Language Delay and Disorders 9Children with language delay and disorders require special consideration due to the inherently
cultural nature of language. Culture and language are fundamentally related. Language carries a
culture’s history, customs, beliefs, and values from one generation to the next. It provides an ave-
nue of cultural expression. Thinking in one language is not identical to thinking about the same
subject in another language, and some have criticized the verbal sections of intelligence tests as not
providing objective, culturally sensitive scores. Speech- language pathologists, whether addressing
dyslexia, attentional deficits, autism, dysgraphia, or other language- based disorders, must consider
the child’s culture when testing, determining goals and objectives, and implementing treatments.
Language differences are not necessarily language disorders, and appreciating the relationship
between culture and language ensures that language delay and disorders are correctly identified
and treated.
Case Study 1-1: Language Delay Secondary to
Environmental Deprivation
The diagnostic team pulls into town, unloads test after test from the trunks of the cars, and
sets up several evaluation stations in the large Head Start center. Today they will screen and, when
indicated, further evaluate twenty- three 4- and 5- year- old children. This center is the final stop
on the diagnostic cir cuit; during the past 2 weeks, the team has visited 14 centers and tested nearly
250 children. The diagnostic team has the screening routine down precisely. Earlier in the week, a
questionnaire was sent to all teachers who identified children they considered at risk for commu-
nication disorders. Although all children will be screened, those whom the teachers thought may
be developing communication disorders will receive special attention.
The purpose of the screening is to detect children who are having prob lems with communica-
tion or are likely to develop them. A series of quick but accurate screening tests are administered
as each child passes through the evaluation stations. One clinician interviews the child’s parents,
if available, and escorts each child from station to station. Most of the screeners are functionally
multilingual, and if the home language of the child is not spoken by the tester, the Head Start
center has arranged for a parent, teacher, or teacher’s aide to be pres ent who speaks this language.
Although each station has a par tic u lar objective, the testers are encouraged to note any type of
communication irregularity they observe.
The first station is for hearing screening. The head teacher’s office is used to set up the portable
audiometer, and it is biologically calibrated. In biological calibration, the clinician screens his or
her hearing and adjusts the base loudness levels for the ambient noise. Of course, screening hearing
with excessive ambient noise is less than desirable, but it is sometimes necessary. At this station,
each child is screened at several pure tone frequencies; if he or she fails two or more of the fre-
quencies tested, then retesting is scheduled. The diagnostic team also has an impedance screening
device capable of detecting middle ear dysfunction.
The second station is for voice, articulation, phonology, and f luency screening. There are words
to repeat, objects to name, and pictures to describe. The activities have been carefully selected so
that each child produces all of the consonants and vowels and talks enough so that f luency can be
assessed. The child’s intelligibility is tested, and a percentage score is assigned ref lecting his or her
ability to be understood. This is an impor tant test; unintelligibility can negatively affect a child
socially and educationally. There is also a section in the screening protocol for voice quality and
loudness.