See Appendix B for normal developmental milestones by age.
Three primary areas or “streams” of development
Motor
Gross motor
Mild—developmental dyspraxia/“clumsy child”/developmental coordination disorder
Severe—cerebral palsy
Fine motor
Mild—dysgraphia
Severe—cerebral palsy
Oral-motor
Mild—speech articulation disorder; drooling
Severe—dysarthria/dysphagia
Cognitive (including language and nonverbal processing)
Slow learner (IQ 80-89)
Borderline (IQ 70-79)
Intellectual disability/mental retardation—(IQ < 70)
Social/behavioral
Social behavior issues
Normal variation—shy/slow to warm up temperament
Mild disorder—socially inappropriate behavior; socially immature; social anxiety
More severe disorder—lack of social reciprocity; lack of joint attention; lack of empathy; lack of imaginative play
Attentional issues
Normal variation—“inattention problem”
Mild disorder—inattention
More severe disorder—atypical attention; limited eye contact; perseveration; insistence of sameness; restricted interests; repetitive play/rituals; sensory hypo-/hyperresponsiveness
Impulsivity/hyperactivity issues
Normal variation—“impulsivity/hyperactivity problem”
Mild disorder—impulsivity; hyperactivity
More severe disorder—disinhibition; stereotypic motor mannerisms
Delay, dissociation, and deviance reflect an underlying central nervous system dysfunction.
The more delayed, dissociated, and deviant the development, the more atypical the behavior.
There is a spectrum of disorders within each developmental area.
Mild disorders predominate over severe disorders.
There is a continuum of developmental-behavioral disorders across areas.
More diffuse/global developmental-behavioral dysfunction predominates over more isolated/focal dysfunction (comorbidities are the rule rather than the exception).
Learning disorders may be familial.
Obtain a detailed family history.
Special circumstances increasing the risk for learning disorders
Premature infants, especially <32 weeks’ gestation
Cyanotic congenital heart disease
Children living in poverty
Specific genetic disorders
Examples:
Klinefelter syndrome
Turner syndrome
Velocardiofacial syndrome
Spina bifida with shunted hydrocephalus (visuospatial cognitive skills and math achievement)
Multiple learning disabilities
Children who have problems in one area of academic achievement often have problems in other areas
35% to 57% of children with math learning disorders also have reading learning disorders.
Learning disability and attention deficit hyperactivity disorder (ADHD)
Comorbid learning disabilities account for at least some of the observed academic underachievement in children with ADHD.
Secondary attention deficits—attention problems secondary to the underlying learning disorder
“It can be very difficult for a student to maintain focus on tasks that are difficult for him or her to understand.”
Language-based versus nonverbal learning disorders
Nonverbal cognitive measures are significantly lower than verbal scores.
Problem areas can include math computation, organizational skills, higher-order math and science concepts.
Problems with social perception and social interaction contribute to negative experiences in educational settings.
Individuals with Disabilities Education Act
Problem areas that qualify for intervention with an Individualized Education Program (IEP) plan. Programs must be provided in the least restrictive environment (LRE).
Oral expression
Listening comprehension
Basic reading skills
Reading fluency skills
Reading comprehension
Mathematics calculation
Mathematics problem solving
Other health impairments (can include ADHD)
Modules
Discrepancy model
Discrepancy between academic achievement and intellectual ability
Response to intervention model
TIER 1—general education or primary prevention
Administrated to all students
TIER 2—secondary prevention
Not doing as well as most peers and needs extra help
Small group tutoring
School-based problem-solving teams for functional assessment and to manage intervention
TIER 3
More intensive, individual programming with progress monitoring
RTI—services must be supported by “scientifically based research… accepted by a peer reviewed journal or approved by a panel of independent experts through a comparably rigorous, objective, and scientific review”
Section 504 of the Rehabilitation Act of 1973
Students receiving services typically have less severe problems than those eligible under IDEA.
Accommodations may include the following:
Extra time to take tests
Verbal versus written responses
Adjusting reading level
Recording of lectures
Submitting homework performed on a computer
Peer tutoring
Multiple-choice versus short essay questions
Shorter homework assignment
General rule of thumb for speaking in sentences
90% of children use
2-word sentences at age 2
3-word sentences at age 3
4-word sentences at age 4
TABLE 11-1 Components of Speech and Language | ||||||||||||||||||||||||||||
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Phonologic or articulation disorder
Substitution, omission, addition, or distortion
Many more difficult sounds are not mastered until age 5-6 years.
Consonants: j, r, l, and y
Blends: ie, sh, ch, th, st
Dysarthria
Disorders involving problems of articulation, respirations, phonation, or prosody as a result of paralysis, muscle weakness, or poor coordination (frequently associated with cerebral palsy)
Apraxia/dyspraxia of speech
Problems in articulation, phonation, respiration, and resonance arising from difficulties in complex motor planning and movement
Not due to weakness of the oromotor musculature as seen with dysarthria
Not associated with other oral-motor skills, such as chewing, swallowing, or spitting
Developmental apraxia of speech is differentiated from expressive language delay in that children with expressive language delay typically follow a normal language trajectory but at a slower pace.
Acquired apraxia/dyspraxia commonly results from head injury, tumor, stroke, or other problems affecting the parts of the brain involved with speaking and involves loss of previously acquired speech.
Voice disorders
Variations in pitch, volume, resonances, and voice quality
Can be seen in isolation or in connection with a language delay
Impaired modulation of pitch and volume can be seen in children with autism spectrum disorders (ASDs) and nonverbal learning disorders and in some genetic syndromes.
Velopharyngeal palatal incompetence can cause hypernasal speech and can be a marker of velocardiofacial syndrome.
Fluency disorders
Interruptions in the flow of speaking
Examples—pauses, hesitations, injections, prolongations, and interruptions
Normal dysfluency is common in early childhood (ages 2.5-4 years).
Persistent or progressive dysfluency is described as “stuttering.”
Examples
Sound prolongations “ca-caaaa-caaaaat”
Multiple part-word repetitions “ca-ca-ca-cat”
TABLE 11-2 Developmental Milestones for Language | |||||||||||||||||||||||||||||||||||||||
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Auditory processing—recognizing and processing verbal information and sounds
The inattention and distractibility in children with ADHD are associated with “auditory processing problems.”
Poor quality acoustic environments; peripheral ear functioning; behavior factors involved in listening; and problems with the cochlea, auditory nerve, brain stem, and cortex can all be involved in causing auditory processing difficulties.
Receptive language problems almost always occur in conjunction with expressive delay.
Broad spectrum of delays, including developmentally inappropriate short length of utterances, word-finding weakness, semantic substitutions, and difficulty mastering grammatical morphemes that contribute to plural or tense
Signs of expressive language weakness include the following:
Circumlocutions (using many words to explain a word instead of using the specific term)
Excessive use of place holders
“um” or “uh”
Nonspecific words (“stuff” or “like”)
Using gestures excessively or difficulty generating an ordered narrative
Verbal auditory agnosia
Difficulty integrating the phenology of aural information—limited comprehension of spoken language
Phonologic—syntactic deficit
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