16 Chapter 1
Case Study 1-5: Reporting Suspected Child Abuse in a
Language- Delayed Preschooler
The student clinician is excited about the midsemester conference she is to have with her
supervisor. Dawn, a preschooler, is making remarkable gains in language therapy. She is small for
her age, with beautiful dark eyes, and on rare occasions an ear- to- ear smile that brightens up the
small therapy suite. She always wears conservative dresses, never shorts or jeans. Her parents are
members of a religious group that also prohibits the cutting of hair, and Dawn’s is either shaped
into a bun or pony tail or hangs luxuriously from her head. The child has started to bond with
the student clinician and eagerly anticipates therapy, obviously basking in the clinician’s attention
and affection.
During the initial sessions, it was hard to get Dawn to talk. When approached, the shy
4- year- old child would turn her head and cry; she never initiated conversations. Gradually, Dawn
is escaping her shell and is learning the pragmatics of language. A game called “Hi Ho Cherry O”
is the key to Dawn’s participation in therapy.
Dawn loves the game. Spinning the arrow, collecting the small red plastic cherries, and experi-
encing the thrill of winning by announcing, “Hi Ho Cherry O” provide a perfect means to improve
Dawn’s pragmatic language skills. During the game, the student clinician feigns ignorance of the
rules and asks Dawn to explain how the game is played. Dawn is encouraged to engage in turn-
taking and to maintain the topic of conversation. Usually she speaks in one- and two- word utter-
ances, and the student clinician is working to increase their overall mean length. She is beginning
to get Dawn to narrate her actions during the game and is making pro gress on additional com-
municative functions. However, she is troubled by the girl’s frequent bruises and injuries.
Several times Dawn has come to the therapy session with large bruises on her arms and legs,
and once, she sported a black- and- blue eye. When asked how she was injured, Dawn did not
respond or simply said, “I fell down.” Suspecting that the child was accident prone, the clinician
continued the therapy session. Recently, however, Dawn came to therapy with what appeared to
be burns on her thighs, and the student clinician can no longer ignore the unthinkable. She asks
her supervisor to look at Dawn’s injuries. Afterward, they decide that the repeated injuries and the
apparent burns warrant an investigation.
The university’s Speech and Hearing Clinic has established a protocol for reporting child
abuse. First, the student clinician must report suspected abuse to a supervisor. The supervisor is
required to immediately file a report with the local office of Child Protective Ser vices. Although
the student clinician and the supervisor can question the child and parents about the source and
nature of the injuries, they are not to investigate them or to indicate their suspicion of child abuse.
Child Protective Ser vices sends a social worker to the family’s home to investigate the complaint.
The identity of the complainants is kept anonymous to prevent retaliation. If the social worker
believes there are grounds for further investigation of child abuse and/or that the child’s health or
safety is in jeopardy, a court order is obtained and the child is immediately placed in temporary
foster care as a ward of the state. The student clinician and the supervisor know the significance
and implications of their actions, but they are morally, ethically, and legally bound to report any
suspected child abuse. They also realize that it is not their responsibility to prove the abuse, only
to report it if they believe the child is in imminent danger.
The suspected child abuse was confirmed by the investigating social worker. Dawn was
removed from her home and placed with foster parents. Child Protective Ser vices was careful to
disrupt only minimally Dawn’s preschool activities and her therapy at the Speech and Hearing
Clinic. Also, to provide continuity, there would be no change in the student clinician at the end
of the semester. The social worker met with the supervisor and the student clinician to discuss
the case and offered helpful suggestions in dealing with Dawn should she question or want to