Rhonda Williams

Mixed Receptive-Expressive Language Disorder: Impairments and Interventions

IMPAIRMENTS
General Language
Interrelationship between childrens language delays, early reading difficulties and learning difficulties. Reading delays are associated with language impairments in verbal memory, vocabulary, syntactic awareness, word segmentation, word naming speed and verbal intelligence Delays in language development are more likely to cause difficulties with peer social interactions, problem solving and behavioural concerns (Hart, Fujiki, Brinton & Hart, 2004; Hay et al., 2007; Willinger et al., 2003) Marked limited vocabulary Errors in tense Difficulty recalling words or producing sentences with developmentally appropriate length or complexity General difficulty expressing ideas Child may be exceptionally quiet or conversely very talkative Conversational skills (e.g. taking turns, maintaining topic) are often poor or inappropriate (APA, 2000) Difficulty understanding words, sentences or specific types of words impaired comprehension and may appear to intermittently not hear, be confused, or not pay attention when spoken to follow commands incorrectly, and give inappropriate responses to questions (APA, 2000)

Expressive Language

Receptive Language

Working Memory
(Dodwell & Bavin, 2008; Montgomery, Magimairaj & Finney, 2010)
Mechanism/Property
Verbal storage

Visuo-spatial storage
Capacity concurrent processing storage Central E xecutive
- attentional capacity - attentional allocation/ shifting - updating - inhibition - sustained attention

Ability in relation to peers poor similar poor poor similar poor poor poor poor

Processing speed

Interventions:
Working Memory
Phonological Capacity (phonological loop): Verbal rehearsal strategies - Use in everyday situations, explicit training can enhance STM and WM capacity and metacognition Teach rhyming and phonological skills Teach listening skills to promote more efficient and elaborate encoding Fast ForWord no empirical evidence WM Capacity: Computerized programs (e.g. Soak Your Brain) that slowly increase the amount of information and time kept in temporary storage Combining verbal and visual information to use relative strengths Chunk information into meaningful parts Compensating for Slower Processing Speed: Present information at a slower pace to allow more time to process Speak slowly and clearly to help encoding, storage and retrieval Promote Attention: Preparatory: communicate intentions ahead of time; use language targets within meaningful context Selective: salient targets and limit distractions Access prior knowledge and topics of interest Organizational Skills: Help organize new material through categorization, recall strategies, paraphrasing, retention cues (Dodwell & Bavin, 2008; Gillam, 1997; Dodwell & Bavin, 2008; Hay et al., 2007; Montgomery, Magimairaj & Finney, 2010; Strong et al., 2011)

Language Interventions
a naturalistic approach to language intervention is the most effective as it creates a communicative context, providing language stimulation using techniques such as self-talk, parallel talk, imitations, expansions, extensions, build-ups and breakdowns, and recasts. Receptive language: comprehending written text - paragraph restatement, story mapping, creative dramatics listening comprehension- direction re-telling, cognitive monitoring, teach vocabulary and concepts in multimodal approach, provide feedback and reinforcement (Bray, Kehle & Theodore, 2002 ; Hay et al., 2007) Expressive language: modelling correct grammar, opportunities for verbal responses, re-telling stories in own words, addition of words in childs utterances through the use of syntactically more complex language Pictography to promote understanding of sequence, quality, length and clarity of content, comprehension monitoring Written expression through story mapping, self-instruction, word processing (Boyle et al., 2009; Bray, Kehle & Theodore, 2002 ; Hay et al., 2007) Pragmatic language social skills training focused on modelling appropriate conversational skills (eye contact, topic maintenance, termination of conversation, turn taking) (Bray, Kehle & Theodore, 2002 ; Hay et al., 2007; Merrison & Merrison, 2005) Use of role plays Edited self-modeling video tapes Build repair skills through explicit teaching

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