This document provides an overview of language development, speech and language disorders, and feeding/swallowing processes and disorders. It discusses the differences between speech, language, and communication. Key factors that can contribute to speech and language disorders are described. Milestones in typical and atypical speech and language acquisition are outlined. Characteristics of autism that can impact communication are summarized. The document concludes with discussing assessment and treatment of speech/language disorders and some pearls and perils related to feeding/swallowing processes.

1. Language Development in
Disorders of Communication and
Oral Motor Function
Dr. Tehreem Anis
DIRS

2. Learning Objectives
By the end of the lecture, students will be able to;
• Understand the difference between speech, Language and
communication
• Understand the factors that might contribute to speech and/or
language disorders
• Use specific terminologies used with such conditions and disorders

3. Speech vs. Language
Speech: the motor action occurring from combined use of the upper body
muscles producing inhalation, exhalation, phonation, resonation and
articulation.
We have to learn to modulate our
Vocalization for volume, pitch, resonance and intonation
Articulation for intelligibility
Fluency for clarity and meaning

4. Speech vs. Language
Language: the use of identified methods that make up a cultural communication
system. This can be hand use, word use or unaided altogether.
It is often composed of a
 phonology
 morphology
 syntax
 semantics
 grammar
 pragmatics

5. Communication
Considerations of the third component
 it takes two to tango!
 message produced – message received
 message understood!
 Dynamic Process

6. Speech and Language Acquisition
Birth–3 Months Makes pleasure sounds such as cooing, Develops differential cries for different
needs, Develops social smile
3–6 Months Increase in variety of vocalizations, Babbling sounds more speech like, with
increased consonant productions, Uses sounds and gestures to indicate wants
6–12 Months Reduplicative babbling occurs (eg, dada, bibi, etc.), Uses speech sounds to get
attention, First words emerge (~10–12 months), Responds to simple requests
Imitates speech sounds
18–24 months Uses words more frequently than jargon, Has expressive vocabulary of 50–100
words, Has receptive vocabulary of 300+ words
2–3 Years Uses two- to three-word sentences, Points to pictures in books, Speech is
understood by familiar listeners most of the time
3–4 Years Uses simple sentences with negatives, imperatives, and questions, Talks about
activities at school and home, Understands simple “wh-” question words
4–5 Years Mean length of utterance (MLU) = 4.6–5.7 words, Uses grammatically correct
sentences, Relays a long story accurately
5–6 Years MLU = 6.6 words, Uses all pronouns consistently, Comprehends 13,000 words
6–7 Years MLU = 7.3 words, Comprehends 20,000–26,000 words, Refines syntax
Speech and Language Disorders
By 6 months Does not respond to the sound of others talking, Does not turn toward
speaker out of view, Makes only crying sounds, Does not maintain eye contact
with caregiver
By 12 months Does not babble, Does not discontinue activity when told “no”, Does not
follow gestural commands, such as “want up” or “give me”
By 24 months Does not say a meaningful word, Does not refer to self by name, Does not
follow simple directions, Does not talk at all at 2 years, Vocabulary does not
seem to increase, Does not have any consonant sounds, Does not answer
simple yes/no questions
By 36 months Does not say whole name, Does not seem to understand “what” and “where”
Questions, Uses jargon a great deal, Answers your question by repeating the
question, Continues to echo statements made by others, Does not use two- to
three-word utterances, Points to desired objects rather than naming
Them, Does not name any objects in pictures, Leaves off the beginning
consonants of words, Cannot be understood even by parents, Does not
respond when you call name

7. Autism and Communication
Five criteria relating to language: delay in, or total lack of, the development of spoken language (not accompanied
by an attempt to compensate through alternative modes of communication such
as gesture or mime), in individuals with adequate speech, marked impairment in
the ability to initiate or sustain a conversation with others, stereotyped and
repetitive use of language or idiosyncratic language, lack of varied spontaneous
make-believe play or social imitative play appropriate to developmental level,
delays or abnormal functioning in language as used in social communication, with
onset prior to age 3 years
Five criteria relating to social interaction: marked impairment in the use of multiple nonverbal behaviors, such as eye to-eye
gaze, facial, expression, body postures, and gestures, to regulate social interaction,
failure to develop peer relationships appropriate to developmental level, a lack of
spontaneous seeking to share enjoyment, interests, or achievements with other
people(eg, by a lack of showing, bringing, or pointing out objects of interest), lack
of social or emotional reciprocity, delays or abnormal functioning in social
interaction, with onset prior to age 3 years
Five criteria relating to patterns of behavior,
interests, and activities:
encompassing preoccupation with one or more stereotyped and restricted
pattern of interest that is abnormal either in intensity or focus, apparently
inflexible adherence to specific, nonfunctional routines or rituals, stereotyped
and repetitive motor mannerisms (eg, hand or finger flapping or twisting, or
complex whole body movements), persistent preoccupation with parts of objects,
delays or abnormal functioning in symbolic
or imaginative play, with onset prior to age 3 years

8. Assessment and Treatment of
Speech/Language Disorders
• Assessment
• Treatment

9. FEEDING AND SWALLOWING PROCESSES AND
DISORDERS

10. PEARLS AND PERILS
• Children with tracheostomies and those on ventilators are capable of oral
communication and oral eating.
• Speech and language delay refers to typical development at a slower pace,
while speech and language disorder refers to atypical development when
compared with peers.
• Autism spectrum disorder is four to five times more common in boys than
girls, and has shown a 10-fold increase in prevalence in 40 years.
• Use of augmentative communication systems (devices, sign language,
PECS) does not impede development of oral communication, and may, in
fact, promote it.
• Liquids are the least safe alternative when initiating feeding following TBI
due to delayed reaction times associated with cognitive level of recovery.

11. References
• Pediatric Rehabilitation –
Principles and Practice.
Chapter 4