths calculations. It is also associated with movement, coordination, and direct attention. LBLD is not usually identified until the child reaches school age. Most people with this disability find it hard to communicate, to express ideas efficiently and what they say may be ambiguous and hard to understand
It is a neurological difference. It is often hereditary, and is frequently associated to specific language problems.
There are two types of learning disabilities: non-verbal, which includes disabilities from psychomotor difficulties to dyscalculia, and verbal, language based.
Primary stuttering behaviors are the overt, observable signs of speech disfluencies, including repeating sounds, syllables, words or phrases, silent blocks and prolongation of sounds. These differ from the normal dysfluencies found in all speakers in that stuttering dysfluencies may last longer, occur more frequently, and are produced with more effort and strain. Stuttering dysfluencies also vary in quality: common dysfluencies tend to be repeated movements, fixed postures, or superfluous behaviors. Each of these three categories is composed of subgroups of stutters and dysfluencies.
- Repeated movements
- Part-word repetition—a single segment of a word is repeated (for example: "s-s-stuttering!") or a part of a word which is still a full syllable such as "un—un—under the..." and "o—o—open".
- Incomplete syllable repetition—an incomplete syllable is repeated, such as a consonant without a vowel, for example, "c—c—c—cold".
- Whole-word repetition—a whole word, or more than one word is repeated, such as "I know—I know—I know a lot of information.".
- Fixed postures
- Prolongation—prolongation of a sound occurs such as "mmmmmmmmmom".
- Block—such as a block of speech or a tense pause where nothing is said despite efforts.
- Superfluous behaviors
- Interjections—this includes an interjection such as an unnecessary "uh" or "um" as well as revisions, such as going back and correcting one's initial statements such as "I—My girlfriend...", where the "I" has been corrected to the word "my".
- Secondary characteristics—these are visible or audible speech behaviors, such as lip smacking, throat clearing, head thrusting, etc., usually representing an effort to break through or circumvent a block or stuttering loop.
Lexical deficit disorder. The child has word finding problems and difficulty putting ideas into words. There is poor comprehension for connected speech. Again, there is little research on this subtype, which is not widely recognised.
Pragmatic language impairment. The child speaks in fluent and well-formed utterances with adequate articulation; content of language is unusual; comprehension may be over-literal; language use is odd; the child may chatter incessantly, be poor at turn-taking in conversation and maintaining a topic. There has been a great deal of controversy about this category, which is termed "pragmatic language impairment (PLI)" in the UK. Debate has centred over the question of whether it is a subtype of SLI, part of the autistic spectrum, or a separate condition. In DSM5, the term "Social Communication Disorder" has been introduced; this is equivalent to PLI.