SPEECH AND LANGUAGE DISORDERS


Definition

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Speech difficulties refer to problems with the perception or articulation of speech sounds, while language difficulties refer to a range of problems that can interfere with communication and the cognition.

Speech and language problems fall into two categories: receptive and expressive. Any child who has difficulty understanding language will also have problems with expression, but some children have good receptive skills while being unable to formulate their thoughts and feelings into spoken language. For this reason, the Diagnostic and Statistical Manual of Mental Disorders - 4th Edition (DSM-IV, 1994) gives criteria for Receptive and Mixed Expressive/Receptive Language Disorder.

Problems can occur with both categories (receptive and expressive) at several levels: phonology, syntax, semantics and pragmatics:

Receptive Expressive
Phonology problems distinguishing between sounds as in 'van' and 'than' articulatory problems e.g. 'fink' for 'think'
Syntax problems extracting meaning from grammatically complex sentences e.g. thinking that 'the cat was bitten by the dog' means 'the cat bit the dog' grammatical construct interferes with meaning e.g. 'the cat that dog bit'
Semantics understanding meaning communicating meaning
Pragmatics understanding the communicative purpose of language, including non-literal meaning as in sarcasm, irony and metaphor e.g. an autistic child may see a sign saying 'Please knock the door' and knock each time he passes using language in a socially appropriate way e.g. tone of voice, eye-contact, turn-taking, maintaining a shared topic

It is important to remember, when looking at the above table, that a child's speech and language are only delayed if inappropriate for his/her age. Deviant language difficulties are those that are considered 'odd' for a child of any age.

Some children will be generally delayed, i.e. their development in all cognitive areas will be slower than is usual. For others, development occurs at a generally normal pace with the exception of one or more areas of speech and language. It is then the term specific language impairment, or difficulty, is used.

The above linguistic categories help us to describe, understand and assess speech and language difficulties. The reasons, or aetiology, of the problems fall into medical categories: structural defects of the speech apparatus; hearing loss; brain loss; brain damage; emotional/behavioural disorders (e.g. elective mutism); environmental deprivation (Donaldson, M. 1995. Children with Language Impairments. Jessica Kingsley, London). The difficulties can be primary, or the secondary effect of another disorder - as in the case of hearing loss.


Assessment

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Assessment is usually undertaken by a Speech and Language Therapist, although an Educational Psychologist (in the UK), or School Psychologist (in the USA) may well be the person who makes this referral. Many children are initially seen by a psychologist because a child has problems with behaviour and attention. Where a child has language difficulties these behaviours are usually secondary effects of the frustration that is caused by communication problems. Children with pragmatic problems are often described as 'odd', in ways others find difficult to describe.

Speech and Language Therapists use a range of standardised tests and norm-referenced checklists, as well as direct and reported observation. The therapist works closely with the Educational Psychologist in order to determine if the disorder is general or specific, and if other disorders may be implicated, for example AD/HD, dyslexia or dyspraxia. It is important to remember that other developmental disorders can, and often do, co-occur, that symptoms overlap and that disorders can mime and disguise one another.

The DSM-IV diagnostic criteria are printed below:

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Interventions

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Donaldson (see above) describes three broad categories of intervention for working with language impaired children.

Behavioural Approaches which aim to teach language skills directly by using such techniques as imitation, reinforcement, shaping, modelling and prompting. For example, a child would be taught words by looking at pictures or objects and learning to label them. While this method is effective, it tends to fail to generalise to related linguistic structures. Donaldson gives the example of children who learned to use the word is in sentences beginning with he and failed to generalise to sentences beginning with she.

Naturalistic Approaches make use of real-life contexts to facilitate language learning in an incidental fashion. The primary purpose of language is to communicate, and this approach rests on the assumption that children learn best in a communicative context. In order to motivate children, and also control linguistic input, work is often centred around an activity or topic which is of particular interest to the child. Despite the efficacy and appeal of this approach, Donaldson points out that the opportunities to work on particular problems may not arise sufficiently frequently in natural situations, and also that the teacher or therapist must be highly skilled in order to teach specific skills within a naturalistic setting.

Combined Approaches have led to the production of structured materials that target specific targets in a realistic format.

Donaldson points out that there is a dearth of research on the efficacy of these approaches. She emphasises that in choosing an approach, therapists and teachers should be eclectic, individualised and principled.


Resources

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The following books are available from the IPS OnLine Bookshop at IPS Publications; prices are shown in £ sterling; an approximate exchange rate for US$ is £1 = US$1-50. Postage is £1 per book for UK domestic orders, and £2 per book50 for overseas surface postage. Any queries may be sent to: pubs@devdis.com

Publications

Child Language Development - Learning to Talk

Children with Language Impairments - Donaldson

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Updated 26dec2000 2200gmt - rl