Chapter 1: Models of Child Language Disorders
After sifting through the surveys there were 3 important questions that arose after reading this chapter.
1. How would you explain what a language disorder is to a parent, a co-worker, or a colleague?
2. What criteria is most important when identifying a language disorder?
3. There are many different models of child language disorders that encompass theories about why, how and what we should do in approaching language disorders. Is it important for the practicing clinician to know these models? How do they help us in our treatment of language disorders?
Here is my attempt to summarize a couple answers to these very important questions.
1. So, what IS a language disorder?
As a practicing clinician I find this one of the most frequently asked questions, as well as one of the hardest to answer. Language disorders are hard to define because language itself is such a broad term. Language is what we use to communicate. It involves words, combining those words to make meaningful messages, interpreting messages, and ultimately using words and word combinations to communicate with others in a meaningful way. A language disorder can look different for each child. One child may have difficulty learning vocabulary, or using the right grammatical forms or even just coming up with a sentence to adequately describe what they are thinking. Another child might talk well but has a hard time understanding the point of a story. Some children appear "socially awkward" because they don't naturally pick up on social language cues about what is appropriate or not. We often further define a language disorder based on the individual child's strengths and weaknesses but when you hear the term language disorder just know that it usually involves some level of difficulty with understanding or using language.
I know this explanation could use a lot of work. How do you describe a language disorder to parents, teachers or colleagues?
2. What criteria should be used to identify a language disorder?
In the school-based SLP world, criteria is often reached by scoring below an arbitrary cut-off on at least 2 standardized measures and the professional interpretation of informal measures such as language samples or criterion referenced assessments. Often the cut-off on standardized tests is low enough to be a severe language disorder. This is a necessary evil to keep our caseloads manageable and provide services to those who need it the very most. It makes me sad that we do not have the resources to provide services to all children with language deficits. I recently tested a child who would truly benefit from language services. His scores were well below average, but not low enough to meet the criteria for services. I am in this constant battle with myself when I think about these cut-offs. On the one hand, it makes my heart sink to think about those children who could understand and communicate so much more with our services. On the other hand, I am so overwhelmed with my large caseload, I am ashamed to admit sometimes I am grateful for the low cut-off.
It is so important to keep in mind that every standardized test is not created equal. Some are better than others at identifying children with language disorders. It is overwhelming and time consuming to determine which tests are best. But it is so important for us as professionals to be aware of the the validity of tests. It would be great if we could have a discussion about which tests are the best in the future. Keep an eye out for a post on this topic in the future.
3. Does it really matter if I know all the models of language disorders?
This chapter discussed some different models of language disorders. A "model" is a basic theory about how a language disorder works. As practicing clinicians we don't have a lot of time to agonize over which theory is most correct. We are mostly concerned about how to help the child.While reviewing this chapter I was surprised to realize that I had developed some of my own beliefs and views about language disorders that fit into certain models better than others. It all seems so much more applicable now that I have lived and breathed language therapy. Your interpretation of how a language disorder works really does effect the way you approach treatment of that disorder. I would encourage everyone to review these models and think about which ones you believe to fit your experience with language disorders the most. I think it is an important exercise for all of us to contemplate our beliefs and reasoning and keep an open eye to other theories.
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