Interpreting the Results

What do speech and language pathologists (SLPs) know that researchers are only beginning to discover? In 1982, a group of SLPs from the Madison Metropolitan School District in Madison, Wisconsin were asked if children with language disorders were all alike or if there were distinct types of language disorders. When asked to indicate perceived types of disorders as well as a description of the performance differences of each, there was uniformity among the responses. The following typology summarizes seven perceived types of language disorders along with the associated characteristics.

A Clinical Typology of Language Disorders*

CLINICAL TYPE

CHARACTERISTICS

Delayed Development

Decreased number of different words and total number of words; delayed syntactic development as measured by MLU and other detailed syntactic analyses

Utterance Formulation

Maze revisions at word and phrase level units; increased MLU; pauses within and between utterances; word order problems

Word Finding

Maze revisions and repetitions at word or part-word level units; pauses within utterances; word omissions; word choice errors

Hypo-verbal Rate

Decreased number of utterances and words per minute; pauses within and between utterances

Hyper-verbal Rate

Increased number of utterances and words per minute which may be combined with reduced semantic content

Semantic or Reference

Over-generalization errors; word choice errors; NP-VP symmetry errors; abandoned utterances; redundancy; indefinite reference

Pragmatic or Discourse

Decreased turn length; decreased responses to questions; non-contingent utterances; pronominal reference errors; problems with topic maintenance (new vs. old information); problems with narrative structure

As you can see, there is one category for developmental delay, and six different types of "disordered" performance generally defined by different error patterns. It should be noted that these categories are neither well documented nor validated by research at this time. They are clinically valid by virtue of the fact that SLPs easily recognize examples of these types of deficits. The descriptive "edges" of the categories remain fuzzy. The strength of language sample analysis lies in its utility to describe any definable aspect of language performance. The flexibility of language sample analysis provides opportunity to use both quantitative methods comparing individual performance with that of peers, and clinical judgment using clinical experience to interpret language performance and develop an intervention plan.

The characteristics for these disorder types are not distinct, reminding us that there is a clinical art as well as a science to identifying and describing language disorder. The picture painted so far clearly indicates that the science is far from complete. However, the recognition of the complexity of the problem and the development of assessment tools that will allow description of developmental progress as well as deficits in performance is encouraging. We are not just dealing with delays in language development; we must sort out a variety of productive language problems. The focus here is on language production because it is the most measurable aspect of language performance. This focus does not minimize the importance of language comprehension to language and communication development. Production is accessible. The behavioral categorization and measurement problems in production can be solved, and the solutions should aid the more difficult problem of quantifying the largely private event nature of language comprehension. The focus on language production suggests that direct analysis of talking in various speaking conditions will be the most valid indicator of usual performance.

The next sections list each clinical type along with the relevant SALT variables. Remember that these categories are not mutually exclusive. They are neither well documented nor validated by research at this time. They are clinically valid by virtue of the fact that SLPs easily recognize examples of these types of deficits. The descriptive "edges" of the categories remain fuzzy.

* Adapted from Miller (1987; 1991). The early versions of this typology were based on an ongoing project with the speech and language clinicians of the Madison Metropolitan School District.

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