Home > Uncategorized > Communication Disorders: Research, Approaches, Measurement & Intervention.

Communication Disorders: Research, Approaches, Measurement & Intervention.

During the Brain and Mind lectures we were given insight to the complexities of speech, language and comprehension.  We were able to observe the distinct regions of the brain involved in these different processes.  Moreover, how patients with damage to specific regions, have provided evidence to support the double disassociation of Broca’s and Wernicke’s areas.  Damage to Broca’s region causing impairment of speech production, or damage to Wernicke’s area causing impairment of speech comprehension, also known as Broca’s or Wernicke’s Aphasia.    It’s important to note that whilst this distinction provided the beginnings of neuropsychological investigations of language.  There are however many communication disorders that exhibit combined impairment of both speech production and language comprehension.  These are disorders which are not a result of brain damage but rather children whose brains are developing differently.  Unfortunately, in such scenario’s plasticity theories offer little to no hope. 

http://www.youtube.com/watch?v=RmQyHD_OmmQ 

http://jslhr.highwire.org/cgi/content/abstract/40/6/1272 

http://informahealthcare.com/loi/lcd

http://books.google.co.uk/books/about/Uncommon_understanding.html?id=dt91xUIfbR8C&redir_esc=y

By four years of age most children have the ability to communicate through language and by seven years of age comprehension has typically developed.  So many take this ability for granted, yet there are growing numbers of children with (SLI) Speech and Language Impairment who do not develop speech and language typically.  Statistical figures for prevalence and incidence of language disorders for the UK are difficult to obtain this may be due to the following factors.  Often such disorders are accompanied by social stigma and therefore parents can be reluctant to register their child as having a disability.  As a nation we appear to be further behind the Americans in our approaches to identification and classification of such disorders.  Additionally similarities in the characteristic traits of communication disorders can make clear and accurate diagnosis a tricky process.  Furthermore a child’s circumstance and age may also contribute to whether or not they are identified.  Finally a general lack of awareness in society means that many children, especially those who are affected to a lesser degree can fail to be recognised as having difficulties.  All such factors may culminate and contribute to why the demographics remain so evasive.

The American Speech, Language and Hearing Association report the following figures of incidence and prevalence in the US.  Between 2%-19% of preschool children have language difficulties.  Speech and language impairment is one of the most common childhood disorders, affecting approximately 7% of children entering school and it is associated with later difficulties in learning to read.  2003 figures for the numbers of children between ages 3-21 receiving services for speech or language disorders was 1,460,583 (24.1%).   Astonishingly, these figures do not include children who have speech and language problems secondary to other conditions. These figures highlight the necessity for continued research of communication disorders.  Speech, language and comprehension are the fundamental tools that mediate our functioning and behaviour within society and this is why differences need to be exhaustively researched.  

Research undoubtedly provides the foundations for designs of intervention.  Only through research of measures can we fully appreciate and validate the effectiveness of intervention.  There is then, a significant relationship between research and the scientific credibility associated with therapy.  Categories of research are split between the domains of either applied or theoretical.  (SLT) Speech and Language Therapy as one may suspect, aims to deliver intervention with positive outcome.  In contrast, theoretical research explores and investigates the likely causes of communication impairments.  Theoretical research can take time to complete and this is often the source of much frustration to therapist’s who are eager to deliver intervention.  Theoretical and applied researchers may be at opposite ends of a spectrum, but the relationship and interface between both parties is crucial to the success of any (SLT) programme.

There are alternative approaches to the research of children with communication disorders.  Approaches may involve experiments, quasi-experiments, observational studies, interviews or even questionnaires.  Researchers may even choose triangulation also referred to as “cross-examination” methods.  This would involve combining more than one method of investigation.  This method normally acts as a safe guard against any flaws, weaknesses or bias within the independent studies.

An example of the experimental approach may involve randomly dividing children into two groups thus ensuring comparability in their average effect.  Group one may be exposed to therapy whereas group two would be the control group that is not exposed to treatment.  In this true type of experiment therapy is the independent variable being manipulated and measured for effect.  However, in a true type experiment of this nature the study of behaviour is somewhat compromised by the need for control of other variables, of course this would never occur in a real life setting and so these type of experiments are criticised for inducing a-typical behaviours.

Quasi-experiments differ from true experiments because they cannot ever claim cause and effect.  This is mainly due to the fact that in this type of investigation variables are less rigorously controlled, normally due to the nature of the investigation.  For example, a researcher may be interested in the factors that are influential to language recovery in children having suffered seizures.  Therefore the researcher may wish to consider factors such as the age of subjects, severity and nature of epilepsy, the level of support the child is receiving from the family, the school and the type of intervention.  Therefore the researchers aim is to gather information on all of these variables and establish if a there is an apparent relationship between them and the child’s language recovery.  This is known as a correlational approach to investigation.

Other approaches to investigation involve either interview or observation.  These are the two most expansive methods and they stem from the belief that we can understand the most about behaviour from either asking or watching those who are directly engaged in it.  This may be achieved through either conducting interviews or questionnaires or by either means of co-vert or overt observation.  Typically a researcher may pre-define behaviours they wish to monitor before an investigation and measure how often it occurs.

Research in this area is met with serious challenges in terms of measure.  For example, will one measurement capture the entire picture to facilitate meaningful intervention?  Think about how we would approach measuring discussion with a child.  Children don’t naturally engage with strangers and less so in unfamiliar surroundings.  Therefore it may be more conducive to investigations to ask a family member to take part in the assessment.  Giralometto (1997) describes such a method where parents take on the role as assessor of their child’s communication, arguing that it is they who often know them the best.

Think about how we may measure the level of a child’s dysfluency.  We may be able to count a stammer but how do we characterise it?  Counting it may provide us with quantitative data but it tells us little about the impact it may be having on the child’s self-image, which if negative can often be further perpetuating factor.  Yaruss (2001), highlighted the need for development of research into this area, he suggested that historically designs were choosing measures of ease, such as stammer counts, rather than those measures of real merit such as social engagement because they may be more difficult to obtain.  Sadly such issues can also influence the types of therapy that are available.  For example, therapist may be required to deliver programmes that are geared towards resolving wider communication difficulties within children such as delay’s in speech development which then fails to address the needs of children with more complex difficulties.

Research of the impact of communication disorders on social interaction is another important factor which is notoriously difficult to simulate in a laboratory setting.  Children are less likely to engage freely in play when they are aware of being observed by researchers.  To resolve this problem it may be more conducive for researchers to encourage teachers to conduct assessments and interpret a child social ability and thus providing a more accurate and objective measure.  Fujiki et al. (2001) investigated social interaction within a group of children with language impairment whilst comparing them to a controlled group of non-language impaired children.  The researcher video recorded interactions and classified behaviour every 5 seconds and evaluated the scores from both groups.  The merit of this type of research is that it facilitates realistic behaviours within a realistic setting and therefore the findings are high ecological validity.

To conclude communication difficulties can be painfully frustrating for a child and they can lead to maladaptive behaviours which can be difficult to separate and distinguish from other conditions.  Communication disorders are recognised as having similar characteristics, especially in the young.  Because of such overlaps, they have been difficult to distinguish and correctly treat.  With continued research classification systems can improve and we can expand on our understanding of these types of disorders, in future we may then be able to provide better treatment in terms of therapy. 

http://www.youtube.com/watch?v=meJ4RCY2g_Y&feature=related 

http://www.youtube.com/watch?v=sDl39VmDXlM   

Latest Technological Advances:

Dr Brian Pasley of University California and his team have developed new technology that has the capability to decode auditory information.  This technology has huge potential and it could provide the key to un-locking the Aphasic world.  At present the technology is able to decode and distinguish spoken words but this is only the tip of the iceberg in terms of what the technology can offer.  The developers are optimistic that in future they will have technology that can reconstruct speech from thoughts. 

 http://www.bbc.co.uk/news/science-environment-16831891 

 

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