Speech and Language Studies (4FHE1049)

CASE STUDY:SPEECH AND LANGUAGE IMPAIRMENT

NOR AFRAH BINTI ROSSAMPLPPIP2011/107/KIC930429016058A4PUAN HAZINA ZAKARIAINTRODUCTION & HISTORYSpeech and language disorders are among the most common developmental problems in childhood. Severe difficulties may restrict the child from social participation and academic achievement and lead to a permanent dysfunction in adulthood (Conti-Ramdsen et al., 2001, Young et al., 2002, Snowling et al., 2006). Children with language disorders have been variously referred to as language disordered, language impaired, language delayed, or as having a specific language impairment. Clinicians tend to use the first three terms; specific language impairment is the preferred term in research publications. A language disorder can be defined as a significant delay in the use and/or understanding of spoken or written language. The disorder may involve the form of language (phonology, syntax, and morphology), its content or meaning (semantics), or its use (pragmatics), in any combination (American Speech-Language-Hearing Association 1993). Phonology is the aspect of language concerned with the rules that govern the structure, distribution, and sequencing of speech sounds. Syntax is the rule system that governs how words are combined into larger meaningful units of phrases, clauses, and sentences. Morphology is the aspect of a language that governs word structure and includes grammatical word inflections that carry tense. Semantics is the aspect of language that governs the meaning of words and word combinations. Pragmatics is concerned with the social use of language. Difficulties with any aspect of language must be in a person's first language in order for language disorder to be considered. Some cases ofspeech sound disorders, for example, may involve difficulties articulating speech sounds. Educating a child on the appropriate ways to produce a speech sound and encouraging the child to practice this articulation over time may produce natural speech, Speech sound disorder. Likewise, stuttering does not have a single, known cause, but has been shown to be effectively reduced or eliminated by fluency shaping (based on behavioural principles) andstutteringmodification techniques.

BACKGROUND OF THE RESEARCHAimsThis research attempts to explore the development of speech and language in children and explore strategies to meet the needs of learners with speech and language difficulties. Further, understand the role of adults in childrens speech and language development and also understand the educational implications of speech and language difficulties or challenges.

Definition & ConceptsLanguage refers to the cognitive set-up of the sounds of a language, the rules for their combination into words and sentences and the meaning behind them. Speech refers to the articulated utterances and the motor act and ability to perform them. Speech and language are mainly used for communication and this term also incorporates the use and understanding of social context and meaning. Language is usually described as consisting of phonology, which means the set-up of sounds and the rules for their combinations into words. It also consists of lexicon, meaning the vocabulary of a language and the meaning of words, which is also referred to as semantics. Additionally it consists of grammar, which refers to the combination of words into sentences, and pragmatics, which means the social use of language, or communication.Children with specific speech and language disorders are those whose non-verbal ability is in the average band or higher and whose skill in understanding or expressing themselves through the medium of spoken language is severely impaired. Their disability is not attributable, however, to factors such as defective hearing, emotional or behavioural disorders or a physical condition. The disorders may involve difficulty with one or more of the main components of communication through spoken language, receptive and/or expressive, such as patterning and production of speech sounds, the message content, the syntax and grammar, or the use of speech in interacting with other people.Speech and language disorders refer to problems in communication and related areas such as oral motor function. These delays and disorders range from simple sound substitutions to the inability to understand or use language or use the oral-motor mechanism for functional speech and feeding. Some causes of speech and language disorders include hearing loss, neurological disorders, brain injury, mental retardation, drug abuse, physical impairments such as cleft lip or palate, and vocal abuse or misuse. Frequently, however, the cause is unknown.

Types of Speech and Language Disordersa) Speech disordersA speech disorder affects the ability to produce normal speech. Speech disorders may affect articulation (phonetic or phonological disorders); fluency (stutteringor cluttering); and/or voice (tone, pitch, volume, or rate). Speech disorders may have their roots in oral-motor difficulties, although some involve language processing problems. Diagnosis is made through speech/language assessment that is performed by a licensed speech/language pathologist. Treatment is by speech therapy.b) ArticulationAphasia is condition characterized by either partial or total loss of the ability to communicate verbally or using written words. A person with aphasia may have difficulty speaking, reading, writing, recognizing the names of objects, or understanding what other people have said. Aphasia is caused by a brain injury, as may occur during a traumatic accident or when the brain is deprived of oxygen during astroke. It may also be caused by abrain tumour, a disease such as Alzheimer's, or an infection, likeencephalitis. Aphasia may be temporary or permanent. Aphasia does not include speech impediments caused by loss of muscle control.c) FluencySpeech impairments where a childs flow of speech is disrupted by sounds, syllables and words that are repeated, prolonged or avoided and where there may be silent blocks or inappropriate inhalation, exhalation or phonation patterns. A fluency disorder, or stuttering, is when speech shows anabnormalnumber of repetitions, hesitations, prolongations, or disturbances in this rhythm or flow. Tension may also be seen in the face, neck, shoulders, or fists. There are many theories about why children stutter. Most experts agree that certain environmental reactions to normal disfluency can result in stuttering.d) VoiceOccur when children have difficulty with pitch, intensity, vocal quality, or resonance. For example, a child might not be speaking in a voice that ever exceeds a whisper. The voice is produced as air from the lungs moves up through and vibrates the vocal cords. This is called phonation. The voice is then changed as it travels up through the different-shaped spaces of the throat, nose, and mouth. This is called resonance. Voice disorders include both phonation and resonance disorders.e) LanguageLanguage impairments are where the child has problems expressing needs, ideas, or information, and or in understanding what others say.f) ApraxiaThe difficulty planning and coordinating the movements needed to make speech sounds.

Characteristics of Speech or Language ImpairmentsSpeech or language impairment is a problem in communication and can refer to a childs language development being significantly below age level. A childs communication is considered delayed when the child is noticeably behind peers in the development of speech or language skills such as stuttering, impaired articulation, language impairment, or a voice impairment, that adversely affects a childs educational performance. The characteristics of speech or language impairments will vary depending upon the type of impairment involved. There may also be a combination of several problems. When a child has an articulation disorder, he or she has difficulty making certain sounds. These sounds may be left off, added, changed, or distorted, which makes it hard for people to understand the child.Leaving out or changing certain sounds is common when young children are learning to talk, of course. A good example of this is saying wabbit for rabbit. The incorrect articulation is not necessarily a cause for concern unless it continues past the age where children are expected to produce such sounds correctly. Fluency refers to the flow of speech. A fluency disorder means that something is disrupting the rhythmic and forward flow of speech, usually a stutter. As a result, the childs speech contains an abnormal number of repetitions, hesitations, prolongations, or disturbances. Tension may also be seen in the face, neck, shoulders or fist.Voice is the sound that is produced when air from the lungs pushes through the voice box in the throat (also called the larynx), making the vocal folds within vibrate. From there, the sound generated travels up through the spaces of the throat, nose, and mouth, and emerges as our voice. A voice disorder involves problems with the pitch, loudness, resonance, or quality of the voice. The voice may be hoarse, raspy, or harsh. For some, it may sound quite nasal; others might seem as if they are stuffed up. People with voice problems often notice changes in pitch, loss of voice, loss of endurance, and sometimes a sharp or dull pain associated with voice use. Some characteristics of speech disorders are noticeably behind other students in speech and/or language skills development, trouble forming sounds (called articulation or phonological disorders), difficulties with the pitch, volume, or quality of the voice, may display stuttering (dysfluency), an interruption in the flow of speech, omits or substitutes sounds when pronouncing words, sounds nasal and voice may have a "whining" quality and has abnormal rhythm or rate of speech.

METHODOLOGYThis research was took place during my School Based Experience (SBE) 3 in Kedah. First, I asked the teacher about the students who have speech and language disorders. The teacher told me that particular student is 8 years old and her name is Nur Husnina Alya binti Nafil. She has four siblings and her father works as a labor while her mother as a housewife. Her academic performance was not good because she has difficulties to communicate with the teacher or even their friends. The teacher has to teach personally to Husninas and use variety of teaching materials according to her ability. Then, I gave the questionnaire to the teacher to fill in regarding about the student behaviour in classrooms. After that, I followed the teacher to enter the Husninas classroom. Then, the teacher introduced Husnina to me. In the classroom, I observed Husninas behaviour. She was really passive in the classroom and did not give co-operation in the learning activities. Besides that, she cannot give full attention in the teaching and learning process because she did not has interest in the subject that has been taught. Then, she likes to move around a lot and did not stay still. After the class ended, I interviewed the student and asked her about her hobby and ambition. Husnina has difficulty to pronounce the words and stutter. When I asked Husnina some questions, she was slow to respond because she did not know the meaning of the questions given to her. Moreover, she occasionally spoke in complete sentences. Then, I asked Husnina to invite her parents to come to the school if they have their free time. The next day, her parents came to the school. Then, I took this opportunity to discuss and interview about her daughter behaviour at home. Her parents stated that Husnina was really taciturn and did not socialize with her siblings. She likes to play alone and always remain silent. After that, I gave the questionnaire to the Husninas parents to be filled in. Her parents gave full commitment and co-operation when we discussed about this problems.

FINDINGSInside the ClassroomThis section has been divided into three sections which are before, during and after. Before the class begun, the student did not talk with the peers and she always moves around a lot and do not stay still. Besides that, she did not make noises or being too loud. She stayed inside the classroom even though the teaching and learning process did not occur. Then, she did not prepare before class such as takes out books and stationary. During the teaching and learning process, she always fiddles and fidgets while listening and need breaks and distractions from the task in classroom. She is very passive in the classroom and seldom asks questions to the teacher. Then, she always uses body or hand gestures while explaining and also uses small notes when asking or answering peers. She always gives up when trying explaining something. Besides that, she has a bland facial expression while listening to others. She did not talk too loud or high pitch voice and always talks with low voice or very quietly. She did not use harsh words when answering the questions and did not has the effort in order to ask for help from others if does not understand the task given. After the classroom, she greets the teacher properly and arrange her belongings appropriately. She did not change her mood suddenly after class is finished and did not continue playing with peers.

Outside the ClassroomHusnina appears frustrated or gives up when struck on words and frequently loses her voices. She did not consistent harsh or hoarse vocal quality. She also has nasal quality when speaking and did not always sounds like having a cold. She tends to speak in short and simple sentences and always interact in passive ways with peers. Besides that, Husnina always seem fidgety and restless and did not always being hyperactive. Then, she always uses body or hand gestures while explaining instead of speaking. Further, she did not always have a bland facial expression while listening to others. She always stutters while speaking or explaining to peers all the time. Moreover, she did not ask help from peers to speak on her behalf and whispers to peers instead of speaking. Then, she acts very shy when meeting unfamiliar person and did not avoids conversation with unfamiliar person. Husnina usually nods or shakes head when implying yes or no as an answer.

Interview and QuestionnaireStudentThe student that I have interviewed is Nur Husnina Alya binti Nafil who is study at Sekolah Kebangsaan Seri Gedong, Sungai Petani, Kedah. She is 8 years old and her first language is Malay. She has 4 siblings and she is the younger ones. She did not always communicate with her family and she find it is hard to communicate with friends and teachers. She claimed that her friends always respond to her when she tries to communicate with them. She also find it is hard to use appropriate words to express the ideas. Besides that, she did not always respond to instruction correctly. Further, she often takes time in understanding certain instructions or conversations. She also ever thinks of giving up in learning due to her speech and language disorders. Her parents did help her with the homework at home. Then, her parents always support and encourage her in communication. She did not prefer to speak or express her feeling rather than keep it to herself. Husnina always think that she need someone to help her to understand better and at the same time she always think that she need someone to improve her conversations. The things that she usually talk about with her siblings is about herself regarding her problems in speech and language. She also seldom shares her experience at school with her siblings because she likes to remain silent. The next is she did have a problem to complete the sentences during expressing her ideas and sharing her thoughts. Sometimes she also quarrels with her siblings and pinches them without use bad words. Her parents always try to correct the mistake that she have done during her speech. Further, her parents also encourage her to speak more but she prefers to listen to others rather than to speak. She feels comfortable when speak with her family members and feel fearful when speak with a group of friends. Besides that, she will feel anxious when communicate with one friend. The speaking situation that she will avoid is when her family or friends ask about the subject that has been taught. The strategy that she will use to get through a disfluent moment is by avoiding the situations and plays alone.

TeacherThe teacher that I have interviewed is Puan Azura binti Marzuki. She is 33 years old and has the qualification under graduated from Universiti Malaya. Her major subject is English. Her works experience in Sekolah Kebangsaan Seri Gedong for almost 9 years. She is the classroom teacher of 2 Dedikasi which is Husninas class and she has been observed about Husninas behaviour for almost 1 years. She is the teacher who is in charged for enrichment class. The hardest thing to teach Husnina is she always has a difficult time following spoken directions. According to Puan Azura, Husninas voice is usually soft and frequently stutters when speaking. Further, she claimed that Husnina has problems with her voice like hoarseness, nasal and breathy. Husnina also like to use excessively um, uh, you know and a when speaking. During Puan Mazura an observation regarding Husninas interaction, Husnina is seldom interacts with peers. However, the other students react nicely to Husninas speech. Besides that, Husnina is not sensitive than most children but she will getting upset easily if she cannot do something well. Husnina never use dirty words when she upset and she will avoid talking in a group, making oral reports and answering questions in class. Puan Azura stated that Husnina will not always excited while doing activities and she did not expressed concern about her speech errors. Puan Azura also said that Husnina has spelling problems due to articulation problems and her voice cannot be heard clearly. According to Puan Azura, she needs to make special preparation before class according to Husninas learning styles and abilities in order to make the teaching and learning process become meaningful and not bored. Puan Azura also give strategies to overcome the students who have speech and language difficulty which are used step by step symbol or picture cards, clear verbal explanations and break down tasks and instruction into manageable. Puan Azura also clarified that there is obstacles that she had faced while dealing with this particular students which are lack of interest to study and cannot give full attention and co-operation the teaching and learning process. Puan Azura also made an adaptations to her lesson plan to fulfil the needs of students with speech difficulty by providing different kinds of teaching materials according to the students ability, interest and learning styles such as picture books and flash cards.

ParentsThe heir of the student that I had interviewed is Husninas father, Nafil bin Kassim. He is 48 years old and works as a labor. Her father was stopped by at the school when I said to Husnina that I would like to meet her personally. Her fathers academic level is SPM level and he is from a poor family background. His wife did not work so he has to bear the cost for his family all alone. From his observations, he said that Husnina enjoy going to school. He also always keeps in touch with the teachers at school regarding her daughters behaviour and academic performance. According to Encik Nafil, his daughter achievement at school is moderate. Husnina never have friends at school that she always talks about. Encik Nafil did encourage her to socialize with people around her. Then, she did not have closed relationships with other siblings and did not share her problems with the siblings. Encik Nafil also said that Husnina always quarrel with the others when they are gathering at home. However, Husninas other siblings always help her to teach or to help her to communicate her needs. The problem that she usually shares with Encik Nafil is about her. Encik Nafil also always repeats the words during giving instructions to Husnina and it do really take a lot of time to communicate with her. Further, Encik Nafil said that he realised that his daughter has speech disorder and there is other family members has the same disorder as Husnina. He also clarified that he did not know any specialist to be referred regarding this disorder. Encik Nafil will allocate his time to interact with his daughter. During the process of communication withing the family, Encik Nafil noticed that Husnina take part passively and in order to overcome this problem, Encik Nafil will ask Husnina some questions that will catch her attention such as about giving the suggestion for having a picnic. Besides, Encik Nafil stated that Husnina do have strong interest in drawing. Encik Nafil also detected that Husnina will get frustrated when she fails to communicate her needs.

SUGGESTIONSTeachersA speech disorder refers to a problem with the actual production of sounds, whereas a language disorder refers to a difficulty understanding or putting words together to communicate ideas. The teacher should know the ways to overcome speech impairment and how it affects the students communication abilities. The strategies for teaching and learning for speech impairment is first by teach an understanding of words and concepts through the use of actual objects and progress from the concrete to the abstract. The teacher also can use a slower speech rate if necessary as this facilitates the processing of information. However, it is important that the speech rate is not so slow as to lose the continuity of the message. Then, use pictures or photographs to reinforce and review the vocabulary that has been taught and use role play as a regular feature of language learning as this helps alternate speaker roles. Further, the teacher also has to variety the teaching materials by conduct activities such as conversations, discussions, radio or television broadcasts, puppetry, telephoning, reporting, interviewing, telling riddles, book reports and role playing can be used to develop oral language activities.

ParentsLearn the specifics of their childs speech or language impairment. Parents can read the same story book again and again before the bedtime or any leisure time. This is because the repetition will help the child to learn language. Besides that, always keep in touch with the childs teachers. Always up to date on the child development in school. Moreover, use simple sentences and instructions when speak with the child as it will reinforce key words. Be well informed about the speech-language therapy of their son or daughter is receiving. Talk with the specialist, find out how to augment and enrich the therapy at home and in other environments. Then, listen to the child. Dont rush to fill gaps or make corrections. Conversely, dont force the child to speak. He/she may feel demotivated. Lastly, try to give the child chores. Chores build confidence and ability.CONCLUSIONSpeech and language impairments include a variety of conditions that interfere with communication. Many of these disabilities are relatively rare or subtle in appearance, and the individuals lack of any visible abnormalities may further disguise speech and language impairments. The field of speech-language pathology is diverse and complex. Only a speech-language pathologist can accurately and thoroughly diagnose and treat speech and language impairments. These professionals are available in the public schools, hospitals, university clinics, or private practice clinics. A child with this problem should be help as soon as possible with an appropriate style and ways. In this circumstance, parents and teachers play a very important role as they the closest person to the child. Parents should be more aware of their children problem and spend a quality time with them. As a teacher, he or she need to variety the teaching materials in order to make the teaching and learning process become more meaningful and grab the child attention to learn.

REFFERENCESAsha.org, (2014). Speech and Language Disorders and Diseases. [online] Available at: http://www.asha.org/public/speech/disorders/ [Accessed 9 Apr. 2014]. Chicagospeechtherapy.com, (2014).Speech Therapy Tips: What Should Parents of Children with Auditory Processing Disorder Do? | Chicago Speech Therapy, LLC. [online] Available at: http://www.chicagospeechtherapy.com/speech-therapy-tips-what-should-parents-of-children-with-auditory-processing-disorder-do/ [Accessed 9 Apr. 2014].Kidshealth.org, (2014).Speech-Language Therapy. [online] Available at: http://kidshealth.org/parent/system/ill/speech_therapy.html [Accessed 9 Apr. 2014].Med.umich.edu, (2014). Speech and Language Delay and Disorder: Your Child: University of Michigan Health System. [online] Available at: https://www.med.umich.edu/yourchild/topics/speech.htm [Accessed 9 Apr. 2014]Nichcy.org, (2014).Speech and Language Impairments in Your Classroom: 8 Tips for Teachers National Dissemination Center for Children with Disabilities. [online] Available at: http://nichcy.org/s-l-i-8-tips-for-teachers [Accessed 9 Apr. 2014].Speech And Language Difficulties (Sp&LD) | Speech And Language Difficulties (Sp&LD) | Sensory Difficulties | The Good Schools Guide [online] Available at: http://www.goodschoolsguide.co.uk/help-and-advice/special-needs-advice/types-of-sen/sensory-difficulties/206/speech-and-language-difficulties-sp-ld [Accessed 9 Apr. 2014].

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