Numerous studies have shown that children identified with Language Impairment (LI) have marked difficulty with producing story narratives compared to their typically developing peers. One particular area of weakness seen in the narratives of children with LI is their ability to incorporate internal states, specifically internal response, internal plan, and emotion words. The current study examines five children with LI and their descriptions of mental and emotional states of characters in story narratives under spontaneous and prompted conditions. Participants produced story retells based on a series of wordless picture books taken from the Edmonton Narrative Norms Instrument. Story retells were elicited twice for each story, once with and once without verbal prompts. As expected, children produced more internal state story elements in response to prompts. As children produced more of these elements, however, their accuracy decreased, and the states they reported did not always reflect the story content. The children with LI showed limited understanding and ability to interpret the reactions, motivations, and emotions that characters experienced. However, verbal prompts did reveal children's current abilities and understanding of internal states.

Narrative production and comprehension is a difficult task for children with language impairment (LI). Their stories are typically shorter and contain more grammatical errors than the stories of typically developing age-matched peers. This pilot study describes the abilities of six children with LI to produce stories from pictured stimuli. Stories were elicited from each child during a 10-week period. Stimulus pictures and coding procedures from the Edmonton Narrative Norms Instrument were employed to analyze the participants' story grammar (SG). Eight SG elements were assessed including character introduction, setting, initiating event (IE), internal response (IR), internal plan (IP), attempt, and outcome. The children varied highly in their production of SG elements. The SG elements that described the internal states, emotions, and motivations of the characters were the most difficult for all participants.

Many children identified with Language Impairment (LI) demonstrate difficulty comprehending and producing narratives. Their narratives are often structurally less complex and of overall poorer quality than those produced by their typically developing peers. These difficulties may negatively impact the academic and social success of children with LI. This thesis evaluates the performance of five school-aged children with LI on a story retell probe embedded within an intervention designed to address their social and emotional language abilities. During the 10-week intervention, participants completed a series of story retell probes using wordless picture books. The story stimuli were taken from the Edmonton Narrative Norms Instrument, which included six stories (divided into two story sets), elicited twice (12 total story retells). The production of story grammar (SG) categories was analyzed for each story retell. The results for each participant and SG category varied greatly, but all participants had difficulty producing the more complex SG elements. Although each participant demonstrated some improvement from the first retell to the second on at least one story, overall performance remained fairly stable over the 10-week period. Future research is needed to determine effective ways to support more complex story narratives in children with LI.

Many school-age children with a diagnosis of Language Impairment (LI) also have social communication difficulties. Some of these difficulties are related to deficits in emotion understanding. This thesis evaluates the effects of a social communication intervention designed to increase the production of emotion-based words as an indicator of emotional competence. For five elementary school-aged children with LI, the production of emotion-based words was analyzed by first determining the frequency of words produced in preintervention sessions for the following categories: happiness, sadness, anger, fear, surprise, and disgust. Following these measures, the participants received 20 intervention sessions over the course of treatment. Treatment involved the use of narratives to address emotion recognition and inferencing abilities. Individual analyses for each participant, including percent of nonoverlapping data (PND), were conducted for each participant in the categories of anger, fear, and surprise, to determine the effects on the production of emotion-based words during the intervention. The results for each participant and emotion category varied greatly, but each participant demonstrated improvement in the PND for at least one emotion category. These results were promising and underscore the value of social communication intervention for children with LI in the area of emotion understanding.

INTRODUÇÃO: O envelhecimento populacional é uma problemática para o setor saúde, que pelas suas características são mais freqüentes os processos de hospitalização, que conseqüentemente favorecem a presença de incapacidades funcionais temporais ou permanentes nos idosos, fato que não é priorizado em pacientes hospitalizados e que requer estratégias de solução visando a melhora da qualidade de vida. OBJETIVO: estudar o impacto de uma intervenção comunicativa fundamentada na concepção de Paulo Freire na capacidade funcional dos idosos, por meio de atividades básicas da vida diária (ABVD). METODOLOGIA: estudo quase-experimental em 184 pacientes, divididos em grupo controle (n=92), experimental (n=92), no hospital HGDIMP, San Luis de Potosí, México. Prévia aprovação do comitê de ética, foi aplicado o índice de Barthel por meio de entrevista para as ABVD: duas semanas antes da hospitalização, na admissão, após 48 horas da hospitalização, na alta e duas semanas depois da alta hospitalar. O instrumento \"índice de Bartel \" foi submetido a uma adaptação cultural e a uma prova piloto em 96 idosos. Foi aplicado o questionário de Pfiffer (SPMSG), validado ao espanhol, para identificar o estado cognitivo e um questionário para dados gerais e antecedentes de saúde. A intervenção comunicativa iniciou 48 horas após hospitalização e terminou duas semanas depois da alta hospitalar. Aplicaram-se estatísticas descritivas, análise multivariada de perfis, testes t de student e exato de Fisher; para tanto, foi utilizado o programa SPSS versão 13.0. RESULTADOS: A idade média dos participantes foi 70 ± 7,7 anos, 60% casados, 41,9% com ensino fundamental completo e 40,2% analfabetos.As principais causas de hospitalização foram por doenças cardiovasculares (40,2%) As co-morbidades mais freqüentes foram hipertensão arterial (49,5%) e Diabetes Mellitus (33,2%) . Antes da hospitalização 37,0% consumiam um medicamento, 25,5% consumiam dois, sendo os mais utilizados os antihipertensivos (39,1%) e hipoglicemiantes (30,4%). O nível de saúde percebido foi 50,5% para \"regular\" e 38,6% para \"bom\". Antes da hospitalização as ABVD mais afetadas foram subir e descer escadas (18,5%), tomar banho (17,4%) e todas as ABVD, de ambos os grupos apresentaram p>0,050, não apresentando diferenças significantes. Na admissão ao hospital observou-se aumento da dependência em todas as ABVD, principalmente tomar banho, vestir-se e caminhar; porém analisando as ABVD, entre os grupos controle e experimental, encontrou-se p=0,015 para caminhar e para transferência da cama para a cadeira p=0.030. Encontrou-se diferença significante entre os grupos. Após 48 de hospitalização houve recuperação das ABVD no grupo controle (media 50,1) e no grupo experimental 40,2 p=0,003; portanto, houve significância estatística. Após finalizar a intervenção, a média do grupo experimental aumentou para 90,0 e o grupo controle apresentou 67,0, p=0,001, observando-se diferenças significantes. Ao comparar os perfis médios encontrou-se p<0.001, razão pela qual conclui-se que não houve paralelismo. A média das ABVD foi maior no grupo experimental em relação ao controle. CONCLUSÕES: o presente estudo mostrou a efetividade de uma intervenção comunicativa, na melhoria da capacidade funcional em pacientes idosos hospitalizados, além de identificar fatores de risco que podem ser controlados. Considera-se que a proposta contribui na recuperação e obtenção da melhora do grau de independência dos idosos por médio de sua participação ativa. / INTRODUCTION: Population aging is a problem for the health sector. Due to its characteristics, hospitalization processes are more frequent, consequently favoring the presence of temporary or permanent disabilities in the elderly, a fact that is not prioritized in hospitalized patients and that demands solution strategies with a view to a better quality of life. OBJECTIVE: To study the impact a communication intervention based on Paulo Freire\'s conception exerts on elderly people\'s functional capacity through basic activities of daily living (ADL). METHODOLOGY: Quasi-experimental study of 184 patients, divided in a control (n=92) and experimental group (n=92), at the HGDIMP hospital in San Luis de Potosí, Mexico. After approval from the ethics committee was obtained, the Barthel index was applied to the BADL through an interview: two weeks before the hospitalization, at the time of hospitalization, after 48 hours of hospitalization, upon discharge and two weeks after discharge from hospital. The \"Barthel index\" was submitted to cultural adaptation and to a pilot test involving 96 elderly. Pfiffer\'s questionnaire was applied (SPMSG), in its version validated for Spanish, in order to identify the cognitive state, while a questionnaire was used to collect general data and health antecedents. The communication intervention started 48 hours after hospitalization and finished two weeks after discharge from hospital. Descriptive statistics and multivariate profile analyses were applied, as well as student\'s t and Fisher\'s exact test, using SPSS software version 13.0. RESULTS: The participants\' mean age was 70 ± 7.7 years, 60.0% were married, 41.9% had finished basic education and 40.2% were illiterate. The main causes of hospitalization were cardiovascular diseases (40.2%). The most frequent comorbidities were arterial hypertension (49.5%) and Diabetes Mellitus (33.2%). Before hospitalization, 37.0% used to take one and 25.5% two medications. The most frequently used drugs were antihypertensive (39.1%) and hypoglicemic agents (30.4%). The perceived health level was 50.5% for \"regular\" and 38.6% for \"good\". Before two weeks of hospitalization, the most affected BADL were climbing and moving down stairs (18.5%), bathing (17.4%) and all BADL in both groups displayed p>0.050, without significant differences. Upon hospital admission, increased dependence was observed on all BADL, mainly bathing, dressing and walking; however, when analyzing the BADL between the control and experimental groups, p=0.015 was found for walking, and p=0.030 for moving from the bed to the chair. A significant difference was found between the groups. After 48 of hospitalization, recovery of BADL was found in the control group (mean 50.1) and in the experimental group 40.2 p= 0.003; thus, statistical significance was found. After finishing the intervention, the mean of the experimental group increased to 90.0 and that of the control group to 67.0 p=0.001, observing significant differences. When comparing the mean profiles, p<0.001 was found. Therefore, it was concluded that no parallelism occurred. The mean score of BADL was higher in the experimental than in the control group. CONCLUSIONS: this study showed the efficacy of a communication intervention for the improvement of functional capacity in hospitalized elderly patients, and also identified risk factors that can be controlled. The proposal contributes to the elderly people\'s recovery and achievement of a better independence level through their active participation.

Children with language impairment (LI) have often been identified as having social communication breakdowns. A number of these problems are likely the result of deficits in emotional competence. This thesis examines a social communication intervention designed to target the emotional competence of children with LI. Three elementary school-aged children with LI were recruited to receive twenty, 20-minute intervention sessions over the course of four months. Each intervention session involved a combination of activities targeting emotion recognition and emotion inferencing using story retell, story exploration, story enactment, perspectives charts, journal entries, emotion labeling, and personalization. These activities revolved around Mercer Mayer's A Boy, A Dog, and A Frog (1967) wordless picture book series. These books were used because of their age-appropriate subject matter and clear, simple depictions of character actions and facial expressions. To analyze the effectiveness of this intervention package in improving emotional competence, the number of emotion-based words belonging to the emotional categories of happiness, sadness, anger, fear, surprise, and disgust that were produced each session was counted. The percentage of appropriate usage was calculated to represent how often the participants used each emotion-based word in a semantically correct manner. Finally, emotion word productions that did not match the intended target word were analyzed for valence agreement. Results were highly variable but all three participants demonstrated improvements in the percentage of accurate productions in at least one emotional category. Although all three participants usually used words of a positive valence in an appropriate manner, inappropriate uses were also observed. When actual emotion-word productions mismatched the intended emotions, all three participants produced low valence agreement for words of positive valence and high valence agreement for words of negative valence. Further research is warranted but results suggested that this particular social communication intervention was effective in improving the production of specific emotion words by children with LI.

This thesis examines a social communication intervention that targets the emotional competence of children with language impairment (LI). Three elementary school-aged children with LI received twenty, 20-minute intervention sessions over four months. Each intervention session involved a combination of activities targeting emotion recognition and emotion inferencing. The emotion-based word productions were counted and analyzed. Categorized words belonged to the emotional categories of happiness, sadness, anger, fear, surprise, and disgust. The percentage of appropriate usage was calculated to represent how often the participants used each emotion-based word in a semantically correct manner. Emotion word productions that did not match the intended target word were analyzed for valence agreement. Results were variable but two of the participants improved in the percentage of accurate productions in at least one emotional category while one participant did not improve over the intervention. Two of the participants also showed a decrease in the number of valence errors with no notable change in valence errors for the third participant. This suggests that this type of intervention can be effective in improving the use of emotion-based words in children with LI. More research is needed to develop this type of intervention.

Historically, social communication approaches to intervention for children with developmental language disorders (DLD) have been limited. However, several recent studies have shown that these interventions can produce positive changes in children with DLD. One weakness that children with DLD demonstrate is the production of words to express emotion. This thesis evaluates the effectiveness of a story-based social communication intervention to increase the production of emotion words in three elementary school-age children diagnosed with DLD. Data were collected and analyzed in pre-treatment baseline sessions, throughout the intervention, and in post-treatment follow-up data for the seven target emotion word categories of happiness, surprise, fear, anger, sadness, disgust, and contempt. The specific targeted emotion word categories were determined based on individual participants limited proficiency during baseline sessions. Thus, the emotions targeted were unique to each child. Intervention consisted of 40 intervention sessions using a combination of storybook therapeutic strategies (e.g., story enactment, story sharing, and modeling by the clinician to help increase the child's emotion understanding) as well as emotion recognition and emotion inferencing tasks. Each participants data were analyzed and presented in figures. The percentage of non-overlapping data (PND) was used in data analysis, quantifying how successful the intervention was for each of the targeted emotions. While the target emotion word categories varied between participants, all of the children showed improvement in the targeted emotions. While the intervention was more effective for some children than others, all increased in their ability to use the target emotion words more accurately as a result of participating in intervention.

Children with Developmental Language Disorder (DLD) often have difficulties with social and emotional learning, including emotion understanding and inferencing. Five children with DLD, ages 6;4 to 11;9, identified emotions depicted in pictured scenarios over a period of 10 weeks. Emotion categories included happy, sad, anger, fear, surprise, and disgust. Each child's responses were analyzed and plotted on a confusion matrix. In a few cases, children did not interpret the scenario accurately. Even when they interpreted the scenario accurately, all of the children misapplied, overgeneralized, or confused emotion labels in some cases. These errors represented limitations in social and emotional learning that could negatively impact the ability to interact with others, to establish and maintain relationships, and to succeed academically.

The study identifies the increase in populations at risk for communication disorders world-wide and in South Africa as one the reasons for research to develop early communication intervention (ECI) services as a societal responsibility in South Africa. Since ECI is largely an unknown entity in the South African health system, but shares several mutual objectives, the dire need for data of populations at-risk validates the development of a computer-based relational data system as a 21st century research tool for ECI. Underpinnings for the development of a research database for ECI were obtained from the use of database management systems for early intervention in the USA, identified as leaders in the application of database technology in the field of Speech-Language Pathology. The aim of the study was to develop and establish a computerized database system to describe the characteristics of young children at risk for communication disorders enrolled in an existing ECI programme. Using a descriptive survey as research design, a rich description of 153 subjects and their families was obtained. The findings relating to the multiple risk profiles of the subjects revealed results not extensively described or emphasized in the literature, indicating the in-depth analysis of results that is possible when utilizing a database approach to research. The complex risk profile found in the subgroup of subjects with cleft lip and palate is an example of a need for further investigation. The results also indicated the critical importance of early identification of risk events throughout a child’s life to improve the efficacy of ECI services. Further results emphasized the important role of parents to identify the early signs of risks for communication disorders in their children, provided they are equipped with the necessary knowledge. A conceptual framework for the early identification of risks for communication disorders is proposed for best practice in ECI in South Africa. The study concluded that the CHRIB database system was successfully applied in the empirical research and is now established as a versatile 21st century research tool to be utilized in second generation research in ECI in South Africa. / Thesis (DPhil(Communication Pathology))--University of Pretoria, 2005. / Speech-Language Pathology and Audiology / Unrestricted