10 Chapter 1
The third station is for language screening. These tests determine whether the child has age-
appropriate expressive and receptive language. They are by far the most time consuming because
there are many aspects to test and lengthy responses are required. At this station, the child names
and describes the functions of objects, identifies colors, makes grammatical constructions, and
follows commands; the clinician assesses the average number and length of utterances. The teach-
ers’ reports are reviewed to learn their impressions of the child’s use of language at snack times,
during classroom activities, and at play.
At the final station, all of the information is reviewed, and the clinicians, teachers, aides, and
parents are questioned about unusual scores and irregularities. Children with below- average
scores are given a follow-up screening test to confirm or reject the results. A child who fails the
screening is referred for a comprehensive hearing, speech, and/or language evaluation. Because
the clinicians recognize that accurate screening of hearing, speech, voice, f luency, and language
in children enrolled in Head Start is challenging, they have agreed that if an error is to be made, a
false positive is preferable to a false negative. Although they try to avoid mistakes, they are careful
in making recommendations for further testing. They would rather refer a child for an evaluation
unnecessarily than miss a child with a developing communication disorder.
During the screening, Blake, a 5- year- old boy, comes to the final station. He is described as
significantly delayed in learning expressive and receptive language. He speaks primarily in one-
word utterances, rarely combines words correctly into two- and three- word utterances, and shows
poor grammatical development, phonological delay, and a restricted receptive vocabulary. The
teacher’s report also shows that Blake is talking at a 2- year level. According to the teacher, Blake
lives on a farm many miles from town, is an only child, and, until enrollment in Head Start, had
very little interaction with other children. A comprehensive speech and language evaluation is
recommended.
The evaluation at the university’s speech and hearing clinic confirms Blake’s language delay.
Tests show that he uses receptive language at a 2- year, 3- month level, and his expressive language is
even more delayed. The percentile rank, a test score comparing him to his peers, shows him to be
functioning at the fifth percentile, meaning that about 95% of children his age use language more
efficiently. Intelligence testing conducted by a neuropsychologist does not suggest intellectual dis-
ability. The diagnostic team believes the cause of the language delay to be environmental deprivation.
Actually, for Blake, this diagnosis is misleading; he is far from deprived of environmental
stimulation. Farm life is healthy, exciting, and exhilarating. Blake has 40 acres of rolling hills to
roam, barns and outbuildings to explore, fresh air, and open spaces in which to play. He has his
own pony, pet goats, rabbits, and his faithful dog, who accompanies him everywhere. There are
daily chores for the young boy, including gathering eggs and feeding the chickens. He rides with
his father on the tractor and helps his mother in the family garden. But unfortunately, this rich
environment lacks social interaction. Blake has no siblings and no other playmates of his age. He
has no one with whom to talk, argue, squabble, discuss, banter, and joke. Consequently, he has not
learned the vocabulary of children his age or how to use language pragmatically.