Even though the symptoms and severity of a child's language disorder may change over time, language disorders tend to be chronic. Preschoolers who are identified with language disorders are at substantial risk for experiencing language disorders during the school years and are also at risk for the academic, social, and vocational difficulties often associated with language disorders. Like younger children with language disorders, school-age children with language disorders are characterized by their heterogeneity. This heterogeneity manifests itself in the severity of the disorder, with some children showing mild grammatical difficulties, others showing no syntactic knowledge, and still others having no expressive language. For children with severe language disorders, spoken language may present inordinate difficulties. In these instances, children may use augmentative forms of communication, such as graphic systems, manual signs, and electronic speech output devices, to facilitate language development or to serve as alternate forms of communication.
The heterogeneity of language disorders in schoolage children is also evident in the particular aspects of language that are disordered, with some children, for example, showing word-finding deficits, others having difficulty understanding complex directions, and yet others exhibiting global language deficits. Conventionally, a distinction is drawn between language disorders that affect only the production of language (expressive language disorders) and those that affect language comprehension in addition to production (mixed receptive-expressive language disorders). Children with either expressive or mixed language disorders may have a concomitant speech disorder, reflecting difficulty with speech sound representation and/or production. Disorders of reading and writing also may accompany language disorders (see language impairment and READING disability).
For some children, language is the only developmental area in which they experience obvious difficulty; these children are often identified as having specific language impairment (SLI) (see specific language impairment in
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children). Omission of grammatical markers may be the most salient language characteristic in SLI, but it is not the only language deficit that may hinder a child's academic performance. In other children the language disorder is secondary to other cognitive, motor, or sensory disorders.
Several populations of school-age children are at risk for language disorders. These populations include children with developmental disabilities, such as children with mental retardation, autism, or a pervasive developmental disorder, and also children in whom only subtle cognitive deficits are implicated. Among the latter are children with learning disabilities or disorders as well as children with attention deficit disorder, characterized by frequent instances of inattention and impulsiveness, and children with disruptive behavior disorder, marked by aggressive behavior or the violation of social norms. Children with hearing impairments are also at risk for language disorders. Although most school-age language disorders are developmental, children may have acquired language disorders resulting from closed head injuries, seizure disorders, or focal lesions such as stroke or tumors. Taken together, children with language disorders constitute a large group of students for whom language poses substantial difficulties.
About 5% of students in the United States show a learning disorder (American Psychiatric Association, 1994). Learning disorders are identified as disorders of reading, written expression, and mathematics. However, many children with learning disorders appear to have an associated difficulty with spoken language that substantially affects their ability to meet classroom language demands. The comorbidity of language disorders, learning disorders, and also attention deficit and disruptive behavior disorders is well-established. The overlap between disorders is at some level intuitive. For instance, children with attention deficit disorder often show deficits in executive functions, such as difficulties in goal setting, monitoring behavior, and self-awareness (Ylvisaker and DeBonis, 2000). These characteristics may have deleterious effects on the child's ability to deal with the complex language tasks encountered in the classroom.
Traditionally, a distinction was made between language delay and language deviance. For example, children with mental retardation were considered to show a delayed profile of language development, consistent with delay in other cognitive abilities. Children with autism were considered to show deviant language characterized by patterns not found for typically achieving children. Current research suggests that this global distinction does not fully capture the language profiles of children with language disorders. Contrary to the idea of simple delay, for example, children and adolescents with Down syndrome show greater deficits in expressive than in receptive language (Chapman et al., 1998). And contrary to the notion of overall language deviance, children and adolescents with autism have been found to produce narratives similar to those of children with mental retardation (Tager-Flusberg and Sullivan, 1995).
Across populations of children, difficulties in all domains of language, semantic, syntactic, and pragmatic, have been found. Current thinking in speech-language pathology, however, is not to address individual skills in isolation but to focus on broader aspects of the child's language and the learning environment that will best promote the child's current and future communicative success (Fey, Catts, and Larrivee, 1995). This includes recognizing the link between language, especially phonological awareness (awareness of the sound structure of words), and literacy skills (Catts and Kamhi, 1999). Oral narrative production is another area that has received attention, in part because the ability to tell a cohesive story rests on other language and cognitive skills and in part because good narrative skills seem to be associated with good academic performance (Hughes, McGillivray, and Schmidek, 1997). Also, children with language disorders are at risk for fewer and less effective social interactions than other children of the same age. Thus, the language foundations for social interaction, particularly conversational skills, constitute a major area to be addressed.
The school years cover a broad developmental range, and language disorders during adolescence are as important to identify as disorders occurring at earlier ages. However, language development is more gradual and individual in adolescence than it is in younger children, and identification of a disorder may be particularly challenging. Later language developments, such as the acquisition of figurative language (e.g., metaphors and idioms), advanced lexical and syntactic skills (e.g., defining abstract words, using complex sentences), analogical reasoning, and effective conversational skills, such as negotiation and persuasion, each develop over an extended period. At the same time, competence with these language skills is fundamental for dealing effectively with the academic and social curricula of high school. Adolescents with language disorders are at risk for dropping out of school or in other ways not making a successful transition to employment or university after high school. Thus, emphasizing adolescents' functional competence in social communication has been increasingly advocated.
Both standardized and nonstandardized measures are used to assess school-age language disorders in children and adolescents. Although below-average performance on standardized tests compared with chronological or developmental norms remains the primary way of identifying the presence of a language disorder, criterion-referenced assessments provide a more direct guide to intervention. In criterion-referenced assessments, the emphasis is on how well the child reaches certain levels of achievement rather than on how the child's language performance compares with that of other children of the same age. For instance, criterion-referenced assessments can be used to determine how well a child understands vocabulary used in classroom textbooks or how effectively a child initiates conversations with other children. (Paul, 2001, describes many standardized and criterion-referenced language assessments.)
Another form of nonstandardized assessment focuses on the underlying cognitive processing skills that potentially are linked to some language disorders. This evaluation includes tasks assessing verbal working memory (e.g., recalling an increasing number of real words), phonological working memory (e.g., imitating nonsense words), and auditory perception (e.g., discriminating speech and nonspeech sounds). School-age children with language disorders have been distinguished from their age peers by lower accuracy on verbal working memory and nonword repetition tasks (Ellis Weismer, Evans, and Hesketh, 1999; Ellis Weismer et al., 2000). Dynamic assessment also has been advocated as an effective non-standardized assessment strategy (Olswang, Bain, and Johnson, 1992). In dynamic assessment, aspects of a language task are altered systematically to examine the conditions under which a child can achieve optimal success. Thus, dynamic assessment can be used to determine a child's potential for benefiting from intervention, and also what guidance or structure will be most helpful in intervention. Criterion-referenced, processing-dependent, and dynamic assessments may be especially important for children from culturally and linguistically diverse backgrounds, for whom many current standardized language tests may be inadequate or inappropriate (Restrepo, 1998; Craig and Washington, 2000).
See also speech disorders in children: speech-language approaches; specific language impairment in children.
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