Nonverbal Perceptual and Cognitive Processes in Children With Language Disorders

Toward A New Framework for Clinical intervention

Walter Bischofberger, F‚licie Affolter, Ida J. Stockman

• Publisher: Psychology Press
• Year: 2000
• ISBN:
  9781135670191
• Edition: 1
• Topic: Personal Development
• Subtopic: Writing & Presentation Skills

A growing body of literature is suggesting that many children with language disorders and delays--even those with so-called specific language impairment--have difficulties in other domains as well. In this pathbreaking book, the authors draw on more than 40 years of research and clinical observations of populations ranging from various groups of children to adults with brain damage to construct a comprehensive model for the development of the interrelated skills involved in language performance, and trace the crucial implications of this model for intervention. Early tactual feedback, they argue, is more critical for the perceptual/cognitive organization of experiences that constitutes a foundation for language development than either visual or auditory input, and the importance of tactually-anchored nonverbal interaction cannot be ignored if efforts at treatment are to be successful. All those professionally involved in work with children and adults with language problems will find the authors' model provocative and useful.

CHAPTER ONE
The Problem

This book describes research on problems we observed during 40 years of working with a variety of clinical populations. Many questions emerged from our observations of children with hearing loss, children with severe difficulties in the acquisition of language, deaf-blind children, adults with acquired brain damage, and elderly adults with degenerative diseases of the nervous system.

Our intervention work began with hearing-impaired children. After a time, hearing children were also referred to our clinical center because of their difficulties in acquiring language. This was not a homogeneous group. For those who came there were many diagnoses: autism, emotional disturbances, behavior disorders, hyperactivity, attention deficit, and so on. We called them children with language disorders because the language acquisition problem was in the foreground for the professionals who referred them to us, and they were classified as “language-disordered” by the Swiss government. This volume focuses on children with language acquisition problems. They became a special concern in our clinical work because their language deficits were puzzling to us. The deficits could not be accounted for by hearing loss. Across time, we also came to realize the extent of the children’s additional nonverbal difficulties.

To learn more about these difficulties, we compared children with language disorders to children with congenital deafness and to those with normal hearing and language. Affolter (1954) observed that deaf children did not differ from normally developing children in their nonverbal performances, but children with language disorders did. Although hearing-impaired children’s difficulty with acquiring oral language could be accounted for by their hearing loss, this was not the case for children with language disorders. Because most children with language disorders could hear, we asked why they fail to acquire language like other children with no hearing loss.

We observed the behavior of children with language disorders in natural settings. When they walked up the stairs to enter our center, their movements seemed stiff and awkward. This was in contrast to walking up familiar stairs such as those in their own homes. When they shook hands in greeting, they were unable to meet our gaze. Some were clumsy playing with toys; some moved rapidly and superficially from toy to toy; some merely sat motionless in their parents’ laps or in a corner of the waiting room.

We also collected, tested, and analyzed data in a more systematic and formal way. In addition to their language problems, these children showed poorer performance than both normal and hearing-impaired children on such nonverbal tasks as: imitation of movements, reconstruction of three-dimensional patterns, and analysis of spatial relationships when reproducing complex figures. Even when they could classify graphic presentations of geometric forms, they were not able to classify pictures that represented events (Affolter, Brubaker, & Bischofberger, 1974). We asked ourselves if there was a relationship between these children’s language deficits and their nonverbal difficulties. If the answer was yes, we wondered how the relationship then could be described, and, ultimately, we wanted to determine what kind of treatment would be effective.

To answer such questions, we began our own research in 1970. The first 10 years were financed by the Swiss National Science Foundation. The research became a part of our work at a center for children with hearing impairment and children with severe developmental language delays and nonverbal behavioral problems—the rest of which consisted of clinical evaluation and intervention. The interrelationship between our clinical and research work remained strong over many years—each influencing the other. We drew on the research to answer clinical questions and used the clinical setting to test research hypotheses and findings.

To carry out our research agenda, it was also necessary to investigate normal learning and development so as to have a reference point for abnormal learners. Comparative observations of normal and clinical groups have long been viewed as fruitful for learning more about both normal development and clinical pathology. More than 100 years ago, Jackson (1884) argued that the organization of the brain normally develops in levels during childhood, and that brain damage causes a regression of that acquired organization. The regression appears to affect levels in reverse order of the acquired sequence; the most complex levels are affected before less complex ones. This suggests that developmental data collected on normal children ought to fit observations of persons with acquired brain damage. Conversely, we expected our observations of persons with developmental and acquired language disorders to contribute to knowledge about normal development.

The research program included developmental studies of both crosssectional and longitudinal types. Cross-sectional studies were structured around a standard set of perceptual-cognitive tasks that could be administered uniformly to a large number of subjects in different populations across a wide age range. In each cross-sectional study, normal subjects were compared, on the same tasks, to subjects from different clinical populations. Successive Pattern Recognition tasks were used in the first crosssectional perceptual study. Form Recognition tasks were used in the second study, and Seriation tasks were used in the third study. In these studies, tasks were presented, under different complexity and sensory modality conditions, to each child.

Longitudinal studies included observations of children with language disorders. The children were periodically evaluated on a range of verbal and nonverbal skills that represent commonly observed milestones in development such as the emergence of direct imitation or the utterance of first words (see Affolter & Stricker, 1980). All skills had been studied in normal children as well, and many have been described by Piaget in numerous books. The data consisted of naturalistic and test observations.

As the research findings accumulated, it became clear that our data did not support the existing developmental model of hierarchical dependent levels, or for that matter, any other model described in the literature. So we had to find a new model of development. This book presents the evolution of the theoretical and clinical intervention model, that emerged from our research. We take the reader step by step through different stages of the research, with each stage focusing on a new question. The questions for each new study came out of the previous set of studies. They were related to contradicting and supporting data of those studies.

In chapter 1, we summarize the findings of the first two cross-sectional studies and then the longitudinal studies. This research is presented briefly here, as it is described in greater detail in other publications. In chapter 2, we offer a detailed description of the cross-sectional developmental study of seriation performances, as this book provides the first published description of this work. The Seriation study represented a culminating and important point in the research. It was designed to test, empirically, a number of working assumptions that emerged from earlier cross-sectional and longitudinal studies in support of our model.

Throughout the book, we refer to our current research project on babies. The questions being addressed in this latter project followed from the findings of the Seriation study. The Seriation study had been based on normal and language-disordered children in the age range of 3 to 19 years. The findings revealed deviant nonverbal performance profiles for children with language disorders throughout this age range. The profiles suggested that the deviancy may go back to difficulties already observable on a sensorimotor level of development before 18 months of age. Thus, in the new study now in progress (see Section 3.4), 0- to 18-month-old normal babies are being observed and videotaped in natural settings. We refer to some of these observations as needed to clarify claims made in the book.

1.1 THE FRAMEWORK: INITIAL WORKING ASSUMPTIONS

We wanted to answer two fundamental questions, if and how the verbal and nonverbal difficulties were related in children with language disorders. To answer these questions, our earliest research was guided by the assumptions underlying a model of hierarchically dependent levels of development. We set out to reveal how the verbal and nonverbal behavior of the children with language disorders fit into Piaget’s hierarchical developmental model in particular. This model was familiar to us and it appeared to fit our clinical experience at that time. Piaget (1936/1952) made two important assumptions.

First, Piaget assumed that skills develop in levels. At a given level of development, skills are interrelated. For example, babies around 18 months typically exhibit several new performances. They begin to understand the meaning of words referring to past or future events, to understand fiction, such as pretending to be asleep by closing the eyes, and to understand actions represented in pictures. Piaget (1945/1962) described such performances as interrelated and part of a general semiotic function. Our own formal and informal observations of children with language disorders supported this expectation. They showed both verbal and nonverbal difficulties in understanding fiction, in pretending and understanding actions represented in pictures, and in understanding past and future events expressed by words. In short, they presented difficulties in all semiotic performances (Affolter, Brubaker, & Bischofberger, 1974).

Second, Piaget assumed that developmental levels were hierarchically dependent, that is, skills at a lower level were considered prerequisites for the emergence of skills at a higher level. We argued: Failure of skills at a higher level could be of a primary or secondary kind of failure. If no skills at lower levels were failed, but only skills at a higher level, they could be considered to be primary. However, if skills at a lower and a higher level were failed, it was concluded that failures at the higher level were secondary, failures at the lower level primary. Treatment had to focus on primary difficulties. Thus, it became important to know at what level primary failures were observable. We reasoned that language is the most complex performance that children acquire (Affolter, 1968; Piaget, 1963). Consequently, language performance is characteristic of the highest level of development. Performances that develop before language acquisition begins belong to less complex levels of development. If language acquisition is disordered, this disorder may be of a primary or secondary kind. To decide, one has to evaluate skills a child begins to develop at lower levels preceding language acquisition. If no skills at lower levels were failed, failures in language acquisition could be considered primary and treated directly. If skills at lower levels were deficient, these deficiencies could be considered primary, with failures in language acquisition as secondary. Treatment had to focus on the primary difficulties.

Among skills developing on lower levels preceding language acquisition, we focused on perceptual skills. Our clinical work with children with hearing impairment corroborated a well-known fact; namely, an early profound hearing loss typically prevents children from perceiving speech well enough to develop an adequate oral language. Other observations fed the hypothesis that perceptual skills may be important prerequisites for language development. These observations came from a pilot study of non-verbal skills of 4- to 10-year-old children with language disorders (Affolter, Brubaker, & Bischofberger, 1974). We analyzed the nonverbal tasks used in terms of their perceptual prerequisites. These analyses revealed that some children with language disorders had particular difficulty with performing tasks, requiring them to rely on tactual information. Such tasks included those that required them to insert puzzle parts into a shape board or to string beads. Other children had difficulty performing tasks such as imitating gestures, which required visual-tactual information or performing tasks that required the integration of sequences, as in the case of constructing building block towers (see Affolter, 1987/1991). Such findings further supported the hypothesis that different perceptual processes may be prerequisites to language acquisition.

With this hypothesis in mind, we turned to Piaget’s assumption of hierarchical levels and argued, as follows: Perceptual performances develop to a critical level before language is discovered, and continue to develop throughout the period of language acquisition (Affolter, 1968, 1970). That period appears to last up to 14 years in children (Menyuk, 1971). If developmental levels are hierarchically dependent, then perceptual disorders can be considered to be the primary difficulty, and language disorders the secondary one when both perceptual and language performances are disordered. Thus, we formulated our first research hypothesis: Children with language disorders may fail in verbal and nonverbal performances at higher levels of development because they fail in perceptual performances characteristic of lower levels of development. We tested this basic assumption by investigating improvement of perceptual skills within the age range of 3 to 14 years, the time period spanning the critical stages of language acquisition. We focused first on normal children, then on children with severe congenital hearing or visual impairment, then on children with language disorders in the absence of hearing or visual loss.

1.2 DEVELOPMENT OF PERCEPTUAL SKILLS

To study developmental changes in perceptual skills, we designed standard tasks that varied in stimulus complexity, and could be presented under different sensory modality conditions in a uniform way across different age cross-sections.

1. Stimulus complexity: The focus on stimulus complexity was inspired by Piaget’s (1961/1969) discussion of perceptual mechanisms in which perceptual activity and its organization were differentiated. Piaget pointed out that the environment is structured, but that the structure of the environment is not perceived directly. To perceive it, Piaget (1947/1950, 1961/1969) insisted that the perceiver has to organize the input in an active way. Such organization is learned by the child and improves with age. Because such organization develops over time, the child will be able to deal adequately first with just simple structures, and later on with more complex ones. In general, Piaget’s theory meant that children of increasing age can successfully deal with an increasing degree of complexity of stimuli. This assumption could be supported by showing that children at different ages give different responses to tasks of varying stimulus complexity.
   
   
2. Modality conditions: We presented analogous tasks at similar complexity levels in the auditory, visual, and tactual modalities. Different sensory modalities were assumed to contribute to spoken language acquisition. It is known that children with profound hearing impairment fail to acquire oral language because they lack auditory input. Children with blindness are delayed in language acquisition (Fraiberg, 1977; Mills, 1993) because they cannot perceive the visual cues of speech signals. Children with language disorders without hearing or visual loss appear to have tactual or visual-tactual or sequential processing difficulties (Affolter, Brubaker, & Bischofberger, 1974).

1.2.1 Cross-Sectional Studies of Perceptual Development in Normal Children

We designed Successive Pattern Recognition tasks and Form Recognition tasks to study perceptual development and the difficulties of children with language disorder in the first two cross-sectional studies.

Tasks were designed to meet several criteria, including the following:

• Refer to perceptual processing (i.e., be of a recognition kind with minimal demands on memory).
  
  
• Require a search for relevant information and provide feedback during the task instruction-learning process.
  
  
• Offer successive items or spatial features on different levels of complexity.
  
  
• Be testable in different modality conditions.
  

To study the difficulties of sequential processing of children with language disorders, we designed Successive Pattern Recognition tasks to meet the described criteria.

1.2.1.1 Successive Pattern Recognition in Normal Children

First we studied normal children to investigate the development of Successive Pattern Recognition.

1.2.1.1.1 Procedures.

Four series of patterns of increasing complexity were created and presented to 250 normal children in the age range of 4 to 14 years. Each child was tested individually and had to judge whether two consecutive patterns were the same or different. The number of elements in a pattern increased from one element per pattern (Series 1) to two, three, and four elements per pattern (Series 2, 3, and 4, respectively, as shown in Table 1.1).

Patterns were presented in the visual, auditory, and vibro-tactile¹ modalities. The stimulus features differed in two dimensions: two levels of intensity and frequency for the auditory patterns, two levels of brightness and color for the visual patterns, and two levels of intensity and two places of stimulation for the vibro-tactile patterns (see Table 1.2). All children included had been screened on perceiving the stimulus dimensions in the various modalities (i.e., intensities, colors, frequencies, and locations).

Instruction for Successive Pattern Recognition tasks consisted of five training items. Each item included two consecutive patterns, a standard pattern and a comparison pattern as shown in Table 1.1 for Series 1 to 4. After each item was presented, the children had to indicate (by speaking or by gestures) if the patterns were the same or different. Critical dimensions were never pointed out to the children. Examiners acknowledged a correct response by saying “yes,” or saying “no” for an incorrect one. This instructional approach allowed us to determine whether children could search for and select the relevant information on their own without being told what to look for. Such performance is typical of daily-life situations in which children have to evaluate stimuli and discriminate relevant from irrelevant ones in a spontaneous active way (see more details about the procedures in Affolter, 1970; Affolter, Brubaker, Stockman, Constam, & Bischofberger, 1974; Affolter & Stricker, 1980).

TABLE 1.1 Standard and comparison Patterns for the successive Pattern Recognition Tasks

TABLE 1.2 Description of Stimuli for Successive Pattern Recognition Tasks

We expected the number of correct responses to decrease from Series 1 to 4 in all modalities (series effect), and to increase in all modalities as the children got older (age effect). We assumed that the pattern of the increase reflected development in the organization of perceptual activity as described next.

1.2.1.1.2 Results.

The results revealed:

• Instruction: Children were able to learn the tasks with the instruction provided.
  
  
• A significant age main effect: The children showed a larger number of correct responses to all modality conditions as age increased. They were first successful in recognizing short successive patterns with one and two elements. Later on they were also successful in recognizing longer patterns with three and four elements.
  
  
• A significant series main effect: Correct responses decreased systematically as the complexity of the stimuli increased from Series 1 to Series 4.
  
  
• A significant modality main effect: Scores in the visual and auditory modality conditions were higher than those in the vibro-tactile condition. Likewise, ceiling scores were reached at an earlier age in the visual and auditory modalities than in the vibro-tactile modality condition.
  
  
• A significant triple age-by-series-by-modality interaction effect: This effect was due to the clustering of correct responses to Series 1 and 2 in all three modalities at about age 6, and the clustering of correct responses to Series 3 and 4 in the 12 to 14 age range. Ceiling scores were reached earliest at about 12 years for visual patterns followed in order by auditory and then vibro-tactile patterns at about 14 years.
  
  
• An item analysis: Patterns with maximum contrast (BB vs. rr) were recognized correctly before patterns with minimum contrast (bB vs. BB).

1.2.1.1.3 Interpretations of Successive Pattern Recognition inNormal Children.

Instruction: The instructional approach showedthat the children could select the relevant information without being told what to search for.

The age effect suggested a development in Successive Pattern Recognition. Because the stimuli remained the same for children at different ages, the score shifts across age implied changes in the children’s ability to more adequately organize their search for relevant information in the stimulus patterns.

The series effect can be accounted for by the differences in complexity that corresponded to the number of elements included in...

Table of contents

• Cover Page
• Title Page
• Copyright Page
• Acknowledgments
• Introduction: From Product to Process in Investigating Problem Solving in Children With Language Disorders
• Chapter One: The Problem
• Chapter Two: Problem Solving in Normal and Language-Disordered Children: The Seriation Study
• Chapter Three: Clinical Implications
• Chapter Four: Epilogue: Language Learning and Nonverbal Interaction in Daily Events
• Chapter Five: Concluding Remarks
• Appendix A—Experimental Design
• Appendix B—Measurements
• References