Clinical Decision Making in Developmental Language Disorders (COMMUNICATION AND LANGUAGE INTERVENTION SERIES) - Softcover

Excerpted from Chapter 4 of Clinical Decision Making in Developmental Langugage Disorders, by Alan G. Kamhi, Ph.D., Julie J. Masterson, Ph.D., & Kenn Apel, Ph.D.

Copyright © 2007 by Paul H. Brookes Publishing Co. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.

Charlie, a 16&#ndash;year–old high school sophomore, was recently referred to me by his parents, who were concerned about his academic progress and limited ability to communicate. Charlie had a history of speech and language delays and had received treatment services focused on syntactic and semantic development until third grade, at which time he was discharged from therapy given his ageappropriate speech and language. In addition, Charlie had always struggled in school and received special education services for his reading and writing since his early elementary school years. At the time of the referral, Charlie was still receiving special education literacy services

Charlie's case may be similar to those referrals with which speech–language pathologists (SLPs) working with adolescents and young adults are confronted on a consistent basis. Adolescence—defined as the stage from age 12 to 20—is a time when students are faced with increasing language demands, and students such as Charlie, with literacy deficits and a history of spoken language delays, may experience difficulties comprehending and producing complex language. Charlie may face increased language pressures in his school curriculum, where he is expected to use formal language in both spoken and written forms. In addition to the demands of the school curriculum, older students, such as Charlie, face challenges in their social environment. At this age, skills such as the mastery of figurative language and the use of slang are an important part of developing a sense of self–identity and fitting in with one's peer group. Another important part of forming a self–identity is to negotiate for independence with one's parents, which requires structured and planned spoken language (Whitmire, 2000). Thus, the language demands on adolescents and young adults are quite high and should be considered within a functional context.

When faced with a case such as Charlie's, I consider several different factors and language areas. First, I considered Charlie's cognitive functioning. A previous 55 psychoeducational evaluation revealed that Charlie's IQ was well within the average range. This testing, however, revealed that he had difficulties with listening comprehension and his ability to retain information in memory, such as the details of a story. Next I wanted to know more about the kinds of communication difficulties that Charlie was experiencing and the contexts and settings in which these difficulties occurred. Charlie was having word–finding problems and difficulty explaining himself when expressing his opinion or answering questions that required planned and lengthy responses in both spoken and written contexts. These difficulties arose in the academic setting when talking to his teachers or participating in group discussions, as well as when he was making a point or negotiating with his parents. In addition, Charlie was having difficulty organizing and producing language when he was expected to give an oral presentation or write a paper on a specified topic in school.

Beyond this background information, I was interested in learning more about Charlie's performance in the areas of semantics, syntax, morphology, pragmatics, narratives, and executive functioning. Moreover, I wanted to personally assess whether Charlie experienced language difficulties in certain linguistic contexts such as expository or conversational discourse. I also wanted to determine whether specific language breakdowns occurred in certain settings (e.g., school, home) and what might be contributing toward these respective breakdowns. Furthermore, I wanted to evaluate Charlie's language use in both the spoken and written modes.

Charlie's case will be revisited at the conclusion of this chapter, but for now, let us consider the process of assessing language in an adolescent or young adult. When I complete a comprehensive assessment, I consider my own clinical knowledge and expertise, as well as the research regarding developmental expectations and appropriate assessment measures. My assessment includes standardized tests along with nonstandardized measures such as observations and criterion–referenced tasks. Standardized measures may be required to qualify a student for services and help narrow my focus on where I want to proceed with specific criterion–referenced measures. Clinical observation and criterion–referenced measures then may be conducted to provide me with an in–depth picture of how language is used in context and where I will begin treatment. This chapter discusses how to apply these components in an assessment of an adolescent's spoken language. It should be noted that although a comprehensive language assessment should include evaluations of both spoken and written language, the assessment description is limited to the spoken language domain. The assessment of written language in adolescents and young adults is discussed in Chapter 5.

WORKING MEMORY

Different linguistic contexts may result in varying working memory demands. Adolescents with specific language impairments have been found to have limited working memory (Gillam, 1998; Weismer, Plante, Jones, & Tomblin, 2005) and thus, working memory is an important component to be considered when assessing language in adolescents and young adults. Working memory corresponds to that of which one is conscious at any given moment, and in language production, "it serves the role of 56 Wolter maintaining information while planning happens" (Cowen, 1998, p. 3). Success in language comprehension and production comes from the ability to maintain and integrate linguistic information in working memory (Weismer, 1998). Simply put, many researchers believe that the processing of language breaks down when demands on a system exceed the available resources.

To illustrate how working memory affects language processing, consider the student interacting with friends versus the same student giving a presentation in class. When the student is speaking to his peers, he most likely uses common vocabulary and simple syntax in relation to highly familiar topics; moreover, he can anticipate what his friends are thinking and build on their utterances in the give and take of conversation. In this context, the student may use little of his working memory resources to maintain and integrate the language expressed and comprehended. However, when the student is giving a formal presentation in class, the vocabulary may be new, and more complex and sustained syntax is expected. The student may be worried about what his peers are thinking as he speaks. Thus, the way in which the presentation is given must be planned out. Increased demands require more working memory resources to maintain and integrate the language used and comprehended. When working memory is stressed, the student's language may break down, and behaviors, such as word–finding problems (i.e., mazes) may result.

Given that linguistic context affects the working memory resources available to the student, it is important to consider the context in which communication is breaking down and whether working memory load is a factor. When I conduct an evaluation, I am always considering what the working memory demands may be in varying linguistic contexts.

LANGUAGE SAMPLE DISCOURSE LEVELS

Given the differing working memory and linguistic demands of varying contexts, there are multiple levels of discourse that I believe...