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Review of  Classification of Developmental Language Disorders


Reviewer: Leah R. Paltiel-Gedalyovich
Book Title: Classification of Developmental Language Disorders
Book Author: Ludo Verhoeven Hans van Balkom
Publisher: Lawrence Erlbaum Associates
Linguistic Field(s): Language Acquisition
Book Announcement: 15.1302

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Date: Sat, 24 Apr 2004 23:31:04 +0200
From: Leah R. Paltiel-Gedalyovich <glh33@zahav.net.il>
Subject: Classification of Developmental Language Disorders

EDITOR: Verhoeven, Ludo; van Balkom, Hans
TITLE: Classification of Developmental Language Disorders
SUBTITLE: Theoretical issues and clinical implications
PUBLISHER: Lawrence Erlbaum Associates
YEAR: 2004

Leah R. Paltiel-Gedalyovich, Ben-Gurion University of the Negev


SUMMARY

This volume is an edited collection of papers evolving from
a workshop at the Max Planck Institute for
Psycholinguistics. A short introduction precedes the main
body of the book which is divided into three parts of
roughly equal length: etiology, typology and assessment and
intervention. The editors state the purpose of the book as
'the classification of subtypes of developmental language
disorders' (DLDs, p. 6). This classification is examined with
an eye towards assessment and intervention.

In the introduction, the editors briefly review the various
descriptions of DLD and the implications of the difficulties
for schooling. They then highlight theoretical and practical
difficulties in assessment and differential diagnosis,
making practical if brief recommendations for what may be
involved in the assessment process. Classification of the
type of DLD is seen as a primary goal of assessment,
however, limitations in diagnostic tools limit the ability
to reach such a classification at a clinical level.

Thus, this volume aims to contribute towards remediating
this situation. Multi-faceted approaches of this collection
is emphasized by the very different research orientations
and methodologies of the participants. It brings a range of
theoretical orientations, concentrating on translating
theory into clinical practice.

The stated target population is anyone interested in SLI. It
is also recommended as an introduction to SLI for
undergraduate and graduate students.

PART 1 ETIOLOGY

In the opening chapter, Chapter 1 'Characteristics of
children with specific language impairment (SLI)', Nicola
Botting and Gina Conti-Ramsden describe the difficulty in
reaching a positive criterion for SLI and review the
negative criteria (what to rule out). They then describe
their research project, a survey of 50% of the children
attending special language educational environments in
England. They thus have a large sample size (233 children)
at one age group (7 years) assessed twice at a one year
interval. Note that their group included many children (58)
whose standardized language test scores fell within normal
limits yet were significantly lower than their non-verbal
abilities.

Their research results in a classification of these children
into 6 groups which they compare to the classification of
Rapin and Allen, although, they prefer to characterize their
groups by description of the pattern of performance on a a
number of clinical tasks rather than a label. They report
the changes which occur in the surveyed population over the
year - interestingly, children may change their
classification but new classifications were not found. The
authors compensate for limited discussion, probably due to
length limitations, by references to detailed published
accounts for more in depth discussion.

In my opinion this chapter deals with typology and not
etiology and would have been more appropriately placed as an
opening for the second section of the book.

Chapter 2 ' Neuroplasticity and development: 'The
acquisition of morphosyntax in children with early focal
lesions and children with specific language impairment' by
Judy Reilly, Jill Weckerly and Beverly Wulfeck follows. This
chapter compares the patterns of behavior of children with
focal brain lesions and SLI with their normally developing
peers. Here the emphasis is on the differential patterns
shown by different etiologies. The authors conclude that the
populations are differentiated in terms of patterns of
recovery rather that patterns of disability. As in the
previous chapter, the research brought was carried out on an
impressively large population. Children with focal brain
lesions are found to recover and reach normal levels of
language behavior by age 7-8 while children with SLI retain
impaired behavior until older ages. The results are related
to the question of neuroplasticity. The recovery of the
children with focal lesions shows the plasticity of the
brain with healthy areas compensating for damaged areas.
This is unavailable for children with SLI due to the
postulated diffuse nature of the brain impairment.

Chapter 3 is 'Language disorders across modalities: The case
of developmental dyslexia' by Pieter H. Been and Frans Zwarts.
The authors describe a model of auditory perception, the
combined ARTPHONE-SWEEP model. They use this model to
simulate behavioral and brain study results of phonological
awareness in Finnish and Dutch normal controls, adult
dyslexics and in infants at risk for dyslexia. The model
shows that dyslexic behavior may results from a deficit in
auditory areas which is similar to a visual deficit, based
on general perceptual deficits affecting auditory and/or
visual areas. This is supported by the modelling of the
SWEEP component on models of the visual cortex. However,
similar results can be found based on the ARTPHONE model
which models an auditory, language specific capacity.

The model has the advantage of making predictions (and
recommendations) regarding treatment options, both
pharmaceutical and behavioral. It provides a theory of the
neural structural deficits underlying dyslexia,
specifically, reduced local neural density. Thus deals
directly with the question of etiology for this population.
The chapter is quite technical as a fair bit of familiarity
with neural anatomy and phyiology, as well as modeling is
assumed.

Chapter 4 'Neuroimaging measures in the study of specific
language impairment' by Paavo H. T. Leppanen, Heikki
Lyytinen, Naseem Choudhury and April A. Benasich gives a
review of the results of a variety of neuroimaging
techniques for children with SLI and related deficits. The
accuracy and benefits of such techniques in studying adults
is stressed along with the parallel expectation regarding
children in general and particularly in clinical
populations. Each technique is introduced with a brief
description assuming no or little prior knowledge.
References to detailed reviews of a variety of techniques
are given.

No definitive correlation between anatomical anomaly or
neural function and behavioral pattern (subgroup of SLI )
has been found but some trends are evident, particularly in
the auditory pathway and in auditory processing.
Inconsistencies in techniques, populations and results
between studies make drawing conclusions difficult. It is
not always clear which behavioral pattern is being examined
for a neuro-substrate due to lack of a unified definition of
SLI.

The authors conclude that a potential for neuroimaging as a
technique for identification and prognosis of children at
risk for langauge and language related disorders exists but
it is not yet well enough developed to be used for
differential diagnosis or definitive prediction.

Chapter 5 'Information processing in children with specific
language impairment' by Ronald B. Gillam and LaVae M.
Hoffman deals with etiologies of SLI, accompanying
symptomatology which may or may not be causal: attention
deficits, auditory discrimination and processing deficits,
phonological representation limitations.

After considering research into working memory, specifically
for auditory speech information, Gillam and Hoffman conclude
that the main difficulty is in creating, retaining and using
'verbal codes'. Alternatively, recoding phonological
information may cause system overload for these children.

Along with a survey of the relevant research, the authors
report two experiments of their own. The first (published)
study deals with the question of working memory for verbal
codes. The second (in press) study deals with the role of
central executive function. they found that children with
SLI could not take advantage of the multi-modal clues.
Rather than being integrated, the separate visual and
auditory clues served to detract from each other. Limitations
in verbal storage capacity account for poor performance.
They suggest that children with SLI show problems in general
memory and response time relative to age-matched peers,
concluding that there is a problem with general capacity.

Clinical implications are discussed, specifically, they
suggest a "dynamic assessment" process to assess both
language skills and "psychological functions that support
language development" (p. 150). These psychological
functions include: attention, perception, memory, and
central executive functions. The testing process involves:
pretest, teaching (1-2 sessions), posttest. The posttest
assesses the degree and type of change resulting from the
teaching phase in order to evaluate the child's information
processing abilities. A specific example of the assessment
process using the example of narrative skills is given.

Intervention strategies are based on the results of the
assessment. Although general treatment may be highly
oriented towards ecological validity and pragmatic
appropriateness for the social and academic environment,
'mini-lessons' focussing on particular skill areas are
sometimes needed. Intervention techniques suggested include:
promoting attention, reducing speech rate and improving
clarity, promoting phonological coding by drawing attention
to various aspects of phonology, choosing treatment topics
based on what is familiar to the child, organizing new
information and provide memory aids.

Chapter 6, 'Environmental factors in developmental language
disorders' by Sienke Goorhuis-Brouwer, Francien Coster,
Han Nakken and Henk Lutje Spelberg discusses the role of
social communication in the development of language
disorders and the converse influence of a language disorder
on socio-emotional development.

Three pilot studies are reported: Study 1 examined the
behavior of pre-school (1-3 years) children with SLI. Based
on a behavior and language questionnaire the only difference
between the normally developing preschoolers and those with
SLI was in the adaptation (less open in contact with peers).
The parent interview however showed behavior problems, again
in the area of socialization. Study 2 examined the behavior
of kindergarten (3-6 years) children with SLI. Observations
assessed by the CBCL (Achenbach, 1991) did not show
significant differences between the groups, but again, the
parent interview did. Three quarters of the parents reported
problems. Study 3 examined the behavior of school children
(6-15 years) with SLI. Teachers reported socio-emotional
problems which were supported by their observations reported
by the teachers version (TRF) of the CBCL.

>From the pilot studies the authors hypothesized that there
is a gradual increase in the correlation between reported
and observed aberrant behavior with increased age. The
combination of behavioral problems and language deficit
increasingly interferes with social interactions and
communications with adults and peers. This hypothesis was
examined in a large study (over 150 participants). The
methodology involved the CBCL teacher and parent observation
forms. Around one third of the children were found to be
within the clinical range for socio-emotional development
based on parental ratings, the percentage of children rated
by teachers to be within this range was slightly higher.
When the ratings were taken together almost half the
children were considered to be within the clinical range.
Note that there was poor parent-teacher agreement. This is
interpreted as indicative of the children's differential
behavior depending on the communicative situation and
partner. Discrepancy between early perceived behavior and
actual behavior was found to affect development of deviant
behavior.

Part II Typology

Chapter 7 'Speech output disorders' by Ben Maassen opens
this section. Using Levelt's (1989) model of speech output,
Maasen aims to arrive at clinical diagnosis. He compares
developmental apraxia of speech (DAS) with dysarthria,
phonological delay , other (non-specific) articulation
disorders and normal speech. As such the symptoms of DAS
reflect difficulty 'somewhere between word form retrieval
and articulation' (p. 177) in Levelt's model. He follows
Bishop (1992) as defining the disorder as a deficit in
converting from phonology to motor execution. Five
procedures for evaluating intelligibility both
quantitatively and qualitatively are described: 1.
producing phonetic contrasts, 2. phonological process
analysis of a spontaneous sample, 3. word identification, 4.
Percentage consonants correct (PCC, Shriberg and
Kiawtkowski, 1982), and 5. scales of speech qualities. In
addition Maasen demands of a speech evaluation that it
should aid in determining etiology and allow differential
diagnosis.

An empirical study is reported. Criteria for selecting
participants as DAS, dysarthric, SLI or otherwise are
described in detail. Experimental tasks include real and
nonsense word production as well as rapid syllable string
production. Results show that on the word production task,
children with DAS produce more errors than children with SLI
or dysarthria who produce more errors than their normally
developing peers. Dysarthria results in a high percentage of
distortions while DAS results in a high percentage of place
substitutions. All groups show similar patterns regarding
other aspects of sound production. On the maximum repetition
task children with dysarthria are slower than children with
DAS and SLI who are slower than children with normal
development.

Similarities between the SLI and DAS effects leads to a
closer analysis which suggests that about half of the
children with SLI show dyspraxic symptoms, suggesting a
possible shared underlying deficit. This deficit is thought
to be a deficit at the level of speech segments and
articulatory movement. These are parallel to Levelt's
'segmental spellout' and 'phonetic spellout'. Note that DAS
rarely occurs in isolation. Although the chapter is clearly
written, I would have benefited from a more detailed (and
graphic?) explanation of Levelt's model.

Chapter 8 'Central auditory processing' (CAP) by Jack Katz
and Kim Tillery first gives statistics on the prevalence of
CAP disorders (CAPD) in the normal population (thought to
be 5% -10%); similar or higher percentages may exist in
clinical populations. A disorder in CAP is defined as a
disorder in what is done with auditory input. CAPD has been
associated with learning difficulties, primarily reading but
also other language and communicative areas. Its symptoms
may be confused with attentional disorders. However, many
children with ADHD also suffer from CAPD.

A behavioral CAP assessment battery is described which
includes: 1. Staggered spondaic word test (SSW), this yields
a quantitative score as well as therapeutically useful
qualitative error analysis. , 2. Phonemic synthesis test (PS)
which provides quantitative and qualitative information on
sound blending skills. , and 3. Speech in noise test.

CAP behavioral studies, together with neural lesion
information, have resulted in classification of four
subtypes : 1. 'Decoding category' (DEC), 2. 'Tolerance-fading
memory' (TFM) category, 3. 'Organization category' , and 4.
'Integration'. The categories are summarized in a clear
table. For each category a clear description of the symptoms,
the anatomical areas affected and the relation between these
is given.

The authors follow with a sample case study which relates
assessment results to intervention recommendations. Finally
intervention strategies are suggested for each of the
categories.

Chapter 9 ''Lexical deficits in specific language
impairment' by Laurence B. Leonard and Patricia Deevy looks
at children with lexical rather than grammatical disorders
(cf. work by van der Lely on a lexical subtype of SLI). They
describe the lexicon and its importance, as well as problems
deriving directly from lack of word knowledge, secondary
effects on grammar and morpho-grammar learning.

Although early symptoms of SLI include late first words,
smaller vocabulary, limited comprehension, and decreased
lexical diversity, the general pattern of vocabulary
composition and use is similar to younger normally
developing children. The authors survey some assumptions
regarding lexical processing. Each word entry includes:
"lexical concepts" (meanings are formed for words and links
are made with related meanings), "lemma" (grammatical
properties and links to other entries with similar
grammatical properties), and "lexeme" (phonological
information including links with entries with shared or
similar information). Comprehension progresses from lexeme
to lemma to lexical concept. For production the process is
reversed.

A review of research into lexical skills of children with
SLI shows evidence for relatively normal learning of novel
words for comprehension but reduced learning for production.
An explanation of these results in the context of the given
model suggests that this is indicative of the formation of a
reduced lexeme. There appear to be two groups of impairment,
for one, semantic information is more distorted and for the
other, it is phonological information which is primarily
affected. Specific difficulty with verbs may also be
explained within this model although the authors note that
some 'pure' syntactic difficulties remain.

Chapter 10 is 'Morphological disorders' by Dorit Ravid,
Ronit Levie and Galit Avivi Ben-Zvi. These authors choose
Hebrew derivational morphology as a diagnostic tool in
comparison of school children with SLI and NLA. Thus, they
aim to contribute to the delay versus deviance debate.

Language in school children is characterized by continued
development alongside the interaction of language with
growing literacy skills. Children with SLI show problems
with: 1. lexicon 2. morphological processing, 3.
metalinguistic skills. Children tend to learn the morphology
of morphologically rich languages relatively easily,
including SLI children. On the other hand, studies of
derivational morphology in English have shown that SLI
children have difficulty with this area. Previous study by
these authors has shown children with SLI have difficulty in
production of novel derived nouns and in semantic noun
classification.

Adjectives are a unique content word class semantically,
pragmatically and syntactically. Adjectives characterize
nouns and as such have a morphology which reflects the
characteristics of the noun in morphologically rich
languages. As background to their study, the authors give a
short and clear description of Hebrew verbal, nominal and
adjectival morphology.

Counter to predictions children with SLI perform more
poorly on comprehension task than age and language matched
controls. On production tasks, children with SLI differ from
both groups. Resultative adjectives are found to be
significantly easier than attributive and denominal.
Children with SLI differ from both groups on resultative
adjectives but do not differ from language matched controls
on attributive and denominal adjective derivation.

The difficulty with comprehension is interpreted as
resulting from difficulty in analysis of morphology.
However, the experimental task requires production as well,
such that it is not clear what causes of the poor
performance. The authors note non-language factors which may
have confounded results but do not consider expressive
language difficulty.

The results are interpreted as supporting a deviance (as
opposed to delay) explanation. This is based on a
qualitative analysis of errors (quantitative analysis does
not shown consistent difference from language matched
controls): children with SLI use analytic expressions and
semantic responses more often than their LA matched peers as
well as one strategy (unconventional adjective). They
conclude that this is an appropriate area of study for
distinguishing SLI.

In Chapter 11 'Grammatical impairment: An overview and a
sketch of Dutch' by Jan de Jong examines theories of the
morpho-grammatical deficit which is present in most children
with SLI. De Jong reviews theories of grammatical symptoms of SLI.
1. Non-salience of inflectional markings - "surface" hypothesis.
Leonard (1989) accounts for cross-linguistic differences
where differences in surface saliency of inflections account
for whether or not they are affected by SLI.
2. Decreased control of subject-verb agreement.
3. Prolonged optional infinitive stage.
4. Decreased knowledge of abstract features.

Part of the author's doctoral dissertation is reported which
investigates the nature of tense and agreement in Dutch SLI
and what (if any) of these SLI theories are supported?
Results show error patterns in children with Dutch SLI as
compared with controls including inconsistent marking of
past tense. Errors include omissions, substitution (present
tense affixes), infinitive forms. In addition - omissions of
inflectional markers (regarding 3rd person),
misrepresentation of number (singular instead of plural),
form position concordance.

De Jong explains the data as compatible with all but the
extended optional infinitive stage hypothesis for omissions,
substitutions cause difficulty for the surface theory as
well. Adapting the optional infinitive stage to Dutch is
difficult since this follows (in the proposed stages) a
finite stage. The children use an auxiliary plus infinitive.
The optional infinitive account does not predict the
agreement (person, number) errors. The agreement hypothesis
does not predict the past tense errors. Overgeneralizations
argue against a theory that SLI children have no linguistic
rules. Research into non-English SLI leads to the need to
account for substitutions not just omissions, and to
consider phenomena of verb second languages.

In Chapter 12 'Pragmatic disability in children with
specific language impairments' by Hans van Balkom and Ludo
Verhoeven pragmatic disability is defined as a deficit in
communicative use of language. Specifically "an inability to
select and match a suitable linguistic form to the most
appropriate and effective communicative function. ' (p. 283)

Two approaches modular and functional are described and
illustrated in clear figures. I found it interesting that
the population studied was very young and that the entire
SLI group reached age appropriate behavior as measured by
formal tests within two years. Is this representative of
children with SLI?

Results of the empirical study show that SLI and NLA are not
differentiated by the appropriateness and variety of
communicative functions. Rather, the SLI population uses
inappropriate linguistic forms for these functions. The
authors note the reciprocal relationship between the
children's language performance and the parental language
behaviors resulting in a poorer linguistic environment. The
children have difficulty with discourse processes because of
weaker representation of linguistic knowledge, even when
this knowledge reaches normal levels. Within the SLI group,
higher functioning children perform better than lower
functioning children with regard to form-function mapping
as measured by discourse coherence. Parent interactions with
children with SLI are less involved and less equally
distributed than with children with NLA. This linguistic
environment provides for the child with SLI only limited
opportunities to develop discourse strategies.

PART III Assessment and Intervention

In Chapter 13 'Specific language impairment: Diagnostic
dilemmas' by Dorothy V. M. Bishop, the author begins with
arguing for the different demands of a classification system
for research and clinical purposes. She makes use of the
World Health Organization classification to suggest that
research deals with impairment, while clinical work deals
with disability arising form such an impairment and aims to
minimize handicap resulting from such disability.

The aim of clinical assessment is to determine which
children will benefit from which specific forms of
intervention and educational placement. Traditional criteria
like IQ discrepancy scores need to be used discriminantly,
again depending on the goal of classification. The type of
assessment used is influenced by the model. Qualitative
assessment strategies result from a model which views SLI
behavior as atypical, eg. Rice's (2000) extended optional
infinitive test or non-word repetition. Standardized tests
may not be geared to distinguish impaired and non-impaired
populations.

Children with a really specific disorder are unusual;
usually we find co-morbidity. The search for a very specific
diagnosis may result in a too narrow evaluation of the
child. She notes that various professionals will diagnose
the same symptoms differently. A multidimensional model
(instead of labels) allows us to relate to the child's
function in a variety of critical areas. However, we need
labels to allow appropriate educational placement. Bishop
emphasizes, the pure cases are NOT representative of the SLI
population. For research purposes co-morbidity raises issues
of the relationship between the various impairments.
Clinical approaches are more successful in describing
underlying processes. Bishop ends by describing some different
types of SLI which do have consensus.

In Chapter 14 'A dynamic systems approach to diagnostic
measurement of SLI' Paul van Geert defines a dynamic system
as "a structure of interacting forces" (p. 327) which
undergoes 'self-organization;' becoming increasingly more
ordered and structured.

As opposed to the classical Chomskyan nativist view and the
"poverty of the stimulus" argument for language innateness,
the dynamic systems approach allows rich linguistic
competence to develop from poor linguistic input by not
assuming the axiom of entropy. According to the Chomskyan
view, deficient language development should first of all
reflect a deficit in the innate substrate; according to the
dynamic systems approach, every step in the
self-organization process causes the following step.

This system is iterative; thus the input to the next stage is
the preceding stage plus environmental input. Finding the cause
of impairment requires reconstructing the developmental
process. The system may reach an "attractor state" where the
output stage is similar to input stage which will be
semi-stable unless external factors are changed (e. g. an
individual is given a hearing aid).

The model adopted of development is a linear increase model:
Each successive state depends on the current state plus
input. If increase and decreasing factors are of
statistically equal magnitude the result is a 'random walk'
showing random fluctuations. The use of the model to explain
fluctuations (loss and recovery) is exemplified by
Landau-Kleffner syndrome.

Since more than one skill area competes for the resources
(such as attention) the amount of competition influences the
outcome. The model predicts a bi-modal pattern of
development for two competing factors. The possibility of
innate language disorder or innate language knowledge is
compatible with the model. An innate disordered state
influences the amount of resources which must be allocated.

A dynamic model predicts (as is found) changes in the
pattern across time. An impaired genotype may have different
manifestations as resources are competed for - resulting in
different patterns of strengths and weaknesses.

Psychological properties cannot be accurately measured by
tests because they are the interaction of the individual
with the context and environment. Therefore, assessment
involves describing a range of characteristic performances
for a skill area (e.g. morphosyntax) for a child under
different contexts (e.g. test performance, normal
communication, stress, etc. ) . Thus, one part of the
description of the child's ability addresses the variability
of his/her performance. In this view, test-retest
variability is expected. Rather than giving a child a
specific label, van Geert suggests stating that a diagnostic
label is "characteristic of a specific person to a degree of
approximately. . . . (x). " (p. 345)

I found the detailed explanation of the model and the use of
figures and examples extremely helpful in understanding a
view of language acquisition and disorder which was totally
new to me.

In Chapter 15 'Early detection of developmental language
disorders' Hanneke de Ridder and Heleen van der Stege
discuss a screening instrument for language impairment
introduced as part of a national health center protocol for
infants/toddlers. The screening instrument (VTO)is based on
early precursors of communication evident in parent-child
interactions in children 0-3 years. The instrument schedule
follows regular check-up schedule for health centers:
1,2,3,6,9,12,15,18, and 24 mos. Here results of the last 4
visits where measurements occurred are reported. Note that
the time allowed is less than 5 minutes for administration
of a parent interview with standardized questions.

The areas covered are: production, comprehension,
conversation/play. Close to 900 children participated in
standardization. For the majority of questions, 90% or more
of the children had acquired the surveyed skills, but many
questions did not. A look at the detailed chart of the
results of this survey shows that for almost all items over
80% of the children performed as expected.

As assessed by this screening instrument, underlying
structure emerges at 9 months for comprehension and at 12
months for production - by age 24-30 months production
versus comprehension problems can be distinguished. No
structure for interaction is shown. The cut off score for
normal language behavior is determined by the estimated
incidence of language disorders in the country.

Predictive validity is shown in a follow up study, as a
correlation was found between failing the screening test and
language performance 1 and 3 years later. There were 10%
false negatives, information on false negatives is not yet
available. The authors note that despite the success of the
screening instrument a major problem remains in parents
refusing to follow up recommendations for further testing.

Chapter 16 'Early intervention for children with language
impairments' by Steve F. Warren and Paul J. Yoder discusses
the basis of intervention as the notion that the quality of
the input influences development. The authors present three
different models of intervention: responsive interaction,
milieu, and didactic teaching. They describe how each works
and then argue that children at different stages of
cognitive and language development can best benefit from
different types of therapy. Responsive interaction is found
to be the best option for children at the stage of
development above MLU 2. 5, milieu for children under MLU 2. 0
and didactic teaching for children with MLUs over 2. 5 and
mild cognitive deficits. Also, the therapeutic goal affects
method, e.g. milieu teaching has been found to be effective
for vocabulary teaching. The message is to choose the
therapy method of best-fit to the specific child at the
specific stage of the child as opposed to opting for one
type of therapy throughout. Recommendations which a
clinician can take and apply to his/her clinical work are
made.

Chapter 17 'Benefits of speech manipulation for children
with language disorders' by Ludo Verhoeven and Eliane Segers
discusses intervention based on compensation for assumed
limitations in temporal processing at the basis of language
disorders. Specifically, they look at research showing the
effect of lengthening of formant transitions for individuals
with SLI , as well as research on related intervention
programs. This research has involved phonemic (between
phoneme boundaries) or phonetic (allophonic variation)
discrimination. Individuals with language disorders have been
found to have more difficulty than controls in
discriminating between CVs with a stop consonant. Studies
using a speech continuum find differences between 'slow
learners' and normal controls but differences overall tend
to be smaller. Overall lengthening formant transition was
found to improve discrimination for language disordered
children (but not adult aphasics).

Intervention programs following this research includes
computer assisted training: one example is the fairly
intensive Fast ForWord program. In this program computer
training is adapted to the child's progress, the program
includes syntax and morphology as well as auditory training.
Research evaluating this and similar problems is
methodologically problematic. Furthermore, the intervention
programs do not closely follow the techniques researched.

Although a clear pattern of auditory perceptual difficulty
is shown, the authors question the causal relationship
between this difficulty and the language disorder.

The closing chapter, Chapter 18 'The close association
between classification and intervention of children with
primary language impairments. ' by James Law examines
classification as related to the existence of differential
intervention strategies. He recommends distinguishing
transient from persistent language disability by diagnostic
therapy designed to child's individual needs, matched to a
specific set of behaviors. He reviews research into the
effectiveness of intervention, summarizing 22 group studies.
Conclusions include: parent-directed treatment is as
effective as direct clinician treatment, there is transfer
from intervention in syntax to phonological skills and vice
versa, positive intervention outcomes are found for
articulation/phonology, expressive language, and receptive
language, and finally, auditory training did not improve
articulation/phonology. Usually intervention moved children
into the normal range of language performance.

Law notes that further research is needed to evaluate
whether the effects of intervention are only short terms or
are real long term changes in the child's psycholinguistic
abilities.

Working backwards, behavioral patterns which respond to
intervention can be considered classification categories,
e. g. if work on articulation improves performance we can
identify a category of children with articulatory
impairment. Consequently, the less we know about
intervention with a certain pattern of behavior (such as
pragmatics), the further we are from a useful
classification.


EVALUATION

I found the volume interesting reading throughout. Although
a wide range of theoretical points of view are represented
and within the topic, a wide range of sub-topics, continuity
is maintained by the progression from the theoretical to the
practical. Dorothy Bishop's paper at the beginning of Part
III aids this transition in her discussion of the
differences between research and clinical needs regarding
classification. The fact that many chapters include
references to other chapters in the book, either for
theoretical basis/practical application or for a contrasting
view, adds to the coherence of the volume as a whole. I
found some chapters to assume more previous knowledge or
familiarity with the topic than others, something which may
need to be considered when recommending the book to
students. However, all chapters are clearly written and well
referenced, pointing the reader in the appropriate direction
for filling in any missing background.


REFERENCES

Bishop, D. V. M. (1992) 'The underlying nature of specific
language impairment', Journal of Child Psychology and
Psychiatry and Allied Disciplines, 33, 3-66.

Leonard, L. B. (1989) 'Language learnability and specific
language impairment in children', Applied Psycholinguistics,
10, 179-202.

Levelt, W. J. M. (1989) Speaking: From intention to
articulation. Cambridge, MA: MIT Press.

Rice, M. L. (2000) 'Grammatical symptoms of specific language
impairment', in D. V. M. Bishop & L. B. Leonard, eds., Speech
and language impairments in children: Causes, characteristics,
intervention and outcome, pp. 17-34. Hove, UK: Psychology Press.

Shriberg, L. D. and Kiawtkowski, J. (1982) 'Phonological
disorders III: A procedure for assessing severityof involvement',
Journal of Speech and Hearing Disorders, 47, 56-270.
 
ABOUT THE REVIEWER:
ABOUT THE REVIEWER


Leah Gedalyovich is currently assisting in research into
Hebrew G-SLI at the Department of Foreign Literatures and
Linguistics, Ben-Gurion University of the Negev. She
combines research with part-time work as a speech-language
pathologist in pre-school and school settings. Research
interests include normative first language acquisition
(primarily of Hebrew), language disorders, the interaction
of semantics and pragmatics and the clinical application of
linguistic theory.


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