Fund fonoaudiol
Law 20201
- This Act amends DFL No. 2 of 1998, Education, on grants to schools and other statutory bodies.
- Changes the concept of Basic General Education Special Education Special Differential Differential.
• Wide the concept of Special Needs Education to Education Media Humanistic-Scientific. (Temporary SEN).
• Explain the concept of SEN as those non-permanent Temporary requiring students at some point in their school life as a result of a disorder or disability diagnosed by a competent professional, and need extra help and support to enter or progress in the curriculum for a certain period of schooling.
• This Regulation will consider attentional deficits and specific language disorders and learning.
• Explain the term competent professional. - L be explicit that i nhábil professional for diagnosis of revenues and expenses.
· Clarify the penalties they will suffer the professional authority to carry out fraudulent diagnoses, and the holder that you use for school subsidies. - Modifies and increases school subsidies for special schools.
- Finds that for basic pre-school pupils. requiring primary or secondary remain hospitalized in specialized centers or at the place determined by the attending physician or who are ambulatory medical treatment, the Ministry of Education will provide the appropriate attention in school rather than by prescription must remain
Decree 1300-1302. Based on DSM-IV are defined as children or children with SLI those with a late onset or slow development of speech that is not explained by a sensory deficit, auditory or motor, mental deficiency, mental diseases and disorders by massive development , social withdrawal or emotional injury or brain dysfunction evident. The TEL fall into expressive and mixed (receptive-expressive).
TEL EXPRESSIVE
(A) low scores on standardized tests of expressive language relative to receptive language. Receptive Language normal or slightly altered. The clinical manifestations are extremely limited vocabulary, errors in verb tenses, difficulties in memorizing words or producing sentences in length and complexity appropriate to their age.
(B) The expressive language difficulties interfere with academic or occupational achievement or social communication.
(C) Does not meet criteria for disorder Mixed receptive-expressive language or PDD.
(D) If mental retardation, motor or sensory deficit of speech, or environmental deprivation, poor language to exceed those usually associated with such problems.
TEL JOINT Joint Disorder Expressive Receptive Language:
(A) Scores of developmental assessments of receptive and expressive language, are below those obtained from assessments of nonverbal intellectual capacity. Symptoms are themselves expressive language disorder, as well as difficulty understanding words, sentences or specific types of words, such as spatial terms.
(B) The deficiencies of receptive and expressive language significantly interfere with academic or occupational achievement or social communication.
(C) Does not meet criteria for PDD.
(D) If mental retardation, motor or sensory deficit, or environmental deprivation of speech, the language deficits in excess of those usually associated with these problems.
ETIOLOGY
– Cause unknown and controversial.
– Possible genetic and hereditary links.
– Possible changes related to brain structures related to alterations in information processing in the brain.
– Possible change in the perception of auditory information.
EVALUATION
Clinical Observation
Application History and Interview parents and / or teachers. Analysis of the data compiled for a later diagnosis.
Set physical changes and make a general observation of the structures of the OFA.
To analyze possible changes in a sample of spontaneous speech and not just through the Test.
By observing establishing the existence of patterns
appear to be erroneous, however, may be normal in
special situations (speed of speech, sociocultural, etc.)..
You must always consider the child’s age and its evolution.
It establishes the child’s behavior at the assessment and socio-communicative interaction.
Evaluation
Children under 3 years
- Psychomotor Development Test (TEPSI). Subtest consists of 3 / subtest coordination / subtest language / motor subtest
Test to assess phonological simplification processes TEPROSIF-R (PFS) Test of Chilean origin, created by the speech therapist and Linguist Maggiolo Mariangela Maria Mercedes Pavez, in collaboration with a group of students in the career of audiology at the University of Chile, between 1989 and 1990. It is based on the theory of Natural Phonology from the work of Stampe (1969) and Ingram (1983). It is updated in 2008 giving rise to TEPROSIF.R. Phonologically responses are transcribed the child. This version uses a sample of 620 children of III, IV, V, VII and MR regions, with input from speech therapists of these reg ions GENERAL STRUCTURE OF THE TEST
Set of pictures: 37 black and white drawings. / Blades: consist of a sheet with two drawings, one above and one below. The first is created to give an example for the child and the second elicited words. / Answer Sheet: contains data for the child, and the items of verbal stimuli, next to each transcribed phonetically expressed by the lower. Then there are 5 columns, 3 for the identification of the PFS, 1 for the total and 1 for other answers. / Sheet Analysis: created to simplify the analysis of the test.
Understand the strategies … PFS as in the normal development of phonology, which children use to simplify their speech to be gradually phased out in along the stages of development until the child achieves a production similar to the adult .
APPLICATION OF THE TEST
They should discard the joint problems.
The test is applied individually, under conditions suitable for an evaluation.
The examiner should be familiar with the test.
The examiner applies the test to the child sitting next to the set of sheets in front of them.
Instructions: Look I’ll show you some pictures and say something about them. In the picture above I say a complete sentence and when you show the bottom you complete the sentence.
Such sheets are used to familiarize the child with the test.
It is necessary that the child understood the instruction to continue the test.
It is important that the examiner should be clear that elicit the words NO direct imitation
Always seek the full implementation of the test.
Do not apply the test when the child has a speech unintelligible, since analysis difficult.
In the case of making sweeping, analyzing the initial 15 items and notes if the child has problems or not by comparing the total PFS proposed rule for him.
In the event of problems, you must perform the entire test.
ANALYSIS OF RESULTS
To facilitate the analysis can be the child’s responses recorded.
You must carefully analyze each expression of the minor classified into 3 types of processes.
A general way every process within an emission equivalent to a point.
If the answer does not fit with the types of PFS is considered another response that can be NR (no response), NT (not transcribed), OP (another word), PNI (processes unidentifiable), PNC (processes not classifiable in the categories proposals). These responses are scored.
STANDARDS AND INTERPRETATION OF RESULTS
3 are considered performance levels: normal, at risk and deficient.
We must remember that the fewer the better the performance PSF of the child, much less the PSF child’s performance.
Performance standards are classified by age group.
· Test exploratory Spanish grammar A. Toronto (Comprehension – Spanish Grammar Expression)
· Test for auditory language comprehension E. (Comp-Morphology – Syntax – Semantics)
Children older than 6 years 11 months
- LVET-R: Picture Vocabulary Test
- Illinois Test of Psycholinguistic Abilities (ITPA) (evaluates to children 3
Assessment Guideline for School speech therapy (PEFE) / For children ages 7 to 12 evaluates the semantic level and Level M Sample Language orfosintáctico
· – Evaluate the expression of the minor
· – You can perform a detailed analysis of the child’s language
Children under 3 years
Scale for the Emergence of Receptive Language – Expressive (REEL)
· Evaluate from 0 months to 36 months
Children over 11 years
Procedures for Evaluating Speech (plot) Evaluates mainly adolescents / Evaluate Semantic skills related to speech / Evaluates Description / Narrative Guideline Evaluates Comparison of pragmatic skills, based on Tattershall
Test of Articulation of Repetition (TAR)
Diagnosis:
– Analyze data collected on history, standardized tests, test for articulation, informal guidelines, clinical observation.
– Always consider the age range of children and their developmental stage.
Normal – Abnormal
– Establish differential diagnosis
-Make appropriate referrals in cases that merit it.
Set-associated alterations
– Communicating the diagnosis to parents, multidisciplinary team, teachers of the child.
To inform and explain to the family the meaning of the diagnosis.
-Provide guidance to the family in relation to the possibilities of schooling.
Decree 1300-1302
– Enacted on December 30, 2002.
-Approves plans and programs of study for students with specific language impairment.
-Born from the Organic Constitutional Law on Education and the Law of Integration for People with Disabilities.
– Replaces Decree No. 192/97 related to the care of children with communication disorders primary, secondary, acquired and speech development.
– Regulates the attention of students in special language schools and TEL PIE
-Set the task phonoaudiological.
-Set the pedagogical work.
§ Normalize ingress and egress of children with SLI
§ Set Specific Curriculum for students with SLI.
§ Attention should be performed in speech therapy sessions of 30 minutes, individually or in groups of up to 3 children (as).
§ Indicates how conditions in the differential diagnosis
-Mental deficiency
– Hearing loss
Deaf-
– CP
– Serious disturbances in the relationship and communication capacity to alter social adjustment, behavior and individual development
– Voice alteration
§ states that any assessment must be conducted with the permission of parents or guardians
Change in the decree 170
Functions of the audiologist 
Speech therapy assessment 
Assessing children over 6 years
Instructions on care of children with specific language disorders.
· The tests used must conform structured according to the statement in the regular No. 0610 and in the ACT 1300-1302
• In the case of students whose ages exceed those in the test set forth in the Education Act No. 1300-1302, it is suggested that the evaluation procedure includes the following elements:
a) detailed history and complete.
b) Clinical Observation, including aspects such as physical characteristics of the child, anatomic characteristics of bodies fonoarticulatorios description of the child’s behavior, type of communicative interaction.
c) Records of language that consists of a written transcript of spontaneous speech and narrative of the child. To that end, must include a record of at least 1 page.
d) A Protocol consigning pragmatic elements relating to the handling of language.
e) To supplement and confirm the diagnosis will be necessary to apply formal tests such as the Illinois Test of Psycholinguistic Abilities (ITPA) or other (s) is (are) appropriate (s) for the age range of children who evaluated.
f) Likewise, you will need information on performance at the phonetic-phonological, which is necessary to perform and record a sweep joint.
Instruction No. 610
– It is for April 2005
– Clarifies and reiterates aspects of Decree 1300-1302 for proper application.
-Explains criteria for admission, admission diagnosis, professional accreditation of the audiologist, health teaching, graduation of students, roles of professionals involved, the specific plan development, integration of children under 3 years and children with cleft palate and TEL.
-Describe the role and workload of professionals specializing in speech-language pathologist and teacher language.
§ Clarifies that the diagnosis of income must apply at least 2 instruments to assess one another for understanding and expression
§ Explain to be delivered to the family a report to parents explaining the box TEL including suggestions and activities for home
§ Sets the accreditation of professional speech pathologist, ie it must be registered at the regional level in the corresponding SECREDUC.
§ The audiologists with foreign qualifications must be validated in the U. Chile.
Sets a mathematical formula for the number of hours of speech-language pathologist 
ACT 170
– Enacted in August 2009
– Use the CIF criteria to establish diagnoses.
– This regulation lays down the rules, instruments, diagnostic tests and the profile of and competent professionals to be applied to identify pupils with SEN (…)
– Clarification of the term SEN
– Emphasis is the diagnosis made by a competent professional
– Integrate new impairments and disabilities such as Specific Learning Disorders, Attention Deficit Hyperactivity Disorder with and without, Deaf-Blind Services included in Multidéficit, Multidéficit.
– Clarifies conceptualizations related to these alterations.
– Amends Decree 1300-1302
§ Emphasize the use of evidence of a national standard, current, valid version. He adds that in the evaluation must consider the application of educational tests that are related to curricular learning of the child evaluated.
§ Sets the diagnostic evaluation will be recorded in a single form supplied by the Ministry of Education.
§ In case you need more background of the child should be referred to appropriate specialists and record such information in the Form One
§ It provides that the competent professional is one who is enrolled in the National Registration System Professional Special Education Evaluation and Diagnosis and meets the professional skills by order established by the Ministry of Education.
With respect to TEL
It uses a new definition according to CIF, and provides definitions of the DSM IV-R classification. 
Data Annexes 
Classification of Language Disorders
ž There are a variety of classifications of speech disorders, which are due to different types of thoughts and inclinations of their authors.
žAlgunas rankings are based on the severity of the pictures, others in the age of onset and some in their symptoms.
Zen Chile, the law defines the TEL as classification criteria based on DSM IV and ICD-10
Ingram 1970
ž The classification is based on the severity of the paintings from grade I to IV.
Zesta classification was used by the language schools under Decree 192.
Description Severity Level I Mild delay the acquisition of sounds in words. Language Understanding normal normal. Expressive language performance than chronological age. Grade II Moderate more severe delay in acquiring the sounds of words and language development. Understanding normal. Semantic deficit. Syntax altered. Abundant pragmatic imperatives and “verbal gestures” wake-up call, poor little initiative and start conversations. Severe Grade III even more severe delay of the acquisition of sounds and language development. Difficulties in understanding. Delay important semantic and syntactic level. Pragmatic conversation focused on itself, the pragmatic adjustments to the situation or the speaker is poor. The thematic coherence is unstable. Grade IV Very Severe Great developmental disorder of spoken language. Difficulty in understanding language and meaning of other sounds. Deafness often apparent. Rapin and Allen 1983-87
z Use a clinical approach and is widely used by therapists because of its practicality.
Alteration Programming Description Phonological deficit is relatively normal comprehension, but in this case there is a flow of production, but with little clarity, making it almost unintelligible to those children. It is notable quality improvement in articulatory repetition tasks of isolated elements (syllables, short words) is not observed when it comes to long words or phrases. Phonological-syntactic deficit corresponds to “dysphasia” and these subjects have aunderstanding that expression, but have difficulty understanding when the statement is long, including complex structures is ambiguous, is presented out of context or simply is issued quickly. In speech, highlighted the difficulties of articulation, fluency, and above all, learning and use of links and morphological markers. In some cases, the training itself is sequential statements laborious. Syntactic Lexicon deficit within the delay will exceed its alterations in pronunciation, but have great difficulty of evocation and stability of the lexicon. The understanding of single words may be normal or nearly normal, but not the sentences. There was an abundance of “catch phrases” disruption, paraphasias, in a great difficulty in maintaining the sequential order and use the morphological statements when they have to express complex than the simple dialogs. Agnosia Auditory Verbal The subject does not understand the language but can communicate with natural gestures and their expression is zero or near zero, even in repetition, is a picture comparable to those described under the names of mixed congenital aphasia or word deafness. Verbal Dyspraxia (Speech Disorder) The subject has an understanding normal or nearly normal, but with great difficulties in organizing articulation of phonemes and words. It affects prosody. The statements are limited to one or two words, difficult to understand. Not improve in repetition tasks. In its extreme limit, the subject is completely dumb in this case would be comparable to the paintings of congenital aphasia expressive. Semantic-pragmatic deficit The subject may have early language development within a relatively normal and free of significant problems of speech. His statements may also appear as well developed. However, they suffer great difficulties in understanding, coming to the event that the level of expression is more than understanding. Above all, stresses the need to adapt their language to the interactive environment, the pragmatic adjustments to the situation or the speaker is poor, the thematic coherence can be unstable and echolalia or perseverations.
Summary Rapin and Allen classification 
Le Heuzay, Gerard and Dugas 1990
Is an adaptation of Rapin and Allen from the model of brain function Crosson
Syntactic Description Phonological Disruption Syndrome Better understanding speech. This appears to be very small, laborious and often unintelligible deformed unstable. Agrammatism resistant. Good information value of utterances. Lexicon smooth small but evocative. Phonological Production syndrome expressive difficulties predominate, but in this case the expression is quite smooth although uncontrolled and often unintelligible, even in repetition. Disorders of syntax problems chronological organization. Difficulties in recall. Receptive dysphasia Severely impaired understanding, despite surface expression develop in a natural situation in context, but with seriousproblems of naming, phonemic paraphasias and syntactic disorders in situations addressed. 
Comment …
ž Crosson (1992) Neurolinguistic Model propouso involved in structures like:
– Thalamus
-Based cores
-The anterior portion of Broca’s area
VLOS pulvinar nucleus and ventral anterior thalamus is connected to Wernicke’s area. All these structures would be involved in semantic analysis.
vlas thalamic anterior structures (NVA), inhibition of the globus pallidus and caudate nucleus stria up circuits involved in the verbal flow and the sequential organization of sentences.
DSM-IV 
Specific language impairment
DEFINITION
– According to Benton (1964): developmental disorder characterized by severe problems of expression and language comprehension in the absence of hearing loss, mental retardation or emotional disturbance
-ASHA: American Speech-Language-Hearing Association (1980): Abnormal acquisition or expression, comprehension of spoken or written. The problem may involve all, one or some of the components (phonological, morphological, semantic, pragmatic) of the linguistic system. Frequent problems with language processing or abstraction of meaningful information storage and retrieval of memory.
They consist of a hard-lasting, of varying severity for the processing of language, which can not be attributed to mental retardation or sensory or motor deficits. (Rapin and Allen 1983, Bishop 1987, Leonard, 1998; Aguado, 1999; Chevrie-Muller, 2001).
Criteria
Currently using an exclusion criterion for the diagnosis of SLI, as it is considered that this language disorder can not be explained by alterations associated (Rinkert, 2006).
ž 25 dB hearing level in conversational frequencies.
ž normal emotional and behavioral indicators.
ž superior performance IQ 85.
ž No signs of neurological disorder.
ž normal speech motor skills.
ž Linguistic ability: Score on tests of language – 2 standard deviations or lower
Linguistic features of the TEL
ž Phonology:
– They have altered the normal development of phonology, which results in the presence of PFS exceeding those expected for their chronological age (failure to initial unstressed syllables, errors of substitution and assimilation).
Difficulties in understanding speech.
A child at the age of 6 years should have a full development of phonology.
-Children should not have difficulty in articulating the phonemes.
Phonological Process Simplification (PFS) or Phonological Process Simplification (PSF) based on the theory of Natural Phonology (Stampe, 1969; Ingram, 1983):
– Are part of the language development of children.
-Function as rules or systematic strategies for reducing the complexity phonological words.
‘This theory states 3 types of PFS
a) Related to the structure of the syllable
b) Replacement
c) assimilation
FEZ child simplifies emissions by reducing the basic syllabic structure of the word.
structure žSimplificación CV or CV + CV: Deleting syllable final consonants, consonant clusters or diphthongs reducing, altering the geometry of the word.
TRAIN = / ten /
BRIDGE = / pente /
BANANA = / plántantano /
PANTS = / patalón /
BUTTERFLY = / mops /
UMBRELLA = / Umbrellas /
PFS types of syllabic structure
-Reduction of consonant cluster.
-Reduction of diphthongs.
Omission of consonant-Trabant.
-Coalescence Failure unstressed elements.
-Omission of syllable.
-Addition of phonemes or syllables.
-Investment of phonemes or syllables.
PFS Replacement
žConsisten to change phonemes belonging to a class by another class of phonemes.
Eg fricatives by occlusive
/ Poka / by / foka /
Other examples:
Home / Kapha /
Suitcase / naléta /
Pasto / Paht /
Canto / Kahta /
Guitar / Gitara /
Phone / telésono /
Replacement PFS rates
-Processes affecting the syllable phonemes lock (aspiration) eg / avocado / / Paht /.
-Processes by area of articulation: labial and dental posteriorización of eg / Scarf / / kufánda /; of palatal and velar frontalization; rounding consonants.
-Processes by mode of articulation: Oclusivización fricative or affricate phonemes, phoneme Fricativización occlusive or Africa; fricatives together. eg / mat /, / alsómbra /.
Process according phonation, articulation or quality: Sonarización of consonants Afonización or loss of sonority of consonants.
-Processes as fundamental trait: phonemes liquid / illiquid: Semiconsonantización phoneme liquids Susutitución of liquid phonemes together …
-Process according to additional resonance: Nazalición phoneme …
-Processes affecting the vowel phonemes: Replacement of vowels or dissimilation.
PFS. Assimilation
Involve replacing phonemes to make similar or identical to others present in the word.
Example:
Truck / kanionéta /
Phone / tenéfono /
Clock / lelóx /
Bed / breast /
Shoe / Cover up /
PFS rates Assimilation
Assimilation-identical: eg / Scarf / / bubánda /
-Assimilation by similarities: eg: Lip, dental, palatal, watch, liquid phonemes assimilation, assimilation nasal vowel assimilation, assimilation syllabic
TEL Features
žSemantics:
– Evidence of a slow acquisition of words and meanings, showing a reduced vocabulary in relation to their chronological age.
– Delay in acquisition of first words.
– Delay the lexical explosion at 18-24 months.
– Difficulty to use words they already understand.
– Use of wildcard or general words words instead of words more specific.
– Flow of discontinuous speech with pauses, interjections and repetitions.
– Difficulties in lexical access
Morphosyntax
ž Morphology:
– Omission of plural morphemes, verb inflection and omissions of articles, verbs, auxiliary and copulative.
-Confusion between the singular and plural forms of words.
žSintaxis:
– Very short Productions
– Few changes.
– Low number of complex sentences.
– Low range of sentences.
ž Pragmatics:
– A few comments about people or events.
– Difficulties to describe facts.
– Lack of interaction with adults, limited to shifts
– Limited use of gestures.
– Passivity in the conversation and inappropriate use of speech turn.
– Difficulties to keep the topic of conversation.
– Difficulties in the use of discursive and narrative strategies.
– Great difficulty interacting with peers
TEL assessment in speech therapy
– Clinical Observation:
– Anamnesis
– Establishing Rapport
– OFA
– Sweeping articulatory
Hearing Screening
Child Anamnesis
You should consider:
– Reason for consultation.
– Personal history of the child
– Aspects of child development
For example: birth history, psychomotor development, major diseases, etc..
-Language Development
Family history-eg, relationships with family, friends, siblings with similar symptoms.
-School history
-Other relevant observations (power)
Rapport
It is essential to achieve an appropriate approach at the lowest to be evaluated and opportunities that children manifest shy to strangers.
Rapport should be carried out in a natural environment, trying to draw attention of the child.
You can use themes of interest to you as cartoons, toys or objects striking
OFA evaluation
ž should try to be as traumante or invasive to the child.
ZSE should explain to him and his parents to be performed and which tools will be used.
ZSE fonoarticulatorios evaluate all organs.
Sample žProtocolo
Articulatory Sweep
ž Objective:
– Evaluate the articulatory repertoire of a child.
-Evidence of a phoneme inconsistencies.
– Evidence or rule dyslalias.
In Chile, using the TAR and TAS, a simple test requires the child to repeat words, no age limit, it is quick and easy application.
Evaluate direct syllable phonemes, middle, end, and Trabant, also diphone vowels, consonants and sentences of varying geometry.
See TAR-TAS protocol
TAR Application
– Directions:
I’ll say a few words and then I want you to repeat them.
If the child is shy or worried about the answers is added:
Do not worry, no matter how well you can not say them.
Hearing Screening
– It is done to rule out hearing impairment.
He performed in natural context
He made 3 tests:
-Whispered voice (whispering or murmuring)
Voice-normal
High-intensity-Voice
Concomitant alterations
– Dyslalias
In many cases, children with SLI have dyslalias or articulatory inconsistencies.
Learning-disorders
Without a proper development of the language, you can alter the acquisition of literacy and mathematics difficulties.
Reading and learning can be affected in children with SLI (between 40 and 70%).
Difficulties in attention-concentration
In some cases, children with SLI demonstrate difficulties sustaining attention and concentration during the activities.
Differential Diagnosis
– Phonological Disorder
Simple language-delayed
The child with a phonological disorder programming although it has a delay in sequencing and articulation of the phonemes with respect to their age, also produces phonological forms that are not present in younger children.
Language disorder
– Monfort and Juárez are concerned that the fluidity of these children is higher than those with TEL expression.
-Narbona says the changes are not systematic phonics, phonemes can be altered in words repeated correctly in isolated syllable, the difficulties increase with the length of the word, a word can be altered differently each time.
-Dodd and McCormack (1995) made the following classification of phonological disorders:
– Consistent deviant disorder: All processes can be described in terms of one or more rules. These rules can coexist with any rules delayed or not appropriate to age. The child uses one or more rules facilitating deviant, but they do not vary but the linguistic change. Dodd and McCormack think that in this case there is a deficit of phonological awareness.
– Disorder inconsistent: In this case can not be identified phonological facilitation rules, although these errors can result from complex inconsistent phonological rules. The child varies in pronunciation of a word.
– Phonological Disorder according to DSM IV:
– (A) Failure to use developmentally expected speech sounds and language to the age of the subject, eg.: Errors in the production, use, representation, or organization of sounds.
– (B) deficiencies in the production of speech sounds interfere with academic or occupational achievement or social communication.
– (C) If a mental retardation, motor or sensory deficit of speech, or environmental deprivation, poor speech exceed those usually associated with these problems.
Simple language delay
– According to Juarez and Monfort (1992), is a delayed onset of language levels that primarily affects the expression and that no deficit is explained by intellectual, sensory or behavioral.
Theoretically respected the mechanisms and evolutionary stages of normal development, but with a lag
– Features:
– Appearance of the first words after 2 years (instead of 12 to 18 months).
– First combinations of 2 or 3 words at 3 years (instead of 2 years).
– Persistence of numerous phonetic difficulties, failure syllables after 3 years.
– Limited vocabulary, fewer than 200 words spoken at 3 years.
– There is an improvement with age and total resolution of about 6-7 years.
– It differs from the TEL, since in this disorder are more persistent, lasting at school age and still a teenager, being accompanied by other disorders that compromise neuropsychological especially attention, memory and graphomotor function.
Differential Diagnosis
Slurred speech
-Dyslalias
-Stuttering or Espasmofemia
Dyslalia
Are alterations in the articulation of phonemes, which can be:
– Evolutionary or physiological dyslalias:
– There is a phase in the development of language in the child / not well articulated or distorts some phonemes.
– Usually disappear with time, professional intervention is necessary.
– It usually causes anxiety to parents who think it is a more serious delay.
Audiogenic dyslalia:
– Is a disorder in articulation of phonemes produced by a hearing deficit.
-Often associated with hearing loss, often concomitant with changes in voice and rhythm.
Organic dyslalia (diglossia)
– It is a joint disorder of phonemes by alterations in peripheral organs of speech and central neurological origin.
– Etiology
– Malformations bucofonador musculoskeletal apparatus.
– Eg cleft lip, cleft palate, cleft ensure, macroglossia, malpositioned teeth and jaws, among others.
Functional dyslalia
– Changes in the articulation of certain phonemes as a result of poor coordination of the OFA is necessary to articulate them.
-There is no physical or organic disorder, but a functional disability.
-The most frequent functional dyslalias in terms of phonemes that are affecting the sigmatismo (defect of the phoneme “s”); lambdacismo (defect in the phoneme “l”); rhotacism (defect in the phoneme “r” and “rr”); gammacismo (defect in the phoneme “g”, “k” and “j”); deltacismo (defect in the phonemes “d” and “t”).
-When alterations include large numbers of consonant and vowel phonemes, sometimes unintelligible verbal output (multiple dyslalias).
Stammer
ICD-10 criteria for the diagnosis of stuttering
-A. Impaired flow and normal temporal organization of speech (suitable for the subject’s age), characterized by frequent occurrence of more of the following phenomena:
-1. repetitions of sounds and syllables
2. prolongations of sounds
3. interjections
4. fragmented words (eg., pauses within a word)
5. audible or silent blocks (pauses in speech)
6. circumlocutions (word substitutions to avoid problematic words)
7. words produced with an excess of physical tension
8. monosyllabic word repetitions (eg., “I-I-I see”)
-B. Altering the flow interferes with academic or occupational achievement or social communication.
-C. If a motor or sensory deficit of speech, speech impairments are higher than those usually associated with these problems.
Differential Diagnosis
Psychological Disorders
Selective mutism,
Attention Deficit Syndrome, s / c Hyperactivity
Selective mutism
ICD-10 criteria for the diagnosis of selective mutism <http://www.psicomed.net/cie_10/cie10_F94.html>
A. Persistent inability to speak in specific social situations (which is expected to speak, for example. At school) despite speaking in other situations.
B. The disturbance interferes with work or school performance or social communication.
C. The duration of the disturbance is at least 1 month (not limited to the first month of school).
D. The inability to speak is not due to a lack of knowledge or fluency in spoken language required in the social situation.
E. The disturbance is not better accounted for by the presence of a communication disorder (eg., Stuttering) and does not occur exclusively during the course of a pervasive developmental disorder, schizophrenia or other psychotic disorder.
Attention deficit
– The attention deficit disorder (AD) is a condition that causes changes in attention span and concentration and occurs in children / as with normal intelligence. May or may not appear associated with hyperactivity and impulsivity. What characterizes the child with ADHD is increased frequency and intensity of these behaviors when compared with peers the same age.
-The attention deficit can have consequences: children’s school performance (a) (failing grades), and / or development of personality (low self-esteem, feelings of futility and frustration), and / or
social integration (difficulty
interact with others, isolation, problems
discipline, social rejection and discrimination).
Differential Diagnosis
Severe Communication Disorders
-TGD
-Dysphasia
TGD
According to the DSM-IV and ICD-10, the term Pervasive has a general character as it is a serious and widespread disruption of several areas of development:
-Social interaction
-Communication
-Stereotyped activities and interests
Dysphasia
– Severe language disorder whose causes are not due to obvious reasons such as deafness, mental retardation, a motor impairment, emotional disorders or personality disorders. (Seron and Aguilar, 1992).
According to DSM-IV (1995), criteria for diagnosis of dysphasia are:
-Persistent deficits in language in all levels of comprehension and expression.
-Delay timing and deviation from normal patterns of acquisition and development.
-Serious communication problems.
Difficulties in school learning.
-The alteration was not due to sensory, intellectual or severe motor.
Differential Diagnosis
– Sensory Disorders: Hearing loss
– Hearing loss is called the inability to hear normally, whatever the degree of this.
– The conductive hearing loss: one in which sounds have trouble following the normal way (damage to the outer or middle ear) and therefore there is a hearing loss greater than 20 db. In these patients the bone vibrator stimulation is normal, because the inner ear is normal.
-If the damage is at the inner ear will be conducted the same as sound as the air and bone conduction will exist the same loss. This hearing loss sensorineural hearing loss is called.
– There is a third type called mixed hearing loss is one in which there is an injury to the CAE and / or middle ear and also have an injury to the inner ear. It airway is abnormal and abnormal bone conduction is still, there is a clear separation between the two (10 or more dB).
Language Assessment
Language Assessment Levels
Phonological Level}:
Objectives
– Determine if your child has problems or not in their phonological development
Make a detection or screening of the phonological system
– Determine the status of the child’s phonological system
Predicting the course of evolution
Determine the need for intervention
Establish guidelines for possible intervention
Always consider …
Analyze changes in a sample of spontaneous speech and not just through the Test.
Recognize the existence of patterns but apparently erroneous, however, may be normal in special situations (speed of speech, social and cultural context)
Investigate the influence of context.
Identifying phonological simplification processes always consider the child’s age and its evolution.
During the administration of an articulatory test considering the total production of the word and not only the phoneme investigated by determining whether there are differences in tests of spontaneous recall and repetition.
Testing
Obs}. OFA
ART articulatory Sweep}
Formal tests TEPROSIF}-R
Informal tests: PCC
PCC = Percentage of Consonants Correct
} Is obtained from a sample of 100 set by dividing the total number of consonants correct by the total number of consonants in the sample and multiplying by 100.
FORMULA PCC
TOTAL NUMBER OF CORRECT Consonants
________________________________________ = X 100 PCC
TOTAL NUMBER OF Consonants 
Semantic Level
In Understanding evaluate:
Decoding and attribution of meaning to verbal stimuli
Lexical meaning.
Semantic-grammatical meaning.
Expression:
Selecting the right words to the referent.
Proper organization of words in the sentence.
Significance assessment lexicon:
? Overextension.
? Infraextensión: is evaluated through: Identification of drawings or concrete referents, definitions, associations
? Erroneous reference
? Deficit words
? Infraextensión: limiting the use of a general word for something specific, eg tatoh may mean my shoes blue and nothing else.
? Overextension: expanding the use of a word, eg, Daddy can be used to refer to any man.
Figurative Meaning
Figurative meaning is understood, that extracted the relationships of words whose referents are not usual.
Ex: Idioms / Metaphors / Jokes / Riddles / Inferences
Is evaluated through the use of plates or using jokes and riddles.
Testing
}Formal Test: LVET-R subtests TECAL, Sub ITPA tests (verbal analogies).
No standardized tests}: IDL (lexical diversity index).
TECAL
Test of Auditory Comprehension of Language
Test created by American author Elizabeth Carrow in 1965, named for Auditory Comprehension Test of language (TACL).
Its aim was to obtain information about the understanding of linguistic structures based on the performance of the subject, assign a level of development of understanding, and determines whether or not the child has a deficit in language comprehension.
It is a highly structured instrument that assesses understanding of the vocabulary, morphology and syntax.
It applies to children in an age range that goes from 3.0 years to 6.11 years.
The test discriminates between the different age ranges in normal children with language disorders.
In Chile in 1983 was made the test translation and adaptation of TECAL.
The test was applied to a sample of 120 Chilean children with normal language development to validate the reliability of the instrument.
The adaptation was done by professional linguists and speech pathologists at the University of Chile in conjunction with students from the race.
In 1985 the test was applied to a sample of 30 children with impaired language comprehension.
The year 2002 is TECAL test is included in the Decree 1300-1302 for the diagnosis of specific language impairment
FEATURES OF THE INSTRUMENT
§ The test has 101 items, 48 are categorized Vocabulary, 41 to 12 to Morphology and Syntax.
§ 4 items contemplates initial example, to familiarize the child with the test.
§ It has a protocol consisting of a child’s identification section, an answer section and a separate analysis by the categories of vocabulary, morphology and syntax.
§ The artwork consists of 101 sheets, with 3 pictures at the bottom in each of them.
§ One of the drawings represents the reference that corresponds to the linguistic structure evaluated.
§ Another drawing is a contrast of the referent.
§ The third picture is usually a distraction.
§ At the top of the sheet, the linguistic structure is evaluated.
APPLICATION INSTRUCTIONS
– The test is administered individually by a single examiner and in an environment free of distractions.
– The type of motor response is nonverbal and is to mark the sheet corresponding to the word or language structure that the examiner has indicated orally.
– The set of blades is positioned so that the child faces the drawings and graphics of linguistic structures in front of the evaluator
– The verbal instruction is: Now let’s see some pictures, pay attention. I will say a word and want to show me the picture that corresponds to the word I said.
– At the beginning, you show the child the incentive sheets to make sure you understand what to do.
Scoring, REGISTRATION AND EVALUATION OF RESPONSES
The answers given by the child are recorded on a log sheet.
Each correct answer is assigned 1 point.
Wrong answers do not score, but should be recorded for qualitative analysis.
Lexical Diversity Index (LDI)
} Lexical diversity analysis in 50 or more items.
Application}: 3 to 8 years.
} Is calculated by dividing the number is different words by the number of words produced.
IDL = Number of different words
Total number of words produced
3 YEARS IDL} = 0.46 to 0.50
IDL YEARS} 4 = 0.50 to 0.65
5 YEARS IDL} = 0.65
6 YEARS} IDL = 0.66
7 YEARS IDL} = 0.68
8 YEARS IDL} = 0.68 to 0.69
Morphosyntactic level
Objectives:
} To determine the performance and morphosyntactic development in decoding (reading) and encoding (expression) grammar.
} To determine the presence of impaired morphosyntactic dimension.
} Set the level or degree of morphosyntactic change.
Testing
Standardized}: TECAL, STSG, ITPA
Non-standard: LME (mean length of utterance), speech samples
Average length of sentence
50-100} statements.
} Application: 1.5 and 5 years or 5 to 18 years old, according to the author.
} Is calculated by dividing the total number of different words by the number of statements.
LME} = Number of different words
Number of statements
Pragmatic level
– The evaluation focuses on at least two respects:
– Communicative Functions:
Communicative functions are abstract units and large reflect the speaker’s communicative intent. They refer to the speaker’s motivation, the goals and purposes to be achieved by communicating with the listener.
– Conversational Skills:
The conversation can be understood as an interactive sequence of speech acts or as the result of the communicative exchange between two or more partners who are enrolled in a social context and runs application specific skills.
Formal talks Organization / Development of the ability to maintain the meaning / Ability to adapt to the participants
Testing
Informal} Guidelines: Checklist Tattershall pragmatic language, patterns matching.