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Introduction to Language Disorders
Assignment #2
March 12, 2012

Case 2: Grace – Late Talker

Grace’s parents should not take a wait and see approach for Grace and ask for treatment immediately. In their article Recommending Intervention for Toddlers with Specific Language Learning Difficulties: We May Not Have All the Answers but We Know a Lot, Olswang, Rodriguez, and Tilmer argue that “toddlers who exhibit few positive predictors of change and many risk factors are more likely to have a true impairment and need intervention than toddlers who exhibit many predictors of change and few risk factors” (23). After reading the case, I determined that Grace is an individual with many risk factors (otitis media, low vocabulary, an older sibling with reading difficulties) and few positive predictors of change (tantrums, frustration, and “selective” listening and following directions). It is this writer’s view that Grace should therefore have access to services (at least for the short term) immediately that will help identify whether or not she has a true impairment, because she very well might and the language learning window is too small because of Grace’s age to wait and see. Grace’s learning would suffer and she will be behind her peers for much longer if her parents were to wait and see.

The authors of the article go on to review literature “designed to identify child behaviors that shape a profile of toddlers who should receive intervention” (24). They state that language production is one of these behaviors or “predictors of change.” They go on to state that “a two-year-old with few than 50 words is clearly at risk for continued delay; the risk grows as a child ages with little change in language production (24).” Grace clearly fits this description with less than 20 words that are difficult to understand at over 2 years old. The authors also indicate that “vocabulary in relation to comprehension” (24) is an indicator that there may be a language learning difficulty. Since Grace has trouble understanding her parents and throws tantrums when she gets frustrated, I would bet that she is having a comprehension difficulty. If her expressive vocabulary is only 20 words, her receptive vocabulary might be a little larger, but it’s not clear. Having her receive services would provide access to more concrete assessment tools and help clinicians understand more of what’s going on with her comprehension of language. The fact that Grace plays by herself and won’t sit for a story that is read to her tells me that there is a distinct comprehension difficulty happening with Grace. She can’t enjoy the story because she can’t understand it, and therefore looks to do something she can understand. Until she is seen by a clinic though, the degree of what she understands will never be known, diagnosed, and treated in the future.

The next red-flag that occurred to me when reading Grace’s case was the fact that she is dropping final consonants from the words she does produce. The authors say that phonology is also a predictor of a future language learning difficulty as well. They state “when children begin to produce their first words, the percentage of consonants that is correct has been a variable separating children developing language typically from those with future language learning problems” (25-26). They continue to site other articles and research with similar findings. Because Grace is dropping final consonants, I want to say that she may have expressive language difficulty that has stemmed from a receptive language difficulty; she may just not have understood what was being said to her and is repeating what she does understand. She may have a degree of hearing loss that could be corrected and treated with therapy implemented sooner rather than later.

Furthermore, the authors site heritability and otitis media as risk factors for language learning difficulties. They state “a higher proportion of relatives with histories of language impairment or learning disability in families of children diagnosed as SLI than in those of typically developing children” (27). The fact that Grace’s second grade brother is having difficulty learning to read pops out as another red flag in this writer’s eyes. There may be an SLI that is undiagnosed and untreated there too, and it puts Grace at risk for an SLI. With prompt treatment, her parents could have a better idea of what is going on and to take action. The authors also review articles that contradict each other about otitis media and its effect on hearing and future language learning, but they summarize in way that makes me think that because Grace has had bouts of ear infections, she should be seen because of her other risk factors and predictors of change. The article states “prolonged, untreated otitis media places a child at greater risk of continued language delay. Further, evidence suggests that toddlers with a history of persistent otitis media are at greater risk for difficulties with articulation” (28). Again, because Grace has had ear infections and having trouble with articulation of final consonants, she may be at risk.

The fact is that yes, Grace might be too young to determine whether or not she has a SLI and may outgrow many of her difficulties in years to come. However, she may not, and she has too many risk factors and not enough predictors for positive change not to be seen. Her parents may struggle with her at home, and why not correct the small problems now if the resources are present to do so. By having her evaluated now, her parents are setting her up for a pattern of future success. They are finding a possible problem and addressing it early before too much time passes. Skilled clinicians should be able to diagnose Grace’s specific learning needs and provide the therapy needed to help her better communicate, leading her to become less frustrated both expressively and receptively. Again, in the mind of this writer, it is best for Grace’s parents to ask for treatment immediately.

Source: Olswang, Lesley, Barbara Taylor, and Geralyn Timler. Recommending Intervention for Toddlers With Specific Language Learning Difficulties: We May Not Know All the Answers, but We Know a Lot. American Journal of Speech-Language Pathology. Volume 7. February 1998. 23-27.
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