Language Delay and Disorders 17talk about the separation from her parents. Without providing details about the abuse or how
long it had continued, the social worker thanked the supervisor and the student clinician for
their professionalism in reporting it. The social worker commented that, tragically, the severity
of child abuse often escalates, and that their prompt reporting of it may have saved Dawn from
greater trauma.
Case Study 1-6: Severe Intellectual Disability in a 2- Year- Old Girl
It is nearly a 3- hour drive to the small community in the northwest corner of the state. Many
of the townspeople belong to a sect noted for plural marriages, an offshoot of a major religion
that long ago disallowed polygamy. Curiously, the state seems to turn a blind eye to the region’s
polygamy, possibly to avoid a head-on collision concerning the separation of church and state. You,
as a con sul tant to the state’s Department of Developmental Disabilities, have been asked to evalu-
ate a child with multiple birth defects and severe intellectual disability. The agency wants to know
if she is capable of learning language. The social worker was succinct: “What, if anything, can be
done to help her learn to communicate?” The officials are considering removing the child from the
care of her grand mother and institutionalizing her.
As you drive through the small town, you become increasingly aware that you are a stranger
to the tight- knit community. People on the sidewalk stare relentlessly as you search for the home
in the maze of unlabeled streets. You note that all of the women wear dresses typical of early
pioneers and that there is no shortage of children. Fi nally, you find the correct address and pull
into the gravel driveway of an ancient two- story brick home. Later, you learn that homes like this
were built to accommodate bigamous marriages. There are two separate kitchens, living rooms,
bathrooms, and bedrooms. You are greeted by a woman in her 50s, the grand mother of the child
you are to evaluate. Apparently, the child’s mother was living in Los Angeles and returned home
soon after the child was born. She has since left the community and abandoned her child. The
grand mother expresses her sorrow about her daughter’s decision, but says that she is happy to care
for her grand daughter. You see the child in a homemade crib and are startled at the severity of her
defects. Reading the case history did not prepare you for the real ity.
According to her grand mother, Elizabeth was born almost 2 months prematurely. Her mother
may have tried to induce an abortion, was a heavy user of alcohol and drugs, and was in a drunken
stupor during most of her pregnancy and when Elizabeth was born. The grand mother continued
the litany of birth defects, confirming the medical reports. Elizabeth is deaf, partially para lyzed
on the right side of her body, almost completely blind, and in need of several operations to correct
her deformed spine. The medical reports suggest that Elizabeth had prob ably suffered a stroke
during the pregnancy.
When you ask about Elizabeth’s communication abilities, you discover that she has differential
crying and that her grand mother can tell from the loudness, pitch, and tone of the cry whether she
is hungry, in pain, needs a diaper change, and so forth. Elizabeth cries at an appropriate volume
and does not appear to have laryngeal paralysis. She cooed at a normal age and began babbling.