LANGUAGE DISORDERS

IN CHILDREN
BY
MERLIN A
 DEFINITION

AUTISM ASD is an umbrella term that encompasses a

SPECTRUM range of disorders that are characterized by core

DISORDER impairments in social communication and a

restricted repertoire of interests and behaviors

(American psychiatric association 2013).

DIAGNOSTIC CRITERIA FOR AUTISM SPECTRUM DISORDERS

A. Persistent deficits in social communication and social interaction across

contexts, currently or by history, not accounted for by general developmental
delays, and manifested by the following:

1. Deficits in social/emotional reciprocity; ranging from

abnormal social approach and failure of normal back
and forth conversation through reduced sharing of
interests, emotions, or affect to total lack of initiation
of or response to social interaction
2. Deficits in nonverbal communicative behaviors used
for social interaction; ranging from poorly integrated
verbal and nonverbal communication, through
abnormalities in eye contact and body-language, or
deficits in understanding and use of nonverbal
communication, to total lack of facial expression or
Gestures
3. Deficits in developing and maintaining relationships;
ranging from difficulties adjusting behavior to suit
different social contexts through difficulties in sharing
imaginative play and in making friends to an
apparent absence of interest in people
B. Restricted, repetitive patterns of behavior, interests, or activities as
manifested by at least two of the following, currently or by history:

1. Stereotyped or repetitive speech, motor movements,

or use of objects (such as simple motor stereotypes,
echolalia, repetitive use of objects, or idiosyncratic
phrases)

2. Excessive adherence to routines, ritualized patterns of

verbal or nonverbal behavior, or excessive resistance
to change (such as motoric rituals, insistence on same
route or food, repetitive questioning, or extreme
distress at small changes)
3. Highly restricted, fixated interests that are abnormal
in intensity or focus (such as strong attachment to or
preoccupation with unusual objects, excessively
circumscribed or persevering interests)

4. Hyper- or hypo-reactivity to sensory input or unusual

interest in sensory aspects of environment (such as
apparent indifference to pain/heat/cold, adverse
response to specific sounds or textures, excessive
smelling or touching of objects, fascination with lights
or spinning objects)
C.Symptoms must be present in early childhood (but may not
become fully manifest until social demands exceed limited
capacities or be masked by learned strategies in later life)

D. Symptoms cause clinically significant impairment in social,

occupation or other impairment areas of current functioning
E. These disturbances are not better explained by intellectual
disability (intellectual developmental disorder) or global
developmental delay.

Intellectual disability and autism spectrum disorders frequently

co-occur; to make comorbid diagnoses of autism spectrum
disorder and intellectual disability, social communication should
be below that expected for general developmental level

From American Psychiatric Association. (2013). Diagnostic and

statistical manual of mental disorders
CLASSIFICATION OF AUTISM SPECTRUM DISORDER

There are five major types of autism which include,

✓ Asperger’s syndrome
✓ Rett syndrome
✓ childhood disintegrative disorder
✓ Kanner’s syndrome
✓ pervasive developmental disorder – not otherwise specified.
ASPERGER’S SYNDROME

✓ Although the term Asperger’s syndrome was quite common before

2013, the term is actually no longer used by medical professionals.

✓ It has since been reclassified as level 1 autism spectrum disorder

by the DSM-5 diagnostic manual. Still, Asperger’s syndrome may
be used informally — in fact, autism communities use it more
often than level 1 spectrum disorder.
✓ A child with level 1 spectrum disorder will have above average
intelligence and strong verbal skills but will experience challenges
with social communication. In general, a child with level 1 autism
spectrum disorder will display the following symptoms:
✓ Inflexibility in thought and behavior

✓ Challenges in switching between activities

✓ Executive functioning problems

✓ Flat monotone speech, the inability to express feelings

in their speech, or change their pitch to fit their
immediate environment

✓ Difficulty interacting with peers at school or home

14
RETT SYNDROME

✓ Rett syndrome is a rare neurodevelopmental disorder that is

noticed in infancy.

✓ The disorder mostly affects girls, although it can still be

diagnosed in boys. Rett syndrome presents challenges that
affect almost every aspect of a child's life.

✓ The good thing is your child can still enjoy and live a
fulfilling life with the proper care. You can have family
time together and provide support to allow the child to do
what they enjoy.
Common symptoms of Rett syndrome include:

✓ Loss of standard movement and coordination

✓ Challenges with communication and speech

✓ Breathing difficulties in some cases

CHILDHOOD DISINTEGRATIVE DISORDER (CDD)

✓ Childhood disintegrative disorder (CDD), also known as

Heller's syndrome or disintegrative psychosis, is a
neurodevelopmental disorder defined by delayed onset of
developmental problems in language, motor skills, or social
function.

✓ A child experiences normal development in these areas only

to hit a snag after age three and up to age 10. The
developmental loss can be very heartbreaking for parents
who had no idea their child had autism challenges all along.
✓ The cause of CDD is unknown though researchers
link it to the neurobiology of the brain. Childhood
disintegrative disorder is more common in boys.
Out of every 10 cases of the disorder, nine will be
boys, and only one will be a girl.
In CDD, the child will have normal development up to the time
when the disorder starts, and regressions suddenly start to occur in
more than two developmental aspects of their life. The child may
lose any of the following skills and abilities:

✓ Toileting skills if they had already been established

✓ Acquired language or vocabularies

✓ Social skills and adaptive behaviors

✓ Some motor skill

KANNER’S SYNDROME

✓ Kanner’s syndrome was discovered by psychiatrist Leo Kanner

of John Hopkins University in 1943 when he characterized it as
infantile autism.

✓ Doctors also describe the condition as a classic autistic disorder.

Children with Kanner's syndrome will appear attractive, alert,
and intelligent with underlying characteristics of the disorder
such as:
✓ Lack of emotional attachment with others

✓ Communication and interaction challenges

✓ Uncontrolled speech

✓ Obsession with handling objects

✓ A high degree of rote memory and visuospatial skills

with major difficulties learning in other areas
PERVASIVE DEVELOPMENTAL DISORDER – NOT
OTHERWISE SPECIFIED (PDD-NOS)

Pervasive Developmental Disorder – Not Otherwise Specified

(PDD-NOS) is a mild type of autism that presents a range of
symptoms. The most common symptoms are challenges in
social and language development.
✓ Your child may experience delays in language
development, walking, and other motor skills. You can
identify this type of autism by observing the child and
noting what area the child displays a deficit in, such as
interacting with others.

✓ PDD-NOS is sometimes referred to as “subthreshold

autism,” as it is a term used to describe an individual that
has some but not all symptoms of autism.
 CAUSES OF AUTISM SPECTRUM DISORDER

Autism spectrum disorder (ASD) is typically diagnosed

on the basis of behavioral symptoms, without reference
to etiology. However, researchers have devoted
considerable efforts to investigating etiological factors.

Although no single cause has been identified, the

available data suggest that autism results from different
sets of causal factors, including genetic, neurobiological,
and environmental factors.
GENETIC RISK FACTORS

✓ Researchers largely agree that ASD is the result of hereditable

genetic differences and/or mutations. Findings that support a
genetic link include research results showing the following:

✓ ASD is more common in boys than in girls—it is most likely

linked to genetic differences associated with the X chromosome
(Chakrabarti & Fombonne, 2005).
✓ The rate of concordance for identical twins is higher
compared with the concordance rate in fraternal twins (Bailey
et al., 1995; Colvert et al., 2015).

✓ Almost 20% of infants with an older biological sibling with

ASD also developed ASD; the risk for developing ASD was
greater if there was more than one older affected sibling
(Ozonoff et al., 2011).
NEUROBIOLOGICAL FACTORS

✓ Abnormalities in the genetic code may result in abnormal

mechanisms for brain development, leading in turn to
structural and functional brain abnormalities, cognitive and
neurobiological abnormalities, and symptomatic behaviors
(Williams, 2012).

✓ Structural and functional abnormalities in the developing brain

include
✓ increased gray matter in the frontal and temporal lobes (Carper &
Courchesne, 2005; Hazlett et al., 2006; Palmen et al., 2005);

✓ decreased white matter compared with gray matter by adolescence

(Volkmar et al., 2004);

✓ anatomical and functional differences in the cerebellum and in the

limbic system (Volkmar et al., 2004); and

✓ synaptic deficits that affect anatomical structures and neuronal

circuitry (Ecker et al., 2013).
ENVIRONMENTAL FACTORS

✓ Researchers have begun to investigate how pre- and postnatal

environmental factors (e.g., dietary factors, exposure to drugs and
to environmental toxicants) might interact with genetic
susceptibility to ASD.

✓ Researchers have identified a number of environmental exposures

for future study, including lead, polychlorinated biphenyls
(PCBs), insecticides, automotive exhaust, hydrocarbons, and
flame retardants (Landrigan et al., 2012; Schmidt et al., 2014;
Shelton et al., 2012). However, no specific environmental triggers
have been identified at this time.
 CHARACTERISTICS OF AUTISM SPECTRUM DISORDER

✓ Lack of responsiveness and attention

✓ Gaze aversion ( eye contact is not maintained)

✓ Prefer objects more than people around them (playing)

✓ Social smile is absent

✓ Sensory issues will be present

✓ The child may be hyposensitive or hypersensitive to certain sounds, taste and smell.
✓ IQ is lower than 70 (below borderline)lower intelligence with pure autism,
some might have good IQ

✓ Difficulty in understanding social cues

✓ Difficulty in maintaining or shifting to next task

✓ Play behaviour : Excessive lining of toys or objects, strongment to one

particular toy or object.

✓ Seems to be hearing impaired

✓ Repetitive behaviour : stereotypic and self stimulatory
behaviour present ( flapping of hands)

✓ Walking in toes will present

✓ Resistance to change in routine or environment change can

outburst

✓ Tendency to lose control especially when they feel strange

which results in temper tandrums

✓ Approximately 10 % to 15 % of children exhibits splinter

skills the ability where their performance level are quite high
compared to other area of functioning (ex: excellent memory
in numbers)
Processing characteristics

✓ Difficulty in analyzing and integrating the information

✓ Overselectivity eg (In car focus on only the wheel)

✓ Difficulty in organizing information and environmental cues.

Cognitive characteristics

✓ Difficulty in emotional correction, shifting attention and higher

cognitive functions

✓ Inhibitory response – not observed

✓ Difficulty in theory of mind

Theory of mind refers to the notion that many autistic individuals do

not understand that other people have their own plans, thoughts and
point of view; difficulty in other people beliefs, attitude and emotions
 Speech and language characteristics

Phonological characteristics

✓ Regression may be noted

✓ Unusual and delay in phonological process

✓ Consonant sound is substituted by simple sound ( three is

pronounced as tee)

✓ Deficits in prosody that is the loudness, pitch, stress and resonance

is different from normal typical speakers

✓ Intonation are always monotonous

Semantic characteristics

✓ Poor or well developed vocabularies

✓ Difficulty in using words appropriately in natural situations

✓ Cant comprehend appropriate use of words that can spell anf define

✓ Difficult word retrieval problems

✓ Functional usage is inadequate eg (using a cup the don’t know what

to do – to drink)
✓ Selective
vocabulary present and usage complex verb forms and
growth of vocabulary is slow

✓ Experimental , event , procedural and background knowledge are

present and good
Morphological characteristics

✓ Misuse of markers

✓ Pronoun reversal eg ( instead of you look good they say I look good)

✓ Difficulty in verb ending.

Syntactic characteristics

✓ Comphrends nouns compared to verbs and adjectives

✓ Difficulty in prepositions ; comprehending sentence with

conjunctions , idioms and phrases

✓ Use simple sentence structure ( less complex sentence used)

✓ Echolalia – repeatation of words and phrase said by the speaker or

heard from the surrounding
Pragmatic characteristics

✓ Difficulty in maintaining a topic ; comprehending non – verbal cues ;

paying attention to human voice

✓ Greeting usually absent

✓ Conversation on the topic they like ( keep on talking through listener

like or don’t like) talking without any relationship with that
✓ Difficulty in reading emotions on speakers face; trying to talk
back based on listeners perspective

✓ Situational use of language is difficult ( how to talk with higher

authorities is different from speaking to their mother- they
doesn’t know that)

✓ Difficulty in maintain eye contact.

REFERENCES:

LANGUAGE DISODERS FROM INFANCY THROUGH ADOLOSCENCE

AUTHOR: RHEA PAUL
5TH EDITION
Thank you