Speech and Language Impairments in Children: Causes, Characteristics, Intervention, and Outcome

Speech and Language Impairments in Children: Causes, Characteristics, Intervention, and Outcome, edited by Dorothy V. M. Bishop and Laurence Leonard, Philadelphia, PA, Taylor and Francis, Inc. , 2000, 305 pp, 59. 95 (hardcover), 29. 95 (softcover). Speech and language difficulties are so widespread in children and have such important implications for behavioral and emotional health and school functioning that, as a pediatrician, it's impossible not to be interested in them. The world of speech and language represents a wide territory and one that is likely to feel somewhat foreign, mapped as it has been by psychologists, psycholinguists, and speech and language pathologists. And that map is also rapidly changing. For these reasons, the edited volume under consideration makes particularly interesting reading for a developmental-behavioral pediatrician. The 16 chapters are derived from plenary presentations made at the third international symposium on children's speech and language disorders, hosted by the organization Afasic. The charge to the 20 contributors was to present cutting-edge information from their disciplines in terms that an educated parent, educator, or pediatrician could understand, while also giving sufficient background material to put the newer findings in context. On the whole, they succeeded admirably. Within the 16 chapters, one finds information about normative development, the variants, causes, and consequences of specific language delay, and a smattering of innovative treatments. This isn't a comprehensive survey, but rather a smorgasbord of informed, sometimes brilliant, perspectives, each illuminating the topic from a different angle. Looking over comments scribbled across the 290-odd pages, I find adjectives such as "clear, " "fascinating, " "compelling, " and "revolutionary. " I also find, associated with not a few of the chapters, the word "difficult. " Although all the chapters read well, the concepts in many of them were sufficiently complex and new to me that I found myself needing to reread them, before I felt any real grasp of their content. Michael Tomasello kicks off the volume with an impressive challenge to Chomsky's theory that language acquisition relies on an inherent, instinctual grammatical processor. Rather, Tomasello argues, children construct their understanding of grammar by internalizing specific phrases and then creating parallel phrases by analogy. If exposure to language triggered a latent grammatical rule, you would expect to see grammatical complexity increase smoothly over time. Instead, progress is piecemeal and uneven. At any given point, a young child produces sentences of widely varying complexity, including some for which no abstract rules apply. One pleasing consequence of this argument is that it allows one to understand language development in terms of familiar cognitive processes (i. e. , imitation and abstraction). Another is that it is consistent with the observation that differences in rate of language acquisition relate to differences in the amount and richness of children's exposure to language. Another gem in the collection is the chapter by Robert Plomin and Philip S. Dale on the genetics of language and language delay. Presenting data from the Twins' Early Development Study (TEDS), a large, community-based study of language development in twins, the authors take us through methods used to estimate the hereditability of both normative language and language delay. (The latter, it turns out, is even more hereditable than the former. ) They then give us glimpses into the brave new world of multivariate genetic analysis, a method of estimating the extent to which two different traits share the same genes. Finally, they explain why language may be a particularly good area in which to look for the multiple genes that together determine language and many other continuously distributed traits. In the next chapter, Grover Whitehurst and Janet Fiscel report on their explorations of the relationships between language development and reading in children growing up in poverty, a group with an extraordinarily high rate of both language delay and reading impairment. They lay the groundwork by reviewing the theory of emergent literacy, then describe a fascinating statistical approach for detecting underlying subgroups within data that appear to be normally distributed. Using this approach, they estimate that a surprising 20% to 25% of a sample of children in poverty have dyslexia. After a refreshingly nontechnical description of structural equation modeling, they use data from a large longitudinal sample of low-income children to show how language development is directly linked to letter and phonics knowledge at ages 4 or 5 years, but not subsequently. Their data support both the importance of early emergent literacy experiences and also later direct instruction in phonics and related skills. In the chapter that follows, Joy Stackhouse adds to the complexity by showing that, in individual cases, the relationship between early language delay and later literacy deficits is complex and difficult to predict. Paula Tallal provides a particularly clear description of the theoretical underpinnings of FastForword, a computerized intervention for specific language impairment that uses acoustically modified speech sounds and that has shown striking results. Other chapters give similarly clear descriptions of more conventional therapeutic approaches. Chapters providing detailed discussions of the relationships between language and psychopathology and of the range of acquired epileptic aphasia (AEA, or Landau-Kleffner syndrome) are directly relevant to common pediatric dilemmas. Among the more difficult chapters were ones addressing the distinctions between pragmatic language impairments and autistic-spectrum disorders and the patterns of specific language impairments across different languages. Those looking for a comprehensive review of speech and language development and pathology are likely to be disappointed. But for a glimpse at several exciting aspects of the field, presented clearly and in satisfying detail, this volume would be hard to top. Robert Needlman, M. D. Case Western Reserve College of Medicine; Rainbow Babies and Children's Hospital; Cleveland, Ohio