Language profiles in nonspeaking individuals of normal intelligence with severe cerebral palsy

Evidence is presented that verbal intelligence may be relatively superior to nonverbal intelligence in many nonspeaking individuals of normal intelligence with severe cerebral palsy and that unqualified generalizations about language abilities in this patient population should be avoided. Standardized tests of different levels of processing oral language (phonemic analysis, vocabulary knowledge, sentence syntax, discourse comprehension), of processing written language (word decoding out of sentence context and sentence and paragraph comprehension), and of producing written language (spelling single dictated words) were administered to a nonspeaking adult, adolescent, and child of normal intelligence with severe cerebral palsy. Intraindividual differences and common patterns across language profiles were examined. Not all subjects showed the same pattern within their language profiles, but all showed relatively better receptive oral language at the discourse level than any other level and were relatively better at encoding (spelling) than decoding (recognizing) written words. All were underachieving in reading relative to their verbal aptitude and receptive oral language at the discourse level. Implications of the results for the motor theory of speech perception and the view that reading is parasitic upon speech are discussed. Professionals in the communication enhancement field are encouraged to organize assessment results in explicit levels of language processing and production framework so that goals for all levels of language processing and production are included in individualized education plans for nonspeaking students.