language disorders

Here the development of speech is grossly impaired depending on the severity of the loss, mainly because the HOH (Hard of Hearing) child does not know there is anything like sound exists. The Speech and Language milestones get delayed since one of the senses i.e. 'Hearing' is impaired during the developmental stage.

For more questions and further Information, kindly see under 'Loud & Clear' Hearing Aid Center.

'Loud And Clear' Hearing Aid Centre

Hearing Impairment (Hard Of Hearing)

As You Hear, So Shall You Speak
Deaf Need Not Necessarily Remain Dumb
To A Hearing Impaired Child, Silence Is Not Gold.

A) Hearing Impairment Causes/Types

1.Congenital (Since Birth): Conductive Sensory Neural

2. Acquired: Conductive / sensory Neural

It is estimated that the approximately 27 million Americans over the age of 65, as many as 50% may be affected by hearing impairment.

The entire presentation by GN Resound / Donavon- dialogic hearing aids.
Windex hearing Aids.
Option Hearing Aids.

B) Delayed Language Due To Mental Retardation

Learning to talk is a complicated business, requiring cognitive (intellectual) abilities. The term "Mental Retardation" defines the nature of the condition as lowered intellectual capacity.Retarded children are delayed in their development, and the consequences are pervasive. They are slow in all areas-motor skills, Social behaviour, Self-care, Language and in all forms of adaptive behaviour.

Infection, trauma, metabolic disorders, genetic abnormalities. During pre-natal (in mother's womb), natal (at the time of birth), or during early development. Sometimes it can be genetic as in case of down's syndrome. Quite often mental retardation is an associated condition with various syndromes.

Age Range
Since birth or early development (0-3 years).

Refer chart under language disorders. (A link here should take you there straight away.)

Depends on the severity of the retardation. A MR child never develops age appropriate language (chronological age).

At 'Nirmitee', we follow DSM IV criteria for mental retardation and we offer complete evaluation and remediation for them. We prefer to take MR cases belonging to borderline and slow-learner category and not beyond that. Therapist & educationist in our clinic are trained for Makaton Vocabulary Program which is an Alternative & Augmentative Communicative Aid. We have got very positive results with this program with mentally retarded children.

Makaton Vocabulary Program - U.K
One of the most practical program used as alternative technique by professionals at 'Nirmitee' for Mentally Retarded children, Hard Of Hearing children, Paralytic patients and progressive Neuromuscular disease is Mekaton Vocabulary Program. Its a culture free program using manual expression through gesture & speech both together. It follows a holistic approach for communication. Cases where speech is far fetched this program acts as a bridge from total lack of communication to having pleasure of having related one's own ideas and feelings. For further learning lots of computer aids are also available.

C) Normal Delay In Language Development

About 3.8 % of the population suffers language delay. Out of which approx. 0.8 %exhibits delayed development in absence of any known organic cause such as Mental retardation, Hearing loss ( Hard of hearing, Hearing Impairment), Dyslexia etc. Language mile stones are delayed, with normal physical self.

1. Enviornmental - Lack of stimulation
2. Prolonged illness
3. Pampering
4. Mild Emotional & Behavioural Problems

Age Range
Starts during the developmental stage for speech from 6 - 8 months onwards for the language approx. 15 - 18 months onwards.

Good with parents cooperation and understanding of the problem .

At 'Nirmitee' our dedicated proffessional provide intence Language stimulation thorough informal 'Play way' methods, enhancing the pre skills required for the language learning, motivating the child to speak , read, socialise,share and in short enjoy his/her childhood. Parents and very often grand parents are counseled regarding the nature of the problem and its manifestations along with the therapy required.

D) Deviant Language Disorder

While Difficulty Takes A Little Time ,
The Impossible Just Takes A Little Longer

1.What Is Autism?

Autism is a psychotic disorder wherein the autistic child escapes from reality via day dreaming & fantasy. Their mental state is marked by a lack of interest in external reality. The autistic child lives in the world of their own. Contemporary research has indicated the causative factor as emotional trauma. According to Rutter's DSM, autistic characteristics start appearing at the age of 30 months but can be diagnosed only at the age of 5 years.

Autism is a spectrum disorder. In other words, the symptoms and characteristics of autism can present themselves in a wide variety of combinations, from mild to severe. Although autism is defined by a certain set of behaviors, two children, both with the same diagnosis, can act very differently from one another and have varying skills. Terms used to describe children within this spectrum are autistic-like, autistic tendencies, autism spectrum, high-functioning or low-functioning autism, more-abled or less-abled.

Characteristics Of An Autistic Child
  1. Restricted communication. (including parents)
  2. Delayed or no development of speech
  3. Even if speech is developed, it is not used for communication. Autistic language can be described as echolalic i.e. the ability of the child to repeat what is said previously or immediately after sometime.
  4. Good rote memory
  5. Good cognitive abilities
  6. Speech lacks supra -segmental (prosody, intonation pattern etc) filled with unusual snatches of singing, bizarre words and word order. Uses exotic metaphors. Speech is idiosyncratic-Change Word. (personal peculiarity as of taste & behaviour - a constitutional peculiarity that causes unusual reaction to a drug or treatment
Symptoms Of Autism
  1. Banging of head
  2. Spinning of objects
  3. Flapping of hands
  4. Finger flicking
  5. Social smile absent
  6. Tends to stiffen the body when picked up
  7. Toe walking
  8. Exhibits resentment to other people's welcome calls
  9. Milestones may be delayed, jumbled or accelerated
  10. He builds a barrier around for any environmental stimuli
  11. Exhibit qualitative impairment of reciprocal social interactions i.e. can not interact meaning fully with other individuals. They have social rejection and exhibit catastrophic behaviour to changes in environment.
  12. Avoid eye contact.
  13. Avoid cuddling. Sometimes develop mechanical clinging.
  14. Impairment of conductive & imaginative activities.
  15. Do not relate to people.
  16. Abnormal and quite often violent reactions to ordinary stimuli.
  17. Can be self injurious.
  18. Engages only in self play.
  19. Motor milestones are generally delayed.
  20. Human beings are used as mechanical tools to accomplish their tasks.
  21. Physically well developed, but has clumsy gait.
Misconceptions About Autism ~ Autism is not a mental illness. ~ Children with autism are not unruly kids who choose not to behave. ~ Autism is not caused by bad parenting. ~ No known psychological factors, in the development of the child, have been shown to cause autism. Causes of Autism Autism is linked to biological or neurological differences in the brain. General trends within families has indicated there is a genetic basis to the disorder. However, no gene has yet been directly linked to autism.

2.How is Autism Diagnosed?

There are no medical tests for diagnosing autism. An accurate diagnosis, therefore, must be based on observation. Since the characteristics of the disorder vary so much, ideally a child should be evaluated by a multidisciplinary team. A brief observation in a single setting cannot present a true picture of an individual's abilities and behaviors. Parental (and other caregivers') input and developmental history are very important components of making an accurate diagnosis. At first glance, some persons with autism may appear to have mental retardation, a behavior disorder, problems with hearing, or even odd and eccentric behavior. To complicate matters further, these conditions can co-occur with autism.

3.What Are People With Autism Like?

Children within the pervasive developmental disorder spectrum often appear relatively normal in their development until the age of 24-30 months, when parents may notice delays in language, play or social interaction. Any of the following delays, by themselves, would not result in a diagnosis of a pervasive developmental disorder. Autism is a combination of several developmental challenges.

The Following Areas Are Aamong Those That May Be Affected By Autism


Develops slowly or not at all; uses words without attaching the usual meaning to them; communicates with gestures instead of words; short attention span;

Social Interaction
Spends time alone rather than with others; shows little interest in making friends; less responsive to social cues such as eye contact or smiles.

Sensory Impairment
May have sensitivities in the areas of sight, hearing, touch, smell, and taste to a greater or lesser degree;

Lack of spontaneous or imaginative play; does not imitate others' actions; does not initiate pretend games;

May be overactive or very passive; throws tantrums for no apparent reason; perseverates (shows an obsessive interest in a single item, idea, activity or person); apparent lack of common sense; may show aggression to others or self; often has difficulty with changes in routine.

Some individuals with autism may also have other disorders which affect the functioning of the brain such as: Epilepsy, Mental Retardation, Down Syndrome, or genetic disorders such as: Fragile X Syndrome, Landau-Kleffner Syndrome, William's Syndrome or Tourette's Syndrome. Many of those diagnosed with autism will test in the range of mental retardation. Approximately 25-30 percent may develop a seizure pattern at some period during life.

4.What Are The Most Effective Approaches?

Evidence shows that early intervention results in dramatically positive outcomes for young children with autism. While various pre-school models emphasize different program components, all share an emphasis on early, appropriate, and intensive educational interventions for young children.

Studies show that individuals with autism respond well to a highly structured, specialized education program, tailored to their individual needs. A well designed intervention approach may include some elements of communication therapy, social skill development, sensory integration therapy and applied behavior analysis, delivered by trained professionals in a consistent, comprehensive and coordinated manner.

Autistic Disorders
They are impairments in social interaction, communication, and imaginative play prior to age 3 years. Stereotyped behaviors, interests and activities.

Asperger's Disorder
Characterized by impairments in social interactions and the presence of restricted interests and activities, with no clinically significant general delay in language, and testing in the range of average to above average intelligence.

Pervasive Developmental Disorder - Not Otherwise Specified
(Commonly referred to as atypical autism) a diagnosis of PDD-NOS may be made when a child does not meet the criteria for a specific diagnosis, but there is a severe and pervasive impairment in specified behaviors.

Rett's Disorder
Aprogressive disorder which, to date, has occurred only in girls. Period of normal development and then loss of previously acquired skills, loss of purposeful use of the hands replaced with repetitive hand movements beginning at the age of 1 - 4 years.

Childhood Disintegrative Disorder
Characterized by normal development for at least the first 2 years, significant loss of previously acquired skills. (American Psychiatric Association 1994). (All of the above are categorized under Autism as broader term).

Whatever the diagnosis, children can learn and function productively and show gains from appropriate education and treatment. Severity of the problem of course decide the level of prognosis.

Is There A Cure For Autism?
Some of the earlier searches for "cures" now seem unrealistic in terms of today's understanding of brain-based disorders. To cure means "to restore to health, soundness, or normality." In the medical sense, there is no cure for the differences in the brain which result in autism. However, better understanding of the disorder has led to the development of better coping mechanisms and strategies

Age Group
Children and adults can exhibit any combination of the behaviors in any degree of severity. Autistic characteristics start appearing by the age of 24 months as risk factors and can be confirmed by the age of 30-36 months.

We are extremely proud to mention that we have highly successfully attended & treated mild to severe autistic children at 'Nirmitee'. We look forward to challenges. Integrated team approach by various professional at 'Nirmitee' have seen record cases of Autism. Sensory Integration technique & Communicative enhancement techniques are customized for every case that visits our clinic. For out station patients we suggest home program under parents supervision. We put in efforts for inclusion of mild autistic cases into normal education system.


"Say Cheese," Calls the Camera-man--and the word forms signals in the hearer's primary auditory area, at right. Wernicke's area structeres the signals, passing its program via the Arcuate Fasciculus, the Nerve pathway to Broca's area, which direct's the Motor area to make the Mouth say "cheese". If Written the word begins in the Visual cortex, below; the Angular Gyrus must then trigger in Wernicke's area an Auditory form of "cheese".

1.What Is Aphasia?

Aphasia is the neurogenic condition in which an individual has difficulty expressing thoughts and understanding what is said and written by others. It is normally caused by brain damage, resulting most often from a stroke or direct injury to the head.

2.What Are Some Of The Language Problems Associated With Aphasia?

Persons with aphasia will have difficulty understanding what is said to them, and expressing their own thoughts. They also will not be able to read, write, gesture, or use numbers very well. The speech may be limited to short phrases or single words, such as names of objects or actions, with smaller words left out, so that the sentence is shortened. The word order may be incorrect, or the message may be turned around and difficult to understand. Sometimes sounds and words get changed, and nonsense words may be used. Some aphasics may produce speech with obvious effort and misarticulations. The most common characteristic is difficulty in naming. The person with aphasia may know what to do with a toothbrush for example, but will have forgotten what to call it.

3.What Are The Broad Types Of Aphasia?

The Broad Types Of Aphasia
Receptive Expressive Global Difficulty in understanding language Difficulty in expressing language. Difficulty in both understanding and expressing language.

4.Incidence Of Aphasia

It has been estimated that 0.8%-2% population above the age of 60 suffers from Aphasia.
30% of the patients suffering from stroke exhibit mild to severe Aphasia.

5.Do Aphasic Persons Normally Swear?

Since they retain certain automatic responses, such as swearing, counting, days of the week/month, and social responses such as "hi", "thanks", etc, do not criticize them for swearing. They often will not realize that they are saying something inappropriate.

6.Any Other Associated Problems With Aphasia?

Some individuals may have trouble pronouncing words properly. Their speech may be slurred like dysarthric speech. They also may be more emotional. For example they may become frustrated more easily, and they may laugh or cry excessively. They may also be confused or forgetful at times.

7.Why Does It Take An Aphasic Person So Long To Respond?

Persons with aphasia need extra time to understand what is being said to them. They hear the words , but they may not immediately recall the meaning of the word. In some cases, it may sound to the person with aphasia as if the speaker is talking in a foreign language. In addition, they need time to think of the words they want to use. Often they will forget the word once they use it , and will have to renew the searching process when they need it again. Their child's name, for example: they may say it several times, but not be able to recall the name a few minutes later.

8.What Is Spontaneous Recovery?

As the body recovers from the brain damage on a physical level, some individuals with aphasia will regain former skills, like talking or writing. Improvement may be within days or continue for at least six months, or even longer. This immediate improvement is called spontaneous recovery. Spontaneous recovery seldom produces complete return of function, however.

9.How Soon Should An Individual With Aphasia See A Speech Language Pathologist?

Usually within the first few days following the injury. In addition to providing help for speech and language recovery, the speech - language pathologist can offer hope to the individual and guidance for the family. Often the testing information obtained by the speech - language pathologist will be helpful to the medical staff in caring for the aphasic person. During first 6 months if there is lot of language stimulation it enhances the chances for spontaneous recovery.

10.Can Family And Friends Help The Aphasic Individual?

Family and friends are a vital part of the rehabilitation program. The more they understand the problem, the more they can help the recovery of the person with aphasia.

Aphasic patients are our concern. At 'Nirmitee' our dedicated professionals look after them holistically. We understand that these patients are aged hence special care is taken to adhere to their choice of timings, moods etc. family members are constantly kept motivated and are counseled regarding the nature of the problem.

11.What Are The Misconceptions About Apahasia?


Attention Deficit disorder is characterized by serious and persistent difficulties in three specific areas:
Attention span (Inattentive)
Impulse control (Impulsive)

Age Range
Begins in infancy and can extend through adulthood .

3 - 5% of school age group population is affected by ADD.

Screening Test For ADD
In order to receive the diagnosis of ADD a child must exhibit at least eight of the following characteristic for a duration of at least six months with onset before age seven
  1. Often fidgets with hands or feet or squirm in seat (in adolescence may be limited to subjective feelings of restlessness).
  2. Has difficulty remaining seated when required to do so
  3. Is easily distracted by extraneous stimuli
  4. As difficulty awaiting turns in games or group situations
  5. Often blurts out answers to questions before they have been completed
  6. Has difficulty following through on instruction from others ( not due to oppositional behavior or failure of comprehension)
  7. Has difficulty sustaining attention in tasks or play activities
  8. Often shifts from one uncompleted activity to another
  9. Has difficulty playing quietly
  10. Often talks excessively
  11. Often interrupts or intrudes on others, e.g. butts into other children's games
  12. Often does not seem to listen to what is being said to him or her
  13. Often loses things necessary for tasks or activities at school or at home (e.g. toys, pencils, books)
  14. Often engages in physically dangerous activities without considering possible consequences ( not for the purpose of thrill-seeking) e.g. runs into street without looking.
A second diagnosis, Undifferentiated Attention Deficit Disorder, refers to those children who exhibit disturbances in which the primary characteristic is significant inattentiveness without signs of hyperactivity.

Causes Of ADD
There are still many unanswered questions about the causes of ADD. Over the years presence of ADD has been weakly associated with a variety of conditions including: Prenatal &/or perinatal trauma. Maturational dalay. Environmentally caused toxicity such as fetal alcohol syndrome or lead toxicity. Food allergies. Family history. Altered Brain biochemistry. Diagnosis Of ADD: Identification & diagnosis of children with ADD requires a combination of clinical judgment and objective assessment. Since there is high rate of co-existence of ADD with other psychiatric disorders of childhood and adolescence, any comprehensive assessment should include an evaluation of the individual's medical, psychological, educational and behavioral functioning. Prognosis:

Depends on
continuity of therapy
Severity of the problem
Medication and its pros & Cons
Cooperation from Parents

Treatment At 'Nirmitee' For ADD
Most experts agree that a multi-modality approach to treatment of the disorder aimed at assisting the child medically, psychologically, educationally and behaviorally is often needed. The medical opinion is adviced, the rest are very well looked after at our clinic. Sensory Intergration Therapy undoubtedly is helping ADD (inattentive as well as ADHD kids) extremely well. Along with SI therapy counselling, circle time and relaxation through Yoga are offered at 'Nirmitee'