18 Chapter 1
However, no further language development has been observed. Elizabeth’s face and tongue are
para lyzed on the right side, and she requires special and frequent feeding using a syringe. The psy-
chological reports suggest that she has profound intellectual disability, and although a firm deter-
mination cannot be made due to her hearing and visual impairments, her intelligence quotient is
thought to be between 30 and 40. You do as many tests as pos si ble to get some idea of Elizabeth’s
language mental age, strengths, and weaknesses.
You are no stranger to the terrible injuries and birth defects aff licting humans, having seen
hundreds of cases in which the patient’s likelihood of ever having a reasonable quality of life is
remote. But the plight of this young, innocent child, and the severity of her multiple birth defects,
nearly bring tears to your eyes. Her condition seems so unfair, her future so compromised, and her
disabilities so insurmountable.
You spend most of the day with Elizabeth and her grand mother, watching their interaction.
The grand mother is an intelligent, caring, energetic, and nurturing woman. Elizabeth seems to
require constant care, and her grand mother provides it. At Elizabeth’s first sound, her grand-
mother automatically attends to her, almost as if they communicate telepathically. Although
Elizabeth is deaf, her grand mother talks to her while caressing, soothing, and comforting her.
Their interaction is natu ral and unstrained. Occasionally, the grand mother gets irritated at a
messy diaper and baby food pushed aside, but nevertheless, she is loving and caring. You marvel
at her dedication, commitment, and devotion to this abandoned child.
On the drive home, you mentally prepare the report you will write to the Department of
Developmental Disabilities. As a realist, you know that the likelihood of Elizabeth’s ever commu-
nicating functionally is remote, even with the most experienced therapists and the best technol-
ogy. In fact, there are no speech- language pathologists within 100 miles of Elizabeth’s town, and
regular individual and group therapies are unobtainable while she lives with grand mother. If the
state institutionalizes her, a multitude of therapies will be available. She will have all the ser vices
required by state and federal laws, including regular aural rehabilitation, as well as speech and
language therapy. As a realist, you also know that what is legally obtainable for the child will not
be best for her.
In your report to the agency, you make clear recommendations for Elizabeth and speech-
language pathology ser vices. You state that from a communication development standpoint, train-
ing the child’s grand mother in language development is preferable to removing the child from
her loving home and institutionalizing her. You review the test results showing that Elizabeth has
profound language delay, and you report that the prognosis for functional language development
is poor. Certainly, there are areas where Elizabeth can improve, as well as devices and therapies
that may help her achieve her maximum potential. You recommend that the agency contract with
a speech- language pathologist to visit Elizabeth weekly, work with her grand mother to maximize
communication, provide individual therapy, and set realistic goals. Several months later, the
agency reports that you, and virtually all of the other con sul tants, have agreed that Elizabeth was
already receiving the best pos si ble ser vices from her grand mother. Rather than remove the child
from her loving environment, the agency will use all of its resources to support her grand mother
in the care of this child.